DH101 Preclinical Sciences Instrumentation (Posterior) Lisa Mayo, RDH, BSDH Staci Janous, RDH, BS Concorde Career College TXSAN

Objectives Sickle Scaler 204S Universal Curette 13/14 and Barnhart Gracey Curette 11/12 & 13/14 Reminder: Strokes for scaling = short, controlled, overlapping Strokes for assessing = long, light, overlapping

Resources Wilkins CH 38 Nield CH 13, 14, 15, 16, 21

Sickle Scaler 204S Nield p.331 Used on enamel surfaces only Remove calculus deposits from crowns of posterior teeth Working-End Pointed back Pointed tip: face converges w/ 2 lateral surfaces to form the tip, sharp point Triangular cross section: 70-80° internal angles Two cutting edges w/ curved blade Face is perpendicular and flat (between cutting edges)

Sickle Scaler 204S (same as Ant Sickle) Nield p.332 70-80°

Sickle Scaler 204S Nield p.332 Same as Ant Sickle

Sickle Scaler 204S Nield p.344 All 4 cutting edges are used for calculus removal Paired instrument that are mirror images of one another One side adapt from the F and the other from the L

Sickle Scaler 204S Cutting Edges Nield p.344

Scaler 204S ANGULATION Nield p.343 Angle formed by the working end of an instrument with the surface to which the instrument is applied for treatment Insertion angulation = 0◦ Angulation needed to remove calculus without causing tissue trauma = 70◦

Nield p.343

Sickle Scaler 204S GET YOUR TYPODONT & 204S Nield p.345 Sickle Scaler 204S GET YOUR TYPODONT & 204S

Sickle Scaler 204S Technique Nield p.345 Sickle Scaler 204S Technique

Sickle Scaler 204S Technique Nield p.346 Sickle Scaler 204S Technique

Sickle Scaler 204S Technique Nield p.346 Sickle Scaler 204S Technique

Sickle Scaler 204S Technique Nield p.346 Sickle Scaler 204S Technique

Sickle Scaler 204S Technique Nield p.346 Sickle Scaler 204S Technique

Sickle Scaler 204S Technique Nield p.347 Sickle Scaler 204S Technique

Sickle Scaler 204S Technique Nield p.347 Sickle Scaler 204S Technique

Sickle Scaler 204S Technique Nield p.347 Sickle Scaler 204S Technique

Sickle Scaler 204S Nield p.334

Sickle Scaler Reference: Ant & 204S Summary Use of Sickle Scalers Remove med-lg size calculus deposits from the crowns of teeth Pointed tip provides good access to proximal surfaces apical to the contact areas of teeth NOT recommended for use on root surfaces Basic Concepts Tilt lower shank toward tooth surface to establish correct angulation: operator MUST force the instrument into a 70-80 angle Adapt TIP 1/3 of cutting edge of tooth Activate calculus removal stroke using wrist motion activation Relax your fingers between each calculus removal stroke Posterior Teeth Begin at DF line angle of the post-most tooth in the quadrant and work toward the D surface Reposition at the DF line angle and complete the F/L and M surfaces of tooth working toward the front of the mouth

Assessment in Clinic 204S

Universal Curette 13/14 Nield p.357 Uses Remove small – med size deposits both SUB-G and SUPRA-G Crown and root surfaces ant and post (for this class, we will only be using on posterior teeth until your skills are more developed and you can safely use on ant) Design Double-ended instrument w/paired, mirror-image working-ends Rounded back Rounded toe Semi-circular cross section 2 parallel cutting edges on a curved blade Face is at 90° angle to lower shank = 2 cutting edges are level with one another and can be used for calculus removal. Flat in cross-section and curved lengthwise 70-80° internal angles where lateral surfaces meet the face

Nield p.358 70-80◦

Universal Curet 13/14

Universal Curette 13/14 Nield p.358

Universal Curettes Nield p.359 Curettes come in different sizes and lengths

Universal Curettes Nield p.359 Curettes come in different sizes and lengths

Universal Curettes Nield p.359 Curettes come in different sizes and lengths

Nield p.360

Universal Curette 13/14 WORKING END Nield p.362 Universal Curette 13/14 WORKING END Selecting the Correct Working End: LOWER SHANK POSITION

Operator MUST force the instrument into a 70-80◦ angulation Nield p.364 Universal Curette 13/14 Operator MUST force the instrument into a 70-80◦ angulation

Universal Curette 13/14 ANGULATION Nield p.364 Universal Curette 13/14 ANGULATION

Universal Curette 13/14 ANGULATION Nield p.364 Universal Curette 13/14 ANGULATION

4 Cutting edges like sickle’s Nield p.365 Universal Curette 13/14 4 Cutting edges like sickle’s

Universal Curette 13/14 GET YOUR TYPODONT Nield p.366 Universal Curette 13/14 GET YOUR TYPODONT

Nield p.366 Universal Curette 13/14

Universal Curette 13/14 Nield p.366 Initial Insertion ALWAYS zero degrees for ALL instruments!

