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Dr.

Yasir Khattak
Assistant Professor
SBDC
Why do we need instruments in dentistry?

For removal, shaping and restoring of tooth structure


Instruments can generally be classified as

Those used for exploration

Those used for removal of tooth structure

Those used for restoration of teeth


Exploring Instruments
An air syringe and a pair of tweezers
An overhead /intraoral light
Mouth mirrors
Explorers (Probes)
i. Straight explorer
ii. Right-angled explorer
iii. Arch explorer
iv. Interproximal explorere
Exploring Instruments
Explorers has three parts;

a. The handle, which is straight with serrations

b. The shank, which is smooth and may carry a curvature


or one or more angles

c. The exploring tip, which is the terminal portion of the


explorer
Instruments for Tooth Structure
removal
Hand cutting instruments

Rotary cutting and rotary abrasive instruments

Ultrasonic instruments

Laser Equipment
Hand Instruments
Problems with earlier instruments were
Large, heavy handles
Inferior metal alloys in the blades
Awkward to use
Ineffective in many situations
No uniformity of manufacture or nomenclature
Black is credited with the first acceptable
nomenclature for and classification of hand
instruments.

Enabling dentists to communicate more clearly and effectivey


in regard to instrument design and function
Materials
Carbon steel
Harder
Corrodes when unprotected
Stainless steel
Remains bright
Loses a keen edge
Carbide inserts
Hard
Wear resistant
Brittle
Cannot be used in all conditions
Heat Treatments/Manufacturing
Two types of heat treatments;
Hardening
Hardens the alloy
Makes it brittle when the carbon content is high
Tempering
Relieves strains
Increases toughness
Heating or flaming of hand instruments during
dental use can alter the original properties of the
alloy and render it unserviceable.

Improper sterilization procedures can ruin a well


manufactured instrument e.g. dry heat may
reduce the hardness of the alloy.
Terminology and Classification
Instrument Categories:
I. Cutting nstruments
Excavators
Chiesels

II. Non-cutting instruments


Amalgam condensers
Amalgam burnishers
Plastic instruments
Instrument Categories
Excavators
Ordinary hatchets
Hoes
Angle formers
spoons

Chisels
Straight chisels
Curved chisels
Bin-angle chisels
Enamel hatchets
Gingival margin trimmers
Instrument Design
Handle

Shank

Blade
Instrument Design
For many non-cutting instruments, the part
corresponding to the blade is termed the nib.

The end of the nib, or working surface, is known as the


face.

Some instruments have a blade on both ends of the


handle and are known as double-ended instruments.
Handle
It is the part grasped in the operators hand.
Perfectly straight, smooth or eight sided.
Serrated for better gripping and control of the
instrument.
Handles are in conjunction with the shank or it
may be separable.
Separate type is known as cone-socket handle and
allows for replacement of several working ends
e.g. mirrors and condensers.
Shank
Connect the handle to the working end of the
instrument.
Normally smooth, round and tapered.
Have one or more angles to avoid twisting of the
instrument.
Hand instruments must be balanced and sharp.
Balance allows for the concentration of force onto the
blade without causing rotation of the instrument.
Balance is accomplished by designing the angle of the
shank so that the cutting edge of the blade must not
be off axis by more than 1-2 mm.
Sharpness concentrates the force onto the small area
of the edge, producing a high stress.
Shank Angles
Monangle

Binangle

Triple angle

Instruments with small short blades may be


monangle

Instruments with long blades may required two or


three angles in the shank to bring the cutting edge
near to the long axis of the handle. Such shanks are
termed contra-angled.
Blade
This is the working part of the instrument.
Begins at the point where the shank ends.
It is connected to the handle by the shank.
Each blade has a cutting edge which is the
working part of the instrument.
It is usually in the form of a bevel (acute angle)
that cuts into the tooth structure.
Instrument Nomenclature
Black classified all instruments by name.
He classified dental instruments according to:
1. Function e.g. scaler, excavator.
2. Manner of use e.g. hand condenser.
3. Design of the working end e.g spoon excavator,
sickle scaler.
4. Shape of the shank e.g. mono-angle, biangle, contra-
angle.
These names were combined to form the complete
description of the instrument e.g. binangle spoon
excavator.
Operative Cutting Instrument
Formula
Formulas that describe the dimensions and angles of the
working end.

