periodontal instruments and armamentarium with their application 245 slides

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Dr.Vinay JainPG 1st year

Introduction

Classification of Periodontal instruments

Parts of instruments

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 can 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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As with all instruments, they have three distinct sections:

Handle,

Shank, and

Working end, blade or nib

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Handle Handle of the instrument is used for grasping the

instrument.

Available in various weight ,diameter and texture.

Weight:-

Weight of the handle is determined by its diameter and its core(solid or hollow)

Hollow handle: increase tactile transfer and minimize fatigue

Solid handle :reduce tactile transfer and increase fatigue

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Diameter

Small handles(3/17 inch) :decrease control and increase fatigue

Large handless (3/8 inch): maximize control and reduce muscle fatigue

Texture

Serrated knurled handle(bumpy texturing) :maximize control and decrease hand fatigue

Smooth handle :decrease control and increase muscle fatigue

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Handle Selection Criteria

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Recommended Avoid

Large diameter (3/8 inch) Small diameter (3/17 inch)

Lightweight, hollow handle Heavy, solid metal handle

Bumpy texturing Smooth or flat texturing

Shank Shank connect the handle to the

working end of the instrument. Shank can be functional and

terminalFunctional shank extend from the

working end to theshank bend closest to instrument

handle Terminal shank extends between

blade and 1st bendShank can be rigid, moderately rigid

or flexible.

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1. Simple shank design—a shank that is bent in one plane (front-to-back).

2.Complex shank design—a shank that is bent in two plane(front –to-back and side –to-side) to facilitate instrumentation of posterior teeth

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Working end The working end or blade is made up of several

component such as face ,cutting edge ,back and toe .

A rounded working end is called – TOE

A pointed working end is called – TIP

BALANCED INSTRUMENT

If the working –ends are aligned with the long axis of the handle. This design that finger pressure applied against handle is transferred to the working –end of the instument.

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Periodontal instruments are designed for specific purposessuch as removing calculus, planing root surfaces, curetting the gingiva, and removing diseased tissue.

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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.

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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4)Periodontal Endoscope is used to visualize deeply

into subgingival pockets and furcations, allowing the detection of

pockets.

5)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 systems for tooth

polishing.

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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 –

Size of mouth mirror

Size 1 -16mm

Size 2 – 18mm

Size 3 – 20mm

Size 4 - 22mm

Size 5- 24 mm

Most commonly used mirror are size 4 and size 5.

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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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Different types of mouth mirror

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Plane surface mirrors (also know as regular mirrors) have a silver coating on the back of the glass. As a result, light is reflected from the top of the glass as well as from the silver layer. This causes a double image.

FUNCTIONS

Specific uses

Indirect vision

Indirect illumination

Transillumination

Retraction

Nonspecific uses

Handles can be used for checking mobility, percussion.

;

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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.

F. Evaluate Success and completeness of treatment

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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…….Watts

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

Goldman Fox probe

WHO probe

Nabers probe

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ADVANTAGES1.Easily available and inexpensive2.Tactile sensation is preserved3.Colour coding 4.Can be used even in presence of subgingival calculus

DISADVANTAGES1.Probing force cannot be measured2.Heavy in weight3.Inter-examiner variation4.No computer capturing data5.Assistant is required to record thereading

WILLIAMS GRADUATED

PERIODONTAL PROBE

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•Charles H.M. williams in 1936 introduced

graduated periodontal probe.

•It is stainless steel probe with diameter

1mm ,length 13mm and blunt tip end.

•Angle between handle and probe tip is 130*

•Markings include 1,2,3,5,7,8,9 and 10 mm

with 4mm and 6mm marking are missing in

this probe to improve visibility and avoid

confusion in reading the marking

.

Goldman Fox probeGoldman-Fox probe same as Williams

probe`s calibration

- But it is flattened not round

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Glickman periodontal probe

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It has rounded tip with longer shank

The UNC-15 Probe

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15mm long.

Markings are at each mm and

color coding at the 5th,10th and

15thmm

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UNIVERSITY OF MICHIGAN O PROBE

WITHOUT WILLIAMS MARKING

Markings are at 3, 6, and 8mm

MARQUIS COLOUR CODED

PROBE

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•Calibrations are in 3mm sections.

Markings are 3,6,9,12mm

WHO PROBE

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• It has 0.5 mm ball at the tip

• millimeter markings at 3.5/ 5.5/ 8.5/ 11.5mm

• color coding from 3.5 to 5.5 mm.

Types:

CPITN-E(Epidemiological) -Markings at 3.5 and 5.5mm.

CPITN-C (Clinical )- Markings at 3.5, 5.5, 8.5 and 11.5mm.

This probe was designed for

Measurement of pocket depth

Detection of sub gingival calculus

Used in assessment of treatment needs CPITN-C

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CPITN -E

NABER’S PROBE

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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 .

Markings. at 3,6,9 and 12mm

PLASTIC PROBES FOR IMPLANTS

Several different companies are manufacturing plastic

instruments and gold –coated curettes 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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These are pressure-sensitive probes.

It has been shown that with forces upto 20 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 TPS probe.

Advantages Disadvantages

1) Constant pressure 1) Penetration into inflammed

2) Less inter-examiner variation connective tissue

3) Comfortable to the patient 2) Assistant required

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True Pressure Sensitive Probe

To overcome the limitations of conventional probingsystem, pressure-sensitive probes are developed whichhave standardized, controlled insertion pressure.

Introduced by hunter in 1994.

These probe have a disposable probing head and ahemisphere probe tip with a diameter of 0.5 mm

This probe was designed to deliver the same 20 gramsof force every time.

Controlled force to the probe tip was provided using aparallelogram.

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True Pressure Sensitive 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.

ADVANTAGES

1)Constant pressure application

2)Error during data recording minimal

3)Computerized storage of data

4)Printout can be obtained

DISADVANTAGES

1)Penetration into inflamed connective tissue may occur

2)Less tactile sensitivity

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Foster Miller probe Introduced by Jeffcoat et al in 1986

This device capable of providing controlled probing pressure and measuring the pocket depth along with detection of CEJ.

The components of the probe are: a pneumatic cylinder, a linear variable differential transducer (LVDT), a force transducer, an accelerator, and a probe tip.

The main mechanism of action of the Foster-Miller probe is by detection of the CEJ

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The ball tip moves or glides over the root surface at a controlled speed and preset pressure. Abrupt changes in the acceleration of the probe movement (recorded on a graph) indicate when it meets the CEJ and when it is stopped at the base of the pocket

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The Florida Probe was devised by Gibbs et al in 1988.

This probe consists of a probe handpiece and sleeve; a displacement

transducer; a foot switch; and a computer interface/personal computer.

The hemispheric probe tip has a diameter of 0.45 mm, and the sleeve

has a diameter of 0.97 mm.

