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4. Periodontic and Endodontic Instruments

4-2. INSTRUMENTS

a. General. Instruments used in the treatment of periodontal diseases are designed for one or more of the following objectives: determining soft tissue pocket depth; surgically incising and removing soft tissue to eliminate soft tissue pockets; removing calculus and debris from roots of teeth; removing soft tissue from periodontal pockets; removing, reshaping, or contouring hard structure (alveolar bone). Other instruments, such as scalpels, needle holders, hemostats, and suture needles, routinely used in oral surgery, are employed routinely in periodontal surgical procedures. Medical Supply Catalog nomenclature is included in capital letters following the name ordinarily used to designate each instrument.

b. Periodontal Scaler. A periodontal scaler (figure 4-1) is used to remove calculus and stain from the clinical crown of the tooth. The scaler has pointed blades along each side and is used with a pull stroke. The scaler may either be single-ended or double- ended. Some examples of periodontal scalers are the McCall 13-14S and 17-18S, Younger-Good 7/8, Orban straight sickle 14, Crane-Kaplan 6, Towner U-15, Kirkland 13K/13KL, and Pritchard.

Figure 4-1. Periodontal scaler.

c. Periodontal Curette (CURETTE, PERIODONTAL). A periodontal curette (figure 4-2) is used to remove calculus, smooth root surfaces, and the soft tissue wall of the pocket. A curette is used with a pull stroke. The blades must be sharp to be of any value. Examples of periodontal curettes are the Gracey curettes (1 through 14) with flexible shanks. Separate sets for curettage and root planing are usually available.

Figure 4-2. Periodontal curette.

d. Periodontal Hoe (HOE, PERIODONTAL). The periodontal hoe (figure 4-3) is used to remove gross amounts of supragingival calculus and some subgingival calculus in large wide-open pockets where gingival tissues are soft and very easily cleaned. The periodontal hoe is used with a pull stroke. Some examples of periodontal hoes are the Orban 6/7 and 8/9 and Kirkland 14.

Figure 4-3. Periodontal hoes.

e. Periodontal File. A periodontal file (figure 4-4) is used to remove gross supragingival calculus, smooth the cementoenamel junction, and remove overhanging margins of dental restorations. Files are a series of fine short blades or hoes at an angle to the shank and are quite difficult to sharpen. A pulling stroke is used to activate the periodontal file. Some examples of periodontal files are the Orban 10, 11, 12, and 13 and the Sugarman 15/25 and 35/45.

Figure 4-4. Periodontal files.

f. Periodontal Pocket Marker. A periodontal pocket marker (figure 4-5) is used to determine the depth of soft tissue pockets and the contour of the bone resorption about a tooth. While the area is anesthetized, a bleeding point is created for easy identification by the dentist. The surgical knife is placed at the bleeding point and the tissue coronal to that point is excised and removed. This procedure is called a gingivectomy. An example of a periodontal pocket marker is the Goldman-Fox number two.

Figure 4-5. Periodontal pocket marker.

g. Periodontal Probe . A periodontal probe (figure 4-6) is used to locate and measure the depth of a gingival crevice or periodontal pocket. The probe is also used to measure the loss of attachment of the tooth. A probe is round or flat and marked in millimeters on the side. A probe is color coded for easy identification. Some examples of periodontal probes are the Goldman-Fox (flat), Nabers (flat), Glickman (round), Michigan O (round), and Williams (round).

Figure 4-6. Periodontal probe.

h. Chisel. A chisel (figure 4-7) is used to remove heavy supragingival calculus from the proximal surfaces of anterior teeth when the embrasure spaces are open. A push horizontal stroke from facial to lingual is used to dislodge the calculus on the proximal surfaces. The Ochsenbein 1,2, TG, and TGO and Chandler bone chisel C1, C4, and C7 are some examples of chisels.

Figure 4-7. Chisels.

i. Periodontal Knife. A periodontal knife is used to incise gingival tissues. The knife must be sharp to function properly and must not be allowed to touch other instruments or be dropped on a hard surface such as the floor or a sink. The knife must be sharpened after each surgical procedure and before sterilization. To prevent accidents, special care must be taken when preparing and wrapping the knife for sterilization.

(1) Kirkland knife 15/16. This knife (see figure 4-8, top portion) is a single-ended or double-ended knife used for initial gingivectomy incision, tuberosity and retromolar pad reduction, and free gingival grafts preparation.

(2) Orban knife 1/2. This knife (see figure 4-8, bottom portion) is a single-ended or double-ended knife used for interproximal tissue incisions, interproximal tissue removal, and free gingival grafts.

Figure 4-8. Kirkland and Orban knives.

(3) Scalpel. Blades 12, 12B, and 15 (see figure 4-9) are used in every periodontal surgical procedure from free gingival grafts to the inverse bevel incision on a full thickness apically repositioned flap. The blades 12 and 15 are single-edged. The blade 12B is a double-edged blade used to cut in a push and pull motion. The blades are disposable and available in presterilized packages.

Figure 4-9. Blade handle and blades.

j. Ultrasonic Dental Unit. The ultrasonic unit with insert tips (see figure 4-10) is used to remove supragingival and subginginval calculus, stains, amalgam overhangs, and soft tissue pocket wall (curettage). Operating at 25,000 cycles per second, energy is transferred to the calculus, stain, amalgam overhang, or tissue, causing separation from the tooth surface. Operator fatigue is greatly reduced and productivity is increased with the use of an ultrasonic unit. A high-speed evacuator is necessary to keep the bacteria-containing aerosol mist from the air in the operatory. Hand scaling, however, is still the preferred method for root planing. There are two types of ultrasonic units. One type of unit has its own water supply and instrument box. A second type of unit resembles a handpiece and operates using the high-speed handpiece hose.

Figure 4-10. Ultrasonic dental unit.

 


David L. Heiserman, Editor

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Revised: June 06, 2015