Placed on the handle using a code of three or four numbers


separated by dashes or spaces (e.g. 10-85-8-14).

The first number indicates the width of the blade in tenths


of a mm ( e.g. 10 = 1 mm).

The second number, primary cutting edge angle, measured


from a line parallel to the long axis of the handle in
clockwise centigrades.
Operative Cutting Instrument
Formula
The third number indicates the blade length in mm
(e.g. 8 = 8 mm).

The fourth number indicates the blade angle relative


to the long axis of the handle in clockwise centigrades.

Additional number on the handle is the


manufacturers identification number. It should not be
confused with the formula number.
Cutting Instrument Bevels
A single bevel that forms the primary cutting edge.

Additional two secondary cutting edges that extend


from the primary cutting edge for the length of the
blade.

Bibeveled instruments, such as ordinary hatchets, have


two bevels that form the cutting edge.
Cutting Instrument Bevels
Single-beveled instruments are used with

Scrapping cutting motion


Lateral cutting motion
Planing or direct cutting motion

Must be made in pairs, having the bevels on the


opposite sides of the blade..Right or Left Beveled
Instruments.
Cutting Instrument Bevels
Most instruments are available with blades and shanks on
both ends of the handle..Double-ended Instrumets.

Single-ended instruments may be safer to use, but double-


ended instruments are more efficient because they reduce
instrument exchange.

Certain single-beveled instruments are not designated as


right or left, but instead as having a mesial bevel or a distal
bevel, such as bin-angle chisels, wedelstaedt chisels and
hoes.
Cutting Instrument Applications
Excavators are used for

Removal of caries
Refinement of the internal parts of the preparation

Chisels are used primarily for cutting enamel.


Excavators
i. Ordinary hatchets

ii. Hoes

iii. Angle-formers

iv. Spoons
Ordinary Hatchet
Cutting edge is bibeveled.

Cutting edge of the blade parallel to the axis of the


handle handle.

Used promarily in anterior teeth for preparing


retentive areas and sharpening internal line angles,
particularly in preparations for direct gold
restorations.
Ordinary Hatchet
Hoe Excavator
Primary cutting edge of the blade perpendicular to the
axis of the handle.

Used for
Planing tooth preparation walls
Forming line angles

Class III and IV preparations for direct gold restorations


Hoe Excavator
Angle-former
A combination of a chisel and gingival margin trimmer,
available in pairs(right and left).

Mon-angled

Primary cutting edge is at an angle ( other than 90 degrees)


to the blade.

Used
Primarily for sharpening line angles
Creating retentive features in dentin in preparation for gold
restoration
For placing a bevel on enamel margin
Angle-former
Spoon Excavator
Cutting edges are either circular (discoid) or clawlike
(cleoid).

Blades are slightly curved.

Shank may be binangle or triple angle to facilitate


accessibility.

Used for
Removing caries
Carving amalgam
Carving direct wax pattern.
Spoon Excavator
Chisels
Intended primarily for cutting enamel

Grouped as;

i. Straight, slightly curved or bin-angle

ii. Enamel hatchets

iii. Gingival margin trimmers


Straight Chisel
Has a straight shank and blade.
Bevel on only one side.
Primary cutting edge is perpendicular to the axis of the
handle.
The force used with all these chisels is essentially a
straight thrust.
There is no need for a right or left type in straight
chisels.
Straight Chisel
Wedelstaedt and Bin-angled Chisels
The shank and blade of the chisel also may be slightly
curved (Wedelstaedt design) or may be bin-angled.
The primary cutting edges are in a plane perpendicular
to the axis of the handle.
May have either a distal bevel or mesial bevel.
Wedelstaedt and Bin-angled Chisels
Enamel Hatchet
Similar in design to the ordinary hatchet except that;
The blade is larger
The blade is heavier
The blade is beveled on only one side