Constant probing pressure of 15 gm is provided by coil springs inside

the handpiece

Its advantages are

Precise Electronic measurements

Computer storage data

Constant probing force 51

FLORIDA

PROBE

Disadvantages are-

Lack tactile sensitivity

Underestimation of deep probing depths

by the automated probe.

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Florida probe with stent

Florida probe without stent

Fourth generation These are three dimensional probes in which sequential probe

positions are measured.

ADVANTAGES

1)Allow three –dimensional measurement

2)Sequential probe positions can be measured

3)Computerized storage

4)Printout can be obtained

DISADVANTAGES

1)Under developed

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Fifth Generation. Fifth generation are ultrasonographic probes which provides

painless probing to the patient. The guidance path is predeterminedin these probes.

ADVANTAGES

1)Non –invasive

2)Accurate measurement of pocket depth

3)Ultra sound waves accurately detect various periodontal structurelike upper boundary of periodontal ligament and other soft tissuestructure

4)Provides information regarding condition of the gingival tissues.

5)Printout can be obtained.

DISADVANTAGES

1)Technique sensitive

2)Expensive

3)Operator training required for interpreting the image obtained. 55

UltraSonographic (US) probe US probe was devised by Hinders and Companion at

the NASA Langley Research Center.

US probe mapping system is a non –invasiveperiodontal probing

A narrow beam of high frequency (10-15 Hz)ultrasonic waves is passed into the gingival sulcus andechoes of returning waves ,which are reflected backfrom tissues are recorded.

Component of the probe contra-angledhandpiece,computer, electron box for water control,foot pedal, transducer emit and receives sound waves.

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OTHER PERIODONTAL

PROBES

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Thermal Probe Thermal probes are sensitive diagnostic devices used for

measuring early inflammatory changes in the gingival tissues.

One of the commercially available system, the PerioTemp Probe enables the calculation of temperature differential (DT, with a sensitivity of 0.1o C) between the pocket probed and its sub gingival temperature.

This temperature differential is useful because it allows consideration of differences in core temperature between individuals.

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Thermal Probe

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Thermal Probe Sub gingival temperature at diseased sites is increased

compared with healthy sites.

There always exists a natural antero - posterior temperature gradient existing within the dental arches.

Mandibular sites were reported to be warmer than the maxillary sites.

Temperature increases with probing depth due to increase in cellular and molecular activity caused by increased periodontal inflammation with increasing probing depth.

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Flexible Plastic Probes The Colorvue™ Probe Tips from Hu-

Friedy Manufacturing offer the option of using replaceable and flexible tips with 1 mm or 3 mm markings.

The yellow probe with the black markings creates a striking contrast with the gingival tissue. Tips last 30 uses due to wearing of the color markings.

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The PerioWise® Friendly Probe® by Premier Dental is a white, flexible, autoclavable 3-6-9-12 mm or 3-5-7-10 mm probe. At the tip is a green band indicating a 3 mm or less sulcus depth. Red millimeter markings are present at 5 mm or 6 mm and thereafter indicating disease.

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Explorers are sharp, pointed metallic instruments.

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 .

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EXPLORER

Design of Explorers

Explorers are made of flexible metal.

Explorers are circular in cross section.

The working-end is 1 to 2 mm in length and is referred to as the

explorer tip.

The actual point of the explorer is not used to detect dental calculus;

rather,the side of explorer tip is applied to the tooth surface

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SHEPHARDS HOOK

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It is a long stick with a curved end

USE

For supragingival examinations for

dental caries and irrregular margins

of restoration

Straight Explorer. Use:

• Supragingival examination of the

margins of restorations or to assess for

sealant retention.

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Curved Explorer. Use:

Calculus detection in normal sulci or

shallow pockets.

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COWHORN &PIGTAIL

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•Used in calculus detection in

normal sulci or shallow

pockets extending no deeper

than the cervical-third of the

root.

ORBAN TYPE

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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

Tip bent at a 90-degee to the lower shank

11/12 EXPLORER

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It is a universal assessment /diagnostic periodontal

instrument.

The tip is at 90-degree angle to lower shank.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 .

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SICKLE

SCALER

Working-End DesignPARTS OF THE WORKING-END

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Cutting Edge. The cutting edge is a sharp edge formed where the face and lateral surfaces meet

Toe or Tip:The cutting edges of a curette meet to form a rounded surface called a toe. The cutting edges of a sickle scaler meet in a point called a tip.

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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

A universal curet is a periodontal instrument used to remove small- and

medium-size calculus deposits .

Universal curet can be used both supragingivally and subgingivally—on crown

and root surfaces.

A universal curet usually is a double-ended instrument with paired, mirror-

image working-ends.

Example : langer curettes, columbia curettes, indiana university curettes, barnhart

curettes, mc-call’s curettes, younger good curettes.

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The face is at a 90-degree angle with terminal ( lower ) shank.

Two cutting edge which are formed at the junction of the lateral

surface with the facial surface.

Two parallel cutting edges that meet at a rounded toe.

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Design

Paradise Dental Technologies (PDT) (Missoula, Mont) introduced the original Montana Jack scaler, a double ended, curved posterior sickle scaler.

New Rigid Montana Jack for heavier scaling that has larger shanks with blades that are as narrow as the original Montana Jack but thicker face to back.

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The Nevi 1 anterior sickle scaler has two distinct working ends. The small

thin sickle end is paired with an oval disk-shaped end.

The Nevi 2 is a double ended acutely curved posterior sickle that is very

thin.

The new Nevi 3 is a modification of the Wiland Carver that was originally

designed as a restorative finishing instrument. Its thin curved blades for

light to moderate scaling in shallow to moderate depths. The Nevi 3 is also

excellent for scaling of malpositioned teeth and for scaling pediatric

patients.

The new Nevi 4 is a modified Montana Jack design that has strong, curved

blades that are designed for moderate to heavy scaling.

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LANGERThis set of four curette combines the shank design of the standard gracey with a

universal curettes blade design .

This combination allows the advantage of the area-specific shank to be combined

with the versatility of the universal curette blade.

1/2langer :mandibular posterior

3/4 langer: maxillary posterior

5/6 lager : anterior

17/18 langer :posterior

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After Five Langer Curettes Elongated terminal shank (3mm) provides better clearance around

crowns, and superior access to root contours and pockets 5mm or more

in depth.

Blade thinned by 10% to ease gingival insertions and reduce tissue

distention

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Mini Five Langer Curettes Designed with the same elongated

terminal shank (3mm) and thinned

blades as the After Five Langer Curettes

50% shorter blade for access to smaller

roots, narrow pockets, furcations, and

developmental groove

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Standard Mini FiveAfter Five

Gracey curettes- In 1940s dr. Clayton gracey developed 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.

2. One cutting edge

3. A long, complex functional shank

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Design of Gracey curette

Universal curetteGracey curette

All areas and surfacesspecific surfacesArea of use

two cutting edge One 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

Gracey and hugo friedman ,together developed a series of 14 area –specific curettes.

