Fundamentals of Fundamentals of “Universal” Instruments: “Universal” Instruments:

To date you’ve learned:*#17 Explorer

To date you’ve learned: -Gracey 1/2 -204s

2 Types of 2 Types of UniversalUniversal Instruments: Instruments:

1. Scalers1. Scalers - - (in cross-section)(in cross-section)

pointed tippointed tip

pointed backpointed back

supragingival calculus removalsupragingival calculus removal

2. Curets - 2. Curets - (in cross-section)(in cross-section)

rounded tiprounded tip

rounded backrounded back

sub/supragingival calculus removalsub/supragingival calculus removal

Let’s first talk about the Let’s first talk about the

Sickle ScalersSickle Scalers

Types of Sickle Scalers:Types of Sickle Scalers:

Anterior- ‘straight’ shank Anterior- ‘straight’ shank instrumentinstrument

Posterior- ‘curved’ or multiple Posterior- ‘curved’ or multiple shank instrument shank instrument – (actually can be used universally in the mouth)(actually can be used universally in the mouth)

Anterior Sickle

Top instrument (Unpaired) is an example of a curet (on the left) and an anterior sickle on the (right)

Bottom instrument (paired) is an example of a posterior sickle on both ends.

Design Characteristics: Design Characteristics: Basically there are 2 cutting edges at each end. Basically there are 2 cutting edges at each end.

The Face of the Sickle is at a 90 degree angle to the terminal shank. The Face of the Sickle is at a 90 degree angle to the terminal shank.

Flat “face” Terminal shank

Sickle instrument have two cutting edges on each end of the instrument:

Terminal shank is ata 90 degree angle tothe Face

Face

Face

Your instrument casetes do not include the Your instrument casetes do not include the Anterior Sickle.Anterior Sickle.

You will use the Posterior Sickle throughout You will use the Posterior Sickle throughout the mouth including the anterior teeth.the mouth including the anterior teeth.

Let’s get prepared to Let’s get prepared to

Initial scaling with theInitial scaling with the

Sickle ScalerSickle Scaler

P. 210

p.290

In Nield Book

(mirror)

(mirror, sickle, etc.)

(sickle)

(fulcrum)

Keep In Mind:Keep In Mind:

Operator and Client PositioningOperator and Client Positioning Instrument Blade SelectionInstrument Blade Selection GraspGrasp FulcrumFulcrum InsertionInsertion AdaptationAdaptation AngulationAngulation

Please remember:Please remember:

The Sickle instrument is used The Sickle instrument is used

SUPRAGINGIVAL!SUPRAGINGIVAL!(You can go sub about 1-2 mm if necessary, but not (You can go sub about 1-2 mm if necessary, but not

more than that!!!)more than that!!!)

Anterior ScalerAnterior Scaler

The above shows a straight shankedsickle. Since we will not use this type of instrument, please focus instead on the Terminal Shank and its cuttingedges and how it relates to the tooth.

Initial point of insertion is always at the line angle

Mandibular Anteriors: BuccalMandibular Anteriors: BuccalRight Handed ClinicianRight Handed Clinician

1. From a 12:00 position, insert at the Distal Buccal Line Angle of #22 (tip towards the col)2. Initiate walking stroke towards and into the distal col. Remove at end of pull stroke3. Reinsert at the Mesial Buccal Line Angle of #22 (tip towards the mesial col) 4. Initiate walking stroke toward and into the mesial col. Remove at end of pull stroke5. Move onto #23 D and then #23 M, then #24D, #24 M, etc.

#22#23#24#25#26#27

123456

Mandibular Anteriors: Lingual Mandibular Anteriors: Lingual Right Handed ClinicianRight Handed Clinician

1. From a 12:00 position, insert at the Distal Lingual Line Angle of #22 (tip towards the col)2. Initiate walking stroke towards and into the distal col. Remove at end of pull stroke3. Reinsert at the Mesial Lingual Line Angle of #22 (tip towards the mesial col) 4. Initiate walking stroke toward and into the mesial col. Remove at end of pull stroke5. Move onto #23 D and then #23 M, then #24D, #24 M, etc.

