PERIODONTOLOGY

1. PERIODONTAL
INSTRUMENTS AND
INSTRUMENTATION

2. CONTENTS
 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

3.  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

4. INTRODUCTION
 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.

5.  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).

7. CLASSIFICATION OF INSTRUMENTS
PERIODONTAL INSTRUMENTS
ASSESSMENT INSTRUMENTS THERAPEUTIC INSTRUMENTS
Mouth mirrors Scalers
Probes Curettes
Explorers Files

8. BASED ON DESIGN
Single Ended Type-One Working end.
Double- Ended- May have paired or
complementary working ends.

9. BASED ON THE PURPOSES THEY SERVE
Periodontal Instruments are classified as follows-
 1. PERIODONTAL PROBES used to locate,
measure and mark pockets as well as
determine their course on individual tooth
surfaces.
 2. EXPLORER used to locate calculus
deposits and caries.

10. 3.SCALING,ROOT-PLANING AND CURETTAGE
These 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
• debridement of the soft tissue lining the pocket.

11. 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.

12.  Hoe,chisel and file scalers
• Used to remove tenacious subgingival calculus
and altered cementum.
• Their use is limited compared with that of
curettes.
4. ULTRASONIC AND SONIC INSTRUMENTS
are used for scaling and cleansing tooth surfaces
and curetting the soft tissue wall of the periodontal
pocket .

13. 5.PERIODONTAL ENDOSCOPE is used to
visualize deeply into subgingival pockets and
furcations, allowing the detection of pockets.
6.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.

14. PARTS OF INSTRUMENTS
As with all instruments, they have three distinct sections:
• handle,
• shank, and
• working end, blade or nib

15. HANDLES
 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:

16.  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.

19. 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 20

25. MATERIALS USED
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.

26. 2. NON METAL –
 Alternative plastic working ends are available for
restorative work that cannot withstand scratching
from metals, such as implant abutments.
 Material : - Plastic ,Nylon, Graphite
Uses
 a. Probes and debriding instruments for dental
implants.
 b. Probes and mirrors for screening and surveys.

27. MOUTH MIRROR
 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 “.

28.  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.

29. 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

30. 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 .

31. FUNCTIONS
SPECIFIC USES
 Indirect vision
 Indirect illumination
 Transillumination
 Retraction
NONSPECIFIC USES
 Handles can be used for Checking mobility and
percussion.

32. PERIODONTAL PROBES
 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.

33.  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.

34. USES
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.

35. 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

36. 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.

37. 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.

38. CLASSIFICATION
Periodontal probes are classified as
 1 st generation probes
 2nd generation probes
 3 rd generation probes
 4 th generation probes
 5th generation probes

39. FIRST GENERATION PROBES
These include-
 William’s periodontal probe
 UNC-15 probe
 University of Michigan O probe
 Marquis colour coded probe
 WHO probe
 Nabers probe 45

40. WILLIAMS GRADUATED PERIODONTAL PROBE
 Markings include 1,2,3,5,7,8,9 and 10 mm with
4mm and 6mm missing for ease in measuring .

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

42. UNC-15 PROBE
 15mm long. Markings are at each mm and
color coding at the 5th,10th and 15thmm

43. MARQUIS COLOR CODED PROBE
 Calibrations are in 3mm sections. Markings
are 3,6,9,12mm

44. GOLDMAN-FOX PROBE
 same as Williams probe’s calibration - But it is
flattened not round

45. WHO PROBE
 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.

46. 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

48. NABER’S PROBE
 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.

50. PLASTIC PROBES FOR IMPLANTS
 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.

52. SECOND GENERATION PROBES
 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.

53. THIRD GENERATION PROBES
 These are computerized probes.
 Refer to automated probing systems.
Gibbes et al designed Florida probes
other eg- Foster miller probe ,toronto automated
probes which can detect cemento- enamel junction.

54. FLORIDA PROBE
 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

55. Disadvantages are-
 Lack tactile sensitivity
 Underestimation of deep probing depths by
the automated probe.

58. FOURTH GENERATION
• These are three dimensional probes in which
sequential probe positions are measured.
FIFTH GENERATION
• Ultrasonographic probes in addition to 3D which
provides painless probing to the patient.
• The guidance path is predetermined in these
probes.
• Used for a more comfortable examination and a
precise mapping

59. EXPLORER 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.
• 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 .

60. SHEPARDS HOOK
USE
 For supragingival examinations for dental
caries and irrregular margins of restorations.

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

62. ORBAN TYPE
 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 .

63. 11/12 EXPLORER
 Used for assessment of root surfaces on
posterior and anterior teeth .

64. SICKLE SCALER
• 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 .

65. • 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

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

67. 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.

69. Curette
 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 .

70. General characteristics ( design ) :
Rounded toe, no sharp points, can be inserted
into deep pockets with minimal soft tissue
trauma.
In cross section , the blade
appears semicircular
( spoon-shaped blade )

71. UNIVERSAL CURETTE
 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 .

72.  The face is at a 90-degree angle with terminal
( lower ) shank.
 Two cutting edge.

74. COLUMBIA
2R/2L
COLUMBIA4R/
4L

75. Area specific curettes
 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.

76. Design of Gracey curette
 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.

77.  2. One cutting edge.

79. DOUBLE ENDED GRACEY CURETTES
(Set of 7 instruments)
 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 lingual.
 Gracey # 11-12 : posterior teeth : mesial
 Gracey # 13-14 : posterior teeth : distal .

80. STANDARD GRACEY CURETTES

81. REDUCED SET OF GRACEY CURETTE
# 5-6 # 7-8 11-12 # 13-14

82. Gracey # 15-16
 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.

83. Extended shank instruments
(After five curettes)
• 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

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

86.  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.

87. 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.

