The document discusses the principles of periodontal instrumentation. It covers topics like accessibility, visibility, illumination, retraction, instrument stabilization, grasps, finger rests, instrument activation, conditioning and sharpening of instruments. It emphasizes the importance of following these principles for appropriate periodontal treatment. Instrumentation requires proper patient and operator positioning, visibility, stability of instruments, adaptation, angulation, strokes and maintenance of a clean field. Various grasps, finger rests, types of strokes and sharpening techniques are described.
3. The accurate use of periodontal instruments is
fundamental for appropriate periodontal treatment.
The outcome of periodontal therapy to a great extent
depends on the operator’s skill to use the periodontal
instruments in an accurate manner, following the
principles of instruments.
With clinical experience, the principles of periodontal
instruments can be mastered.
5. Patient and operator
Accessibility
1. Position of the patient
2. Position of the operator
Operating area
Visibility, illumination and retraction
1. Use of good light source
2. Use of mouth mirror
3. Use of retraction methods
Maintaining a clean field
1. Adequate suction
2. Removal of all obstacles in the operated area.
7. Accessibility facilitates thoroughness of instrumentation.
The position of the patient and the operator should
provide maximal accessibility to the area of operation.
9. S.
No.
Patient Right
handed
clinician
Left
handed
clinician
1 Front of the
head
7 o’clock 5 o’clock
2 Side of the
head
9 o’clock 3 o’clock
3 Back of the
head
10-11
o’clock
2-10
o’clock
4 Directly
behind the
head (rear
position)
12 o’clock 12 o’clock
Sitting position of
operator when related to
clock
Clinical positions for operator
10. S.No. Body Part Permissible Avoid
1 Head Head should be tilted 0-15° 1. Head should not be tilted to one side
2. Head should not be tipped too
forward.
2 Trunk 1. Trunk flexion of 0-20°
2. Leaning forward slightly from the waist or
hips.
1. Avoid overflexion of the spine
(curved back)
2. Sitting with weight on one hip
3 Shoulders Shoulders should be in horizontal line. 1. Shoulders hunched forward
2. Shoulders lifted up towards the ears.
4 Elbows Elbows should be at waist level and held slightly
away from the body.
1. Elbows held above the waist level
2. Elbows more than 20° away from the
body.
5 Arms 1. Upper arm should hang parallel to the long
axis of torso.
2. Forearm should be parallel to the floor.
3. Forearm should be raised or lowered, if
necessary, by providing at the elbow joint.
Angle between forearm and upper arm
lesser than 60°.
6 Palm 1. Wrist should be aligned with forearm.
2. Little finger side of the palm should be
slightly lowered than thumb side of the
palm.
1. Hand or wrist should not be bent up
or down.
2. Thumb side of the palm should not
be rotated down so that palm is
parallel to the floor.
14. S.No. Treatment area Clock position Patient head Position
Maxillary arch
1 Anterior surface toward 8-9° Slightly toward Chin-up
2 Anterior surface away 12° Slightly toward Chin-down
3 Posterior aspects facing
towards
9° Slightly away Chin-up
4 Posterior aspects facing
towards
10-11° Toward Chin-up
Mandibular arch
1 Anterior surface toward 8-9° Slightly toward Chin-down
2 Anterior surface away 12° Slightly toward Chin-down
3 Posterior aspects facing
towards
9° Slightly away Chin-down
4 Posterior aspects facing
towards
10-11° Toward Chin-down
15.
16. Patient
Upright
Semi upright
Supine
Trendelenburg
Patient positions on dental
chair
Upright Initial positions from which
chair adjustments are made
Semi upright Respiratory and CVS patients
should be in semi-upright
position during treatment
Supine Flat positions with the head and
feet on the same level
Trendelen-
burg
Modified supine position when
the head is lower than the heart.
The brain is lower than heart
and feet are slightly elevated.
17. VISIBILITY
- Whenever possible, ‘direct vision with direct
illumination’ from the dental light is desirable.
