Advanced Instrumentation and Instrument Sharpening

Advanced Periodontal Instrumentation

  • The use of specialized instruments is to access challenging areas

    • deep pockets and furications

    • improving ergonomics

  • instruments are designed with:

    • Extended terminal shanks

    • Thinner blades

    • Modified designs for enhanced access

NOTE: These features allow for effective debridement in complex situations

Instrument Sharpening

  • How Often to Sharpen:

    • only as needed

    • Check periodically

    • Use selective sharpening (focus on dull areas)

Types of Sharpening Stones

  • Ceramic: Fine grit; maintains cutting edge

  • Arkansas Stone: Moderately coarse; oil recommended; restores partially dull blades

  • Carborundum Stone:  rough, irregular particles that restore dull blades

  • Diamond-Coated (Card/Steel): Most aggressive; for completely dull instruments

Sharpening Procedure

  • Position the terminal shank:

    • Area-specific: slightly tilted away

    • Universal/scaler: perpendicular to the floor

  • Motion:

    • up-and-down motion (end on a downward stroke)

    • Maintain correct angulation

    • Focus on the heel, middle, and toe (tip third)

  • Pressure:

    • light to moderate

    • Listen for a “squeak”

    • 3–5 strokes

Check Your Work

  • Test all thirds for a “bite”

  • Re-sharpen if needed

  • Round tip/toe last

Characteristics of Dull vs. Sharp Instruments

Instrument Review

Instrument

Primary Uses

Key Design Features

Stroke Style

Chisel Scaler

Anterior teeth with Type III embrasures and lingual calculus bridges

45° angle to terminal shank

Facial-to-lingual push stroke.

Hoe

Removal of large supragingival calculus deposits.

Cutting edge is at a 99° angle; not for subgingival use due to gouging risk.

Vertical pull stroke

Debridement Curette

Smoothing root surfaces and removing residual deposits in deep pockets.

Multidirectional strokes with feather-light pressure.

Periodontal Files

Crushing/fracturing heavy or burnished calculus; used when ultrasonics are contraindicated.

Multiple cutting edges at 90° to the shank; must be followed by a curette.

Moderate lateral pressure; pull stroke only.

Finishing files

Vision Curvette

Laser Therapy

Chisel Scaler

  • Uses:

    • Type III embrasures (anterior teeth only)

    • Removes calculus bridges on lingual

  • Stroke: Facial → lingual push stroke

  • Design: Straight cutting edge at 45° to terminal shank

Extended Gracey Curets

After Five Curettes

  • Terminal shank 3 mm longer

  • Blade 10% thinner

  • Designed for pockets ≥ 5 mm

Mini Five Curettes

  • Terminal shank 3 mm longer

  • Blade 10% thinner

  • Blade length 50% shorter

Best for:

  • Deep pockets (≥ 5 mm)

  • Concavities

  • Longitudinal depressions

  • Furcations

Hoe Scaler

  • Uses:

    • Removes large supragingival calculus

  • Design: Cutting edge at 99° to terminal shank

  • Limitations:

    • Not for subgingival use

    • Risk of gouging root surfaces

  • Stroke: Vertical pull stroke (coronal direction only)

Debridement Curette

  • Uses:

    • Smooth root surfaces

    • Remove residual deposits

    • Ideal for deep pockets

  • Design:

    • 1.5 mm disc blade (270°)

    • Long shank (15mm)

  • Application:

    • Feather-light pressure

    • Multidirectional strokes (horizontal, vertical, oblique)

    • Push-pull motion

Periodontal Files

  • Uses:

    • Crush and burned calculus

    • Used when ultrasonics are contraindicated

    • Must be followed with a curette

  • Design:

    • Multiple cutting edges

    • Blades at 90° to the terminal shank

    • Paired working ends

  • Application:

    • Can be used supra- or subgingivally

    • Moderate lateral pressure

    • Pull stroke only