periodontal scaling instruments
TRANSCRIPT
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Periodontal ScalingInstruments
(Gracey Curettes and Sickle Scalers)
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Periodontal scaling is the therapeuticprocedure performed by a dentist or
dental hygienist to remove all
mineralized, hardened deposits fromthe tooth's surfaces. It is performed
supra and subgingivally and can be
done using a non surgical (closed) ora surgical (open) approach.
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Based on instrument design, how they
are used, where they are used and how
they work, the following classificationof periodontal scaling instruments is
used.
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Periodontal Scaling Instruments
Sickle scalers
Universal Curettes
Area Specific Curettes Files
Ultrasonic/Sonic Instruments
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Periodontal Scaling Instruments
In the category of area specific curettes a subclassification exists.
Area Specific Curettes
Gracey Curettes
Vision Curettes
Modifications to Gracey Design
After five or extended series Mini series
Langer series
Furcation series
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Gracey Curettes
The original Gracey series wasdeveloped in the 1930's by Dr.Clayton Gracey, a periodontist
at the University of Michigan. They were designed to provide
better access to root surfaces indeep pockets.
They feature long shanks andunique blades, some with bendsimproving access to complexroot surface morphology.
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Gracey Curettes
The original series contained
7 double ended instruments
(1/2; 3/4; 5/6; 7/8; 9/10;
11/12; 13/14).
In the 1980's, 2 modified
instruments were added to
the collection (15/16; 17/18).
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Gracey Curettes
Gracey curettes 1/2, 3/4, and 5/6 are used to
scale all tooth surfaces in the anterior sextants.
7/8 and 9/10 are used for scaling the buccal
and lingual aspects of teeth in the posteriorsextants.
11/12 and the 15/16 are used to scale the mesial
aspects of the teeth in the posterior sextant. 13/14 and 17/18 are used to scale the distal
aspects
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Gracey Curettes
Gracey curettes are available in stainless steel
or in carbon steel. Carbon steel requires more
care as it rusts very easily and also wears away
more quickly. Instruments can come in the form of a solid
one piece instrument (usually stainless steel) or
as a cone socket instrument (usually carbonsteel). With the cone socket instrument, shank
and blade can be unscrewed and replaced.
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Gracey Curettes
The design of the Gracey
curettes is unique in that
each end had only onecutting edge
It can adapt closely to
the specific tooth surfacefor which it is intended.
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Gracey Curettes
The cutting or useable edge ofthe blade is the lower outeraspect of the blade.
It can be identified by holdingthe terminal shank of the end inquestion, blade side lower, in a
vertical position and viewing theblade portion head on.
The blade of the curette is
machined at a 70 degree angleand the cutting edge exhibits acurve, which is longer or convexin relation to the "non-
working" edge.
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Gracey Curettes
When adapting the Gracey instruments to
the teeth to perform scaling, the cutting
edge must first be identified and placed
against the surface to be scaled and the
terminal shank should be parallel to that
surface.
In this position, the ideal working
angulation for calculus removal is
achieved.
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Gracey Curettes
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Sickle Scalers
The sickle scaler, primarily used for
supragingival calculus removal, is a very
useful instrument.
It is often the first instrument used to
remove large, heavy deposits thus
improving access to subgingival area forother instruments.
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Sickle Scalers
A number of different sickle scalers are
available in a variety of shapes and sizes.
Towner H-15Jacquette
204 S; 204 SD
MorseUSC - 128
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Sickle Scalers
They all however have common featuresmaking them suited to the removal of heavycalculus deposits and working interproximally,around the contact areas of teeth.
A flat blade cut at a 90 degree angle to theshank.
Cutting edges on both sides of the face of theblade.
The face of the blade is triangular tapering to astrong, sharp point at the toe.
The face of the blade may be straight or curved.
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Sickle Scalers
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Grasp
The firm but light hold a dental clinician has ontheir instruments is referred to as "grasp".
A proper grasp enables the clinician to maneuverthe instrument around the tooth and correctly
direct pressure application for calculus removalwithout damaging the periodontal tissues.
Three specific grasps are used. They are: pen grasp
modified pen grasp
palm-thumb grasp.
The modified pen grasp is the most useful.
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Fulcrum
The resting of the third finger on a firm
intra- or extraoral site acts as a fulcrum.
This improves control of the instrumentand application of forces by the
working end against the tooth.
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Wrist and Arm Motion
The instrument/wrist/ forearm complex
must act as a unit rocking firmly but
smoothly on the fulcrum.
Wrist twisting or independent finger
movement should be avoided. This would
result in pain, muscle fatigue, and
inflammation of the ligaments and nerves
of the wrist.
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Adaptation
This refers to the placement of the
working end of the instrument in thecorrect relationship to the tooth.
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Angulation This is the angle formed by
the plane of the toothsurface and the plane of
the face of the blade.
Efficient cuttingangulation is between 45,
90, and 70 degrees is
considered ideal. Less than
45 degrees is considered"closed" and more than 90
degrees is considered
"open".
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Insertion
To avoid damaging the soft
tissues when entering the sulcus
with a large, sharp instrument,
the working end is inserted into
the sulcus with the face of the
blade "closed" or flattened to
the tooth surface.
Once in the depth of the pocketor sulcus, the blade is opened 45
to 90 degrees for working
strokes.
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Strokes This is the action of the working end on
an instrument as it is moved across atooth surface.
Exploratory strokes provide light tactilefeedback from the instrument tip.
Working strokes provide controlledpressure against a tooth surface using anappropriate cutting angulation.
Scaling strokes are short pulling strokesmade with firm pressure to removeincrement from root and enamelsurfaces.
Root planning strokes are made toremove deposits and smooth the rootsurface.
Working strokes are ideally a series ofoverlapping strokes covering the entiretooth surface.
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