Fundamentals of “Universal” Instruments: Deborah l. Cartee, RDH, MS.
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Transcript of Fundamentals of “Universal” Instruments: Deborah l. Cartee, RDH, MS.
Fundamentals of “Universal” Instruments:
Deborah l. Cartee, RDH, MS
Homework
Reading Assignments: Wilkins Chapter 38
Darby Chapter 26
Objectives1. Describe and identify the general
characteristics of dental instruments.2. Discuss variations in instrument shank
length, curvature, flexibility, and blade-to-shank angulation.
3. Identify a given instrument by its classification, design, number and manufacturer’s name
4. Select the appropriate instrument for a given task.
5. Discuss proper instrument blade adaptation and angulation.
6. Compare and contrast the metals used in instrument construction.
7. Compare scalers and curettes.
Objectives Cont.
8. Compare universal and area specific curet. 9. Describe the distinct characteristics of a
scaler.10.Describe the distinct characteristics of a
curet.11.Determine and descrbe the correct cutting
edge for each instrument in the cassette.12.Demonstrate proper adaptation, insertion,
angulation, and activation of each instrument in the cassette.
13.Evaluate successful instrumentation.
Instrument Parts
Handle Shank
– Shape (straight or angled)– Flexibility – Lower or terminal shank
Working End- Blade
Handle, Shank, Blade
Materials Used for Blade Stainless Steel
– Metal– Maintains adequate sharpness– Do not rust or discolor
Carbon Steel– Metal– Feel sharper clinically and hold their sharpened edges longer– More brittle, can break more easily than SS– Tends to oxidize or rust
*Gold “tipped”– Metal– Expensive– Used for Implants
*Teflon– Plastic/Graphite reinforced nylon– Only used for Implants *See Darby page 1032-1035
Implant – Teflon Instruments
Instrument Handle
Overall design – single ended vs. double ended Weight Diameter Surface texture
– Serrations
Parts of an Instrument
A = HandleB = ShankC = Working-end
Single ended
Single ended
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.
Double Ended Design
Handle Diameters
Handle Texturesmooth
knurled
ribbed
knurled
Working End
2 Types of Universal Instruments:
2 Types of Universal Instruments:
1. Scalers - (in cross-section)
pointed tip
pointed back
supragingival calculus removal
2. Curets - (in cross-section)
rounded tip
rounded back
sub/supragingival calculus removal
Face
Face
To date you’ve learned:*#17 Explorer * ODU Explorer
Let’s first talk about the
Sickle Scalers
Types of Sickle Scalers:
Anterior- ‘straight’ shank instrument
Posterior- ‘curved’ or multiple shank instrument – (actually can be used universally in the mouth)
Terminal shank is ata 90 degree angle tothe Face
Anterior Sickle
Straight Shank
Design Characteristics: Basically there are 2 cutting edges at each end.
The Face of the Sickle Scaler is at a 90 degree angle to the terminal shank.
Flat “face”
Terminal shank
Note:
You do NOT have an anterior sickle scaler in your cassette.
You have a “posterior” sickle scaler – 204S (S204S7).
We will use this instrument in the anterior and the posterior (universal).
We will use this instrument on proximal (mesial and distal) surfaces only. We will NEVER use it on facial and lingual surfaces.
Sickle scalers have a pointed tip and two cutting edges on each end of the instrument:
Let’s get prepared to scale with the
Sickle Scaler – 204S
Must maintain side of tip!
Correct! Incorrect
P. 210
(retraction, mirror)
(light, bracket tray)
(sickle)
(stool position)
(supine, chin & head position)
(fulcrum)
Keep In Mind:
Operator and Client Positioning Instrument Blade Selection Grasp Fulcrum (Max. palm up, Mand. palm down) Insertion at 0° Adaptation open to 70°to 80° Angulation- maintain side of tip
Please remember:
The Sickle instrument is used
SUPRAGINGIVAL!(You can go sub about 1-2 mm if necessary, but not more than that!!!)
The Sickle instrument will be used
Mesial & Distal!(You can NOT use on facial and lingual surfaces!!! )
Start at the Line-angle
Anterior 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: BuccalRight Handed Clinician
1. From a 11:30 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 Right Handed Clinician
1. From a 11:30 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: BuccalLeft Handed Clinician
1. From a 12:30 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 Left Handed Clinician
1. From a 12:30 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 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 working end:
Terminal Shank
Auxiliary Shank
Incorrect working end:
Terminal Shank
Auxiliary Shank
Correct!
Working End
Incorrect
Correct!
Working End
Incorrect
Angulation
Correct Angulation- 70°to 80°
Burnished Calculus –< than 70°
Angle >90°Angle <45°
Incorrect angulation- 90°
Why is this a problem?
Start at the distal line-angle with the tip facing distally.
Do Not use the sickle on directbuccal/lingualsurfaces!!!
Walking Sequence (per quadrant):
(limited radius)
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)
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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Summary
You will be using the Posterior Sickle on
ALL proximal surfaces in the mouth.
When you are scaling only the anterior teeth- please follow the sequence in slides (slides #44-45)
When scaling posterior and anterior teeth in a single session- instrumentation sequence is:
quadrant at a time! (slides #44-45)
In Review You Should ALWAYS Keep in Mind:
Lateral Pressure Strokes Stroke Direction Stroke Length Reinforcement
Now, Let’s take a look at the
Universal Curet
The Universal curet is similar to the Sickle in that it also has two cutting edges per end.
The difference between them is that the tip of the Universal curet is rounded- not pointed like the Sickle.
This allows you to use this instrument
SUBGINGIVAL!!!
Universal Curets:Scalers - (in cross-section)
pointed tip
pointed back
supragingival calculus removal
Curets - (in cross-section)
rounded tip
rounded back
sub & supragingival calculus removal
Universal Curets
Columbia 13/14 (SC13/147) Barnhardt Younger Good
Blade size, shank length and design will determine preferred area usage.
So, Let’s Keep in Mind. . . Fulcrum rest must be near, but not directly over
the surface being scaled (fulcrum on same arch). Determine correct working end of instrument:
Terminal shank parallel to MESIAL line angle of molar Foot of instrument curves towards the tooth
Angle for insertion is 0-40 (closed blade)
Oblique Stroke
Continued. . . .
With closed blade, insert subgingival to JE- lateral pressure should be fairly light.
Open angle to 45-90° (subgingival) and initiate exploratory stroke (pull stroke)
Lateral pressure against tooth should remain fairly light unless a ‘bump’ is felt. Return back to JE and apply firmer pressure during pull stroke to remove ‘bump’ calculus?
Fulcrum pressure increases during pull stroke
Continued. . . Relax fingers during exploratory stroke
Apply greater lateral pressure during pull stroke.
Strokes should be short and controlled, with moderate pressure from the base of the pocket, toward the gingival margin.
Stroke direction – vertical, oblique & horizontal (overlapping) remaining primarily in the gingival sulcus.
Please remember…
You should ALWAYS scale a tooth to completion!!!
That means: Look at the clock and budget your time!!!
How long will it take you to scale a lingual/buccal surface?
Dependent on : How ‘heavy’ the calculus is
How ‘tenacious’ the calculus is
How good is your technique?
Then determine how many teeth you can scale thoroughly and completely with the amount of time you have. . .
Cutting Edges
Adaptation
Incorrect 90°Angulation