Dental Hand Instruments Chapter 34 Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 1

Chapter 34 Lesson 34.1 Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 2

Learning Objectives Define and spell the Key Terms. Describe the three parts of a dental hand instrument. Describe the instrument formula designed by G.V. Black. Discuss the theory of placing an instrument in a specific sequence. List the examination instruments and their uses. (Cont’d) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 3

Learning Objectives Identify examination instruments. (Cont’d) Identify examination instruments. List the types of hand (manual) cutting instruments and their uses. Identify hand (manual) cutting instruments. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 4

A wide variety of dental instruments are used in dental procedures. Introduction A wide variety of dental instruments are used in dental procedures. Today’s discussion will include the purposes of dental instruments that are most commonly used in dentistry for general restorative purposes. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 5

Identifying Hand Instruments Reference By name By assigned number Black’s instrument formula Width of blade Length of blade Angle of blade Most hand instruments are made of stainless steel, carbon steel, plastic, or specialized metal. The dentist will refer to an instrument either by name or by number. This number is a universal representation of the instrument. G.V. Black designed a formula that describes the angulations and dimensions of the working ends of hand instruments. Why is it important that the dental assistant have knowledge regarding instrument design and usage? Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 6

Design of Hand Instruments Handle Portion of the instrument that the operator grasps Shank Part of the instrument that connects the working end to the handle Working end Portion of the instrument designed for a specific function What are the advantages to a handle with a larger circumference? (Larger handles are ergonomically designed to reduce fatigue and stress on hand muscles.) Where would you use an instrument with an angled shank? (Posterior areas.) The working end may be a point, blade, or nib. Instruments can also be single- or double-ended. Double-ended instruments are mirror images or have reverse angles. What are mirror-image instruments called? (Left and right instruments.) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 7

Fig. 34-2 Three parts of a dental hand instrument. Define each part of the instrument in your own words. What information is found on the handle of a dental instrument? (Name of the instrument, manufacturer’s name, and the universal identification number.) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 8

Classification of General Dental Instruments Examination Hand-cutting Restorative Accessory In what procedures would an examination instrument be used? (Caries examination, inspection of the oral soft tissues, periodontal assessment.) In what procedures are hand cutting instruments used? (Cutting bevels in the cavity prep, removing decay close to the pulp, removing soft dentin.) In what procedures are restorative instruments used? (Amalgam placement, composite placement, etc.) Can students name an accessory instrument? Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 9

Fig. 34-5 Examination instruments Fig. 34-5 Examination instruments. (A-D from Boyd L: Dental instruments: a pocket guide, ed 3, St Louis, 2009, Saunders.) Mouth mirror: designed to have a straight handle, a slight angle to the shank, and a working end consisting of a round metal disk with a mirror on one side. Why is the tip so thin on an explorer instrument? (Tactile sensitivity is increased.) A periodontal probe is used to measure sulcus and pocket depths of the periodontium of each tooth. The working end is calibrated in millimeters. Can you think of something else the periodontal probe can be used to measure? (Oral lesions, the width of an anterior overjet.) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 10

Fig. 34-6 Uses for the mouth mirror. A, Indirect vision Fig. 34-6 Uses for the mouth mirror. A, Indirect vision. B, Light reflection. C, Retraction. D, Tissue protection. A B D C What are the indirect areas of a patient’s mouth for the right-handed operator? Light reflection/reflective illumination: directs additional light into areas of the mouth. Retraction: helps maintain a clear field and protects the soft tissues from injury caused by the dental bur or hand instruments. What is another function of the dental mirror? Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 11

Fig. 34-9 Hand (manual) cutting instruments Fig. 34-9 Hand (manual) cutting instruments. (Photos from Boyd L: Dental instruments: a pocket guide, ed 3, St Louis, 2009, Saunders; Drawings in parts A, B, D, E, and F from Baum L, Phillips RW, Lund MR: Textbook of operative dentistry, ed 3, Philadelphia, 1995, Saunders.) Hand cutting instruments are the group of instruments placed on the tray after the examination instruments. The spoon excavator is the most commonly used excavator. The hoe is similar in appearance to a garden tool. The blade is perpendicular to the handle. What function do you think the chisel has? Remember, it has a cutting edge. (Cutting enamel margins of the tooth preparation, forming sharp lines and point angles, placing retention grooves.) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 12

Chapter 34 Lesson 34.2 Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 13

Learning Objectives List the types of restorative instruments and their uses. Identify restorative instruments. Describe additional accessory instruments and items used in general dentistry. Identify accessory instruments and items. Describe the use of preset trays and tubs in dentistry. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 14

Fig. 34-10 Restorative instruments Fig. 34-10 Restorative instruments. (From Boyd L: Dental instruments: a pocket guide, ed 3, St Louis, 2009, Saunders.) Restorative instruments, generally made of stainless steel, are used primarily to place, condense, and carve the restorative dental materials back to the normal anatomy of the tooth: Amalgam carrier Condensers Burnisher Carvers Amalgam knife Composite-placement instruments Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 15

Fig. 34-11 Accessory instruments and items Fig. 34-11 Accessory instruments and items. (From Boyd L: Dental instruments: a pocket guide, ed 3, St. Louis, 2009, Saunders.) Accessory instruments are not necessarily kept on the tray but should be readily available when needed: Spatulas Scissors Dappen dish Amalgam well Howe pliers (also called 110 pliers) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 16

Preset Cassettes Hand instruments and related accessories for a given procedure are prepared, stored, and transported together. Exam Amalgam Composite Crown and bridge Endodontic Surgical A dental practice will have sufficient types of cassettes for most common procedures to allow adequate sterilization and preparation time before the tray is needed. Sterile trays or cassettes are taken into the treatment area as part of the advanced preparation of the treatment room before the patient is seated. How will you know which trays or cassettes to bring into the treatment room before seating the patient? (Look at the daily schedule and patient record to review the patient and the planned procedure.) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 17

Instrument Sequence on a Tray Left-to-right setup Basic setup Additional examination instruments Hand cutting instruments Restorative instruments Accessory items How do you know the order in which to set up a tray? (The sequence is based on how instruments are transferred and used throughout a dental procedure.) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 18

Fig. 34-12 Preset restorative tray. (Courtesy of A-dec.) Note how the examination instruments are placed on the tray starting from the left. Following the examination instruments are the restorative instruments and then the accessory instruments. Judging from the setup shown on the slide, what procedure is to be performed? (Amalgam-restoration placement.) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 19

Color-Coding of Instruments Organization Instruments with bands of of same color Tray of the same color Tub with dental materials of the same color Coding of instruments with the use of colored bands on the handle is a common way of organizing instruments. What are two reasons for using a color-coding system? (Convenience and efficiency.) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 20