Dr Jamal Naim PhD in Orthodontics

1. Pre-clinical Periodontics Dr Jamal Naim PhD in Orthodontics Instruments and instrumentation

4. Curettes Are instruments for: • Deep subgingival scaling • Root planing • Removal of soft tissue lining the pocket

5. Working end of curettes The curette blade has two cutting edges, which meet to form a rounded tip or toe. The cutting edges are formed by the junction of the flat face of the blade and the curved sides, or lateral surfaces. The lateral surfaces extend from each cutting edge and converge to form the convex back of the blade face Cutting edge Non- functional Lateral surface Cutting edge -functional toe

6. Types of curettes

7. Types of curettes Universal curettes: • The blade has 90 degree angle to the lower shank • One curve from the head of the blade to the toe

8. Types of curettes Area specific curettes: • Are designed and angled to adapt to specific anatomic areas. Gracy curettes:

9. Gracey curette design There are four design features that make the Gracey curettes unique: 1.they are area-specific 2.the blade is ‘offset’ (60-70 degree angle to the lower shank) 3.only one cutting edge on each blade is used 4.the blade is curved in two planes. Each of these features directly influences the manner in which the Gracey curettes are used.

10. Types of curettes

11. Gracy curretes

12. Gracy curettes #11-12 Gracy curettes #13-14

13. Uses of the Gracy curettes

15. Positions of curettes

16. Types of curettes • MiniFive curettes • Extended shank curettes (after 5 curettes) • Gracy curvettes (50% shorterr blade) Gracy curvettes

18. Hoe Scalers

20. Periodontal Files (correction) • Periodontal Files: is a calculus removal instrument that has many cutting edges per working-end and is used to prepare calculus deposits before removal with another instrument.

22. Fundamentals of scaling • Scaling – process for removal of plaque and calculus above and below gingival margin • In subgingival scaling often called root debridement, calculus and plaque are not always visible making its detection and removal hard • Instrumentation: is using periodontal instruments on the tooth surface

23. Adverse effects of scaling • Adverse effects of scaling (especially if not performed properly) can include- • Removal of cementum • Exposure of dentinal tubules • infection

24. Only one of the cutting edges is used against the tooth surface while calculus is being removed. Because the other cutting edge and the toe are not in use, the blade must be adapted very carefully during scaling to prevent laceration of the soft tissues.

26. Adaptation The curved cutting edges adapt better to the curved surfaces of the teeth than the straight cutting edges of the sickles, hoes and files. Also, the rounded toe is an important safety feature that other instruments lack. The sickles, hoes and files all have the disadvantage of possessing sharp corners and points on their blades that can gouge the cementum surface or the soft tissues.

27. Adaptation When a Gracy curette is adapted to the tooth with the lower shank parallel with the tooth surface, the angle between the face of the blade and the tooth is about 700 This angle will enable effective calculus removal with pull strokes

28. Adaptation Use this edge against the tooth surface where the calculus is to remove

29. Adaptation The Gracey curette is adapted to the root surface at approx. 70o. This angle enables effective removal of calculus with pull strokes

34. Effectivity Although the curette is considered to be the most effective instrument for removal of calculus, all instruments tend to leave calculus deposits on the tooth surface at the microscopic level. The difficult accessibility of molar root surfaces and the anatomic features of multirooted teeth make complete removal of calculus a clinical impossibility.

35. Before and during scaling procedures • Sharp instrumants • Accessibility: positioning of patient and operator • Visibility, illumination and retraction • Clean field • Instrument stabilization: • Instrument grasp • Finger rest

36. Modified pen grasp Pad of middle finger against the shank of the instrument. The thumb and index finger should be opposite each other at the junctionof handle and shank

38. Before and during scaling procedures • Dry the surface using air, gauze, isolation with cotton rolls. • Tactile sensitivity is the only sensory means by which results can be evaluated, as bleeding is likely to impede visual assessment post scaling. • Assess whether calculus has been removed using curette, explorer, air and floss