Seminar on Periodontal Instruments.ppt
- 1. Seminar on Periodontal Instruments Presenter: Dr. Nilima Sharma
- 2. INTRODUCTION Since ancient times when dental therapists recognized the impor- tance of removal of calculus and materia alba (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). As with all instruments, they had three distinct sections: handle, shank, and sharpened blade.
- 3. Classification according to the purpose they serve Diagnostic instruments Mouth mirror Periodontal probes are used to locate, measure, and mark pockets, as well as determine their course on individual tooth surfaces. Explorers are used to locate calculus deposits and caries. The periodontal endoscope is used to visualize deep subgingivally in pockets and furcations enabling the detection of deposits. Scaling, root planing, and curettage instruments supragingival scalers :Sickle scalers , jacquette scalers, morse scalers, cumine scaler subgingival scalers: Hoe, chisel, and file scalers Curettes – universal , gracey, eyelet Ultrasonic and sonic instruments Cleansing and polishing instruments such as rubber cups, brushes, and dental tape are used to clean and polish tooth surfaces. Also available are air-powder abrasive systems for tooth polishing.
- 4. Periodontal surgical instruments are classified as follows Excisional and incisional instruments Surgical curettes and sickles Periosteal elevators Surgical chisels Surgical files Scissors
- 12. UNC-15 Probe
- 13. Explorers from L- R shepherds hook, 3A, ODU 11/12, 17.
- 14. DENTAL PERIOSCOPY Fiberoptic imaging of the periodontal pocket, called dental perioscopy, allows subgingival visualization for diagnosis as well as treatment (DentalView Perioscopy). Using dental perioscopy, the clinician magnifies, visualizes, and accesses deep subgingival calculus, root fractures, and the periodontal pocket's internal wall. Magnification is from 24x to as high as 46x, depending on the distance between the object and the lens. Under endoscopic magnification, ledges of black calculus are actually white, porous, and crystalline in appearance, and sheets of subgingival calculus may occur in colors from golden brown to black.
- 15. The system is composed of a disposable sterile sheath that houses a fiberoptic endoscope, provides continuous irrigation, attaches to modified periodontal assessment and treatment instruments, and has a metal soft tissue shield that keeps the soft tissue away from the tube. The actual size of the hand-held sheath and instrument with proper hand grasp. There is a flat- panel LCD color display, and a small footprint transport system. A composite video-out source connection allows users to employ a digital system to record and later view endoscopic images if desired.
- 16. SICKLE SCALERS
- 20. Curettes
- 21. Examples of paired universal curets include: the Columbia 2R/2L, Columbia 13/14, Rule 3/4, Barnhart 1/2, Barnhart 5/6, Younger-Good 7/8, Indiana University 13/14, HU 1/2, Bunting 5/6, Mallery 1/2, Langer 1/2, Langer 3/4, and Langer 5/6. The Langer curets combine partial design elements of universal and area-specific curets. The working end of a Langer curet has the design characteristics of a universal curet. The shank design of a Langer curet is similar to that of an area-specific curet with a long, complex functional shank.
- 28. Historically, following scaling and root planing, the teeth have been smoothed using an abrasive agent and some type of polishing device. This procedure, known as poolishing, was performed on a routine basis for all patients at each recall appointment. In the past, polishing was believed to have both cosmetic and therapeutic value. We now know that very little therapeutic value is associated with polishing. In addition, researchers have suggested that fluoride uptake during a topical fluoride application is not influenced by the presence of plaque or pellicle and polishing is ,(lot necessary before a professional fluoride application.
- 29. In the early 1980s, the concept of selective polishing was introduced in the dental hygiene literature. According to this concept, polishing is performed only in areas where the patient's own oral hygiene procedures are ineffective. Polishing has been used to prepare teeth for pit and fissure sealant application and to motivate_patients to maintain their plaque control on a daily basis. In addition, amalgam and composite restorations are polished following placement to increase their life within the oral cavity.
- 30. Polishing
- 31. SURGICAL INSTRUMENTS: Excisional and incisional instruments Knives are basic instruments and can be obtained with both fixed and replaceable blades
- 34. (Gingivectomy knives) Design: These are kidney or bean shaped knives, they have broad flat blades, which are nearly perpendicular to the lower shank of the instrument. There curved cutting edge extends around entire outer edge of the blade which is formed by junction of the outer and inner surfaces of the blade. The sharp cutting edge extends upto few millimeters from the shaft to the entire outer edge. These knives are designed to cut both ways, forward and backward stroke. These knives can be obtained as either double or single ended. Examples: Kirkland No. 15, 16, Gold man fox No.: 7, Buck No.3, 4. In Kirkland, the blade tapers to a point at one end unlike in Goldman fox knives the blade is rounded. This design is for entry into interproximal area.