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 .89

Double-ended Gracey curettes

are 7 instruments

The 15/16 Gracey Curette was introduced in 1993

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 maxillary molars with an

intraoral finger rest.

The terminal shank is 9 mm

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Gracey #15-16

The 15/16 Gracey Curette (right) has the same shank design as

the 13/14 (left); however, the blade is finished like an 11/12

(center) for the posterior mesial surfaces.

9113/14 11/12 15/16

17/18 Gracey Curette The 17/18 Gracey Curette is modified version of the Gracey 13-

14 allows better access and a more comfortable hand and finger

position access to the distal surfaces of posterior teeth.

Accentuated angles and long terminal shank allows for placement

into deep periodontal pocket.

The multiple bends improve the handle positioning so

interference from the opposing arch is significantly reduced.

Reduced blade length enhances adaptation of the entire blade to

the tooth.

The terminal shank is 7 mm

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17/18 Gracey Curette

• With the 17/18’s multiple bends, the handle position is closer to

horizontal which minimizes the contact with the opposing arch.

Allowing the clinician improved access to difficult to reach posterior

areas.

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13/14 Gracey

17/18 Gracey13/14 Gracey

17/18 Gracey

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1. The terminal shank is 3 mm longer ( allowing

extension into deeper periodontal pockets of 5

mm or more).

2. A blade thinned by 10% . For smoother

insertion , and reduced tissue stretching.

3. 1mm shorter blade

4. Available After Five instruments :

#1-2, 3-4, 5-6, 7-8, 11-12, 13-14

Extended shank instruments

- After Five curette

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

- Advantages :

1. can be used easily with vertical strokes,

2. With reduced tissue distention,

3. and without tissue trauma.

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Mini-bladed curettes

- Mini Five-

Standard After Five Mini Five

Available in both:

- Rigid Mini Five Gracey curette( calculus removal)

- Finishing Mini Five Gracey curette (light scaling)

- Available in all standard Gracey numbers except for the # 9-10

Function:

1. Deep, narrow pockets,

2. Furcations,

3. Developmental grooves,

4. Line angles,

5. Deep, tight pockets.

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Micro Mini Five GraceyCurettes• Blade is 20% thinner than a Mini Five Gracey to

further reduce tissue distention and ease sub-

gingival insertion.

• Elongated terminal shank for access into deep

periodontal pockets and root surfaces of 5mm

and more.

• Slightly increased shank rigidity compared to

traditional Mini Five Gracey Curettes

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Micro Mini

Five Gracey

Vision Curvettes

The curvettes are modification of gracey curettes .

These modifications include

50% shorter blade

Increased blade curvature

Straighter and longer terminal shank

Blade I.D. mark 5mm and 10mm

Markings on the shank

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99

+

OUTLINE OFVISION CURVETTE

(solid)

OUTLINE OFGRACEY CURETTE

(dashed)

SGCSUB0 – SUB-0

For anterior teeth.

SGC1/2 – Curvette 1/2

For anterior and premolar surfaces.


For mesial posterior surfaces and furcations;

elongated shank, 1 band on handle for easy

identification.


For distal posterior surfaces and furcations;

elongated shanks; 2 bands on handle for easy

identification.

KRAMER-NEVINS PERIODONTAL SURGICAL CURETTE

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Larger and heavier curettes for the

removal of granulation tissue and

tenacious subgingival deposits.

TURGEON MODIFIED GRACEY CURETTE

The Turgeon Modified

Gracey features narrow

blades for ease of insertion.

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QUETIN Furcation curettesThese 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 tip 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.

Example BL 1 and MD1 small and fine with 0.9mm blade width and

BL2 and MD 2Large and wider with 1.3 blade width

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Quétin furcation curettes : BL2 (larger) and BL1 (smaller).

PERIOTRIEVERS

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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Periodontal file

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A periodontal file is a instrument that is used to crush or roughen a

heavy calculus deposits so that it can be removed with sickle scaler or

curette.

The working end of periodontal file has unique charaterstic

1)Thin and flat working end can be used to remove large deposit that

are inaccessible to the sickle scaler.

2)The cutting edge are at 90 to 105 degree angle to the base.

3) The base may be round and rectangular.

4)The shank is rigid

HIRSCHFELD FILES

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File is an instrument used to crush calculus deposits.

Hirschfeld 3/7 (facial and lingual surfaces of posterior

teeth)

5/11(proximal surface of posterior teeth)

9/10 file(facial and lingual surfaces of anterior teeth)

Orban 10/11(facial and lingual surfaces of posterior teeth)

12/13(proximal surface of posterior teeth) file.

DIAMOND COATED FILES

Diamond –coated file are instrument used for finishing of root surface.

These files do not have cutting edges; instead, they are coated with very-

fine-grit diamond. The diamond-coated instruments from Hu-Friedy

Manufacturing Company have diamond coating placed 360° around the

tip.

The most useful diamond files are the buccal-lingual instruments,

which are used in furcations and also adapt well to many other root

surfaces.

Diamond files can produce a smooth, even, clean, and highly polished

root surface.

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HOE SCALER

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.

The blade is slightly bowed so that it can

maintain contact at two point on a convex

surface.

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CHISEL SCALER

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 .

The blade are slightly curved and have a straight cutting edge beveled at 45 degrees.

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Implant Instruments To remove a tenacious calculus deposit from an implant with a graphite or

plastic instrument is extremely difficult.

A new solid titanium implant instrument series (Brasseler USA) is available

that does not damage the implant surface, yet is able to effectively remove

the deposit .

Hartzell and Son Co makes titanium-coated implant instruments that are

rigid and they have a stainless steel core underneath the titanium coating to

increase rigidity

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Sharpening Eliminated A new technology is being manufactured to eliminate, not reduce, the

need for sharpening periodontal curette and sickle instruments.

These instruments (XP™ Technology, American Eagle Instruments® Inc)

have gold colored working ends created by impregnating titanium nitrate

into stainless steel by surface engineering.

Indications: Debridement, fine scaling, and root planing of nontenacious

deposits.

Contraindications: are tenacious calculus deposits, overhang removal,

and trimming restorative margins

112

113

Oscillating scaler

Ultrasonic sonic

Ultrasonic and sonic instruments may be used for removing plaque,scaling,curetting

and removing stain.

Sonic unit consist of a handpiece that attaches to a compressed –air line and uses a

variety of specially designed tips.

Vibrations in sonic tip range from 2000 to 6500 cycle per seconds .

Sonic scaler tips are large in diameter and universal in design. A sonic scaler tiptravels in an elliptical or orbital stroke pattern.

This stroke pattern allows the instrument to be adapted to all tooth surfaces.

The motion of the tip of the instrument is between 0.08–0.20mm.

114

Ultrasonic Ultrasonic units are either manual-tuned or autotuned.

