Periodontal Scaling Instruments (Gracey Curettes and Sickle Scalers)

Periodontal scaling is the therapeutic procedure performed by a dentist or dental hygienist to remove all mineralized, hardened deposits from the tooth's surfaces. It is performed supra and subgingivally and can be done using a non surgical (closed) or a surgical (open) approach.

Based on instrument design, how they are used, where they are used and how they work, the following classification of periodontal scaling instruments is used.

Periodontal Scaling Instruments Sickle scalers Universal Curettes Area Specific Curettes Files Ultrasonic/Sonic Instruments

Periodontal Scaling Instruments In the category of area specific curettes a sub classification exists. Area Specific Curettes Gracey Curettes Vision Curettes Modifications to Gracey Design After five or extended series Mini series Langer series Furcation series

Gracey Curettes The original Gracey series was developed in the 1930's by Dr. Clayton Gracey, a periodontist at the University of Michigan. They were designed to provide better access to root surfaces in deep pockets. They feature long shanks and unique blades, some with bends improving access to complex root surface morphology.

Gracey Curettes The original series contained 7 double ended instruments (1/2; 3/4; 5/6; 7/8; 9/10; 11/12; 13/14). In the 1980's, 2 modified instruments were added to the collection (15/16; 17/18).

Gracey Curettes Gracey curettes 1/2, 3/4, and 5/6 are used to scale all tooth surfaces in the anterior sextants. 7/8 and 9/10 are used for scaling the buccal and lingual aspects of teeth in the posterior sextants. 11/12 and the 15/16 are used to scale the mesial aspects of the teeth in the posterior sextant. 13/14 and 17/18 are used to scale the distal aspects

Gracey Curettes Gracey curettes are available in stainless steel or in carbon steel. Carbon steel requires more care as it rusts very easily and also wears away more quickly. Instruments can come in the form of a solid one piece instrument (usually stainless steel) or as a cone socket instrument (usually carbon steel). With the cone socket instrument, shank and blade can be unscrewed and replaced.

Gracey Curettes The design of the Gracey curettes is unique in that each end had only one cutting edge It can adapt closely to the specific tooth surface for which it is intended.

Gracey Curettes The cutting or useable edge of the blade is the lower outer aspect of the blade. It can be identified by holding the terminal shank of the end in question, blade side lower, in a vertical position and viewing the blade portion head on. The blade of the curette is machined at a 70 degree angle and the cutting edge exhibits a curve, which is longer or convex in relation to the "non-working" edge.

Gracey Curettes When adapting the Gracey instruments to the teeth to perform scaling, the cutting edge must first be identified and placed against the surface to be scaled and the terminal shank should be parallel to that surface. In this position, the ideal working angulation for calculus removal is achieved.

Gracey Curettes

Sickle Scalers The sickle scaler, primarily used for supragingival calculus removal, is a very useful instrument. It is often the first instrument used to remove large, heavy deposits thus improving access to subgingival area for other instruments.

Sickle Scalers A number of different sickle scalers are available in a variety of shapes and sizes. Towner H-15 Jacquette 204 S; 204 SD Morse USC - 128

Sickle Scalers They all however have common features making them suited to the removal of heavy calculus deposits and working interproximally, around the contact areas of teeth. A flat blade cut at a 90 degree angle to the shank. Cutting edges on both sides of the face of the blade. The face of the blade is triangular tapering to a strong, sharp point at the toe. The face of the blade may be straight or curved.

Sickle Scalers It is the sharp pointed toe and the first 1-2 mm of the lateral cutting edges that perform the work.

Sickle Scalers

Grasp The firm but light hold a dental clinician has on their instruments is referred to as "grasp". A proper grasp enables the clinician to maneuver the instrument around the tooth and correctly direct pressure application for calculus removal without damaging the periodontal tissues. Three specific grasps are used. They are: pen grasp modified pen grasp palm-thumb grasp. The modified pen grasp is the most useful.

Fulcrum The resting of the third finger on a firm intra- or extraoral site acts as a fulcrum. This improves control of the instrument and application of forces by the working end against the tooth.

Wrist and Arm Motion The instrument/wrist/ forearm complex must act as a unit rocking firmly but smoothly on the fulcrum. Wrist twisting or independent finger movement should be avoided. This would result in pain, muscle fatigue, and inflammation of the ligaments and nerves of the wrist.

Adaptation This refers to the placement of the working end of the instrument in the correct relationship to the tooth.

Angulation This is the angle formed by the plane of the tooth surface and the plane of the face of the blade. Efficient cutting angulation is between 45, 90, and 70 degrees is considered ideal. Less than 45 degrees is considered "closed" and more than 90 degrees is considered "open".

Insertion To avoid damaging the soft tissues when entering the sulcus with a large, sharp instrument, the working end is inserted into the sulcus with the face of the blade "closed" or flattened to the tooth surface. Once in the depth of the pocket or sulcus, the blade is opened 45 to 90 degrees for working strokes.

Strokes This is the action of the working end on an instrument as it is moved across a tooth surface. Exploratory strokes provide light tactile feedback from the instrument tip. Working strokes provide controlled pressure against a tooth surface using an appropriate cutting angulation. Scaling strokes are short pulling strokes made with firm pressure to remove increment from root and enamel surfaces. Root planning strokes are made to remove deposits and smooth the root surface. Working strokes are ideally a series of overlapping strokes covering the entire tooth surface.

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