Periodontal Instruments Guide

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Guided by- Presented by-
DR.RUCHI BANTHIA DR.HITESH MANKAD
PROFF. P.G. Student

Introduction
Classification of Periodontal instruments
Parts of instruments
Materials used
Mouth Mirrors
Periodontal Probes
Explorers
Scalers
Curettes
• Universal Curettes
• Area specific Curettes
• Extended Shank Curettes
• Curvettes
• Langer and Furcation Curettes
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File,Chisel and Hoes
Mechanized Instruments
Polishing Instruments
Surgical Instruments
 Excisional and incisional instruments
 Surgical curettes and sickles
 Periosteal elevators
 Surgical chisels & files
 Scissors
 Needle holders
EVA System
Conclusion
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 Since ancient times when dental therapists recognized the
importance of removal of calculus and dental plaque as a
treatment for gum disease, instruments were specifically
designed to affect the procedure.
 Tooth scalers and "scalper medicinalis" were used by the
Romans since the time of Celsus, who suggested that stains on
teeth be scraped away.
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 An elaborate set of 14 double ended instruments was
used by Albucasis (936-1013 AD.), a Moorish
physician. These instruments were primarily hooks or
straight and slightly curved gravers (chisel-like
scrapers).
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Periodontal Instruments
Assessment Instruments Therapeutic Instruments
Mouth mirrors, Probes, Explorers Scaler Curets Files
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1. Single Ended Type- 1 working end.
2. Double- Ended- May have paired or complementary
working ends.
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Periodontal Instruments are classified according to the
purposes they serve as follows-
1. PERIODONTAL PROBES are used to locate, measure and
mark pockets as well as determine their course on individual
tooth surfaces.
2. EXPLORER are used to locate calculus deposits and
caries.
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3.Scaling,root-planing and curettage
instruments are used for removal of plaque and calcified
deposits from the crown and root of a tooth ,removal of altered
cementum from the subgingival root surface and debridement
of the soft tissue lining the pocket.
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Scaling and curettage instruments are classified as follows :-
Sickle scalers are heavy instruments used to remove
supragingival calculus.
Curettes are fine instruments used for subgingival
scaling,root planing and removal of the soft tissue lining the
pocket.
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Hoe,chisel and file scalers are used to remove
tenacious subgingival calculus and altered cementum. Their
use is limited compared with that of curettes.
Ultrasonic and sonic instruments are used for
scaling and cleansing tooth surfaces and curetting the soft
tissue wall of the periodontal pocket .
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Periodontal Endoscope is used to visualize deeply
into subgingival pockets and furcations, allowing the
detection of pockets.
Cleansing and polishing instruments such as
rubber cups,brushes and dental tapes are used to clean and
polish tooth surfaces.
 Also available are air- powder abrasive abrasive systems for
tooth polishing.
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As with all instruments, they have three distinct
sections:
 handle,
 shank, and
 working end, blade or nib
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The handle is that part of instrument that is held during
activation of the working end .
A) Types:
1. Cone socket handles –Are separable from the shank and
working end. They permit instrument exchange and
replacements.
2. Fixed:
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B. Weight
Hollow handles are light and are preferred to solid handles
because the lighter weight enhances track sensitivity and lessens
fatigue.
C. Diameter – The instrument is both broad and narrow type.
D.Surface Texture : Variations
Instrument handles may be smooth, ribbed or knurled. For
control and comfort without muscle fatigue and to prevent
slippage, a smooth handle should be avoided.
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The blade at the
same level with the
handle.
Different handles,
Diameter range
between 5 to 10 mm
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Based on material:
Metal – Traditionally all handles are composed of stainless
steel.
Non- Metal – Some manufacturers offer handles composed of
alternate materials in addition to stainless steel .
Resin and Nylon
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 Rigid, Thick shank – A thick shank is stronger and is able to
withstand pressure without flexing when applied during
instrumentation. Strong ones are needed for removal of heavy
calculus deposits.
 Less Rigid, More Flexible shank- A thinner shank may
provide more tactile sensitivity and is used for removal of fine
deposits of calculus and for root debridement.
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A. Working ends-
1.Metal
The type of steel used at the working end can affect the
performance of the instrument .
a.Stainless steel
Maintains its finish without corrosion.
b. Carbon steel
Known for its hardness, strength and ability to hold an edge
longer.
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2. Non metal –
Alternative plastic working ends are available for restorative
work that cannot withstand scratching from metals, such as
implant abutments.
a. Material : - Plastic ,Nylon, Graphite
Uses
a. Probes and debriding instruments for dental implants
b. Probes and mirrors for screening and surveys.
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Mirror Surfaces -
1.Plane ( Flat ) . May produce a double image .
2.Concave - For magnifying
3. Front Surface -The reflecting surface is on the front of the
lens rather than on the back as with plane or magnifying mirror.
The front surface eliminates “ ghost images “.
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Diameter –
Diameter may vary from 5/8 inches to 1 ¼ inches.
In addition, special examination mirrors are available in 1 ½ to
2 inch diameters.
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Attachments
Mirrors may be threaded plain stem or cone socket to be joined
to a handle . Because mirrors tend to become scratched,
replacement of the working end is possible without purchasing
new handles.
Handles
Thicker handles contribute to a more comfortable grasp and
greater control .
Wider handles are especially useful for mobility determination.
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Disposable Mirrors
May be plastic in one piece or may be a handle with replaceable head
for professional use.
Also there are Take home mirrors for patient instruction . Patient may
observe lingual and posterior aspects .
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Specific uses
 Indirect vision
 Indirect illumination
 Transillumination
 Retraction
Nonspecific uses
Handles can be used for Checking mobility,
percussion
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Indirect Illumination
Reflection of light from the dental overhead light to any area of
the oral cavity can be accomplished by adapting the mirror .
Transillumination
Reflection of light through the teeth -
Mirror is held to reflect light from the lingual aspect while
facial surfaces to the teeth are examined to evaluate
translucency of teeth.
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Procedure for use –
Grasp – Use modified pen grasp with finger rest on a
tooth surface wherever possible to provide stability and
control .
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Retraction-
1. Use a water- based lubricant on dry or cracked lips and
corners of mouth.
2. Adjust the mirror position so that the angles of the mouth
are protected from undue pressure of the shank of mirror .
3. Insert and remove mirror carefully to avoid hitting the teeth
because this can be very disturbing to the patient .
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Maintaining Clear vision –
Warm mirror with water, rub along buccal mucosa to coat
mirror with thin transparent film of saliva, and request patient to
breathe through the nose to prevent condensation of moisture on
the mirror.
Use a detergent or other means for keeping a clear surface.
Discard scratched mirrors .
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Care of Mirrors –
It should be examined carefully after ultrasonic cleaning or
scrubbing with brush prior to sterilization to ensure removal of
debris around back, shank and rim of reflecting surface .
It should be handled carefully during sterilization procedures to
prevent other instruments from scratching reflecting surface.
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 Periodontal probes are used to locate, measure and mark pockets as
well as determine their course on individual tooth surfaces .
 It is usually long, thin, and blunted at the end.
 The markings are inscribed onto the head of the instrument for
accuracy and readability.
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PERIODONTAL PROBES