Manual-tuned units are magnetostrictive ultrasonic devices.

Autotuned unit there is no tuning knob to adjust the speed (frequency) of

the tip. The majority of magnetostrictive units and all piezoelectric units are

autotuned.

Manual-tuned unit permits the clinician to adjust the frequency via the

tuning knob.

115

Magnetostrictive ultrasonic devices work in a frequency range of 18,000 to 50,000

cycles per second.

In a magnetostrictive unit is a core attached to the working end.

The core is either a stack of metal strips or a ferrite rod, depending on the type of

unit.

The handpiece is a copper wire coil that exposes the core to a varying magnetic field

when it receives an electrical current. When magnetized, the core contracts; when

demagnetized, the core returns to its original size.

116

117

Vibrations travel from the metal stack to a connecting body that causes the

vibration of the working tip.

Tips move in an elliptical or orbital stroke pattern. This allows the tip four

active working surfaces.

118

Beavertail Low to high Supragingival moderate to heavy calculus, Removing stain from all accessible tooth surfaces

Design Power setting Indication

Universal Low to high Light ,moderate and heavy calculus removal in all areas

Probelike Low to medium Light subgingival periodontaldebridement(calculus and plaque) ,Shallow and deeppocket depth and furcations

Dental implants Low Debridement of dental implants

Piezoelectric ultrasonic units work in a frequency range of 18,000 to

50,000 cycles per second.

They have ceramic discs that are located in the handpiece power

piezoelectric technology. They change in dimension as electrical energy

is applied to the tip.

Piezoelectric tips move in a linear pattern, giving the tip two active

surfaces.

119

120

A Time Line for the Evolution of Powered InstrumentsDate Event

Late 1950s Development of the first electronically powered instruments.

1960s and 1970s Powered instruments are used to remove heavy calculus deposits. The bulky design of the power instrument tip limits use to supragingival instrumentation or sites where the tissue allows easy subgingival insertion. The Gracey curet is the primary instrument for use within periodontal pockets.

Late 1980s Slim-diameter instrument tips are developed for electronically powered devices.

1990s Research studies establish that bacterial products are easily removed from the root surfaces, leading to a new approach to instrumentation and the conservation of cementum.

Today Modern powered instrument tips have been shown to be as effective as hand instruments for removing subgingivalcalculus deposits, plaque biofilms, and bacterial products from periodontally involved teeth.

Three modes of action Mechanical action, or vibration of the tip, results in deposit removal.

Mechanized instruments are said to have clinical power, referring to the

ability to remove calculus deposits under load.

Tip action that provides clinical power is dependent on the stroke,

frequency, type of tip motion, and angulation of the motion against the

tooth surface..

Cavitation is the action created by the formation and collapse of bubbles

in the water by high-frequency sound waves surrounding an ultrasonic tip.

Cavitation results in lavage, which is the therapeutic washing of the

pockets and root surface to remove endotoxins and loose debris.

Acoustic microstreaming occurs because agitation in the fluids

surrounding a rapidly vibrating ultrasonic tip has the potential to destroy

or disrupt bacteria.

121

Sonic scalerAdvantages

They create less heat at the scaling tip than an ultrasonic machine.

Used with air pressure so no need for separate installation as in case of

ultrasonic scalers

Disadvantages

Noisy during use

These scalers have low range of vibraton and high tip amplitude as

compared to Ultrasonic scaler so hardly ever leads to cavitation of the

water jet.

122

Insert Design Diamond-coated inserts are available for furcations, fine scaling,

and root planing.

Standard inserts (1 to 3 mm) are used for supragingival orsubgingival Light, moderate, or heavy calculus

Universal inserts can be used supragingivally, primarily for initialdebridement of moderate to heavy nontenacious deposits.

Precision thin inserts have probelike slim workingend designs(from 0.3 to 0.6 mm wide) indicated for light-deposit periodontaldebridement in shallow and deep pockets.

Available in three configurations—straight, right, and left

Straight design—indicated for periodontal pockets that are 4 mm orless

Right and left designs—indicated to reach depths greater than 4mm, concavities, and furcations

123

Furcation inserts have a 0.8-mm ball-end feature, providing more tip surface area for periodontal debridement of furcations and root concavities

124

Ultrasonic scaler hazards Aerosol and splatter

Micik and colleagues defined aerosols and splatter

Dental aerosols are fine, airborne particles that are liquid, solid, or a

combination of both and are 50 μm or less in size.

Spatter includes particles greater than 50 μm.

Two type of infectious aerosols :Dust born and Droplet nuclei

Dust born aerosols are larger in diameter and they can be easily

removed from the air by sedimentation or filtration.

Droplet aerosols are smaller in size and settle out of the air slowly.

125

Adverse effect of noise

The noise exposure from ultrasonic scalers commonly produced

hearing loss after long periods of time and can temporarily alter

patient hearing.

Thermal hazards

Absorbtion of acoustic energy by the tooth surface can result in an

elevation of tooth temperature causing heat injury.

Tactile sensitivity is impaired

Affect on pacemakers discharge rate.

126

Indications

Supragingival debridement of dental calculus and extrinsic stain

Subgingival debridement of calculus, oral biofilm, root surface constituents, and periodontal

pathogens

Removal of orthodontic cement

Gingival and periodontal conditions and diseases

Precautions

Unshielded pacemakers

Infectious diseases: human immunodeficiency virus, hepatitis, tuberculosis

Exposed dentin (especially associated with sensitivity)

Restorative materials (porcelain, amalgam, gold, composite)

Titanium implant abutments unless using special insert,

Children (primary teeth)

Immunosuppression from disease or chemotherapy

127

Contraindications

Chronic pulmonary disease: asthma, emphysema, cystic fibrosis, pneumonia

Cardiovascular disease with secondary pulmonary disease

Swallowing difficulty (dysphagia)

128

One study revealed that magnetostrictive, piezoelectric, and sonic

instruments produced an equal amount of contamination that

contained bacteria as small as 0.65 μm. Despite different volumes of

coolant water, there is no difference in the amount of aerosols emitted.(

Gross KB et al. 1992.)

Another study found that the piezoelectric unit produced the greatest

amount of contamination because of the linear motion of the tip as

compared with magnetostrictive units. (Harrel SK et al. 1998)

A greater production of aerosols and spatter also was observed in some

of the precision thin inserts when compared with standard inserts.

129

POLISHING INSTRUMENTS

130

• 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.

BRISTLE

Available in wheel and cup shapes.

Used in prophylaxis 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 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.

133

DENTAL ENDOSCOPEDental endoscope is a long, flexible tubular device that has a fiber optic light and

video camera attached.

The dental endoscope is about 1 m in length and 0.99 mm in diameter .

The dental endoscope allows for subgingival visualization of the root surface at

magnifications of 20x to 40x .

