Department of Periodontology Dr.

Zaid Mohannad Yasser

Periodontal instruments
Periodontal instruments are designed for specific purposes, such as removing
calculus, planning root surfaces, curetting the gingival wall or removing disease
tissues.

Periodontal instruments composed of: a. Blade b. Shank c. handle

Classification of Periodontal Instruments

Periodontal instruments are classified according to it purposes into:-

1. Diagnostic instruments :

A. Dental mirrors
B. Dental explorers used to locate calculus deposits and caries.
C. Periodontal probes are used to locate, measure, and mark pockets, as well as
determine their course on individual tooth surfaces.
2. Debridement (scaling, root-planing, and curettage) instruments: are used for
removal of biofilm and calcified deposits from the tooth, removal of altered
cementum from the subgingival root surface, and debridement of the soft tissue
lining the pocket. Scaling and curettage instruments are classified as follows:

 Sickle scalers are heavy instruments used to remove supragingival calculus.

 Curettes are fine instruments used for subgingival scaling, root planing, and
removal of the soft tissue lining the pocket.
 Hoe, chisel, and file scalers are used to remove tenacious subgingival
calculus and altered cementum. Their use is limited compared with that of
curettes.
 Implant instruments are plastic or titanium scalers and curettes designed
for use on implants and implant restorations.
 Ultrasonic and sonic instruments are used for scaling and cleansing tooth
surfaces and curetting the soft tissue wall of the periodontal pocket.
3. Cleansing and polishing instruments, such as rubber cups, brushes, and dental
tape, are used to clean and polish tooth surfaces. Also available are air-powder
abrasive systems for tooth polishing.

4. Advance periodontal devices: Periodontal endoscopes are used to visualize

deeply into subgingival pockets and furcations, allowing the detection of deposits.
Also advance periodontal devices include ablative laser devices.

5. Surgical periodontal instruments.

Fig.:- Debridement periodontal & implants instruments.

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1- Diagnostic instruments

A. dental mirrors used for specific uses:-

 Indirect vision
 Indirect illumination
 Transillumination
 Retraction
Nonspecific uses Handles can be used for checking mobility ,percussion.
B. Dental Explorers : are used to locate calculus deposits and caries. Also
used to locate subgingival deposits in various areas, and to check the
smoothness of the root surfaces after root planing. Explorers are designed
with different shapes and angles for a variety of use.

Fig.:- Five typical explorers. A, #17; B, #23; C, EXD 11-12; D, #3; E, #3CH pigtail.

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C. Periodontal Probes

Periodontal probes are used to measure the depth of pockets and to determine their
configuration. The typical probe is a tapered, rod-like instrument calibrated in
millimeters, with a blunt, rounded tip. There are several other designs with various
millimeter calibrations. The World Health Organization (WHO) probe has
millimeter markings and a small, round ball at the tip. Ideally, these probes are
thin, and the shank is angled to allow easy insertion into the pocket.

Types of Periodontal probe shown in the following figure:

Fig. : Types of periodontal probe : A, Marquis color-coded probe. Calibrations are in 3-

mm sections. B, University of North Carolina-15 probe, a 15-mm long probe with
millimeter markings at each millimeter and color coding at the fifth, tenth, and fifteenth
millimeters. C, University of Michigan “O” probe, with Williams markings (at 1, 2, 3, 5, 7,
8, 9, and 10 mm). D, Michigan “O” probe with markings at 3, 6, and 8 mm. E, World
Health Organization (WHO) probe, which has a 0.5-mm ball at the tip and millimeter
markings at 3.5, 8.5, and 11.5 mm and color coding from 3.5 to 5.5 mm.

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Furcation areas can best be evaluated with the curved, blunt Nabers probe. 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.

Fig.:- Curved Nabers probe for detection of furcation areas, with color-coded markings at
3, 6, 9, and 12 mm.

When measuring a pocket, the probe is inserted with 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. Several measurements are made to determine the level
of attachment along the surface of the tooth.

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2. Debridement (scaling, root-planing, and curettage) instruments:

Classified as follows:

 For supra gingival scaling which include : Sickle scalers, cumine , push
scalers.

Sickle Scalers:-

Sickle scalers have a flat surface and two cutting edges that converge in a sharply-
pointed tip. The arch-shape of the instrument makes the tip so strong that it will not
break off during use. The sickle scaler appear triangular in cross-section. The
sickle scaler is used primarily to remove supragingival calculus. The sickle scaler
is inserted under ledges of calculus no more than 1 mm below the gingival sulcus.
It is used with a pull stroke. Sickles with straight shanks are designed for use on
anterior teeth and premolars. Sickle scalers with contra-angled shanks adapt to
posterior teeth.

Fig. :- Sickle scaler.

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 Fig.:- Both ends of a U15/30 scaler.