The cutting edge is in a plane that is parallel with the


axis of the handle.
Comes in right and left sides.
Used for cutting enamel.
Enamel Hatchet
Gingival Margin Trimmer
The blade is curved.
The primary cutting edge is at an angle (other than
perpendicular) to the axis of the handle.
Designed to produce a proper bevel on gingival enamel
margins of proximo-occlusal preparations.
Also used for rounding or beveling of the axiopulpal
line angles of two surface preparations.
Gingival Margin Trimmer
Other Cutting Instruments
Knife
File
Discoid-cleoid instrument

Used for trimming restorative material


Other Cutting Instruments
Knife
o Also known as finishing knives, amalgam knives or gold
knives
o Designed with a thin, knife-like blade that is made in various
sized and shapes
o Used for trimming excess restorative material on the gingival,
facial or lingual margins of a proximal restoration or trimming
and contouring the surface of a Class V restoration
Other Cutting Instruments
Files
o Used to trim excess restorative material
o Particularly useful at gingival margins
o Blades of files are extremely thin and teeth on the
cutting surfaces are short
o Designed to make the file either a push or a pull
instrument
Other Cutting Instruments
Discoid-cleoid Instrument
o Used principally for carving occlusal anatomy in unset
amalgam restorations

o Used to trim or burnish inlay-onlay margins

o The working ends of this instrument are larger than the


discoid or cleoid end of an excavator
Hand Instrument Techniques
Modified pen
Inverted pen
Palm-and-thumb
Modified palm-and-thumb

The conventional pen grasp is not an acceptable


instrument grasp
Conventional Pen Grasp
Modified Pen Grasp
Permits the greatest delicacy of touch.
Pads of the thumb, index and middle fingers contact
the instrument while the tips of the ring and little
fingers are placed on the nearby tooth surface of the
same arch as a rest.
The palm of the hand is facing away from the operator.
The instrument should not be allowed to rest on or
near the first joint of the middle finger as in the
conventional pen grasp, as it limits the application of
pressure.
Modified Pen Grasp
Inverted Pen Grasp
The hand is rotated, however, so that the palm faces
more toward the operator.

This grasp is used mostly for tooth preparations


employing the lingual approach on anterior teeth.
Inverted Pen Grasp
Palm-and-Thumb Grasp

The handle of the instrument is placed on the palm of


the hand and grasped by all the fingers while the
thumb is free of the instrument and rested on the
nearby tooth of the same arch or on a firm, stable
structure.
Palm-and-Thumb Grasp
Modified Palm-and-Thumb Grasp
Used when it is feasible to rest the thumb on the tooth
being prepared or the adjacent tooth.
The handle of the instrument is held by all four
fingers, whose pads press the handle against the distal
area of the palm and the pad and first joint of the
thumb.
Grasping the handle under the first joint of the ring
and little fingers act as a stabilizer.
This grip fosters control against slippage.
Modified Palm-and-Thumb Grasp
Hand Instrument Techniques
The modified pen and inverted pen grasps are used
practically universally.

The modified palm-and-thumb grasp usually is


employed in the area of the maxillary arch and is best
adopted when the dentist is operating from a rear-
chair position.
Rests
A proper instrument grasp must include a firm rest to
steady the hand during the operating procedures.

The closer the rest areas are to the operating area, the
more reliable they are.

