# Basic Chairside Instruments and Tray Systems

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Basic Chairside Instruments and Tray Systems
Chapter 18

Basic Structural Parts of Dental Hand Instruments
Working end Shank Handle The dental hand instrument can be single- or double-ended and is usually 6 inches long. It is important and will aid the dental assistant by knowing the parts and functions of the dental hand instruments. © Cengage Learning 2013

Basic Classification of Dental Instruments
Number of working ends Functions Manufacturer’s number Black’s formula By knowing the classifications, it is easier to remember each instrument’s name and function. The two categories of working ends are single-ended and double-ended. If an instrument is classified by function, there is cutting and non-cutting. Also, there are instruments used for a specialty. On the handle of an instrument is the manufacturer’s number. Some instruments will have the name of the individual who designed the instrument. Black’s formula consists of the exact size and angulation of an instrument.

Classification of Instruments
Black’s three-number formula First number Width of blade Second number Length of blade Third number Angle of blade Instruments, such as chisels, hatchets, and hoes, have a series of three numbers. © Cengage Learning 2013

Classification of Instruments
Black’s four-number formula First number Width of blade Second number Degree of angle of cutting edge of blade to handle Instruments, such as angle formers and gingival margin trimmers, have four numbers. © Cengage Learning 2013

Classification of Instruments
Black’s four-number formula Third number Length of blade Fourth number Angle of blade to axis of handle © Cengage Learning 2013

Dental Check What is the end of the working end called if it is blunt and serrated? Nib

Cutting Instruments Chisels Straight Wedelstaedt Bi-angle
Hand cutting instruments are used in cavity preparation. Chisels are unique hand cutting instruments because they come in three different shanks to reach different areas of the mouth. © Cengage Learning 2013

Cutting Instruments Hatchets Beveled on one side Blade on one side
Refines cavity walls Obtain retention in cavity prep © Cengage Learning 2013 These instruments are used to refine and define different areas of the cavity prep. It is important for the dental assistant to be able to identify and know the use of each instrument. By doing so, the dental assistant will be able to assist the doctor in a more efficient and accurate manner.

Cutting Instruments Hoes Smoothes and shapes floor of cavity prep

Cutting Instruments Gingival margin trimmers Curved blade
Angled cutting edge Bevel gingival margin wall of cavity prep Distal © Cengage Learning 2013 Mesial © Cengage Learning 2013

Cutting Instruments Angle formers Define point angles
Sharpen line angles © Cengage Learning 2013

Cutting Instruments Excavators Blade or spoon
Removal of carious materials Removal of excess cement Tucking of rubber dam Packing of retraction cord Blade © Cengage Learning 2013 Spoon © Cengage Learning 2013

Dental Check Name the cutting instrument that is used to plane and shape enamel and dentin walls. Chisel

Noncutting Instruments
Basic examination instruments Mouth mirrors Explorers Cotton pliers Periodontal probes Common to all tray setups, these instruments are used to begin all procedures. There are three types of mirrors: Plane or regular surface mirrors, front surface mirrors, and concave surface mirrors. The most common size used is a 4 or 5. The explorers come in a variety of angles and different ends in order to access various areas of the mouth. It is used to detect irregularities. Common shapes include the pig tail, the shepherd’s hook, and the right angle. Cotton pliers are used to remove, transfer, and retrieve materials from the oral cavity and/or drawers and cupboards. Their handles are either locking or non-locking, and the tips may be straight or angled. The periodontal probes measure the depth of the gingival sulcus. An instrument called the expro is a combination of a periodontal probe and an explorer. Mirror and explorer Courtesy of Integra Life Sciences Corporation (through Integra Miltex)

Noncutting Instruments
Plastic filling instruments Placing and condensing restorative materials Composite instrument Placing, condensing, carving, contouring, and burnishing These instruments are used after the cavity has been prepped. It is important for the dental assistant to learn these instruments and the sequence in which they are used. The instruments are used for placing bases and liners, placing amalgam and composites, and contouring and smoothing final restoration. © Cengage Learning 2013

Noncutting Instruments
Composite instruments Amalgam carriers Amalgam condensers Carvers

Noncutting Instruments
Amalgam carrier Carry and dispense amalgam Amalgam condenser Pack amalgam into cavity prep Courtesy of Integra Life Sciences Corporation (through Integra Miltex) Courtesy of Hu-Friedy Mfg., Co., Inc.

Noncutting Instruments
Carver Remove excess restorative material Carve wax inlays and onlays Courtesy of Hu-Friedy Mfg., Co. Inc.

Noncutting Instruments
Burnishers Smooth restorations Shape matrix bands © Cengage Learning 2013 © Cengage Learning 2013 © Cengage Learning 2013

Noncutting Instruments
Files Trim filling material Finishing knife Trim excess material © Cengage Learning 2013 Courtesy of Hu-Friedy Mfg., Co. Inc.

Noncutting Instruments
Miscellaneous Spatulas Articulating forceps Scissors Courtesy of Integra Life Sciences Corporation (through Integra Miltex)

Care and Maintenance Extend lifespan of instrument due to proper care and maintenance Properly clean and sterilize Examine all instruments thoroughly All instruments should be properly cleaned and disinfected as soon as possible after use. If they are not able to be cleaned right away, they should be pre-soaked in a solution to prevent the debris from drying on the instruments. Instruments should be cleaned in an ultrasonic bath or other similar solution. Hinged instruments should be cleaned in the open position and should be lubricated as appropriate. After cleaning for the appropriate amount of time, the instruments should be rinsed and dried. Once dried, they should be sterilized and stored. All instruments should be carefully inspected before use for properly functioning parts, broken parts, and sharpness.