 Function : to measure the depth of the pockets.
 General characteristics :
- tapered
- straight
- millimeter calibration
- blunt, rounded tip
- thin ( 0.5 mm at the end )
- the shank is angled to allow easy insertion
in the pocket.
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Probe is used to
A. Assess the periodontal status for preparation of a treatment
plan
1. Classify the disease as gingivitis or periodontitis by determining
whether the bone loss has occurred and whether the pockets are
gingival or periodontal.
2. Determine the extent of inflammation in conjunction with overall
gingival inflammation. Bleeding on probing is an early sign of
inflammation in the gingiva.
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B. Make a Sulcus and pocket survey
1. Examine the shape ,topography and dimension of sulci and
pockets.
2. Measure and record probing depths.
3. Determine the clinical attachment level .
C. Make a Mucogingival Determinations
1. Determine relationship of gingival margin, attachment level
and mucogingival junction .
2. Measures width of attached gingiva
3. Roll test to locate mucogingival junction
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D. Make Other Gingival Determinations
1.Evaluate gingival bleeding on probing and prepare a index.
2. Measure the extent of visible gingival recession.
3. Detect anatomic configuration of roots, subgingival deposits
and root irregularities that complicate instrumentation. For this,
the probe is used in conjunction with the explorer.
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F. Evaluate Success and completeness of treatment
1. Evaluate post treatment tissue response to professional
treatment on an intermediate, short term ,basis as well as at
periodic maintenance examinations.
2. Evaluate patients self-treatment through therapeutic disease
control procedures.
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 Periodontal probes are classified as
 1 st generation probe
 2nd generation probe
 3 rd generation probe……Pihlstrom
 4 th generation probe
 5th generation probe
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These include-
 William’s periodontal probe
 UNC-15 probe
 University of michigan O probe
 Marquis colour coded probe
 WHO probe
 Nabers probe
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Markings include 1,2,3,5,7,8,9 and
10 mm with 4mm and 6mm
missing for ease in measuring .