Sometimes soft tissues are used as rests, but neither


soft tissue rests nor distant hard tissue rests affords
reliable control and they reduce the force or power that
can be used safely.
Guards

Guards are hand instruments or other items, such as


interproximal wedges, used to protect soft tissues from
contact with sharp cutting or abrasive instruments.
Sharpening Hand Instruments
The cutting edge of the hand instrument should
always be kept sharp as dull instruments may
cause:
Loss of control.
More pain.
Prolonged time for the operative procedure.
Reduce the quality and precision of tooth
preparation.
Sharpening Hand Instruments
Instruments can be sharpened with;
Stationary sharpening stone e.g. Arkansasstone, silicon
carbide.

Mechanical sharpener; moves at low speed while the


instrument is held at the opposite angle and supported
by a rest . easier and less time consuming.
Rotary Instrumentation
The most universally used instruments for gross
removal of tooth structure.

These are tools used to cut and reduce tooth


structure, they are fitted in hand-pieces, & work by
energy delivered from a source of power.

Rotary instruments complete different functions in the cutting, polishing, and finishing of tooth
structure and the restoration process.
Characteristics;
Speed
Pressure
Heat production
Vibration
Patient reaction
Operator fatigue
Sources of power
Instrument design
Speed
Refers to the revolutions per minute as well as the surface feet
per unit time of contact that the tool has with the work to be cut.

The maximum cutting efficiency of a cutting tool of uniform


width ranges between 5000-6000 surface feet per minute.

Since the surface feet per minute is controlled mainly by the


RPM and the size of the revolving tool, it is important to
consider the size of the working tool in relation to the speed of
operation.
Speed
Speeds are classified for dental use as;

Ultra-low speed (300-3000 RPM)


Low speed (3000-6000 RPM)
Medium high speed (20 000-45 000 RPM)
High speed (45 000-100 000 RPM)
Ultra-high speed (100 000 RMP and more)
Pressure
Pressure is a resultant effect of two factors (force and
area) under the control of the dentist.
P = F/A

It has been observed clinically that low speed requires


2-5 pounds force, high speed requires less force (1
pound) and ultra-high speed still less force (1-4
ounces) for efficient cutting.
Heat Production
Heat is directly proportional to;
Pressure
RPM
Area of tooth in contact with the tool
A temperature of 113F within the pulp can produce
inflammatory responses that could result in pulpitis and
eventual pulp necrosis. Pulps of teeth will be permanently
damaged if a temperature of 130 F is reached.
Coolants be used to eliminate eventual pulpal damage, such as
flowing water, a water-air spray, or air.
Vibration
Adverse effects of vibration are;
Annoying for the patient
Fatigue for the operator
Excessive wear of instruments
Destructive reaction in the tooth and supporting tissues
The rotation of approximately 6000 RPM sets up a fundamental
vibrational wave of approximately 100 cycles per second, this is
the range most annoying to the patient and the dentist. At 1300
cycles per second, vibrations are practically imperceptible to the
patient.
Patient Reaction
The factors that cause patient apprehension are
Heat production
Vibrational sensation
Length of operating time
Number of visits
The use of coolants, intermittent application of a tool
to the tooth and sharp instruments all aid greatly in
minimizing both patient discomfort and unnecessary
irritation to the oral structures.
Operator Fatigue
The major causes of fatigue are;
Duration of operation
Vibration produced in the handpiece
Forces needed to control the rotating instrument
Apprehension on the part of the dentist regarding the
possibility of producing a pulp exposure or injuring adjacent
oral, intra- or paraoral tissues
Lack of patient co-operation
Sources of Power

The air turbine remains the main power source,


although electric motors can also be used as the power
source.
Instrument Design
Instrument design for rotary instrumentation should
be evaluated in two parameters;
The handpiece