The endoscope is attached to a flat-screen monitor that provides a highly magnified

picture of subgingival conditions.

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.

The dental endoscope is not recommended for routine subgingivalinstrumentation because this process would be too time consuming.

134

These are classified as :

Excisional and incisional instruments

Surgical curettes and sickles


Surgical chisels

Surgical files

Scissors

Needles and Needle holders

Bone files

136

These include periodontal knives, interdental knives and

surgical blades.

Gingivectomy knives Eg: Kirkland knifes

Interdental knives Eg: Orban knife #1-2, Merrifield

knife #1,2,3 and 4

Surgical blades Eg: 11, 12,#12D,15, and 15C

137

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 .

Use for gingivectomy bevel incisions.

138

INTERDENTAL KNIVES

The orban knife#1-2 and the merrifield knife # 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.

Double-ended mirror image blades on a contra-angled shank that are pointed

for access to interproximal tissue.

139

orban knife#1 (left).

orban knife#2 (right)

Pocket marker Pocket marker are similar in appearance to cotton plier.

In pocket marker one tip is smooth and straight ,and the other tip is sharp and bent at a right angle.

The smooth tip of the pocket marker is inserted to the base of the pocket.

When the instrument is pressed together ,the sharp tip makes small perforation in the gingiva ,which are referred to as bleeding point an use to outline the area for a gingivectomy .

140

These are used to put incision during periodontal surgical procedures . Most

commonly used surgical blade during periodontal surgery are #12 D,15,15C.

These are mounted on bard-parker handle.

#11 Triangular blade with sharp point, flat cutting edge parallel to the handle

and flat back. And allow precise, vertical and acute angled incisions. It is useful

to drain an abscess and perform a biopsy

#12 : A small, pointed, crescent-shaped blade sharpened on the inside edge of

the curve.

142

#11 #12

# 12D blade:It is a double edged blade, beak –shaped with cutting edges

on both sides,allowing the operator to engage narrow, restricted areas with

both pushing and pulling cutting motions.

#15 blade : It has a small curved cutting edge and ideal for making

short and precise incision, Is used for thinning flap and general

purposes.

#15 C blade: This blade has a longer cutting edge than traditional

no.15 blade . used for making the initial scalloping type incision.

Bard parker handlesBard Parker handle may be straight or contra-angle.

It is a metal instrument used to attach different type of blade. Shaft is flat with 1cm,

breadth at the middle, distal end is narrow and Proximal flat end is round.

These design help in performing procedures in different parts of oral cavity used for

cutting gingival tissue and making surgical incisions. The handle is also known as a

"B.P. handle", named after Charles Russell Bard and Morgan Parker, founders of the

Bard-Parker Company

144

Handle #3 for use with scalpel blade #10,#11,#12 and #15

145

For palatal surgery and other bowed blade techniques

Periodontal surgical curette LUCAS SURGICAL CURETTE

Surgical Curettes are designed for curettage,

cyst removal and tooth socket debridement

Lucas R/L Curette, designed with a long 20mm

shank, medium 2.5mm spoon shaped blades.,

Large octagonal handle for firm control, also

available in round handle for easy rotation and

maneuvering in difficult areas.

146

2.5mm ,3mm, 3.5mm, 4.5mm

Hemingway(1/2,2/2,3/2,4/2mm)

147

MILLER SURGICAL CURETTE

Designed for curettage, cyst removal and

tooth socket debridement. Miller R/L

Curette, designed with long 23mm shanks

3.6mm wide spoon shaped blades.

PRICHARD SURGICAL CURETTE

Larger and heavier curettes for the removal

of granulation tissue and tenacious

subgingival deposits

148

Ball scaler designed for the removal of supragingival calculus.

Periosteal elevators used to detach the periosteum (bone covering) and gingival

tissues from around the tooth .

These are needed to reflect and move the flap after the incision has been made for

flap surgery.

Periosteal elevator are double –ended instrument ,one end is pointed and the other is

rounded. Pointed end ,used for elevating the interdental papilla of the gingiva and

rounded end ,elevating the mucoperiosteum from the bone .

The Woodson and Prichard elevators are well-designed periosteal instruments.

149


150

Prichard #3

Combines a large ,flat blade used for retraction and a

smaller curved tip used for reflection and retraction of

tissue .The Prichard Periosteal Elevator can be used as

a retractor. The larger diameter, round, lightweight,

and knurled handle make it easier to control.

Woodson periosteal elevator

151

Howarth Septum Elevator Combines a blunted end that is 4.5 mm wide with a chisel end that is 5 mm wide.

Gargiulo #2 Combines a curved blade that is 5 mm wide and a rounded tip with a flat blade that is 4 mm wide and a rounded tip. Both ends are sharp around the periphery

Allen #9A Combines the same tips as the traditional Molt 9 but the round end has a 3 mm suture hole

Molt #9 Combines a large curved blade that is 7.5 mm wide and has a rounded tip with a curved blade that is 3.5 mm wide and has a pointed tip. Both ends are non-cutting.

Goldman Fox #14 Both curved blades are 4.5 mm wide and have a rounded tip. One end is sharpened around the periphery and the other end is non-cutting

Tissue forceps are used to handle tissues and other materials and also to

manipulate needles and other instruments while operating.

A variety of forceps have been developed to suit different purposes and many

of them are available in different lengths. The jaws of the forceps may be

toothed, plain or have specialised grips.

DeBakey's forceps

•Used to hold the flap during suturing

•Used to position & displace the flap after the flap

has been reflected

•DeBakey's forcep widely used in general

abdominal and vascular surgery. Designed to

grasp delicate tissues without trauma.

153

Corn Suture PliersSerrated blades allowsuture to pass throughthe jaws

Adson toothed forcep Straight design with 1x2 interlocking “Rat Tooth. Fine dissectors with teeth for gripping fine but tougher tissues.

Semkin-Taylor forcep Curved design with 1x2 interlocking “Rat Tooth”

Adson-Brown Blades have 7 interlocking teeth

Adson Tissue Plain Forcepuseful for grasping delicate tissues to dissect out nerves and vessels.

Chisels and hoes are used during periodontal surgery for removing and

reshaping bone.

Surgical hoe

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.

154

The surgical hoe is generally used for detaching pocket walls after the gingivectomy

incision, but it is also useful for smoothing root and bone surfaces made accessible

by any surgical procedure.

Surgical hoe used with a pull stroke

Surgical chisels

It is a double ended instrument with a curved shank at one end and a straight shank at

the other .

The blade are slightly curved and have a straight cutting edge beveled at 45 degrees.

The ochsenbein no 1-2 is a useful chisel with a semicircular indentation on both sides

of the shank that allow the instrument to engage around the tooth and into the

interdental area.

Surgical chisels are engaged with a push stroke.

The Wiedelstadt and Todd-Gilmore chisels are straight shanked. 155

156

Fedi #1 Double-ended opposing blades that are 1.75 mm wide with semi-circular cutting edges on each side and set at a 10˚ angle.

