"periodontal- instruments and instrumentation"
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PeriodontalINSTRUMENTS AND INSTRUMENTATION
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
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
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.
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 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.
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 INSTRUMENTS
As with all instruments, they have three distinct sections: handle, shank, and working end, blade or nib
HANDLESThe 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.
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 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
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 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 .
Diameter Diameter may vary from 5/8 inches to 1 inches. In addition, special examination mirrors are available in 1 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 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 bluntrounded 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 Determine relationship of gingival margin, attachment level and mucogingival junction . Measures width of attached gingiva 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 PROBES
These include- Williams periodontal probe UNC-15 probe University of Michigan O probe Marquis colour coded probe WHO probe Nabers probe 45
WILLIAMS GRADUATED PERIODONTAL PROBEMarkings 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 PROBE15mm long. Markings are at each mm and color coding at the 5th,10th and 15thmm
MARQUIS COLOR CODED PROBECalibrations are in 3mm sections. Markings are 3,6,9,12mm
GOLDMAN-FOX PROBE same as Williams probes calibration - But it is flattened not round
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.
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
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.
PLASTIC PROBES FOR IMPLANTSSeveral 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 PROBESThese are pressure-sensitive probes.
It has been shown that with forces upto 30 gms the probe tips remai