Cumine: A hybrid (double ended) instrument – one end is a “spoon” curette -the
other is a heavy duty tooth scaler. It is hook-like having a simple curved shape
without offset which tapers to a sharp point.

Uses Both ends can be used to dislodge

thick calculus deposits to allow visualization
of the crown or prior to further scaling.
Scaler end to remove heavy supragingival
calculus deposits from interproximal area.
Curette end or spoon end ; gentle curettage
of large sockets to remove the granulation

Fig.:- Cumine double ended instrument.

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tissue (if present), removal of soft tissues from sites of bony pathology e.g. to clean
out the bony defect in debridement of bone cyst lesions. also used to clean labial
and lingual surfaces from calculus.

Push scaler: These have been designed for the proximal surfaces of teeth and
primarily used in the anterior areas. Push stroke through interproximal contact
while maintaining contact with tooth surface. Needs sufficient interproximal space
and care with surrounding tissues.

Fig.:- Push scaler.

 For subgingival scaling :

Hoe scaler :- used to remove tenacious subgingival deposits, Hoe scalers are used
for scaling of ledges or rings of subgingival calculus. The blade is bent at a 99-
degree angle; the cutting edge is formed by the junction of the flattened terminal
surface with the inner aspect of the blade. The blade has been reduced to minimal
thickness to permit access to the roots without interference from the adjacent
tissues.

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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. This stabilizes the
instrument.

2. The instrument is activated with a firm pull

stroke toward the crown, pull action parallel to
the long axis of the tooth.

Fig:- Hoe scaler.

Fig.:- Hoe scaler application.

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Curettes:- The curette is the instrument of choice for removing deep subgingival
calculus, root planing, and removing the soft tissue lining the periodontal
pocket. Each working end has a cutting edge on both sides of the blade and a
rounded toe. 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 . Therefore
curettes can be adapted and provide good access to deep pockets, with minimal
soft tissue trauma . There are two basic types of curettes: universal and area
specific.

Area-Specific Curettes (Gracey Curettes)

 Double-ended Gracey curettes are paired in the following manner:

 Gracey #1-2 and #3-4: Anterior teeth
 Gracey #5-6: Anterior teeth and premolars
 Gracey #7-8 and #9-10: Posterior teeth, facial and lingual
 Gracey #11-12: Posterior teeth, mesial
 Gracey #13-14: Posterior teeth, distal

Fig. :- Gracey curettes numbers& uses.

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 Area-Specific (Gracey) Vs. Universal Curettes

Schwartz Periotrievers :- are a set of double-ended, highly magnetized

instruments designed for the retrieval of broken instrument tips from the
periodontal pocket. They are indispensable when the clinician has broken a curette
tip in a furcation or deep pocket.

Fig. :- Schwartz Periotrievers instrument

Files:- have a series of blades on a base. Their primary function is to fracture or

crush large deposits of tenacious calculus. Files can easily scratch and roughen root
surfaces when used improperly. Therefore are not suitable for fine scaling and root

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planing. Files are sometimes used for removing overhanging margins of dental
restorations.

Fig.:- File.

Ultrasonic and Sonic Instruments :- used for removing plaque, scaling,

curetting, and removing stain. Sonic devices use air pressure to create mechanical
vibration that in turn causes the instrument tip to vibrate; the frequencies of
vibration ranging from 2000 to 6500 cycles per second. Ultrasonic scalers convert
electrical current into mechanical energy in the form of high-frequency vibrations
at the instrument tip; the vibration frequencies ranging from 20,000 to 45,000
cycles per second.

There are two types of ultrasonic scalers: magnetostrictive and piezoelectric.

Magnetostrictive: Vibration of the tip is elliptical; hence all the sides can be used.

Piezoelectric: Pattern of vibration of the tip is linear; only two sides of the tip are
active.

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Ultrasonic vibrations range from 20,000 to 45,000 cycles/second. They operate in a
wet field and have attached water outlets. Ultrasonic instrument tip must be cooled
by fluid to prevent overheating of the vibrating instrument tip. They have been
shown to be as effective as hand instruments in subgingival calculus removal,
removal of attached and unattached subgingival plaque, removal of toxins from
root surfaces, and in reduction and maintenance of pocket depth.

The water lavage from ultrasonic instruments has three benefits on the treatment
site.

 Flushing action–flushes calculus, blood, bacteria, plaque from treatment site.

 Cavitation. As the water exits from instrument tip, it forms a spray of tiny bubbles that
collapses and releases shock waves in a process known as cavitation. It causes disruption of
bacterial microflora
 Acoustic streaming.

Advantage of ultrasonic over hand instruments :

1. Less effort, pressure, trauma and time.

2. Simple manipulation.
3. Water sprays clean debris.

Disadvantage of sonic & ultrasonic instrumentations:

1. Lack of tactile sensation because of light pressure during manipulation.

2. Heat generation, required coolant system.
3. Impair of visibility because of water spray.
4. Aerosol contamination.
5. Damage restorative materials (porcelain, amalgam, gold, composite
&Titanium implant abutments).