Fedi #2 Double-ended opposing blades that are 2.5 mm wide with semi-circular cutting edges on each side and set at a 15˚ angle.

TG Chisel Double-ended opposing blades that are 2.5 mm wide

Surgical chisel Surgical hoe 157

Ochsenbein Chisel

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.

158

Reverse action chisel(Rhodes Chisel )

159

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.

Surgical files

SUGARMAN

PERIODONTAL FILE

Used interproximally. File

surfaces on both sides allow for

push or pull application.

FUNCTION: To recontour and smooth bone in bony pockets

160

161

SCHLUGER PERIODONTAL

FILE

Used interproximally. File surfaces

on both sides allow for push or pull

application.

Scissors are used in periodontal surgery for such purposes as

1)Removing tags of tissue during gingivectomy,

2)Trimming the margins of flaps,

3)Enlarging incisions in periodontal abscesses,

4)Removing muscle attachments in mucogingival surgery.

162

163

Iris #301 Straight blades

Iris #302 Curved blades

Castroviejo Curved blades with spring action handle. Excellent for tissue and Suture(4’’)

LaGrange #314 A unique curvature allows easy access to the tightest areas. One blade is serrated to hold tissue when cutting.

164

Suture #304 Angular blades with suture hook

Spencer Suture #306 Straight blades with suture hook

Suture #322 Long handle, straight blades with suture hook

Suture #322 Long handle, straight blades with suture hook

165

•Goldman-Fox Scissor is curved with 1

serrated blade

•These scissors feature specially-

designed razor sharp upper blade edges

to cut effortlessly and cleanly through

dense or delicate tissue.

•Bottom blade has diamond-cut micro-

serrations to grip tissue and prevent

slippage

•5" in length

Goldman-Fox scissors

Super-cut Iris Curved scissors one blade are

honed/serrated to razor sharpness with

opposing blade finished with fine serration

to avoid tissue slippage. One finger ring is

gold plated for easy identification

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

166

167

Mosquito Straight jaws (120 mm).

Mosquito Curved jaws ( 120 mm)

KellyStraight jaws ( 145 mm).H103

Kelly Curved jaws (145 mm).

Allis artery forcep

CURVED KELLY-RANKIN HEMOSTAT:Multipurpose instrument used

to clamp off blood vessels, remove small root tips and grasp loose

objects.

168

SURGICAL NIPPERS To remove tissue “tags” and contour interproximal gingiva

during soft tissue surgery

Serve same purpose as Scissors.

They are also used for contouring the architectural form.

169GOLDMAN-FOX TISSUE NIPPER

Compact, sharp nippers with smooth action useful for accentuating interproximalgingival contour during soft tissue surgery.

SUGARMAN NIPRO TISSUE NIPPER

Anatomy of a Surgical Needle

Needle point Geometry

Taper-Point•Suited to soft tissue

•Dilates rather than cuts

Reverse

cutting

•Very sharp

•Ideal for skin

•Cuts rather than dilates

Conventional

Cutting

•Very sharp

•Cuts rather than dilates

•Creates weakness allowing suture

tearout

Taper-cutting•Ideal in tough or calcified tissues

•Mainly used in Cardiac & Vascular

procedures.

Needle ShapesEyeMicrosurgery

Dura

Eye

Fascia

Nerve

Muscle

Eye

Skin

Peritoneum

Cardiovascular

Oral

Pelvis

Urogenital tract

Nasal cavity

Nerve

Skin

Tendon

Eye (Anteriorsegment)

Laparoscopy

173

In periodontal surgery because of the

interdental space,particularly between the

posterior teeth, long , large radius needles are

required which can easily be grasped again

after being introduced into the interdental

space on the opposite side.

Needle that 3/8 of a circle particularly suitable

for this purpose.

It is important that the needle have a triangular

cross –section. This makes it eaiser to insert

the needle and pass it through the tissue

because the needle cuts through the tissue

with its two outer cutting edge. The third

cutting is formed by the outer curvature.

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

techniques that require quick and easy release and grasp of the

suture.

174

175

Mayo-Hegar needle holder. Large jaws with carbide inserts and fine serrations

Crile-Woodneedleholder Mediumjaws with carbideinserts and fineserrations

Castroviejo Very fine serrations on narrow profile jaws with carbide inserts. The locking mechanism is activated by squeezing the spring-action handle. This is a great needle holder for periodontal applications where a very fine suture is used

BONE FILES Used to remove or smooth rough edges of alveolar bone

during surgical procedures. Straight-cut bone files are

used with a pull stroke. Cross-cut bone files can be used

with a push-pull motion.

176

MILLER BONE FILEStraight-cut bone file used for final smoothing of bone. MILLER-COLBURN BONE FILE

The advancing abilities of instrument makers, coupled with the in-

genuity 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.

177

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.

178

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

179

http://www.google.com/images

Armamentarium and Advanced Surgical Instruments

CONTENTS

Basic surgical instrument

Instruments for Transferring Sterile Instruments

Instruments for Retracting Soft Tissue

Instruments for removing bone

Instruments for suctioning

Photographic mirror

Sharpening instrument

Dental burs

Callipers

Instrument for implant surgery

Instrument for Maxillary sinus floor augmentation

Indirect and direct

Autogenous bone grafts harvesting instrument

180

181

Basic surgical armamentarium

Dressing trolley

182

Frame and removable tray in stainless steel Height adjustable from 90 to115cm.Dimensions tray 70x45x2 h cm

TRAYS

183

200 x 90mmKidney tray

300 x 140mmKidney tray

300 x 200 x 50mmEnamel tray

Drums

184

mm 190 x 160

mm 160 x 140

mm 120 x 120

mm 100 x 120

185

mm 30

mm60

mm 80

mm 45

mm 25

Cups

INSTRUMENTS FOR

TRANSFERRING STERILE

INSTRUMENTS

186

CHEATLE FORCEPS

Long handles

Long, angulated beaks: serrated

Beaks: dipped in antiseptic solution

Lift up sterile instruments from autoclave/ drum

SWAB HOLDING FORCEPS

Long handles, straight beaks- fenestrated ends

Rings : end of handles

Working end- inner aspect: serrated

Pick up sterile gauze- transfer to tray

Hold gauze dipped in antiseptic solution- scrub the surgical field

187

INSTRUMENTS FOR TRANSFERRING STERILE INSTRUMENTS

INSTRUMENTS FOR RETRACTING

SOFT TISSUE

188

INSTRUMENTS FOR RETRACTING SOFT TISSUE

Right angle Austin retractor

o ‘L’-shaped- no handle

o Retraction of small intraoral flaps: removal of impacted teeth

UNIVERSITY OF MINNESOTA-

o Cheek Retractor/Tongue Depressor

189


Towel clip

o Hold the tongue

o Biopsy: performed on the posterior aspect; by holding the anterior tongue.