- If ‘direct vision with direct illumination’ is not
possible, indirect vision is obtained by using a mouth
mirror to reflect light when it is needed.
19. ILLUMINATION
- When transillumination of a tooth, the mirror is used to
reflect light through the tooth surface. The
transilluminated tooth almost will appear to glow.
- It is effective only with anterior teeth because they are thin
enough to allow the light to pass through them.
Light positions
for maxillary
and mandibular
teeth
21. Maintaining a clean field
- Despite good visibility, illumination and retraction,
instrumentation can be hampered if the operative field is
obscured by saliva, blood and debris.
- Adequate suction is essential and can be achieved with a
saliva ejector or, an aspirator.
- Blood and debris can be removed from the operative field
with suction and by wiping or blotting with gauze squares.
The operative field should also be flushed occasionally with
water.
- Compressed air and gauze square can be used to facilitate
visual inspection of tooth surfaces just below the gingival
margin during instrumentation.
- Retractable tissue can also be deflected away from the
tooth by gently packing the edge of gauze square into the
pocket with the back of a curette.
22. Stability of the instrument and the hand is the primary
requisite for controlled-instrumentation.
Stability and control is essential for effective
instrumentation and to avoid injury to the patient or
clinician. The two factors that provide stability are,
instrument grasp and finger rest.
Instrument
stabilization
23. The act of seizing and holding an instrument is called
as instrument grasp.
Purpose
A proper grasp is essential for precise control of
movements made during periodontal
instrumentation.
Types of grasps
1. Standard pen grasp
2. Modified pen grasp
3. Palm and thumb grasp
25. Synonym- Fulcrum
The finger rest serves to stabilize the hand and the
instrument by providing a firm fulcrum, as movements
are made to activate the instrument.
Finger Rests in Periodontology
1. A good finger rest prevents injury and laceration of
gingival and surrounding tissues.
2. The ring finger is most commonly preferred as a
finger rest. Maximal control is achieved when the
middle finger is kept between instrument shank and
4th finger.
26. S.No. Finger Recommended position Function
1 Thumb & index finger 1. The finger pads rest opposite to
each at or near the junction of the
handle and shank.
2. They do not overlap and a tiny space
exists between them.
3. The instrument is held in a relaxed
manner.
4. The index finger and thumb curve
outward from the handle in a C-
shape.
- The main function of
these digits is to hold the
instruments.
2 Middle finger 1. One side of the finger pad rests
lightly on the instrument shank.
2. The other side of the finger pad
rests against the ring finger.
-It helps to guide the
working end and also feel
the vibration.
3 Ring finger 1. Finger tip balances firmly on the
tooth to support the weight of the
hand and instrument.
2. The finger is held straight and
upright.
-Acts as strong support
beam for the hand.
4 Little finger 1. It should be held in a relaxed
manner.
- No function.
31. ADAPTATION
- Adaptation refers to the
manner in which the working
end of periodontal instrument
is placed against the surface of
a tooth.
- The objective of adaptation is
to make the working end of
the instrument confirm to the
contour of the tooth surface.
Advantages
- Avoid trauma to the soft tissues
and root surfaces.
- Ensure maximum effectiveness
of instrumentation.
32. ANGULATION
- Angulation refers to the angle between the face of a bladed instrument
and the tooth surface. It is also called as tooth-blade relationship.
- The exact blade angulation depends on the amount and nature of
calculus, the procedure being performed and condition of the tissue
during scaling or root planing.
Angulation Purpose
0° For blade insertion
0° − 40° For insertion beneath the
gingival margin
<45° For scaling and root planing
45° − 90° For calculus removal
>90° For gingival curettage
100-110° For instrument sharpening
Angulation in periodontal
instrumentation
Blade Angulation
33. STROKES
- Stroke is the working efficiency of the instrument.
Types of strokes
Strokes
Exploratory
strokes
Scaling
strokes
Root planing
strokes
Direction of strokes
1. Vertical direction
2. Horizontal direction
3. Oblique direction.
34. S.No
.