- 37. The ORBAN No. 1-2 are spear shaped blades attached to the handle by al offset shank to provide accessibility to the interproximal areas. The blade has two cutting edges formed by the junction of the rounded outer and the flat inner surface that tapers to a sharp point. The Orban knife #1.2 and the Merrifield knife #1, 2, 3, and 4 examples of knives used for interdental areas, The BUCK knives are spear shaped and the MONAHAN-LEWIS knives have detachable blades.
- 39. Surgical Curettes and Sickles Larger and heavier curettes and sickles are often needed during surgery for the removal of granulation tissue, fibrous interdental tissues, and tenacious subgingival deposits. The Kramer curettes #1, 2, and 3 and the Kirkland surgical instruments are heavy curettes, . whereas the Ball scaler #B2-B3 is a popular heavy sickle. The wider, heavier blades of these instrumtnts make them suitable for surgical procedures.
- 40. Surgical Chisels and Hoes Chisels and hoes are used during periodontal surgery for removing and reshaping bone. The hoe has a curved shank and blade, this no. 19 G instrument has a fish tail shaped with blade with a pronounced convexity in its terminal portion. The cutting edges is beveled with a rounded edges and projects beyond the long axis of the handle to preserve the effectiveness of the instrument when the blade is reduced by sharpening.
- 41. Generally used for detaching pocket walls after the gingivectomy incision, but it is also useful for smoothing root surfaces made accessible by any surgical procedure. The Wiedelstadt and Todd-Gilmore chisels are straight shanked. The Ochsenbein #1-2 is a useful chisel with a semicircular indentation on both sides of the shank that allows the instrument to engage around the tooth and into the interdental area. Surgical hoes are usually used with a pull stroke, whereas chisels are used with a push stroke.
- 44. Surgical Scissors and Nippers: Scissors and nippers are used in periodontal surgery for such purposes as removing tabs of tissue during gingivectomy, trimming the margins of flaps, enlarging incisions in periodontal abscesses, and removing muscle attach- ments in mucogingival surgery. Eg. the Goldman-Fox #16 scissors with a curved beveled blade with serrations and the nippers. Characteristics: 1. Long handles with thumb and finger rings. 2. Short cutting edge with straight or curved blades. Blade may be serrated or nonserrated. Types: Scissors are of various types according to the size and shape, 1. Goldman Fox No. 16: It has a curved blade, with serrations. It is mainly used in Gingivectomy or periodontal surgical procedures. Iris scissors - These are straight bladed fine small and delicate scissor used for fine works,
- 45. Metzenbaum scissors: These are blunt nosed scissors used for undermining soft tissues as well as for cutting tissues. These scissors are not used for cutting sutures as edges will dull and make less effective for cutting tissues. 4. Straight stille and Mayo 6 inch instruments: These scissors are with two blunt tips and serve well for dissection as well as cutting sutures or trimming wound margins. 5. Nippers: Serve same purpose as Scissors. They are also used for contouring the architectural form and for forming interdental sluiceways. Most commonly used scissors are Dean Scissors these have slightly curved handle and serrated blades. Ophthalmic Scissors: used in periodontal surgery, because of their size they can be engaged in almost any area.
- 48. Micro surgical tissue pliers and forceps Micro surgiery may be defined as a refinement in operative technique by which visual acuity is improved through magnification.. In addition to use of magnification &reliance on atraumatic technique microsurgery entails the use of specially constructed microsurgical instruments to minimize trauma.. To permit primary woumd closure, microsutures in the rangr of 6-0 to9-0 are required to approximate the wound edge.
- 56. Conclusion The advancing abilities of instrument makers, coupled with the ingenuity of dental practitioners, have provided the present practitioner with a multitude of instrument designs capable of reaching nearly every portion of the dentition. In the past, complete sets of instruments frequently included so many variations of angulation and were so numerous as to preclude their general use. However, some of the more efficient instruments from these sets have withstood the test of long-term use and now appear and reappear in newly created instrument sets.
- 57. References Fundamentals of periodontal instrumentation: Neild/Gehrig 3rd edition Fundamentals of periodontal instrumentation: Neild/Gehrig 4th edition Contemporary periodontal instrumentation Schoen/Dean DentalHygiene theory &Practice:Darby 2nd edition Clinical periodontology Glickman 4th edition Carranza’s Clinical Perioidontology : Newman/ Takei/ Newman 9th edition Periodontics: Medicine Surgery &Implants: Rose /Mealey /Genco/Cohen Root Scaling &Planing:a fundamental therapy:Bernard Waserman Local flap in Facial Reconstruction :Swanson/Shah Contemporary oral and maxillofacial surgery; Peterson/Hupp HU-friedy instrument catalogue