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UNIVERSITY OF MICHIGAN O PROBE
WITHOUT WILLIAMS MARKING
Markings are at 3, 6, and 8mm

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15mm long.
Markings are at each mm and
color coding at the 5th,10th and
15thmm

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Calibrations are in 3mm sections.
Markings are 3,6,9,12mm

Goldman-Fox probe same as Williams probe`s
calibration
- But it is flattened not round
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It has 0.5 mm ball at the tip
millimeter markings
at 3.5/ 5.5/ 8.5/ 11.5 mm
color coding from 3.5 to 5.5 mm.

Types:
CPITN-E(Epidemiological)
CPITN-C (Clinical )
This probe was designed for
 Measurement of pocket depth
 Detection of sub gingival calculus
 Used in assessment of treatment needs
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 It is used to determine the extent of furcation involvement on
a multi-rooted teeth .
 It has a curved working end for accessing the furcation area.
 The end is blunt so that it will not harm the soft tissues .
 Most of Nabers probe do not have markings.
 Few have markings at 3,6,9 and 12mm.
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Several different companies are manufacturing plastic
instruments for use on titanium and other implant abutment
metals.
It is important that plastic rather than metal instruments be used
to avoid scarring and permanent damage to the implants.
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The Florida probe was developed using NIDCR(National
Institute of Dental & Craniofacial Research ) criteria.
This automated probe system consists of probe hand piece
digital readout foot switch computer interface and computer.
Its advantages are
 Precise Electronic measurements
 Computer storage data
 Constant probing force
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FLORIDA
PROBE

Disadvantages are-
 Lack tactile sensitivity
 Underestimation of deep probing depths by the automated
probe.
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These are pressure-sensitive probes.
It has been shown that with forces upto 30 gms the probe tips
remains within junctional epithelium and forces upto 50 gms are
necessary to diagnose osseous defects.
This probe did not solve many problems of conventional probes
and lacked tactile sensitivity.
Examples are Vive-valley ,viva care TPS probe.
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These are computerized probes. Gibbes et al designed Florida
probes ex- Foster miller probe ,toronto automated probes
which can detect cemento- enamel junction.
Fourth generation
These are three dimensional probes in which sequential probe
positions are measured.
Fifth Generation are ultrasonographic probes which
provides painless probing to the patient. The guidance path is
predetermined in these probes.
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Explorer is an assessment instrument with a flexible wire like
working end.
Functions-
These are used to detect by tactile means , the texture ,and
character of tooth surfaces before,during and after periodontal
debridement to assess the progress and completeness of
instrumentation.
.
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EXPLORER

They are also used to detect tooth surfaces for calculus
decalcified and carious lesions dental anomalies and anatomic
features such as grooves , curvatures or root furcations .
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USE
For supragingival examinations for
dental caries and irrregular margins
of restorations.

