PRINCIPAL OF INSTRUMENTATION.ppt
- 1. 16-10-06 1 KOTHIWAL DENTAL COLLEGE AND RESEARCH CENTRE SEMINAR ON PRINCIPLES OF INSTRUMENTATION GUIDED BY : PRESENTED BY : DR RAJESH K. THAKUR DR MUKESH KUMAR (M.D.S.) M.D.S. 1ST YEAR
- 2. 16-10-06 2 CONTENT INTRODUCTION BASIC DESIGN PRINCIPLES -ACCESSIBILITY -VISIBILITY -ILLUMINATION -RETRACTION GRASP - PEN GRASP - MODIFIED PEN GRASP - PALM AND THUMB GRASP
- 3. 16-10-06 3 CONTENT FINGER REST EXTRA ORAL FULCRUMS INTRA ORAL FINGER REST INSTRUMENT ACTIVATION -ADAPTION -ANGULATION -LATERAL PRESSURE -STROKE CONCLUSION REFERENCES
- 4. 16-10-06 4 INTRODUCTION To restore the health of periodontal tissues by removing microbial plaque. Achieved by following the proper principles of instrumentation To make the procedure untiring for operator and patient, proper position of both, illumination, retraction and visibility The basic concepts of grasp finger rest, adaptation, angulations and stroke must be understood before clinical instrument handling.
- 5. 16-10-06 5 BASIC DESIGN Single and double ended instruments - single ended instruments are less efficient to use - double ended instruments allow the clinician to simply flip the instruments to use the other working end.
- 6. 16-10-06 6 CONT.. Instruments handles Instrument handle are available in a wide variety of diameters and textures. Characteristics of handle of instruments • Weight- • Diameter- - small diameter handles (3/17 inch) - large diameter handle (3/8 inch)
- 7. 16-10-06 7 CONT.. Texture - handles with no texturing decrease control of the instrument and increase muscle fatigue. - handles with bumpy texturing maximize control of the instrument and reduce muscle fatigue.
- 8. 16-10-06 8 CONT.. Shank design It facilitate placement of the working end against the tooth surface. - Simple shank design- a shank that is bent in one plane (front to back) . - Complex shank design- a shank that is bent in two planes (front to back and side to side)
- 9. 16-10-06 9 SHANK FLEXIBILITY RIGID FLEXIBLE Larger in diameter. Thinner in diameter. Heavy forces can be applied. Lighter forces can be applied. Lesser tactile sensation. Better tactile sensation.
- 10. 16-10-06 10 Functional and the lower shank Functional shank- - Allows the working end to be adapted to the tooth surface. - Begins below the working end and extends to the last bend in the shank nearest the handle. Lower shank- - The portion of the functional shank nearest to the working end
- 11. 16-10-06 11 WORKING END DESIGN Parts of working end design 1. Face and back 2. Lateral surfaces 3. Cutting edge 4. Toe or tip
- 12. 16-10-06 12 ACCESSIBILITY Position of patient and operator- - provide maximal accessibility Position of patient Body - supine position - patients heels slightly higher than tip of nose Head - mandibular areas- chin down position - maxillary areas- chin up position
- 13. 16-10-06 13 CONT.. Position of operator - Head - tilt of 0 to 15 degrees. - Shoulders - in a horizontal line . - Back - straight or leaning forward slightly from the waist or hips. - Thighs - parallel to the floor; weight is evenly balanced - Upper arms - parallel to the long axis of the torso. - Forearms - parallel to the floor .
- 14. 16-10-06 14 VISIBILITY, ILLUMINATION AND RETRACTION Direct vision with direct illumination. Indirect vision and indirect illumination. Retraction provides visibility, accessibility and illumination.
- 15. 16-10-06 15 CONDITION OF INSTRUMENT Prior to any instrumentation , all instruments should be examined to make sure that they are clean , sterile, and in good condition. The working ends of pointed or bladed instruments must be sharp to be effective. Sharp instruments enhance tactile sentivity and allow the clinician to work more precisely and efficiently.
- 16. 16-10-06 16 Dull instruments may lead to incomplete calculus removal and unneccessary trauma to the gingival tissues.
- 17. 16-10-06 17 MAINTAINING A CLEAN FIELD Interferences in visibility, illumination and retraction. - saliva - blood - debris Removal of interferences - saliva ejector - aspirator - gauze squares
- 18. 16-10-06 18 INSTRUMENT STABILIZATION Stability and control essential for effective instrumentation. Two factors - instrument grasp - finger rest
- 19. 16-10-06 19 INSTRUMENT GRASP Standard pen grasp- thumb, index finger, and middle finger used to hold instrument. Modified pen grasp- thumb, index finger, and middle finger used to hold instrument. Palm and thumb grasp- used for sharpening
- 20. 16-10-06 20 Standard pen grasp
- 21. 16-10-06 21 Modified pen grasp
- 22. 16-10-06 22 Palm and thumb grasp
- 23. 16-10-06 23 FINGER REST The finger rest serves to stabilize the hand and the instrument by providing a firm fulcrum Classified as Intra oral finger rest -conventional -cross arch -opposite arch -finger-on-finger Extra oral fulcrums -palm up -palm down
- 24. 16-10-06 24 CONT.. Conventional finger rests - Established immediately adjacent to working area. Advantages - provides the most stable, secured support for the hand - provides leverage and power for instrumentation - provides excellent tactile transfer to the finger - permits precise stroke control Disadvantages - may be difficult to obtain parallelism of the lower shank to the tooth surface for accessing deep pockets.