Nield p.367 Universal Curette 13/14

Nield p.367 Universal Curette 13/14

Nield p.367 Universal Curette 13/14

Nield p.367 Universal Curette 13/14

Nield p.368 Universal Curette 13/14

Nield p.368 Universal Curette 13/14

Universal Curette 13/14 Nield p.368 After done distal, then scale mesial

Nield p.370 Universal Curette 13/14 Scaling the Interprox

Universal Curette 13/14 Adaptation to F/L root surfaces of mandibular post teeth is challenging Clinician’s hand position may block the view of mandibular lingual surfaces Rounded posterior crowns make it difficult to instrument the root surfaces of these teeth Height of Contour on Molars Crown protrudes over & overhangs the root surface

Universal Curette 13/14 Incorrect Technique Nield p.373 Universal Curette 13/14 Incorrect Technique

Universal Curette 13/14 Incorrect Technique Nield p.373 Universal Curette 13/14 Incorrect Technique

Universal Curette 13/14 Correct Technique Nield p.374 Universal Curette 13/14 Correct Technique

Universal Curette 13/14 Correct Technique Nield p.374 Universal Curette 13/14 Correct Technique

Instrument Assessment Curette 13/14

Universal Curets Barnhart

Barnhart Names for University of Southern California where was developed by DH faculty Universal Curet 2 cutting edges, rounded toe Thin, sharp cutting edge Longer shank & blade than Columbia 13/14 More effective at times on interproximal molars Uses Slips easily under tight tissues Light to mod calculus both supra and sub-g

Universal Curettes Curettes come in different sizes and lengths

Universal Curettes Curettes come in different sizes and lengths

Gracey 11/12 & 13/14 Area-Specific Instruments Nield p.387 Gracey 11/12 & 13/14 Area-Specific Instruments

Gracey 11/12 & 13/14 Nield p.387 All Gracey’s are called “Area-Specific Curets” Remove light to moderate calculus deposits from the crowns and roots of teeth To instrument all surfaces of posterior teeth – will need to use both sides of the instrument Characteristics of all Gracey’s Face is tilted in relation to lower shank: 70° and one cutting edge lower then the other Only one cutting edge per working-end Long, complex functional shank Rounded back Rounded toe Semi-circular cross section

Gracey 11/12 & 13/14 Nield p.388 70-80°

Gracey 11/12 & 13/14 Nield p.388

Gracey 11/12 & 13/14 Tilted face causes one cutting edge – “working cutting edge” – to be lower than the other cutting edge on each working end Side in contact with tooth to remove deposits Nonworking edge is too close to the lower shank to be used for calculus removal and is the “higher” edge Side in contact with tissue

Gracey’s

Nield p.392

Nield p.398 Gracey 13/14 11/12 Distal Mesial

Gracey: Correct Working-End Nield p.399 Gracey: Correct Working-End

GET YOUR TYPODONT & G13/14 1st Mand Molar

Gracey 13/14

NIELD p.400 Gracey 13/14

NIELD p.400 Gracey 13/14

NIELD p.401 Gracey 13/14

NIELD p.401 Gracey 13/14

NIELD p.401 Gracey 13/14

Gracey 13/14 NIELD p.401

NIELD p.404 Gracey 13/14

GET YOUR TYPODONT & G11/12 1st Mand Molar

NIELD p.402 Gracey 11/12 Notice how much MORE of the tooth you cover with 11/12 than 13/14!

NIELD p.402 Gracey 11/12

NIELD p.402 Gracey 11/12

NIELD p.402 Gracey 11/12

NIELD p.403 Gracey 11/12

NIELD p.403 Gracey 11/12

NIELD p.403 Gracey 11/12

NIELD p.403 Gracey 11/12

NIELD p.404 Gracey 11/12

NIELD p.404 Gracey 11/12

Assessment in Clinic Gracey

Gracey Root Debridement Strokes NIELD p.408

Gracey Root Debridement Strokes NIELD p.408 70◦

Gracey Root Debridement Strokes NIELD p.408

Gracey Horz Strokes Sub-G NIELD p.409

Gracey Horz Strokes Sub-G NIELD p.409

Gracey Horz Strokes Sub-G NIELD p.409

Scaling Steps: IN THIS ORDER! Select Correct Cutting Edge Instrument Grasp: modified pen grasp Stabilization: Finger Rests/Fulcrum Adaptation: toe/tip 1/3 of a blade Insertion: Insert at 0° angle/flat against tooth surface to base of pocket then adapt to 70° Angulation: 70° for scaling to avoid Trauma to Tissue Lateral Pressure: light, moderate, heavy Stroke: wrist-rock with vert/horz/oblique

Instrument Angles 70◦

Instrument Selection Nield CH21 Instrument selection based on size & location of deposit EX: Small-medium sized SUBgingival calculus Universal curet Area-specific curet

Lighter Deposits Subgingival Heavier Deposits Subgingival WHICH INSTRUMENT WOULD YOU USE?

Instrument Selection Nield CH21

Instrument Selection Nield CH21

Angulation & Calculus Removal Nield CH13 Nield p.320 Calculus Removal Stroke Assess & find the calculus deposit Cup the calculus with the face of the instrument Stroke: lock toe-third against the tooth surface, open face to 70 degrees & stroke AWAY from the base of the pocket

Nield p.321

Nield p.321

Angulation & Calculus Removal Nield CH13 Errors in Angulation Will burnish or injure tissue Angles more than 90◦ = 1 cutting edge will be in contact with tissue

Angulation & Calculus Removal Nield CH13 Errors in Angulation Angles less than 45◦ = cutting edge slides over deposit rather than biting into it (burnish calculus) Nield p.324

Nield p.325