Periodontal Periodontal Scaling Scaling

InstrumentsInstruments(Gracey Curettes and Sickle (Gracey Curettes and Sickle

Scalers)Scalers)

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

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

Periodontal Scaling Periodontal Scaling InstrumentsInstruments

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

Periodontal Scaling Periodontal Scaling InstrumentsInstruments

In the category of area specific In the category of area specific curettes a sub classification exists. curettes a sub classification exists.

Area Specific CurettesArea Specific Curettes Gracey Curettes Gracey Curettes Vision Curettes Vision Curettes Modifications to Gracey Design Modifications to Gracey Design

After five or extended series After five or extended series Mini series Mini series Langer series Langer series

Furcation series Furcation series

Gracey Curettes Gracey Curettes

The original Gracey series The original Gracey series was developed in the was developed in the 1930's by Dr. Clayton 1930's by Dr. Clayton Gracey, a periodontist at Gracey, a periodontist at the University of Michigan. the University of Michigan.

They were designed to They were designed to provide better access to provide better access to root surfaces in deep root surfaces in deep pockets. pockets.

They feature long shanks They feature long shanks and unique blades, some and unique blades, some with bends improving with bends improving access to complex root access to complex root surface morphology. surface morphology.

Gracey CurettesGracey Curettes

The original series The original series contained 7 double ended contained 7 double ended instruments (1/2; 3/4; 5/6; instruments (1/2; 3/4; 5/6; 7/8; 9/10; 11/12; 13/14). 7/8; 9/10; 11/12; 13/14).

In the 1980's, 2 modified In the 1980's, 2 modified instruments were added instruments were added to the collection (15/16; to the collection (15/16; 17/18). 17/18).

Gracey CurettesGracey Curettes

Gracey curettes 1/2, 3/4, and 5/6 are used Gracey curettes 1/2, 3/4, and 5/6 are used to scale all tooth surfaces in the anterior to scale all tooth surfaces in the anterior sextants.sextants.

7/8 and 9/10 are used for scaling the 7/8 and 9/10 are used for scaling the buccal and lingual aspects of teeth in the buccal and lingual aspects of teeth in the posterior sextants. posterior sextants.

11/12 and the 15/16 are used to scale the 11/12 and the 15/16 are used to scale the mesial aspects of the teeth in the mesial aspects of the teeth in the posterior sextant. posterior sextant.

13/14 and 17/18 are used to scale the 13/14 and 17/18 are used to scale the distal aspects distal aspects

Gracey CurettesGracey Curettes

Gracey curettes are available in Gracey curettes are available in stainless steel or in carbon steel. stainless steel or in carbon steel. Carbon steel requires more care as it Carbon steel requires more care as it rusts very easily and also wears away rusts very easily and also wears away more quickly. more quickly.

Instruments can come in the form of a Instruments can come in the form of a solid one piece instrument (usually solid one piece instrument (usually stainless steel) or as a cone socket stainless steel) or as a cone socket instrument (usually carbon steel). With instrument (usually carbon steel). With the cone socket instrument, shank and the cone socket instrument, shank and blade can be unscrewed and replaced. blade can be unscrewed and replaced.

Gracey CurettesGracey Curettes

The design of the The design of the Gracey curettes is Gracey curettes is unique in that each unique in that each end had only one end had only one cutting edge cutting edge

It can adapt closely It can adapt closely to the specific tooth to the specific tooth surface for which it surface for which it is intended. is intended.

Gracey CurettesGracey Curettes The cutting or useable edge The cutting or useable edge

of the blade is the lower of the blade is the lower outer aspect of the blade. outer aspect of the blade.

It can be identified by It can be identified by holding the terminal shank holding the terminal shank of the end in question, blade of the end in question, blade side lower, in a vertical side lower, in a vertical position and viewing the position and viewing the blade portion head on. blade portion head on.

The blade of the curette is The blade of the curette is machined at a 70 degree machined at a 70 degree angle and the cutting edge angle and the cutting edge exhibits a curve, which is exhibits a curve, which is longer or convex in relation longer or convex in relation to the "non-working" edge. to the "non-working" edge.

Gracey CurettesGracey Curettes

When adapting the Gracey When adapting the Gracey instruments to the teeth to perform instruments to the teeth to perform scaling, the cutting edge must first scaling, the cutting edge must first be identified and placed against the be identified and placed against the surface to be scaled and the terminal surface to be scaled and the terminal shank should be parallel to that shank should be parallel to that surface. surface.

In this position, the ideal working In this position, the ideal working angulation for calculus removal is angulation for calculus removal is achieved. achieved.