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Used in calculus detection in
normal sulci or shallow
pockets extending no deeper
than the cervical-third off the
teeth.

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Used for assessment of anterior
root surfaces and the facial and
lingual surfaces of posterior teeth .
Difficult to adapt to the line angles
and proximal surfaces of the
posterior teeth .

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Used for assessment of root surfaces on
posterior and anterior teeth .

These have a flat surface and two cutting edges that converge in
a sharply pointed tip. The shape of the instrument makes the tip
strong so that it will not break off during use . These is
primarily used to remove supragingival calculus .
Because of the design of this instrument it is difficult to insert a
large sickle blade under the gingiva without damaging the
surrounding gingival tissues .
Small, curved sickle blades such as 204SD can be inserted
under ledges of calculus a few millimeters below the gingiva .67
SICKLE
SCALER

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Blade ( working end )
(B) Tip (C) Toe (H) Heel (F) back (D)
Face
(G) lateral surface (E) cutting edge (internal angle )

Types of scalers
1)- Different blade size.
2)- Different blade design
curved, or straight .
3)- Different shank type :
- Straight shanks are designed for
use on anterior teeth and
premolars.
- Angled shanks adapt to posterior.
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204 S C103 CK6
Crane-Kaplan
Sickle scalers
angled shank, curved blade, different blade
sizes

A curette is the instrument of choice for removing deep
subgingival calculus,root planing altered cementum and
removing the soft tissue lining the periodontal pocket .
Each working end has a cutting edge on both sides of the blade
and a rounded toe .
The curette is finer than sickle scalers and does not have any
sharp points or corners other than the cutting edge of the blade
.
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CURETTE

General characteristics ( design ) :
 Rounded toe, no sharp points, can be inserted into deep
pockets with minimal soft tissue trauma.
 In cross section , the blade
 appear semicircular
 ( spoon-shaped blade )
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These have cutting edge that may be inserted in most areas of the
dentition by altering and adapting the finger rest, fulcrum and hand
position of the adaptor.
The blade size and angle and length of the shank may vary but the face
of the blade of every universal curette is at 90-degree angle to the lower
shank when seen in cross section from the tip .
The blade of universal curette is curved in one direction from the head
of the blade to the toe .
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 The face is at a 90-degree angle with terminal ( lower )
shank.
 Two cutting edge.
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Gracey curettes- These are representatives of the area-specific
curettes, a set of several instruments designed and angled to
adapt to specific anatomic areas of the dentition.
These curettes and their identification are probably the best
instruments for subgingival scaling and root planing because
they provide the best adaptation to complex root anatomy.
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AREA SPECIFIC
CURETTES

1. Blade is at 70 degrees from the lower shank (offset
blade). This angulation allows the blade to be inserted in the
precise position , provided parallel lower shank with the long axis
of the tooth surface being scaled.
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Design of Gracey curette

Universal curetteGracey curette
All areas and surfacesspecific surfacesArea of use
two cutting edgeOne cutting edgeUse of cutting edge
Curved in one planeCurved in two planesCutting edge curvature
Not Offset , 90 degreesOffset blade, 70 ْBlade angle
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Universal curetteGracey curette

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•Larger, stronger, and less
flexible shank and blade
•Used to remove moderate-to-
heavy calculus
Rigid
design(A)
•Thinner shank, more flexible,
•Enhanced tactile sensitivity,
used to finish root planning.
Finishing
design (B)
Rigidity type of shank

