DEPARTMENT OF PERIODONTOLOGY

PRINCIPLES OF INSTRUMENTATION

PRINCIPLES OF PERIODONTAL INSTRUMENTS• ACCESSIBILITY: POSITION OF PATIENT

&OPERATOR• VISIBILITY, ILLUMINATION &

RETRACTION.CONDITION & SHARPNESS OF

INSTRUMENTS.MAINTAINING A CLEAN FIELD.INSTRUMENT STABILIZATION.INSTRUMENT ACTIVATION.

ACCESSIBILITYACCESSIBILITY means to accessACCESSIBILITY FACILITATES THOROUGHNESS

OF INSTRUMENTATION.POSITION OF PATIENT & OPERATOR SHOULD

PROVIDE MAXIMAL ACCESSIBILITY.INADEQUATE ACCESSIBILITY IMPEDES

THROUGH INSTRUMENTATION , PREMATURELY TIRED THE OPERATOR DIMNISHES EFFECTIVENESS OF CLINICIAN.

CLINICIAN SHOULD BE SEATED COMFORTABLY ON A OPERATING STOOL , SO THAT CLINICIANS FEET ARE ON THE FLOOR THE THIGHS PARALLEL TO THE FLOOR.

BE IN A STRAIGHT AND HEAD ERECT POSITION.

Patient should be in supine position &placed so that the mouth closed to the resting elbow of the clinician

For instrumentation of maxillary arch patient chin should be rise slightly

For mandible arch, ask the patient to lower the chin until the mandible is parallel to floor

VISIBILITY, ILLUMINATION AND RETRACTIONVISIBILTY means to see.ILLUMINATION means lightRETRACTION means to retractDIRECT VISION WITH DIRECT ILLUMINATION

FROM DENTAL LIGHT.INDIRECT VISION BY USING MOUTH MIRROR.RETRACTION PROVIDES VISIBILITY,

ACCESSIBILITY AND ILLUMINATION.MIRROR ALSO USED FOR RETRACTION OF

CHEEKS AND TONGUE.INDEX FINGER IS USED FOR RETRACTION.

WHEN RETRACTING , CARE SHOULD BE TAKEN TO AVOID IRRITATION TO THE ANGLE OF MOUTH.

CAREFUL RETRACTION IS ESPECIALLY IMPORTANT FOR PATIENTS WITH THE HISTORY OF RECURRENT HERPES LABIALIS, BECAUSE THESE PATIENTS MAY EASILY DEVELOP HERPETIC LESIONS AFTER INSTRUMENTATION.

CONDITIONINIG AND SHARPNESS OF INSTRUMENTMAKE SURE THAT INSTRUMENTS ARE CLEAN , STERILE &

IN GOOD CONDITION.WORKING END OF THE POINTED OR BLADED

INSTRUMENT MUST BE SHARP TO BE EFFECTIVE.SHARP INSTRUMENTS ENHANCE TACTILE SENSTIVITY & ALLOW THE CLINICIAN TO WORK MORE EFFICIENTLY.DULL INSTRUMENT MAY LEAD TO INCOMPLETE

CALCULUS REMOVAL AND UNNECESSARY TRAUMA BECAUSE OF EXCESS FORCE USUALLY APPLIES TO COMPENSATE FOR THEIR INEFFECTIVENESS.

MAINTAINING A CLEAN FIELDDESPITE GOOD VISIBILITY,ILLUMINATION AND RETRACTION

INSTRUMENTATION CAN Be HAMPERED IF THE OPERATIVE FIELD IS OBSCURED BY SALIVA ,BLOOD&DEBRIS

THE POOLING OF SALIVA INTERFERES WITH VISIBILITY DURING INSTRUMENTATION &IMPEDES CONTROL ,BECAUSE A FIRM FINGER REST CANNOT Be ESTABLISHED ON WET,SLIPPERY TOOTH SURFACE

ADEQUATE SUCTION IS ESSENTIAL &CAN BE ACHIEVED WITH SALIVA EJECTOR

COMPRESSED AIR & GAUZE SQUARES CAN BE USED TO FACILITATE VISUAL INSPECTION OF TOOTH SURFACES JUST BELOW THE GINGIVAL MARGIN DURING INSTRUMENTATION

INSTRUMENT STABILISATION INSTRUMENT GRASPMODIFIED PEN GRASPSTANDARD PEN GRASPPALM AND THUMB GRASPFINGER REST CONVENTIONALCROSS ARCHOPPOSITE ARCHFINGER ON FINGER

INSTRUMENTATION GRASP PEN GRASPTHE THUMB ,INDEX FINGER&MIDDLE

FINGER ARE USED TO HOLD INSTUMENT AS PEN IS HELD.