Gracey CurettesGracey Curettes

Sickle ScalersSickle Scalers

The sickle scaler, primarily used The sickle scaler, primarily used for supragingival calculus for supragingival calculus removal, is a very useful removal, is a very useful instrument. instrument.

It is often the first instrument It is often the first instrument used to remove large, heavy used to remove large, heavy deposits thus improving access deposits thus improving access to subgingival area for other to subgingival area for other instruments. instruments.

Sickle ScalersSickle Scalers

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

Sickle ScalersSickle Scalers They all however have common features They all however have common features

making them suited to the removal of making them suited to the removal of heavy calculus deposits and working heavy calculus deposits and working interproximally, around the contact areas interproximally, around the contact areas of teeth. of teeth. A flat blade cut at a 90 degree angle to the A flat blade cut at a 90 degree angle to the

shank. shank. Cutting edges on both sides of the face of Cutting edges on both sides of the face of

the blade. the blade. The face of the blade is triangular tapering The face of the blade is triangular tapering

to a strong, sharp point at the toe.to a strong, sharp point at the toe. The face of the blade may be straight or The face of the blade may be straight or

curved.curved.

Sickle ScalersSickle Scalers

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

SickleSickle Scalers Scalers

GraspGrasp The firm but light hold a dental clinician The firm but light hold a dental clinician

has on their instruments is referred to as has on their instruments is referred to as "grasp". "grasp".

A proper grasp enables the clinician to A proper grasp enables the clinician to maneuver the instrument around the maneuver the instrument around the tooth and correctly direct pressure tooth and correctly direct pressure application for calculus removal without application for calculus removal without damaging the periodontal tissues. damaging the periodontal tissues.

Three specific grasps are used. They are:Three specific grasps are used. They are: pen grasppen grasp modified pen graspmodified pen grasp palm-thumb grasp. palm-thumb grasp.

The modified pen grasp is the most useful. The modified pen grasp is the most useful.

Fulcrum Fulcrum

The resting of the third finger on a The resting of the third finger on a firm intra- or extraoral site acts as a firm intra- or extraoral site acts as a fulcrum. fulcrum.

This improves control of the This improves control of the instrument and application of forces instrument and application of forces by the working end against the tooth. by the working end against the tooth.

Wrist and Arm MotionWrist and Arm Motion

The instrument/wrist/ forearm The instrument/wrist/ forearm complex must act as a unit rocking complex must act as a unit rocking firmly but smoothly on the fulcrum. firmly but smoothly on the fulcrum.

Wrist twisting or independent Wrist twisting or independent finger movement should be finger movement should be avoided. This would result in pain, avoided. This would result in pain, muscle fatigue, and inflammation muscle fatigue, and inflammation of the ligaments and nerves of the of the ligaments and nerves of the wrist. wrist.

AdaptationAdaptation

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

Angulation Angulation This is the angle This is the angle

formed by the plane of formed by the plane of the tooth surface and the tooth surface and the plane of the face of the plane of the face of the blade. the blade.

Efficient cutting Efficient cutting angulation is between angulation is between 45, 90, and 70 degrees 45, 90, and 70 degrees is considered ideal. is considered ideal. Less than 45 degrees Less than 45 degrees is considered "closed" is considered "closed" and more than 90 and more than 90 degrees is considered degrees is considered "open". "open".

Insertion Insertion

To avoid damaging the soft To avoid damaging the soft tissues when entering the tissues when entering the sulcus with a large, sharp sulcus with a large, sharp instrument, the working instrument, the working end is inserted into the end is inserted into the sulcus with the face of the sulcus with the face of the blade "closed" or flattened blade "closed" or flattened to the tooth surface. to the tooth surface.

Once in the depth of the Once in the depth of the pocket or sulcus, the blade pocket or sulcus, the blade is opened 45 to 90 degrees is opened 45 to 90 degrees for working strokes. for working strokes.

Strokes Strokes This is the action of the working This is the action of the working

end on an instrument as it is end on an instrument as it is moved across a tooth surface.moved across a tooth surface.

Exploratory strokes provide light Exploratory strokes provide light tactile feedback from the tactile feedback from the instrument tip. instrument tip.

Working strokes provide Working strokes provide controlled pressure against a controlled pressure against a tooth surface using an tooth surface using an appropriate cutting angulation. appropriate cutting angulation.

Scaling strokes are short pulling Scaling strokes are short pulling strokes made with firm pressure strokes made with firm pressure to remove increment from root to remove increment from root and enamel surfaces. and enamel surfaces.

Root planning strokes are made Root planning strokes are made to remove deposits and smooth to remove deposits and smooth the root surface. the root surface.

Working strokes are ideally a Working strokes are ideally a series of overlapping strokes series of overlapping strokes covering the entire tooth surface. covering the entire tooth surface.

THANK YOUTHANK YOU