Feature Exploratory
strokes
Scaling
strokes
Root planing
strokes
1 Purpose 1. Assess tooth
anatomy
2. The level of
attachment
3. Evaluate dimensions
of the pocket
4. Detect calculus and
tooth surface
irregularities.
- Used to remove
supra-gingival and
sub-gingival
calculus.
1. To remove
residual calculus,
bacterial plaque
and other
byproducts.
2. For final
smoothening and
planing of root
surfaces
2 Character - Light feeling strokes of
moderate length
Short, powerful pull
strokes
- Long, moderate to
light pull strokes
3 Direction - Vertical, oblique and
horizontal
- Vertical, oblique
and horizontal
- Vertical, oblique and
horizontal
4 Number - Many covering entire
root surface.
- Limited to area
where needed root
surface.
- Many covering
entire root surface.
35. STERILIZATION
- Prior to any instrumentation, all instruments should
be inspected to make sure that they are clean, sterile
and in good condition.
SHARPNESS
- The working ends of the pointed or bladed
instruments must be sharp to be effective.
- Ideally, it is best to sharpen the instruments after
autoclaving and then re-autoclave then prior to patient
treatment.
36. Various cutting stones may be used to sharpen the cutting edge and
keep the instrument in good working condition.
Objectives
- The objective of sharpening is to restore the fine, thin linear cutting
edge of instrument.
Principles of sharpening
1. Use a sterilized sharpening stone.
2. Maintain a stable, firm grasp of both the instrument and the
sharpening stone.
3. Establish proper angle between the sharpening stone and the surface
of instrument.
4. Avoid excessive pressure during the sharpening of any instrument.
5. Avoid formation of ‘wire-edge’, characterized by minute filamentous
projections of metal extending as a rounded ledge from the
sharpened cutting edge.
6. Lubricate the stone during sharpening; this minimizes clogging of
the abrasive surface of the sharpening stone with metal particles
removed from the instrument.
37. The sharpening technique uses the grinding ofa coarse stone against
instrument to create a sharp edge. The following three different
techniques results in sharpening of hand instruments:
1. Reducing the face of blade.
2. Reducing the lateral surface to create a sharp edge through
movement of a sharpening stone against a stationary cutting edge.
3. Moving the instrument against a stationary sharpening stones.
38. The sharpness of instrument, can be evaluated by light
and touch. Tactile sensation by drawing the
instrument lightly across an acrylic rod is known as
‘sharpening test stick’.
S.N
o.
Test Dull instrument Sharp
instrument
1 Light When a dull
instrument is held
under a light, the
rounded surface of
cutting edge reflects
light back.
The acutely angled
cutting edge of a
sharp instrument
has no surface area
to reflect light. No
bright line can be
observed.
2 Touch Dull instrument will
slide smoothly on
sharpening test stick.
Sharp instruments
will not slide
smoothly.
Evaluation of sharpness of instrument
Sharpening test stick
39. The sharpening stones may be quarried from natural
mineral deposits or produced artificially.
Mode of supply
1. Stones are available in different grits depending on
the size of the abrasive crystals on it.
2. The abrasive crystals are harder than the metal of the
instrument to be sharpened.
Sharpening stones
40. Based on availability
1. Natural sharpening stones – Arkansas oil stones
2. Synthetic sharpening stones – Ceramic /carborundum
Based on sharpness
1. Coarse sharpening stones – For dull instrument
sharpness
2. Synthetic sharpening stones – For final sharpness of
slight dull instruments.
Based on mounting
1. Mounted sharpening stones
2. Unmounted sharpening stones.
42. S.No. Stone Use Grain Lubrication
1 Arkansas natural
stones
Routine reshaping
of well maintained
cutting edges
Fine Oil
2 Composition synthetic
stones
Extensive
reshaping of
improperly
sharpened or
extremely dull,
worn cutting edges
Coarse Water
3 Ceramic synthetic
stones
Routine reshaping
of well maintained
cutting edges
Fine Water
4 Indian synthetic
stones
Reshaping of dull
cutting edges
Medium Water or oil
