Periodontal Scaling Instruments

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Periodontal ScalingInstruments

(Gracey Curettes and Sickle Scalers)


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Periodontal scaling is the therapeuticprocedure performed by a dentist or

dental hygienist to remove all

mineralized, hardened deposits fromthe tooth's surfaces. It is performed

supra and subgingivally and can be

done using a non surgical (closed) ora surgical (open) approach.


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Based on instrument design, how they

are used, where they are used and how

they work, the following classificationof periodontal scaling instruments is

used.


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Periodontal Scaling Instruments

Sickle scalers

Universal Curettes

Area Specific Curettes Files

Ultrasonic/Sonic Instruments


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Periodontal Scaling Instruments

In the category of area specific curettes a subclassification exists.

Area Specific Curettes

Gracey Curettes

Vision Curettes

Modifications to Gracey Design

After five or extended series Mini series

Langer series

Furcation series


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Gracey Curettes

The original Gracey series wasdeveloped in the 1930's by Dr.Clayton Gracey, a periodontist

at the University of Michigan. They were designed to provide

better access to root surfaces indeep pockets.

They feature long shanks andunique blades, some with bendsimproving access to complexroot surface morphology.


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Gracey Curettes

The original series contained

7 double ended instruments

(1/2; 3/4; 5/6; 7/8; 9/10;

11/12; 13/14).

In the 1980's, 2 modified

instruments were added to

the collection (15/16; 17/18).


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Gracey Curettes

Gracey curettes 1/2, 3/4, and 5/6 are used to

scale all tooth surfaces in the anterior sextants.

7/8 and 9/10 are used for scaling the buccal

and lingual aspects of teeth in the posteriorsextants.

11/12 and the 15/16 are used to scale the mesial

aspects of the teeth in the posterior sextant. 13/14 and 17/18 are used to scale the distal

aspects


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Gracey Curettes

Gracey curettes are available in stainless steel

or in carbon steel. Carbon steel requires more

care as it rusts very easily and also wears away

more quickly. Instruments can come in the form of a solid

one piece instrument (usually stainless steel) or

as a cone socket instrument (usually carbonsteel). With the cone socket instrument, shank

and blade can be unscrewed and replaced.


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Gracey Curettes

The design of the Gracey

curettes is unique in that

each end had only onecutting edge

It can adapt closely to

the specific tooth surfacefor which it is intended.


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Gracey Curettes

The cutting or useable edge ofthe blade is the lower outeraspect of the blade.

It can be identified by holdingthe terminal shank of the end inquestion, blade side lower, in a

vertical position and viewing theblade portion head on.

The blade of the curette is

machined at a 70 degree angleand the cutting edge exhibits acurve, which is longer or convexin relation to the "non-

working" edge.


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Gracey Curettes

When adapting the Gracey instruments to

the teeth to perform scaling, the cutting

edge must first be identified and placed

against the surface to be scaled and the

terminal shank should be parallel to that

surface.

In this position, the ideal working

angulation for calculus removal is

achieved.


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Gracey Curettes


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Sickle Scalers

The sickle scaler, primarily used for

supragingival calculus removal, is a very

useful instrument.

It is often the first instrument used to

remove large, heavy deposits thus

improving access to subgingival area forother instruments.


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Sickle Scalers

A number of different sickle scalers are

available in a variety of shapes and sizes.

Towner H-15Jacquette

204 S; 204 SD

MorseUSC - 128


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Sickle Scalers

They all however have common featuresmaking them suited to the removal of heavycalculus deposits and working interproximally,around the contact areas of teeth.

A flat blade cut at a 90 degree angle to theshank.

Cutting edges on both sides of the face of theblade.

The face of the blade is triangular tapering to astrong, sharp point at the toe.

The face of the blade may be straight or curved.


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Sickle Scalers


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Grasp

The firm but light hold a dental clinician has ontheir instruments is referred to as "grasp".

A proper grasp enables the clinician to maneuverthe instrument around the tooth and correctly

direct pressure application for calculus removalwithout damaging the periodontal tissues.

Three specific grasps are used. They are: pen grasp

modified pen grasp

palm-thumb grasp.

The modified pen grasp is the most useful.


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Fulcrum

The resting of the third finger on a firm

intra- or extraoral site acts as a fulcrum.

This improves control of the instrumentand application of forces by the

working end against the tooth.


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Wrist and Arm Motion

The instrument/wrist/ forearm complex

must act as a unit rocking firmly but

smoothly on the fulcrum.

Wrist twisting or independent finger

movement should be avoided. This would

result in pain, muscle fatigue, and

inflammation of the ligaments and nerves

of the wrist.


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Adaptation

This refers to the placement of the

working end of the instrument in thecorrect relationship to the tooth.


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Angulation This is the angle formed by

the plane of the toothsurface and the plane of

the face of the blade.

Efficient cuttingangulation is between 45,

90, and 70 degrees is

considered ideal. Less than

45 degrees is considered"closed" and more than 90

degrees is considered

"open".


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Insertion

To avoid damaging the soft

tissues when entering the sulcus

with a large, sharp instrument,

the working end is inserted into

the sulcus with the face of the

blade "closed" or flattened to

the tooth surface.

Once in the depth of the pocketor sulcus, the blade is opened 45

to 90 degrees for working

strokes.


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Strokes This is the action of the working end on

an instrument as it is moved across atooth surface.

Exploratory strokes provide light tactilefeedback from the instrument tip.

Working strokes provide controlledpressure against a tooth surface using anappropriate cutting angulation.

Scaling strokes are short pulling strokesmade with firm pressure to removeincrement from root and enamelsurfaces.

Root planning strokes are made toremove deposits and smooth the rootsurface.

Working strokes are ideally a series ofoverlapping strokes covering the entiretooth surface.


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Periodontal Scaling Instruments

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