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Contraindication of ultrasonic device: 1-Infectious diseases. 2-Cardiac
pacemaker & hearing aids. 3-Gag reflex. 4-young children 5- pain.

Aerosol Production Universal infection control procedures can help minimize the
amount of aerosol produced. Three levels of defense in the reduction of dental
aerosols have been recommended :-

 The first recommended layer of defense is personal protective barriers such as a

mask, gloves, and safety glasses.
 The second layer is routine use of an antiseptic preprocedural mouth rinse.
 The final layer is the use of a high-speed evacuation device.
 A preprocedural rinse with 0.12% chlorhexidine gluconate should be used to minimize
the microbial content of the aerosol. High-speed evacuation should also be used to eliminate
as much of the aerosol as possible.
 Cardiac Pacemakers :- Magnetostrictive devices have been reported to interfere with the
function of older cardiac pacemakers.

Plastic and Titanium Instruments for Implants: Different companies are

manufacturing plastic and titanium instruments for use on titanium and other
implant abutment materials. It is important that plastic or titanium instruments be
used to avoid scarring and permanent damage to the implants.

Fig.:- Plastic probe & New Implacare (plastic curette tips).

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Dental Endoscope:- has been introduced for use subgingivally in the diagnosis
and treatment of periodontal disease . The Perioscopy system consists of a 0.99-
mm-diameter, reusable fiberoptic endoscope over which is fitted a disposable,
sterile sheath. This device allows clear visualization deeply into subgingival
pockets and furcation's. It permits operators to detect the presence and location of
subgingival deposits and guides them in the thorough removal of these deposits.
Magnification ranges from 24 to 48 times, enabling visualization of even minute
deposits of plaque and calculus. The Perioscopy system can also be used to
evaluate subgingival areas for caries, defective restorations, root fractures, and
resorption.

Fig. :- Perioscopic instrumentation permits deep subgingival visualization in pockets and

furcations.

Cleansing and Polishing Instruments

Rubber Cups:- consist of a rubber shell with or without webbed configurations in

the hollow interior. They are used in the handpiece . The handpiece, must be
sterilized after each patient use, or a disposable plastic prophylaxis angle may be
used and then discarded. A good cleansing and polishing paste that contains
fluoride should be used and kept moist to minimize frictional heat as the cup
revolves. Polishing pastes are available in fine, medium, or coarse grits.

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Aggressive use of the rubber cup with any abrasive may remove the layer of
cementum, which is thin in the cervical area.

Bristle Brushes:- are available in wheel and cup shapes . The brush is used with a
polishing paste. Because the bristles are stiff, use of the brush should be confined
to the crown to avoid injuring the cementum and the gingiva.

Dental tape :- with polishing paste is used for polishing proximal surfaces that
are inaccessible to other polishing instruments. The tape is passed interproximally
while being kept at a right angle to the long
axis of the tooth and is activated with a
firm labiolingual motion. Particular care is
taken to avoid injury to the gingiva. The
area should be cleansed with warm water to
remove all remnants of paste.

Fig.:- Dental tape.

Air-Powder Polishing. The first specially designed handpiece to deliver an air-

powered slurry of warm water
and sodium bicarbonate for
polishing was introduced in the
early 1980s. This device, called
the Prophy-Jet is very effective
for the removal of extrinsic
stains and soft deposits.

Fig. :- Air-powder polishing device.

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Surgical instruments

Excisional and incisional instruments, surgical curettes and periodontal elevators

scissors and nippers Knives are basic instruments and can be obtained with both
fixed and replaceable blades.

1. Kirkland knife:- typically used for gingivectomy. These knives are kidney
shaped and can be obtained as either double -ended or single-ended instruments.

2. Interdental knives:- Orban knife These spear-shaped knives having cutting

edges on both sides and are designed with either double-ended or single-ended
blade. useful for excising interproximal tissue.

Fig:- Kirkland knife & Orban knife.

3. Surgical blades :- Scalpel & blades of different shapes and sizes are used in
periodontal surgery. The most common blades are #12D, #15, and #15C.

4. Periodontal elevators These are needed to reflect and move the flap after the
incision has been made for flap surgery.

5. Tissues forceps: used to hold the flap during suturing and used to position and
displace the flap after reflection.

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6. Scissors are used in periodontal surgery for such purposes as removing tags of
tissue during gingivectomy ,trimming the margins of flaps , enlarging incisions in
periodontal abscesses, and removing muscle attachments in mucogingival surgery.

7.Surgical nippers: Serve same purpose as Scissors

8.Needle holders: Used to suture the flap at the desired position after surgical
procedure has been complete.

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