 Gracey # 1-2 and 3-4 : anterior teeth.
 Gracey # 5-6 : anterior teeth (and premolars).
 Gracey # 7-8 and 9-10: posterior teeth : facial and ligual.
 Gracey # 11-12 : posterior teeth : mesial
 Gracey # 13-14 : posterior teeth : distal .
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Double-ended Gracey curettes
are 7 instruments

Reduced set of Gracey
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# 5-6 # 7-8 # 11-12 #
13-14

 It is a modification of the
standard 11-12
 Combines a Gracey :
#11-12 blade with a
#13-14 shank .
 It is allows better adaptation to
posterior mesial surfaces,
especially on the mandibular
molars with an intraoral finger
rest.
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Gracey #15-16

87
• They are modifications of the
standard Gracey curette design.
New features :
1. The terminal shank is 3 mm
longer ( allowing extension
into deeper periodontal
pockets of 5 mm or more).
2. A thinned blade . For
smoother insertion , and
reduced tissue stretching.
3. 1mm shorter blade
Extended shank instruments
- After Five curette -

 Available After Five instruments :
#1-2, 3-4, 5-6, 7-8, 11-12, 13-14
 Available in finishing (fine) or rigid designs:
- rigid After Five Gracey curettes
- finishing After Five Gracey curettes
88

Gracey curettes for posterior proximal surfaces
mesial surfaces distal surfaces
89

 Rigid standard #13-14 adapted to the distal surface of the
first molar. And rigid After Five #13-14 adapted to the distal
surface of the second molar.
 Notice the extra long shank which allows deeper insertion
and better access.
91

 They are modifications of the
After Five curettes
 Features:
1. Blades are half the length of
the After Five or standard
Gracey curettes.
2. Extended shank
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Mini-bladed curettes
- Mini Five-

Function
Easier insertion and adaptation in any area where root
morphology or tight tissue prevents full insertion of
standard Gracey or After Five blade :
1. deep, narrow pockets,
2. furcations,
3. developmental grooves,
4. line angles,
5. Deep, tight pockets.
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- Available in both:
- rigid Mini Five Gracey curette
- finishing Mini Five Gracey curette
- available in all standard Gracey numbers except for the #
9-10
- Advantages :
1. can be used easily with vertical strokes,
2. With reduced tissue distention,
3. and without tissue trauma.
94

The curvettes are modification of gracey curettes .
These modifications include
- 50% shorter blade
- Increased blade curvature
- Straighter terminal shank
- Longer terminal shank
95

This set of three curette combines the shank design of the
standard gracey with a universal blade honed at 90 degrees
rather than offset blade of the gracey curette.
This combination allows the advantage of the area-specific
shank to be combined with the versatility of the universal
curette blade.
97

QUETIN Furcation curettes- These are actually hoes
with a shallow,half moon radius that fits into root or floor of
the furcation.
The curvature of the tip also fits into developmental
depressions on the inner aspects of the roots.The shanks are
slighty curved for better access and the tips are available in
two widths.
These remove burnished calculus from recessed areas of the
furcation where even the mini-bladed curettes are often too
large to gain every access.
99

These are new type of area specific curette designed to remove
light residual calculus deposits and bacterial contaminants from
the entire root surfaces.
These instrument are used with gentle stroke pressure with
either push or pull strokes.
10
1

 Plastic instruments be used to avoid scratching and damage
to the implants.
103
Plastic instruments for implants

The schwartz Periortrievers are a set of two double-
ended,highly magnetized instruments designed for the retrieval
of broken instrument tips from the periodontal pocket.
They are indispensable when the clinician has broken a curette
tip in a furcation or deep pocket.
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4

10
6
File is an instrument used to crush calculus deposits.

