PERIODONTALINSTRUMENTS

AND INSTRUMENTATION

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

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

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.

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).

CLASSIFICATION OF INSTRUMENTS

PERIODONTAL INSTRUMENTS ASSESSMENT INSTRUMENTS THERAPEUTIC INSTRUMENTS Mouth mirrors Scalers Probes Curettes Explorers Files

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

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.

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.

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.

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 .

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.

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

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:

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.

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

MATERIALS USEDA. 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.

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.

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 “.

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.

ATTACHMENTS • Mirrors may be threaded plain stem or cone socket

to be joined to a handle .• Because mirrors tend to become scratched,

replacement of the working end is possible without purchasing new handles.

HANDLES • Thicker handles contribute to a more comfortable

grasp and greater control . • Wider handles are especially useful for mobility

determination.

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 .

FUNCTIONSSPECIFIC USES Indirect vision Indirect illumination Transillumination Retraction

NONSPECIFIC USES Handles can be used for Checking mobility

and percussion.

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.

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.

USESProbe 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.

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 gingiva3. Roll test to locate mucogingival junction

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 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.

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

FIRST GENERATION PROBESThese include- William’s periodontal probe UNC-15 probe University of Michigan O probe Marquis colour coded probe WHO probe Nabers probe 45

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 .

UNIVERSITY OF MICHIGAN O PROBE WITHOUT WILLIAMS MARKING

Markings are at 3, 6, and 8mm

UNC-15 PROBE 15mm long. Markings are at each mm

and color coding at the 5th,10th and 15thmm

MARQUIS COLOR CODED PROBE Calibrations are in 3mm sections.

Markings are 3,6,9,12mm

GOLDMAN-FOX PROBE same as Williams probe’s calibration -

But it is flattened not round

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.

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

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.

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.

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. 

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.

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

Disadvantages are- Lack tactile sensitivity Underestimation of deep probing depths

by the automated probe.

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

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 .

SHEPARDS HOOKUSE For supragingival examinations for

dental caries and irrregular margins of restorations.

COWHORN AND PIGTAIL Used in calculus detection in normal

sulci or shallow pockets extending no deeper than the cervical-third off the teeth.

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 .

11/12 EXPLORER Used for assessment of root surfaces on

posterior and anterior teeth .

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 .

• 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 

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

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.

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 . 

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 )

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 .

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

Two cutting edge.

COLUMBIA 2R/2L

COLUMBIA4R/4L

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.

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.

2. One cutting edge.

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 .

STANDARD GRACEY CURETTES

REDUCED SET OF GRACEY CURETTE

# 5-6 # 7-8 11-12 # 13-14

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.

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

Available After Five instruments : #1-2, 3-4, 5-6, 7-8, 11-12, 13-14

Available in finishing (fine) or rigid designs

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.

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.

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.

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

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.

QUETIN FURCATION CURETTES These are actually hoes with a shallow,half moon

radius that fits into root or floor of the furcation. The curvature of the tip also fits into

developmental depressions on the inner aspects of the roots.

The shanks are slighty curved for better access and the tips are available in two widths.

These remove burnished calculus from recessed areas of the furcation where even the mini-bladed curettes are often too large to gain every access.

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.

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

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. 

FILE File is an instrument used to crush

calculus deposits.

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.

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.

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 .

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.

POLISHING INSTRUMENTS

 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 angle with a

polishing paste .

DENTAL TAPE Dental tape with polishing paste is used for polishing proximal surface that are inaccessible to other polishing instruments.

 Air-powder polishing is used with a specially designed hand piece.

This device is called Prophy-jet. It delivers an air- powder slurry of warm water and sodium bicarbonate for polishing. 

It is very effective for the removal of extrinsic stains and soft deposits

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.

PERIODONTAL SURGICAL INSTRUMENTS

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

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

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.

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

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.

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.

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.

TISSUE FORCEPS  Used to hold the flap during suturing

used to position & displace the flap after the flap has benn reflected

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.

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.

SURGICAL FILES SUGARMAN PERIODONTAL FILE Used interproximally. File surfaces on both sides allow for push

or pull application. 

SCHLUGER PERIODONTAL FILE Used interproximally. File surfaces on both sides allow for push

or pull application.

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

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.

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

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.

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.

SURGICAL NIPPERS Serve same purpose as Scissors. They are also used for contouring the

architectural form and for forming interdental sluiceways.

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.

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.

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 . 

Periodontal Instrumentation Accessibility:positioning of patient and

operator Visibility, illumination &retraction Condition and sharpness of instrument Maintaining a clean field Instrument stabilisation Instrument activation

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.

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

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

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

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

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

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

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

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

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. 

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.

REFERENCES

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