Weider Retractor

o Broad

o Serrated on one side: firmly engage tongue, retract it medially & interiorly

o Don’t position posteriorly-gagging

190

Langenback’s Retractor

o ‘L’ shaped retractor- long handle

o Retraction of flap edges : improved visualization of deeper layers & structures

o Different sizes: handle length & blade width

Seldin retractor

o Similar to a periosteal elevator

o Leading edge: dull- shouldn’t reflect periosteum

191


Bishop cheek retractor

Used to hold mucoperiosteal flaps, cheeks, lips

and tongue away from the surgical area.

Implantology surgical retractor

Arched shaped retractor for retraction of the

maxillary or mandibular lips and tissue.

192


193

COLUMBIA CHEEK RETRACTOR

OptiView

“U” type cheek retractor

“O” type cheek retractor

-

PHOTOGRAPHIC CHEEK RETRACTOR

194

PHOTOGRAPHIC CHEEK RETRACTOR

INSTRUMENTS FOR

REMOVING BONE

INSTRUMENTS FOR REMOVING BONERongeur forceps

o Most commonly used

o Sharp blades- squeezed together; cutting/pinching through bone

o Leaf spring between the handle : instrument opens when hand pressure is released

o Repeated cuts without manually reopening

INSTRUMENTS FOR REMOVING BONEThe type of rongers selected varies with the

density of bone to be removed.the stille –lucer

is a large double –action rongers with blunted

jaws that take a 9-mm wide bite of bone.

uses most dentoalveolar surgical procedures

- inserted into sockets: interradicular bone

- sharp edges of bone

Do not :

-remove large amounts of bone in single bites

- use to remove teeth

INSTRUMENTS FOR REMOVING BONE

Chisel

Surgical chisel are used to remove or shape bone. They can be used alone if the bone is soft, but if the bone is dense, a surgical mallet is used with a chisel

o Monobevel chisel: bone is removed

o Bibevel chisel: used to split teeth

Cylindrical handle- serrated with flat end: struck with mallet

Single bevel- cutting edge


Osteotome

Splitting bone

Cylindrical handle- serrated for good grip

Flat end- tapped with mallet

Flat & rectangular blade

Bibivelled cutting edge- converge to a sharp edge


Surgical Mallet

Cutting bone with osteotome/ chisel

Stainless steel- strong cylindrical handle

Tapped : ‘pull-back’ action- force from wrist

Tapped with controlled force.

INSTRUMENTS FOR REMOVING BONE BONE FILE

Used to remove or smooth rough edges of alveolar bone

during surgical procedures. Straight-cut bone files are

used with a pull stroke. Cross-cut bone files can be used

with a push-pull motion.

201

MILLER BONE FILEStraight-cut bone file used for final smoothing of bone. MILLER-COLBURN BONE FILE


Bur and Handpiece

o Surgical removal of teeth

o High-speed + sharp carbide burs: for cortical bone removal

o No. 557,703 fissure burs; No.8 round bur

o Large bone bur : acrylic bur- large bone removal

INSTRUMENTS FOR

SUCTIONING

INSTRUMENTS FOR SUCTIONING Adequate visualization: blood, saliva, irrigating

solutions suctioned

Surgical suction: smaller orifice than usual- rapid evacuation of fluids

Several designs of orifice: soft tissue not aspirated & injured

INSTRUMENTS FOR SUCTIONING Frazier Suction Tip is a single-patient use surgical

instruments offer surgeons more control with a wide selection of tipand tubing. Its malleable, aluminum-insulated shaft resists flakingand finger cut-off control valve allow suction control. It is designed tominimize patient trauma .

Features

Malleable aluminum shaft can be bent to desired position providesflexibility during procedures.

Available in 6FR, 8FR, 10FR, 12FR and 14FR for procedure versatility

2.0 mm internal diameter

3.0 mm internal diameter

INSTRUMENTS FOR SUCTIONINGHigh Volume Suction Tip

Large bore tubes with slight angulation- end

Autoclavable stainless steel/ plastic

Disposable plastic tubes

Suck out large volumes of irrigation fluids, blood clots & debris

INSTRUMENTS FOR SUCTIONINGSaliva Ejector

Low volume suction tip

Disposable plastic- different designs

Flexible- bent & adapted under tongue

Buccal vestibule: partially retracts cheek

208

PHOTOGRAPHIC MIRROR

Photographic mirror

209

Occlusal Contrasters

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Sharpening instrument Sharpening stones, water stones are used to gride and hone the edges

of steel tools and implements.

Rationale for Sharpening

A sharp periodontal instrument:

Enhances tactile sensitivity

Improves quality of deposit removal

Improves efficiency and control in deposit removal - patient comfort

Requires less lateral pressure - less fatigue for clinician

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Evaluation of Cutting Edges

A dull cutting edge will reflect light.

A sharp cutting edge will appear as a fine black line under light.

A sharp cutting edge will “bite” into an acrylic testing stick.

Sharpening Stones type:

Natural stones (fine - medium) - Arkansas -oil lubrication

Synthetic stones (fine-coarse) - India and Carborundum - water

lubrication

Ceramic stones (fine) - no lubricant needed

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Arkansas fine grain, whitemm 100 x 30 x 6 x 3

India medium grain, redmm 105 x 45 x 10 x 3

Natural stone (extra quality fine grain)mm 100 x 10 x 30

Fine green silicium carbidemm 2/6 x 15 x 8 x 102

arkansas fineø mm 10 x 100

arkansas conicalø mm 10 mm 100 ø mm 3

DENTAL BURS

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Dental burs Dental burs are used for cutting hard tissues - tooth or

bone. They are made of steel, stainless steel, tungsten carbide and diamond grit

Finishing Burs

These heads are used for finishing restorations, soft tissue recontouring, alveolaplasty and odontoplasty.

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Crosscut Tapered Fissure Head These heads are used for sectioning multi-rooted teeth

and reducing crown height .The most useful sizes are 700/700L and 701/701L

Sharpning bur Mandrel Mounted Stone for the handpiece restores the

cutting edge on dull instruments. Stones are made of white aluminum oxide.

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Calipers

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(Straight /Curved)Castroviejo180 mmScale 0-40 mm

155 mmImplantology caliper

(Straight /Curved)Castroviejo85 mmScale 0-20 mm

Socket wall caliper(0-10mm)

Sliding caliper

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Right-angled calipers are ideal for measuring bone through soft tissues

INSTRUMENT FOR IMPLANT SURGERY

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Bone expander An alternative to osteotomes

Bone expander drills for the expansion andcondensing of the atrophic mandible andmaxilla in preparation for dental implantinsertions. Expanders are also an alternative tothe maxillary sinus elevation technique.