 They are also used to roughen the surface of burnished
calculus deposits to facilitate removal of deposits with a curet
.
 They can easily gouge and roughen root surfaces when used
improperly.
 Thus not suitable for fine scaling and root planing.
10
9

 Hoe scaler are used for scaling of ledges or rings of calculus.
 The blade is bent at a 99-degree angle; the cutting edge is
formed by the junction of the flattened terminal surface with
the inner aspect of the blade . The cutting edge is beveled at
45 degrees.
11
0

The chisel scaler designed for the proximal surfaces of teeth
too closely spaced to permit the use of other scalers . It is
usually used in the anterior part of the mouth.
It is a double ended instrument with a curved shank at one end
and a straight shank at the other .
11
2

113
Oscillating
scaler
Ultrasonic sonic

 Ultrasonic and sonic instruments may be used for removing
plaque,scaling,curetting and removing stain. The vibrations in
ultrasonic tip range from 20000 to 45000 cycle/second.
 Vibrations in sonic tip range from 2000 to 6500 cycle per
seconds
 The two types of ultrasonic units are magnetostrictive and
pizeoelectric.
11
4

 In magnetostrictive units the pattern of vibration of the tip is
elliptic, which means that all sides of the tip are active and
will work when adapted to the tooth .
 In piezoelectric units the pattern of vibration of the tip is
linear,or back and forth, meaning the two sides of the tip are
the most active.
11
5

• RUBBER CUPS:- Consist of rubber with or without webbed
configurations in the hollow interior . Used in the handpiece
for prophylaxis.
• A GOOD CLEANSING & POLISHING paste that contain
fluoride should be used & kept moist to minimize friction
heat.

 Available in wheel and cup shapes.
 Used in prophylaxis angle with a
polishing paste .
DENTAL TAPE
 Dental tape with polishing paste is
used for polishing proximal surface
that are inaccessible to other
polishing instruments.

 Air-powder polishing is used with a specially designed
hand piece.
 This device is called Prophy-jet. It delivers an air-
powder slurry of warm water and sodium bicarbonate
for polishing.
 It is very effective for the removal of extrinsic stains
and soft deposits
12
0

DENTAL ENDOSCOPE
These has been introduced recently for use subgingivally in the
diagnosis and treatment of periodontal disease.
This device allows clear visualization deeply into subgingival
pockets and furcations.
12
2

These are classified as
 Excisional and incisional instruments
 Surgical curettes and sickles
 Periosteal elevators
 Surgical chisels
 Surgical files
 Scissors
 Needle holders
12
4

 Knives are basic instruments and can be obtained
with both fixed and replaceable blades.
 Gingivectomy knives Eg: Kirkland knifes
 Interdental knives Eg: Orban knife #1-2, Merrifield
knife #1,2,3 and 4
 Surgical blades Eg: #12D,15,11 and 15C
12
5

The kirkland knife is representative of knives typically used for
gingivectomy.These knives can be obtained as either double-
ended or single-ended instruments.
The entire periphery of these kidney-shaped knives is the
cutting edge .
12
6

The orban knife#1-2 and the merrifield knive # 1,2,3 and 4 are
knives used for interdental areas.
These spear-shaped knives having cutting edges on both sides
and are designed with either double-ended or single-ended
blades.
12
7

Bard Parker handle is used for cutting gingival tissue and
making surgical incisions.
12
9

Scalpel blades of different shapes and sizes are used in
periodontal surgery .The most common blaes are #12 D,15,15C.
The #12D blade is a beak –shaped blade with cutting edges on
both sides,allowing the operator to engage narrow,restricted
areas with both pushing and pulling cutting motions.
13
0

 Larger and heavier curettes and sickles are often needed
during surgery for the removal of granulation tissue, fibrous
interdental tissues, and tenacious subgingival deposits.
 The Prichard curette and the Kirkland surgical instruments
are heavy curettes, whereas the Ball scaler #B2-B3 is a
popular heavy sickle. The wider, heavier blades of these
instruments make them suitable for surgical procedures.
13
2

 These are needed to reflect and move the flap after the incision has
been made for flap surgery.
 The Woodson, Glickman and Prichard elevators are well-designed
periosteal instruments.
13
4