The cutting tool itself


Handpiece
Straight, contra-angled and right-angled.
screw-in, latch or friction grip type of attachment.
Evaluated according to
a. Friction
b. Torque
c. Vibration
Cutting Tool
Two types;
Burs..cutting tools
Stones.abrading tools
Dental Cutting Burs
Steel burs and tungsten carbide burs.
General design of dental burs:
A. Bur Tooth: terminates in the cutting edge or blade.
Has two surfaces, the tooth face and the back or the
flank of the tooth.
B. Rake Angle: the angle that the face of the bur tooth makes with the
radial line from the centre of the bur to the blade.
i. Negative
ii. Zero
iii. Positive
C. Land: the plane surface immediately following the cutting edge.
D. Clearance Angle: the angle between the back of the tooth and the
work. If land is present, the clearance angle is then divided into;
C. Primaray clearance, the angle the land will make with the work
D. Secondary clearance, the angle between the back of the bur tooth and work
E. When the back surface of the tooth is curved, the clearance is called radial
clearance
E. Tooth Angle: measured between the face and the back
F. Flute or Chip Space: the space between successive teeth
Dental Cutting Burs
6-8 teeth in a bur
Three parts;
The head
The shank
The shaft or the attachment part
Dental Cutting Burs
Classified as;
Latch type or friction grip type
A contrangle bur or a straight handpiece bur
Right and left
Long, short or regular
Cutting burs or those used to finish and polish restoration
According to the shapes
Factors Influencing the Cutting
Efficiency of Burs
A. Influence of design and manufacturing
I. Rake angle
The more positive that the rake angle is, the greater is the
burs cutting efficiency.
Positive rake angles can be incorporated in tungsten carbide
burs
II. Clearance Angle
This angle provides clearance between the work and the
cutting edge to prevent the tooth back from rubbing on the
work
Large clearance angle may result in less rapid dulling of the
bur
Influence of Design and
Manufacturing
III. Number of teeth or blades their distribution
Number of teeth limited to 6-8, so as to have increased
space between the bur teeth which decreases their clogging
tendency.
Burs with straight flutes produce less temperature rise than
one with spiral flutes.
However, the fewer the number of bur teeth, the greater the
tendency for vibration. But if there are two or more blades
in contact with the work at one time, this effect would not
be of great importance.
Influence of Design and
Manufacturing
IV. Run-out
Refers to the eccentricity or maximum displacement of the
bur head from its axxis of rotation while the bur turns.
The average value of clinically acceptable run-out is about
0.023 mm.
Depends not only on the eccentricity of the bur itself, but
also on the precision of the dental handpiece.
The efficiency in cutting of the bur is definitely affected by
its run-out.
Influence of Design and
Manufacturing
V. Finish of the flutes
VI. Design of flute ends
VII. Heat treatment
VIII. Bur diameter
IX. Depth of engagement
X. Influence of load
XI. Influence of speed
Dental Abrasive Stones
Abrasive particles are held together by means of a
binder (base) of variable nature.
A ceramic binder is used in many cases, particularly for
binding diamond chips.
Also an electroplating process providing a metallic
binder may be used.
For soft grade stones, rubber or shellaac may be used.
Dental Abrasive Stones
Classified as;
Diamond stones
Carbides
Sand
Aluminium oxide
garnet
Dental Abrasive Stones
Factors influencing the abrasive efficiency of dental
stones:
Irregularity in shape of abrasive particles
Hardness of the abrasive material relative to that of work
Impact strength of the abrasive material
Size of the abrasive particles
Pressure and RPM
Ultrasonic Instruments
The ultrasonic dental unit consists of an ultrasonic
generator, separate from a magnetostrictive transducer
located within the handpiece.
The generator delivers the energy to the transducer
which in turn creates vibrations used to remove hard
substances.
Water cooling system is incorporated to control
heating.
Ultrasonic instruments are not universally used for
cavity preparations; they are mostly used for calculus
and stain removal from teeth and restoration surfaces.
Laser equipments

Used in conservative cutting in tooth


structure
Uses a laser light beam instead of rotary
instruments.
Hazards with Cutting Instruments
Pulpal danger

Soft tissue dangers

Eye, ear and inhalational dangers