Expanders are driven into the bone with aratchet wrench or low speed hand piece. Thisdecreases the surgical trauma of osteotomes.Bone expanders improve the clinical success byimproving stability, maintaining bone densityand increasing fixation.

The Bone expander Kit includes 5 color-codedbone expanders (2.6, 3.0, 3.4, 3.8 and 4.3mm), aratchet wrench, a ratchet wrench extender, apilot drill, a 10mm saw, a hand piece latchadapter, and a thumb knob for finger usage.

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Bone expanders

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surgical guide pins are an excellent way to avoid implant crowding and achieve precise paralleling

Titanium Implant Depth Gauge With Ball TipOne side corresponds to implant lengths 6-17 mmOne side is measuring probe with 0-15 mm markingsTitanium, non-sterile

Implant hygiene and maintenacearmamentatirum

Company Product Feactures

1)Advanced Implant-prophy+ Sharpenable,autoclavable,

implant tech exceptional strength,

2)Brevet Implant cleaning kit light weight,made of

titanium alloy, sterlizable

3)Hu-friedy Implacare Disposible,high -grade

resin, mirror paired tip

4)Pro-dentec Sensor probe Thermoplastic,maintains

consistency of probing pressure

5)steri-oss Scaler system Graphid reinforced nylon

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Implacare

Implant cleaning kit

Implant –prophy+

Sensor probe

Graphid reinforced

MAXILLAY SINUS FLOOR AUGMANTATION

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Maxillary sinus floor augmentation Also termed sinus lift, sinus graft, sinus

augmentation or sinus procedure is a surgicalprocedure .

The goal of the sinus lift is to graft extra bone intothe maxillary sinus, so more bone is available tosupport a dental implant.

Lateral Window approach (opening a window in theanterolateral sinus wall) - done by Tatum inFebruary, 1975

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Sinus Lift Curettes have spoons with smooth non-cutting edges and are available in various shankconfigurations and spoon widths to detach the delicatesinus membrane from lateral walls.

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Indirect sinus lift instrument Avalible in 2.7mm ,3.2 mm ,3.7mm, 4.2mm, and

5mm diameter.

Marking at 6 ,8, 11,15 mm.

Convex and concave-straight

concave- offset

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mm 165mm 165

Lateral window(DIRECT SINUS LIFT) This technique is usually the preferred method of

sinus elevation in situations of poor bone quality and minimal residual bone height because it allows for direct visualization and accurate bone placement and volume at the position of the implant. Also, tearing of the membrane can be easily treated, minimizing contamination of the graft during healing

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Direct sinus lift instrument Sinus curette 1 (de marco curette) are

introduced along the inferior, anterior,

posterior, and superior aspects of the

prepared antrostomy window, gradually

inserting further along the bone until the

membrane begins to separate and lift away

from the bone.

Gracy curette 13/14 are gently introduced

along the bone to continue lifting the

membrane to the desired levels (height,

width, and depth)

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TARNOW-ESKOW SINUS LIFT INSTRUMENT

Used during a sinus lift procedure to separate/reflect the Schneiderian membrane from the maxillary bone and to elevate the membrane.

SINUS CURETTE 2

Mirror image ends with spoon-shaped tips that are 2.7 mm wide.

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KRAMER-NEVINS SINUS LIFT INSTRUMENT, OBTUSE ANGLESUsed during a sinus lift procedure to separate/reflect the Schneiderianmembrane from the maxillary bone and to elevate the membrane.

KRAMER-NEVINS SINUS LIFT INSTRUMENT, ACUTE ANGLESUsed during a sinus lift procedure to separate/reflect the Schneiderianmembrane from the maxillary bone and to elevate the membrane.

Sinus Lift Balloon The sinus lift balloons come in 3 different configurations (straight, angled, and

micro-mini).

while inflating the balloon with the syringe: 1cc of saline equals 6mm of

membrane elevation

Graft material required is in direct proportion to the amount of fluid used to

inflate the balloon: 1cc of fluid will require 1cc of graft material.

Straight model: The straight model features a 3.1mm diameter shaft and has a

4cc capacity.

Angled Model: The angled model also has a 3.1mm shaft and 4cc capacity.

Micro-Mini Model: The micro-mini model has a 1.9mm shaft and has a 1.5cc

capacity.

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Sinus Lift Balloon allows for improved vertical sinus elevation results

and gives clinicians added security when performing a traditional

lateral wall sinus lift procedure — protecting the Schneiderian

membrane from tearing, which can significantly disrupt an implant

case.

The balloon instrument is also well-suited for effectively measuring

the required bone grafting material. For example, 1cc of saline, which

is used to inflate the balloon, is equal to 1cc of grafting material.

The angled design is ideal for lateral window procedures.

The straight model is well suited for a crestal approach, and the

popular micro-mini design can be used for either of these indications.

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Water Lift System for Hydrostatic Sinus Lift

Use the Hydro (Water) Lift system to reduce the risk of Schneiderian membrane perforation during the sinus membrane lifting operation. The system uses the proven technique of hydrostatic sinus lift, to provide evenly distributed hydraulic pressure during sinus membrane elevation, thus ensuring the safety of the procedure.

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AUTOGENOUS BONE

GRAFTS HARVESTING

INSTRUMENTS

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"The Osseo-Tip Bone Grafter proved to be an effective way to harvest sufficient quantities of autogenous bone without the need to employ a bone mill or morselizer. It allowed for bone to be harvested in a safe and rapid manner with no hand fatigue.

Osseous Collectors

It is a fast, easy, way to harvest valuable autogenousbone that can be used to correct small defects around dental implants and periodontal compromised teeth.

The Osseous Collector features a unique shut-off valve that allows to shut off the suction .

Included with each collector are two filters.

The unit is disposable, no cleaning is required.

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Bone mill

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Bone Mill with TITANIUM teeth

Bone cracker for large bone pieces

Bone aspirators

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Filter 7 mm185 mm

Filter ø 12 mm185 mm

Bone injectors and collectors

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Bone injectors 155 mm3,5 mm

Bone well ø 35 mmh 35 mm

stainless steel bone funnel measures 3.5mm in diameter and holds approximately 1.5cc of graft material. Use with particulate or flowable graft material

Bone Scraper Osseous Glider The Osseous Glider is available in Straight or Angled

Versions.

The straight Osseous Glider is recommended for the ramus, symphasis and tuberosity areas and angled Osseous Glider is optimized for the external oblique ridge.

The bone scraper enables you to scrape, collect and transplant the patient’s own bone. The bone is collected in a chamber during the scraping and at the sametime the bone is being mixed with blood. The bone material can be implanted directly out of the bone-scraper whichhas been sterilized before.

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Bone packer

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5 mm - 7 mm Bone grafting packer used during grafting procedures

Bone Trephine Bone trephine designed for obtaining a cylindrically

shaped core of bone that can be used for tests and bone studies, cutting holes in bones.

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periodontal instruments and armamentarium with their application 245 slides

Education