#22 #23 #24 #25 #26 #27

Mandibular Anteriors: BuccalMandibular Anteriors: BuccalLeft Handed ClinicianLeft Handed Clinician

1. From a 12:00 position, insert at the Distal Buccal Line Angle of #27 (tip towards the col)2. Initiate walking stroke towards and into the distal col. Remove instrument at upward stroke3. Reinsert at the Mesial Buccal Line Angle of #27 (tip towards the mesial col) 4. Initiate walking stroke toward and into the mesial col. Remove instrument at upward stroke5. Move onto #26 D and then #26 M, then #25D, #25 M, etc.

#22#23#24#25#26#27

123456

Mandibular Anteriors: Lingual Mandibular Anteriors: Lingual Left Handed ClinicianLeft Handed Clinician

1. From a 12:00 position, insert at the Distal Lingual Line Angle of #27 (tip towards the col)2. Initiate walking stroke towards and into the distal col. Remove at end of pull stroke3. Reinsert at the Mesial Lingual Line Angle of #27 (tip towards the mesial col) 4. Initiate walking stroke toward and into the mesial col. Remove at end of pull stroke5. Move onto #26 D and then #26 M, then #25D, #25 M, etc.

#22 #23 #24 #25 #26 #27

Stroke Sequence for Posterior TeethStroke Sequence for Posterior Teeth::

2

Notice that you will begin your working stroke at the Distal Line Angle (1) and proceed into the distal col.

You will then reinsert tip at the Mesial Line Angle (2)

(tip now pointing towards the Mesial). Remember, Terminal shank of instrument is parallel to the line angle-proceed with walking stroke into the mesial col area.

1 1 1 12 2 2 2

Correct:

Terminal Shank

Auxiliary Shank

Incorrect:

Terminal Shank

Auxiliary Shank

Correct angulation

Incorrect angulation

Do Not use the sickle on directbuccal/lingualsurfaces!!!

Walking Sequence (per quadrant):

(limited radius)

Area Patient’s Head

Clock Position

1. UR and LR Buccal

Left 10:00-11:00-12:00 (Anteriors)

2. UR and LR Lingual

Right 11:0012:00 (Anteriors)

---------------- ------------- ------------------

2. UL Buccal Right 11:0012:00 (Anteriors)

2. UL Lingual Right 11:0012:00 (Anteriors)

2. LL Buccal Right 10:00-11:0012:00 (Anteriors)

1. LL Lingual Left 10:00-11:0012:00 (Anteriors)

For Right Handed Clinicians:

Midline

Notice that operator position and the direction of the instrument handle changes at the canine on the dominant side.

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Walking Sequence(per quadrant):

(limited radius)

Area Patient’s Head

Clock Position

1. UL and LL Buccal

Right 2:00-1:0012:00 (Anteriors)

2. UL and LL Lingual

Left 2:00-1:0012:00 (Anteriors)

---------------- ------------ ------------------

2. UR Buccal Left 1:0012:00 (Anteriors)

2. UL Lingual Left 1:0012:00 (Anteriors)

2. LR Buccal Left 2:00-1:0012:00 (Anteriors)

1. LR Lingual Right 2:00-1:0012:00 (Anteriors)

For Left Handed Clinicians:

Notice that operator position and the direction of the instrument handle changes at the canine on the dominant side.

Midline

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So, what are we saying?So, what are we saying?

You will be using the You will be using the Posterior SicklePosterior Sickle on on

ALLALL proximal surfaces in the mouth.proximal surfaces in the mouth.

When you are scaling only the anterior teethWhen you are scaling only the anterior teeth- - please follow the sequence in slides (slides #20-23)please follow the sequence in slides (slides #20-23)

When scaling posterior and anterior teethWhen scaling posterior and anterior teeth in a in a single session- instrumentation sequence is:single session- instrumentation sequence is:

quadrant at a time! (slides #35/36)quadrant at a time! (slides #35/36)

In ReviewIn Review You Should You Should ALWAYS Keep in MindALWAYS Keep in Mind::

Lateral PressureLateral Pressure StrokesStrokes Stroke DirectionStroke Direction Stroke LengthStroke Length ReinforcementReinforcement

Now, Let’s take a look at the Now, Let’s take a look at the

Universal CuretUniversal Curet

The Universal curet is similar to the Sickle in The Universal curet is similar to the Sickle in that it also has two cutting edges per end.that it also has two cutting edges per end.

