"PERIODONTAL- INSTRUMENTS AND INSTRUMENTATION"

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<p>PowerPoint Presentation</p> <p>PeriodontalINSTRUMENTS AND INSTRUMENTATION</p> <p>CONTENTSIntroduction 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</p> <p>File,Chisel and Hoes Mechanized Instruments Polishing Instruments Surgical Instruments Excisional and incisional instruments Surgical curettes and sickles Periosteal elevators Surgical chisels &amp; files Scissors Needle holders EVA System Conclusion</p> <p>INTRODUCTIONSince 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.</p> <p>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).</p> <p>CLASSIFICATION OF INSTRUMENTS PERIODONTAL INSTRUMENTS ASSESSMENT INSTRUMENTS THERAPEUTIC INSTRUMENTS Mouth mirrors Scalers Probes Curettes Explorers Files</p> <p>BASED ON DESIGN Single Ended Type-One Working end. Double- Ended- May have paired or complementary working ends.</p> <p>BASED ON THE PURPOSES THEY SERVEPeriodontal 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. </p> <p>2. EXPLORER used to locate calculus deposits and caries.</p> <p> 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.</p> <p>Scaling and curettage instruments are classified as follows :- Sickle scalers are heavy instruments used to remove supragingival calculus. </p> <p>Curettes are fine instruments used for subgingival scaling,root planing and removal of the soft tissue lining the pocket.</p> <p>Hoe,chisel and file scalers Used to remove tenacious subgingival calculus and altered cementum. Their use is limited compared with that of curettes.</p> <p> 4. ULTRASONIC AND SONIC INSTRUMENTS are used for scaling and cleansing tooth surfaces and curetting the soft tissue wall of the periodontal pocket .</p> <p>5.PERIODONTAL ENDOSCOPE is used to visualize deeply into subgingival pockets and furcations, allowing the detection of pockets.</p> <p> 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.</p> <p>PARTS OF INSTRUMENTS</p> <p>As with all instruments, they have three distinct sections: handle, shank, and working end, blade or nib</p> <p>HANDLESThe handle is that part of instrument that is held during activation of the working end . </p> <p> A) TYPES: 1. Cone socket handles Are separable from the shank and working end. They permit instrument exchange and replacements. </p> <p>2. Fixed:</p> <p>B. Weight Hollow handles are light and are preferred to solid handles because the lighter weight enhances track sensitivity and lessens fatigue. </p> <p>C. Diameter The instrument is both broad and narrow type.</p> <p> 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.</p> <p>Based on materialMETAL 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</p> <p>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.</p> <p>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 </p> <p>Uses a. Probes and debriding instruments for dental implants. b. Probes and mirrors for screening and surveys.</p> <p>MOUTH MIRRORMirror 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 .</p> <p>Diameter Diameter may vary from 5/8 inches to 1 inches. In addition, special examination mirrors are available in 1 to 2 inch diameters.</p> <p>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. </p> <p>HANDLES Thicker handles contribute to a more comfortable grasp and greater control . Wider handles are especially useful for mobility determination.</p> <p>DISPOSABLE MIRRORS May be plastic in one piece or may be a handle with replaceable head for professional use. </p> <p>Also there are Take home mirrors for patient instruction .</p> <p>Patient may observe lingual and posterior aspects .</p> <p>FUNCTIONSSPECIFIC USES Indirect vision Indirect illumination Transillumination Retraction </p> <p>NONSPECIFIC USES Handles can be used for Checking mobility and percussion. </p> <p>PERIODONTAL PROBES</p> <p>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. </p> <p>The markings are inscribed onto the head of the instrument for accuracy and readability. </p> <p>FUNCTION : to measure the depth of the pockets. </p> <p> GENERAL CHARACTERISTICS : tapered straight millimeter calibration bluntrounded tip thin ( 0.5 mm at the end ) the shank is angled to allow easy insertion in the pocket.</p> <p>USESProbe is used to A. Assess the periodontal status for preparation of a treatment plan </p> <p>1. Classify the disease as gingivitis or periodontitis by determining whether the bone loss has occurred and whether the pockets are gingival or periodontal. </p> <p>2. Determine the extent of inflammation in conjunction with overall gingival inflammation. </p> <p>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 Determine relationship of gingival margin, attachment level and mucogingival junction . Measures width of attached gingiva Roll test to locate mucogingival junction</p> <p>D. Make Other Gingival Determinations 1.Evaluate gingival bleeding on probing and prepare a index. </p> <p>2. Measure the extent of visible gingival recession. </p> <p>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.