- 25. 16-10-06 25 Conventional finger rest
- 26. 16-10-06 26 CONT.. Cross-arch finger rests- Established on other side of same arch. Advantage - allows improved access to the lingual aspect of mandibular posterior teeth Disadvantage - decreases tactile sensitivity and makes strokes difficult
- 27. 16-10-06 27 Cross arch finger rest
- 28. 16-10-06 28 CONT.. Opposite arch finger rests- Established on opposite arch. Advantage - facilitates access to deep pockets Disadvantage - decreases tactile information - uncomfortable for patients with TMJ problems
- 29. 16-10-06 29 Opposite arch finger rest
- 30. 16-10-06 30 CONT.. Finger-on-finger-Established on index finger or thumb of non operating hand. Advantage - provides stable rest to fulcrum finger - improves access to deep pockets Disadvantage - non-working hand cannot be used for retraction or to hold the mirror
- 31. 16-10-06 31 Finger on finger rest
- 32. 16-10-06 32 CONT.. Extra oral fulcrums - Palm up – Established on resting backs of middle and fourth finger on skin overlying lateral aspect of mandible on right side of face. - Palm down-Established on resting front surfaces of middle and fourth finger on skin overlying lateral aspect of mandible on left side of face.
- 35. 16-10-06 35 CONT.. Extra oral fulcrums Advantage - facilitates instrumentation of the proximal root surfaces of maxillary molars Disadvantage - least effective of all fulcrum techniques - stroke control is more difficult and decreases tactile information
- 36. 16-10-06 36 INSTRUMENT ACTIVATION Adaptation- working end of periodontal instrument placed against surface of tooth. - objective of to make working end of instrument conform to the contour of tooth surface. - on convex surface such as line angles adapt within 1-2 mm working end against the tooth.
- 38. 16-10-06 38 CONT.. Angulations- angle between face of bladed instrument and surface of tooth. - exact blade angulations depends amount, nature of calculus - subgingival insertion angulations 0 degree - scaling root planing angulations 45 to 90 degree
- 40. 16-10-06 40 CONT.. Lateral pressure- pressure created when force applied against tooth surface with cutting edge of bladed instrument. - firm, moderate, or light - for calculus it is firm or moderate - root planing it is light
- 41. 16-10-06 41 CONT.. Strokes- three types - Exploratory stroke- light feeling stroke, evaluate pocket, calculus and irregularities. - Scaling stroke- short, powerful pull stroke - Root planing stroke- moderate to light pull stroke - activated by pull or push motion in vertical, oblique, or horizontal direction
- 42. 16-10-06 42 CONCLUSION Proper following of these principles of instrumentation is must, because by following this, treatment can be done more efficiently, precisely and without causing any iatrogenic injury to the oral cavity.
- 43. 16-10-06 43 REFERENCES CLINICAL PERIODONTOLOGY- CARRANZA , NEWMAN- 8TH EDITION OPERATIVE DENTISTRY- STURDEVANT’S- 4TH EDITION MOSBY’S DENTAL HYGIENE- MICHELE L. DARBY- 5TH EDITION
- 45. 16-10-06 45 PRINCIPLES OF SCALING AND ROOT PLANING Scaling – It is the process by which plaque and calculus are removed from both supragingival and subgingival tooth surfaces. Root planing – It is the process by which residual embedded calculus and portions of cementum are removed from the roots to produce a smooth, hard, clean surface. The primary objective of scaling and root planing is to restore the gingival health.
- 46. 16-10-06 46 INSTRUMENTS FOR SCALING AND ROOT PLANING Universal curettes – all surfaces of the teeth can be treated with one double ended instrument or a matched pair of single ended instruments.
- 47. 16-10-06 47 CONT.. Gracey curettes – it is designed by Dr. Clayton H. Gracey of Michigan in the mid 1930s. - they are area specific - only one cutting edge on each blade is used, the blade is curved in two planes, and the blade is “offset”. - single cutting edge used - blade curves in two planes - offset blade
- 48. 16-10-06 48 CONT.. Principles of use - determine the correct cutting edge - make sure the lower shank is parallel to the surface to be instrumented - when using intraoral finger rests, keep the fourth and middle finger together in a built-up fulcrum for maximum control and wrist-arm action - use extraoral fulcrums or mandibular finger rests for optimal angulation when working on the maxillary posterior teeth
- 49. 16-10-06 49 CONT.. on the Concentrate on using the lower third of the cutting edge for calculus removal Allow the wrist and forearm to carry the burden of the stroke, rather than flexing the fingers Roll the handle slightly between the thumb and fingers to keep the blade adapted as the working end is advanced around line angles and into concavities Modulate lateral pressure from firm to moderate to light depending nature of the calculus
- 50. 16-10-06 50 SUPRAGINGIVAL SCALING TECHNIQUE Calculus is less tenacious and less calcified than subgingival calculus. Sickles, curettes, and ultrasonic and sonic instruments are most commonly used for the removal of supragingival calculus.
- 51. 16-10-06 51 SUBGINGIVAL SCALING AND ROOT PLANING TECHNIQUE Subgingival calculus is usually harder than supragingival calculus. Curettes, hoes, files and ultrasonic instruments are used.