The difference between them is that the tip The difference between them is that the tip of the Universal curet is rounded- not of the Universal curet is rounded- not pointed like the Sickle.pointed like the Sickle.

This allows you to use this instrument This allows you to use this instrument

SUBGINGIVAL!!!SUBGINGIVAL!!!

Universal Curets:Universal Curets:ScalersScalers - - (in cross-section)(in cross-section)

pointed tippointed tip

pointed backpointed back

supragingival calculus removal supragingival calculus removal

Curets - Curets - (in cross-section)(in cross-section)

rounded tiprounded tip

rounded backrounded back

sub & supragingival calculus removalsub & supragingival calculus removal

Universal CuretsUniversal Curets

ColumbiaColumbia BarnhardtBarnhardt Younger GoodYounger Good

Blade size, shank length and design will determine Blade size, shank length and design will determine preferred area usage.preferred area usage.

So, Let’s Keep in Mind. . . So, Let’s Keep in Mind. . .

Fulcrum rest must be near, but not directly over Fulcrum rest must be near, but not directly over the surface being scaled the surface being scaled (fulcrum on same arch)(fulcrum on same arch)..

Determine correct working end of instrument:Determine correct working end of instrument: Terminal shank parallel to MESIAL line angle of molarTerminal shank parallel to MESIAL line angle of molar Foot of instrument curves towards the toothFoot of instrument curves towards the tooth

Angle for insertion is 0-40 (closed blade)Angle for insertion is 0-40 (closed blade)

Continued. . . .Continued. . . .

With closed blade, insert subgingival to JE- lateral With closed blade, insert subgingival to JE- lateral pressure should be fairly light. pressure should be fairly light.

Open angle to 45-90° (subgingival) and initiate Open angle to 45-90° (subgingival) and initiate exploratory stroke (pull stroke)exploratory stroke (pull stroke)

Lateral pressure against tooth should remain fairly light unless a Lateral pressure against tooth should remain fairly light unless a ‘bump’ is felt. Return back to JE and apply firmer pressure ‘bump’ is felt. Return back to JE and apply firmer pressure during pull stroke to remove ‘bump’ during pull stroke to remove ‘bump’ calculus? calculus?

Fulcrum pressure increases during pull strokeFulcrum pressure increases during pull stroke

Continued. . .Continued. . . Relax fingers during exploratory stroke Relax fingers during exploratory stroke

Apply greater lateral pressure during pull stroke.Apply greater lateral pressure during pull stroke.

Strokes should be short and controlled, with moderate Strokes should be short and controlled, with moderate pressure from the base of the pocket, toward the pressure from the base of the pocket, toward the gingival margin. gingival margin.

Stroke direction – vertical, oblique & horizontal Stroke direction – vertical, oblique & horizontal (overlapping) remaining primarily in the gingival (overlapping) remaining primarily in the gingival sulcus.sulcus.

Please remember~Please remember~

You should You should ALWAYSALWAYS scale a tooth to scale a tooth to completion!!!completion!!!

That means: Look at the clock and budget your That means: Look at the clock and budget your time!!!time!!!

Quesstimate how long it will take you to scale a Quesstimate how long it will take you to scale a lingual/buccal surface lingual/buccal surface

Dependant on : How ‘heavy’ the calculus isDependant on : How ‘heavy’ the calculus is How ‘tenacious’ the calculus isHow ‘tenacious’ the calculus is How good is your technique?!?How good is your technique?!?

Then determine how many teeth you can scale Then determine how many teeth you can scale thoroughly and completely with the amount of time thoroughly and completely with the amount of time you have. . . you have. . .