</p> <p>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. </p> <p>2. Evaluate patients self-treatment through therapeutic disease control procedures.</p> <p>CLASSIFICATION Periodontal probes are classified as 1 st generation probes 2nd generation probes 3 rd generation probes 4 th generation probes 5th generation probes </p> <p>FIRST GENERATION PROBES</p> <p>These include- Williams periodontal probe UNC-15 probe University of Michigan O probe Marquis colour coded probe WHO probe Nabers probe 45</p> <p>WILLIAMS GRADUATED PERIODONTAL PROBEMarkings include 1,2,3,5,7,8,9 and 10 mm with 4mm and 6mm missing for ease in measuring .</p> <p>UNIVERSITY OF MICHIGAN O PROBE WITHOUT WILLIAMS MARKING </p> <p>Markings are at 3, 6, and 8mm</p> <p>UNC-15 PROBE15mm long. Markings are at each mm and color coding at the 5th,10th and 15thmm</p> <p>MARQUIS COLOR CODED PROBECalibrations are in 3mm sections. Markings are 3,6,9,12mm</p> <p>GOLDMAN-FOX PROBE same as Williams probes calibration - But it is flattened not round </p> <p>WHO PROBEIt 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.</p> <p>TYPES: </p> <p>CPITN-E(Epidemiological) CPITN-C (Clinical ) </p> <p>This probe was designed for Measurement of pocket depth Detection of sub gingival calculus Used in assessment of treatment needs</p> <p>NABERS PROBEIt 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.</p> <p>PLASTIC PROBES FOR IMPLANTSSeveral different companies are manufacturing plastic instruments for use on titanium and other implant abutment metals. </p> <p>It is important that plastic rather than metal instruments be used to avoid scarring and permanent damage to the implants.</p> <p>SECOND GENERATION PROBESThese are pressure-sensitive probes.</p> <p> 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.</p> <p> This probe did not solve many problems of conventional probes and lacked tactile sensitivity. </p> <p>Examples are Vive-valley ,viva care TPS probe.</p> <p>THIRD GENERATION PROBESThese are computerized probes. Refer to automated probing systems.</p> <p>Gibbes et al designed Florida probes other eg- Foster miller probe ,toronto automated probes which can detect cemento- enamel junction. </p> <p>FLORIDA PROBEThe Florida probe was developed using NIDCR(National Institute of Dental &amp; Craniofacial Research ) criteria. This automated probe system consists of probe hand piece digital readout foot switch computer interface and computer.</p> <p> Its advantages are Precise Electronic measurements Computer storage data Constant probing force</p> <p>Disadvantages are- Lack tactile sensitivity Underestimation of deep probing depths by the automated probe.</p> <p>FOURTH GENERATION These are three dimensional probes in which sequential probe positions are measured. </p> <p>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</p> <p>EXPLORER</p> <p>Explorer is an assessment instrument with a flexible wire like working end. </p> <p>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. </p> <p>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 .</p> <p>SHEPARDS HOOKUSE For supragingival examinations for dental caries and irrregular margins of restorations.</p> <p>COWHORN AND PIGTAILUsed in calculus detection in normal sulci or shallow pockets extending no deeper than the cervical-third off the teeth.</p> <p>ORBAN TYPEUsed 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 .</p> <p>11/12 EXPLORERUsed for assessment of root surfaces on posterior and anterior teeth .</p> <p>SICKLE SCALERThese 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 . </p> <p>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 . </p> <p>Small, curved sickle blades such as 204SD can be inserted under ledges of calculus a few millimeters below the gingiva</p> <p>A-Blade( working end),B-Tip,C-Toe,D-Face,E-cutting edge(internal angle),F-back,G-lateral surface,H-Heel</p> <p>Types of scalers</p> <p>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.</p> <p> Angled shanks adapt to posterior.</p> <p>CuretteA 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 .</p> <p>General characteristics ( design ) : Rounded toe, no sharp points, can be inserted into deep pockets with minimal soft tissue trauma. </p> <p>In cross section , the blade appears semicircular ( spoon-shaped blade )</p> <p>UNIVERSAL CURETTEThese 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. </p> <p>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 . </p> <p>The blade of universal curette is curved in one direction from the head of the blade to the toe .</p> <p>The face is at a 90-degree angle with terminal ( lower ) shank. Two cutting edge.</p> <p>COLUMBIA 2R/2LCOLUMBIA4R/4L</p> <p>Area specific curettesGRACEY 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.</p> <p>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.</p> <p>Design of Gracey curette1. 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.</p> <p>2. One cutting edge.</p> <p>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 . </p> <p>STANDARD GRACEY CU...</p>