 USED TO HOLD THE FLAP DURING SUTURING
 USED TO POSITION & DISPLACE THE FLAPAFTER
THE FLAP HAS BENN REFLECTED

 Chisels and hoes are used during periodontal surgery
for removing and reshaping bone.
 The hoe has a curved shank and blade, this
instrument has a fish tail shaped with blade with a
pronounced convexity in its terminal portion.
 The cutting edges is beveled with a rounded edges and
projects beyond the long axis of the handle to preserve
the effectiveness of the instrument when the blade is
reduced by sharpening.
13
7

 Generally used for detaching pocket walls after the
gingivectomy incision, but it is also useful for smoothing root
surfaces made accessible by any surgical procedure.
 The Wiedelstadt and Todd-Gilmore chisels are straight
shanked.
13
8

SUGARMAN PERIODONTAL FILE
Used interproximally. File surfaces on both sides allow for push
or pull application.
14
0

14
1
SCHLUGER PERIODONTAL
FILE
Used interproximally. File surfaces
on both sides allow for push or pull
application.

 The Ochsenbein #1-2 is a useful chisel with a semicircular
indentation on both sides of the shank that allows the
instrument to engage around the tooth and into the interdental
area.
14
2

14
3
Designed for use with a pull
stroke, it is ideal for
removing bone adjacent to
the tooth without causing
trauma, and is especially
useful on the distal of last
molars.

A hemostat (also called a hemostatic clamp, arterial forceps, or pean
after Jules-Émile Péan) is a surgical tool used in many surgical
procedures to control bleeding.
The hemostat has handles that can be held in place by their locking
mechanism.
The locking mechanism is typically a series of interlocking teeth, a
few on each handle, that allow the user to adjust the clamping force
of the pliers. When locked on, the force between the tips is
approximately 40 N
14
5

Scissors are used in periodontal surgery for such purposes as
removing tags of tissue during gingivectomy, trimming the
margins of flaps, enlarging incisions in periodontal
abscesses, and removing muscle attachments in
mucogingival surgery.
14
7

14
9
The Goldman-Fox #16 scissors are
with a curved beveled blade with
serrations and the nippers.
Characteristics:
1. Long handles with thumb and
finger rings.
2. Short cutting edge with straight
or curved blades.

15
0
 Serve same purpose as Scissors.
 They are also used for contouring the architectural form and
for forming interdental sluiceways.

Used to suture the flap at the desired position after surgical
procedure has been complete.
The castroviejo needleholder is used for delicate precise
techinques that require quick and easy release and grasp of the
suture.
15
1

 Microsurgery may be defined as a refinement in operative
technique by which visual acuity is improved through
magnification.
 In addition to use of magnification & reliance on atraumatic
technique microsurgery entails the use of specially
constructed microsurgical instruments to minimize trauma.
 To permit primary woumd closure, microsutures in the range
of 6-0 to9-0 are required to approximate the wound edge.
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EVA SYSTEM
 It is the most efficient and least traumatic instruments for correcting
overhanging or overcontoured proximal alloy and resin restorations
are the motor-driven diamond files of the EVA prophylaxis
instrument.
 These files come in symmetric pairs are made of aluminium in the
shape of a wedge protruding from a shaft,one side of a wedge is
diamond coated and other side is smooth .
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The advancing abilities of instrument makers, coupled with the
ingenuity of dental practitioners, have provided the present
practitioner with a multitude of instrument designs capable of
reaching nearly every portion of the dentition.
In the past, complete sets of instruments frequently included so
many variations of angulation and were so numerous as to
preclude their general use.
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 However, some of the more efficient instruments
from these sets have withstood the test of long-term
use and now appear and reappear in newly created
instrument sets.
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1. Carranza’s clinical periodontology- 10 th edition
2. Principles & Fundamentals of Periodontal Instrumentation
– 6th edition- Neils D. and Gehrig.
3. Textbook of dental hyginist- 3rd edition- Wilkins
4. www.google.com/images
5. www.hufriedy.com
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Periodontal Instruments Guide

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