Dental Check Which type of burnisher is popular for smoothing amalgam or composite restorations? Acorn

Dental Rotary Instruments
Parts of bur Shank Neck Head Straight shank Latch-type shank Friction-grip shank Head Neck Shank Materials that make up the bur are either steel or tungsten carbide. You will find burs not only used chairside, but also in dental laboratories. The use of burs is as follows: cavity preparation, finishing and polishing restorations, surgical procedures, and dental appliance adjustments. The shank is designed to accommodate the dental handpieces. © Cengage Learning 2013

Types of Burs Cutting Diamond Finishing Surgical Laboratory
Fissurectomy The burs are divided into categories according to their use. The cutting burs are separated into different shapes and sizes. These burs are numbered, and students should learn the number ranges. The diamond burs are used for the cavity preparation and finishing the restoration. The finishing burs come in different shapes and are used to smooth the restoration. The surgical and laboratory burs may look similar, but the surgical burs are used in the mouth, and the laboratory burs are used on fixed and removable prostheses. Fissurotomy burs are extremely small and are used to explore the occlusal surface to treat and diagnosis while maintaining tooth structure. © Cengage Learning 2013

Abrasives Nonbladed instruments used to finish and polish restorations and appliances Categorized by shape and materials from which they are made E.g., rubber, stone, sandpaper There are abrasives that are used for cutting. The shapes that categorize abrasives are as follows: discs, points, and wheels.

Types and Functions of Abrasives
Mandrels Rods of various lengths used in low-speed handpieces Discs Used to polish, smooth, and adjust restorative materials and dental appliances Mandrels are used with different abrasives, which are either mounted to the mandrel or unmounted. They come in three different shanks: latch, friction grip, or straight. The types of discs are as follows: sandpaper discs, diamond discs, and carborundum (also known as Jo-Dandy discs and separating discs). They are thin and brittle and break easily.

Types and Functions of Abrasives
Stones Used for cutting, polishing, and finishing amalgam, gold, composite, and porcelain restorations Stones are used in the laboratory and are available in many sizes, shapes, and grits.

Types and Functions of Abrasives
Rubber wheels Used for finishing and polishing Rubber points Used for polishing Adaptable for defining anatomy in restoration © Cengage Learning 2013 After using an instrument in the oral cavity, it is either sterilized or properly disposed. The bur block comes in a variety of designs and sometimes can be sterilized with the burs they hold. © Cengage Learning 2013

Dental Check What type of bur is used to open the cavity and remove the carious tooth structure? Round

Dental Handpieces Used for the following: Remove dental decay
Prepare tooth for restoration Polish Polish and finish dental restorations Cut, finish, and polish dental appliances Trim models and trays The electric handpieces are becoming more popular than the air-driven handpieces. The appeal of the electric handpiece is that it is quiet, vibration-free, efficient, and able to be sterilized.

Parts of the Dental Handpiece
Working end Head Shank Connection end The working end is where the burs, discs, stones, and other rotary instruments and attachments are held. Forward and reverse controls may be located on the connection end.

Dental Handpieces High-speed Low-speed Electric
High–speed handpieces can produce frictional heat, which can cause pulpal damage to the tooth. So it is important to use a coolant, such as air, water, or and air-water spray to reduce the frictional heat. Low-speed handpieces are used in both the dental office and laboratory. Its uses in the dental office are to polish teeth and restorations, remove soft carious material, and define cavity margins and walls. Electric handpieces are an alternative to the air-driven handpiece. They are more versatile and used more commonly today, allowing for smoother cuts and refined margins with higher torque and precision. © Cengage Learning 2013

Maintenance and Sterilization of Dental Handpieces
Follow manufacturer’s directions carefully Sterilization General guidelines for maintenance and sterilization of a dental handpiece are as follows: - While handpiece is still attached to the tubing and a bur, flush for 20 to 30 seconds. - Remove debris by scrubbing the handpiece. - Lubricate using the manufacturer’s suggested lubrication. - Sterilize the handpiece. - Lubricate if instructed.

Air Abrasion Unit and Microetcher
Reduces use of anesthetics and drilling with dental handpieces Microetcher Smaller version of air abrasion unit used for intraoral sandblasting and dentin bonding Both units require air pressure and an abrasive material. Abrasives used in the microetcher should be kept in a tightly sealed container to keep them dry and clean. It is important to consider safety for all involved while using a microetcher.

Tray Systems Preset tray system Other systems Most commonly used
Instruments and auxiliary items Placed on tray in order of use during procedure Other systems An example of a preset tray system is the cassette system. This system allows instruments to be transported to treatment rooms, through the sterilization process, and into storage. It keeps the instruments for each procedure together at all times.

Color Coding Systems Color coding may be set up to indicate:
Procedures Treatment room instruments storage Additional sets of instruments Individual operators Sequence of use Any combination of the above Color coding makes it easy to identify instruments and trays. It is important that the material used for color coding is autoclavable and durable. Types of materials used for color coding include plastic rings and colored coding tape.

Color Coding Systems © Cengage Learning 2013