MODIFIED PEN GRASP:- THE MOST EFFECTIVE & STABLE GRASPTHE PAD OF MIDDLE FINGER REST ON

THE SHANK

PALM AND THUMB GRASP:-

• USEFUL FOR STABILISING INSTRUMENTS DURING SHARPENING & FOR MANIPULATING AIR & WATER SYRINGE

NOT RECOMMENDED FOR PERIODONTAL INSTRUMENTATION

Palm and thumb grasp

FINGER RESTSERVES TO STABILIZE THE HAND &THE

INSTRUMENT BY PROVIDING A FIRM FULCRUM AS A MOVEMENTS

A GOOD FINGER REST PREVENT INJURY MAXIMAL CONTROL IS ACHIEVED BY

USING MIDDLE FINGERMIDDLE FINGER IS KEPT BETWEEN THE

INSTRUMENT SHANK AND FOURTH FINGER

FINGER RESTINTRAORAL FINGER RESTS EXTRA ORAL FALCRUMS1) CONVENTIONAL2) CROSS ARCH3) OPPOSITE ARCH4) FINGER ON FINGER

1)PALM UP2) PALM DOWN

INTRA ORAL FINGER REST

ITS ON TOOTH SURFACE CLOSE TO THE WORKING AREA

1)CONVENTIONAL:- THE FINGER REST IS ESTABLISHED ON TOOTH SURFACES IMMEDIATELY ADJACENT TO THE WORKING AREA.

2) CROSS-ARCH:- THE FINGER REST IS ESTABLISHED ON TOOTH SURFACES ON THE OTHER SIDE OF SAME ARCH.

3) OPPOSITE ARCH:- THE FINGER REST IS ESTABLISHED ON TOOTH SURFACES ON THE OPPOSITE ARCH.

4) FINGER ON FINGER:- THE FINGER REST IS ESTABLISHED ON THE INDEX FINGER OR THUMB OF THE NON OPERATING HAND.

EXTRA ORAL FULCRUMS:-

EFFECTIVE FOR POSTERIOR MAXILLARY TOOTH

ALLOW OPTIMAL ACCESS &ANGULATION WHILE PROVIDING ADEQUATE STABILISATION

FINGERS IS PLACED ON THE PATINT’S FACE TO PROVIDE GREATEST DEGREE OF STABILITY.

2 TYPES 1) PALM UP :- THE PALM FULCRUM IS

ESTABLISHED BY RESTING THE BACKS OF THE MIDDLE FINGER &FOURTH FINGER ON THE SKIN OVERLYING THE LATERAL ASPECT OF MANDIBLE ON THE RIGHT SIDE OF THE FACE.

2) PALM –DOWN:- THE PALM DOWN FULCRUM IS ESTABLISHED BY RESTING THE FRONT SURFACES OF THE MIDDLE & FOURTH FINGER ON SKIN OVERLYING THE LATERAL ASPECT OF THE MANDIBLE ON THE LEFT SIDE OF FACE.

INSTRUMENT ACTIVATION 1) ADAPTATION

ADAPTATION REFERS TO THE MANNER IN WHICH THE WORKING END OF PERIODONTAL INSTRUMENT IS PLACED AGAINST THE SURFACE OF TOOTH

OBJECTIVE IS TO MAKE THE WORKING END OF INSTRUMENT CONFORM TO THE CONTOUR OF THE TOOTH SURFACE

2) ANGULATION:-

IT REFERS TO THE ANGLE BETWEEN FACE OF A BLADED INSTRUMENT AND THE TOOTH SURFACE

ALSO CALLED TOOTH –BLADE RELATIONSHIPDURING INSERTION ANGLE IS-0SCALING &ROOT PLANING -45-90

3) LATERAL PRESSUREIT REFERS TO THE PRESSURE CREATED

WHEN FORCE IS APPLIED AGAINST THE SURFACE OF TOOTH WITH THE CUTTING EDGE OF A BLADED INSTRUMENT

MAY Be FIRM, MODERATE OR LIGHTUNCONTROLLED APPLICATION OF HEAVY

FORCES SHOULD BE AVOIDED

4) STROKES 3 TYPES EXPLORATORY STROKESCALING STROKEROOT PLANING

ANY OF THESE STROKES MAY BE ACTIVATED BY A PULL OR PUSH MOTION IN VERTICAL ,OBLIQUE OR HORIZONTAL DIRECTION

EXPLORATORY STROKELIGHT FEELING STROKE USED WITH

PROBES & EXPLORES TO EVALUATE THE DIMENTION OF POCKET & TO DETECT CALCULUS& IRREGULARITIES ON TOOTH SURFACE

SCALING STROKESHORT POWERFUL PULL STROKE USED

WITH BLADED INSTRUMENTS FOR THE REMOVAL OF BOTH SUBGINGIVAL & SUPRAGINGIVAL CALCULUS .

SCALING MOTION SHOULD BE INITIATED IN THE FORCE ARM &TRANSMITTED TO THE WRIST TO THE HAND WITH A SLIGHT FLEXION OF FINGERS

PUSH SCALING MOTION IS RARELY USED

ROOT PLANING STROKEMODERATE TO LIGHT PULL STROKE

USED FOR FINAL SMOOTHENING &PLANING OF THE ROOT SURFACE

HOES, FILES, CURETTES & ULTRA SONIC INSTRUMENTS CAN BE USED