Periodontal Instruments Classification of periodontal instruments Periodontal instruments are classified according to the purposes they serve, as follows:

1) Periodontal probes : are used to locate, measure, and mark pockets. 2) Explorers : are used to locate calculus deposits and caries. 3) Scaling, root-planing, and curettage instruments : are used for removal of biofilm and calcified

deposits. Scaling and curettage instruments are classified as follows: a) Sickle scalers : are heavy instruments used to remove supragingival calculus. b) Curettes : are fine instruments used for subgingival scaling, root planing, and removal of the

soft tissue lining the pocket. c) Hoe, chisel, and file scalers : are used to remove tenacious subgingival calculus and altered

cementum. Their use is limited compared with that of curettes. d) Ultrasonic and sonic instruments

4) The periodontal endoscope : is used to visualize deeply into subgingival pockets and furcations, allowing the detection of deposits.

5) Cleansing and polishing instruments : such as rubber cups, brushes, and dental tape, are used to clean and polish tooth surfaces.

The parts of each instrument are:

1) the working end. 2) the shank. 3) the handle.

1- Periodontal probes - are used to measure the depth of pockets. - The typical probe is a tapered, rodlike instrument calibrated in millimeters, with a blunt, rounded

tip (Figure 45-2). - When measuring a pocket, the probe is inserted with a firm, gentle pressure to the bottom of the

pocket. The shank should be aligned with the long axis of the tooth surface to be probed

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- There are several other designs with various millimeter calibrations (Figure 45-3).

- Furcation areas can best be evaluated with the curved, blunt Nabers probe (Figure 45-4).

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2- Explorers - are used to locate subgingival deposits and carious areas and to check the smoothness of the root

surfaces after root planing. - Explorers are designed with different shapes and angles, with various uses (Figure 45-5), as well

as limitations (Figure 45-6). - The periodontal probe can also be used in detection of subgingival deposits (Figure 45-6, D).

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3- Scaling and Curettage Instruments - The five basic scaling instruments are in Figure 45-7.

a) Sickle Scalers - Sickle scalers have a flat surface and two cutting edges that converge in a sharply pointed tip.

The shape of the instrument makes the tip strong so that it will not break off during use (Figure 45-8).

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- The sickle scaler is used primarily to remove supragingival calculus (Figure 45-9).

- Because of the design of this instrument, it is difficult to insert a large sickle blade under the gingiva without damaging the surrounding gingival tissues (Figure 45-10).

- Sickle scalers are used with a pull stroke. - It is important to note that sickle scalers with the same basic design can be obtained with

different blade sizes and shank types to adapt to specific uses. Sickle scalers with straight shanks are designed for use on anterior teeth and premolars. Sickle scalers with contra-angled shanks adapt to posterior teeth.

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b) Curettes - The curette is the instrument of choice for removing deep subgingival calculus, root planing

altered cementum, and removing the soft tissue lining the periodontal pocket (Figure 45-13).

- Each working end has a cutting edge on both sides. - The curette is finer than the sickle scalers and does not have any sharp points or corners other

than the cutting edges of the blade (Figure 45-14). - Therefore curettes can be adapted and provide good access to deep pockets, with minimal soft

tissue trauma

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c) Hoe Scalers - Hoe scalers are used for scaling of ledges or rings of calculus (Figure 45-38).

- Hoe scalers are used in the following manner: 1. The blade is inserted to the base of the periodontal pocket so that it makes two-point

contact with the tooth (see Figure 45-38). This stabilizes the instrument and prevents nicking of the root.

2. The instrument is activated with a firm pull stroke toward the crown, with every effort being made to preserve the two point contact with the tooth.

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d) Files - Files have a series of blades on a base (Figure 45-39). - Their primary function is to fracture or crush large deposits of tenacious calculus or

burnished sheets of calculus. - Files can easily gouge and roughen root surfaces when used improperly. Therefore they are not

suitable for fine scaling and root planing. - Mini-bladed curettes are currently preferred for fine scaling in areas where files were once used. - Files are sometimes used for removing overhanging margins of dental restorations.

e) Chisel Scalers.

- The chisel scaler, designed for the proximal surfaces of teeth too closely spaced to permit the use of other scalers, is usually used in the anterior part of the mouth.

- The chisel is inserted from the facial surface. - The slight curve of the blade makes it possible to stabilize it against the proximal surface,

whereas the cutting edge engages the calculus without nicking the tooth. - The instrument is activated with a push motion while the side of the blade is held firmly against

the root.

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Diamond-Coated Files - Diamond-coated files are unique instruments used for final finishing of root surfaces. - New diamond files are sharply abrasive and should be used with light, even pressure against the

root surface to avoid gouging or grooving. - Diamond files can produce a smooth, even, clean, and highly polished root surface. - Diamond files must be used carefully because they can cause over instrumentation of the root

surface. - They will remove too much root structure if they are used with excessive force, are poorly

adapted to root morphology, or used too long in one place. - Diamond files are particularly effective when used with the dental endoscope, which reveals

residual deposits and directs the clinician to the exact area for instrumentation.

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Reference CARRANZA’S CLINICAL PERIODONTOLOGY 11th edition

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