88.  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.

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

91. LANGER
 This set of three curettes 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.

93. 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

95. O’Hehir Curettes
 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.

97.  Plastic instruments be used to avoid
scratching and damage to the implants.

98. PERIOTRIEVERS
 The Schwartz Periotrievers 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.

99. FILE
 File is an instrument used to crush calculus
deposits.

100. DIAMOND COATED FILES
 They are also used to roughen the surface of burnished
calculus deposits to facilitate removal of deposits with a
curette .
 They can easily gouge and roughen root surfaces when
used improperly.
 Thus not suitable for fine scaling and root planing.

101. HOE SCALER
 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.

102.  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
.

103.  Ultrasonic and sonic instruments may be used
for removing plaque,scaling,curetting and
removing stain.
 The two types of ultrasonic units are
magnetostrictive and pizeoelectric.

104. POLISHING INSTRUMENTS

105.  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.

106. BRISTLE
 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.

107.  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

108.  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.

109. PERIODONTAL SURGICAL
INSTRUMENTS
 These are classified as
 Excisional and incisional instruments
 Surgical curettes and sickles
 Periosteal elevators
 Surgical chisels
 Surgical files
 Scissors
 Needle holders

110. INCISIONAL AND EXCISIONAL
 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

111. PERIODONTAL KNIVES
 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 .
 INTERDENTAL KNIVES-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.

113.  Bard Parker handle is used for cutting gingival
tissue and making surgical incisions.

114. SURGICAL BLADES
 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.

115. SURGICAL CURETTES AND
SICKLES
 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.

116. PERIOSTEAL ELEVATOR
 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.

117. TISSUE FORCEPS
 Used to hold the flap during suturing used to
position & displace the flap after the flap has
benn reflected

118. SURGICAL CHISELS AND
HOES
 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.

119.  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.

120. SURGICAL FILES
 SUGARMAN PERIODONTAL FILE
 Used interproximally.
 File surfaces on both sides allow for push or
pull application.

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

122.  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.

123. REVERSE ACTION CHISEL
 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.

124. HEMOSTAT
 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

126. SURGICAL SCISSORS
 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.

127.  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.

128. SURGICAL NIPPERS
 Serve same purpose as Scissors.
 They are also used for contouring the
architectural form and for forming interdental
sluiceways.

129. NEEDLE HOLDER
 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.

130. MICROSURGICAL TISSUE
PLIERS AND FORCEPS
 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 wound closure,
microsutures in the range of 6-0 to9-0 are
required to approximate the wound edge.

131.  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 .

132. Periodontal Instrumentation
 Accessibility:positioning of patient and
operator
 Visibility, illumination &retraction
 Condition and sharpness of instrument
 Maintaining a clean field
 Instrument stabilisation
 Instrument activation

133.  Accessibilty facilitates thoroughness of instrumentation
 Position of patient & operator should provide maximal
acessibility
 Inadequate accessibility impedes through insrumentation,
prematurely tired the operator diminishes effectiveness of
clinician
 Clinician should de seated comfortablely on a operating stool,
so that clinician’s feet are on the floor with the thighs to the
floor
 Be in a straight & head erect position
 Patient should be in supine position & placed so that the
mouth close to the restig elbow of the clinician
 For instrumentatuon of the maxillary arch, the patients chin
should be rise slightly
 For mandibular arch, lower chin untill madible in parallel to
floor.

134.  Direct vision with direct illumination from
dental light
 Indirect vision by using mouth mirror
 Retraction provides visibility, acessibility &
illumination
 Mirror also used for retraction cheeks or
tongue
 Index finger is used for retraction of the lip

135.  Make sure that are clean, sterile & in good
condition
 Working end of pointed or blaed instrument
must be sharp to be effective
 Sharp instruments enchance tactile sensitivity
& allow yhe clinician to work more precisely

136.  Instrument grasp
 Modified pen grasp
 Standard pen grasp
 Palm and thumb grasp
 Finger rest
 Conventional
 Cross arch
 Opposite arch
 Finger on finger

137. Adaptation
 Adaptation refers to the manner in which the
working end of the instrument is placed against
the tooth
Angulation
 Angulation refers to the angle between the face of
a bladed instrument and the tooth surface
 -Also called tooth-blade relationship
 During insertion
 Scaling & root planing

138. Lateral pressure
 It refers to the pressure created when force is applied against
the surface of the tooth with the cutting edge of a bladed
instrument
 May be firm, moderate or light
 Uncontrolled application of heavy forces should be avoided
Strokes
 3 types
 exploratory
 Scaling
 Root planing
 Any of these strokes may be activated by a pull or push
motion in vertical oblique or horizontal direction

139. Exploratory stroke
 Light feeling stroke used with probes and explorers to
evaluate the dimention of pocket & to detect calculus
& irregularities on tooth surface
Scaling stroke
 Short powerfull pull stroke used with bladed
instruments for the removal of both subgingival &
supragingival calculus.
 Scaling motion should be initiated in the fore arm
&transmitted to the wrist to the hand with a slight
flexion of fingers
 Push scaling motion is rarely used

140. Root planing stroke
 Moderate to light pull stroke used for final
smoothening & planing of the root surface
 Hoes, files, curettes & ultra sonic instruments
can be used

141.  Mounted rotary stones
 Mounted on a metal mandrill
 Cylindrical conical or disc shaped
 Difficult to control, creates heat, tends to wear the
instrument easily
 Unmounted stones
 Rectangular, cylindrical or cone shaped
 Either instrument stablized & stone drawn across it or
stone stablized & instrument drawn across stone
 Eg INDIA STONE
 Arkanas stone
 Ceramic stone

142. CONCLUSION
 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.

143.  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.

144. REFERENCES

145. THAN
K
YOU