Handbook of Instruments in Dentistry 9387742830, 9789387742833, 9789388178051

Table of contents :
Front Cover
Half Title Page
Contributors
Title Page
Copyright
Foreword
Preface
Acknowledgments
Contents
1. Dental Chair
Definition
Evolution of Dental Chair
Types of Dental Chair
Portable
Non-Portable
General Dental Chair
Kids Dental Chair
Surgical Dental Chair
Parts of Dental Chair
A. Double-articulating headrest back rest
B. Multi-position armrests
C. Pilot lamp/dental light
D. Three way-syringe
E. Suction tube
F. Compressed air–water line
G. Cuspidor
H. Cavity holder
I. Instrument tray
J. Monitor mount tilt and drift
K. Touchpad chair controls
L. Operator stools
General Considerations
Care and Maintenance
Chair Position
Zone Operating Areas
Patient Positions
Chair Positions
Operating Positions
Right Front Position (7 O’clock)
Right Position (9 O’clock)
Right Rear Position (11 O’clock)
Direct Rear Position (12 O’clock)
Considerations While Doing Patient
2. Conservative and Endodontic Instruments
Introduction
Classification of Instruments
GV Black’s Classification
Marzouk Classification
Parts of Hand Cutting Instruments
Handle (shaft)
Shank
G V Black Classification of Instruments Based on Shank Design
Blade
Instrument Nomenclature (According to G V Black)
Instrument Formula
Three Number Formula
Four Number Formula
Classification of Instruments Based on Their Usage
Exploratory Instruments
Mouth Mirror
Explorers
Probes
Tweezers or Dressing Pliers
Cutting Instruments
Excavators
Chisels
Enamel Hatchet
Gingival Marginal Trimmer
Other Cutting Instruments
Non-Cutting Restorative Instruments
Cement Spatula
Plastic Spatula (Agate Spatula)
Teflon Coated Plastic and Metal Instrument
Amalgam Carrier
Condenser
Carvers
Burnishers
Mortar and Pestle
Glass Slab
Matrix
Ivory No. 1 Matrix
Ivory No. 8 Matrix
Tofflemire Matrix Retainer: Universal Matrix
Compound Supported Matrix
T-Band Matrix
Precontoured Matrix
Copper Band Matrix
Automatrix
Clear Plastic/Mylar Strips
Cellophane Strips
Transparent Plastic Crown Form Matrixes
Window Matrix
Tin Foil Matrix
Preformed Transparent Cervical Matrixes
Wedges
Wooden Wedges
Plastic Wedges
Light Transmitting Wedges
Endodontic Instruments
Classification
Group I: Hand-Operated Instruments
Barbed Broaches
Rasps
Reamers
Files
Engine-Driven Instruments
Gates-Glidden Drills
Flexogates
Peeso Reamers
Nickel Titanium (NiTi) Endodontic Instruments
Greater Taper Files (GT Files)
Protaper Files
Shaping Files
Finishing Files
Instruments Used for Filling Root Canals
Hand Spreaders
Finger Spreaders
Hand Pluggers
Finger Pluggers
Lentulo Spirals
Isolation of Operating Field
Rubber Dam
Dental Handpieces and Accessories
Dental Handpiece
Handpiece Maintenance
Rotary Cutting Instruments
Abrasive Materials Used in Dentistry and Their Uses
3. Prosthodontic Instruments
Heat Sources
Bunsen Burner
Alcohol Torch
Spatula
Straight Mixing Spatula
Curved Mixing Spatula
Wax Spatula
Mixing Bowl
Rubber Bowl
Prosthodontic Knife
Plaster Knife
Wax Knife
Carver
Wax Carver
Impression Trays
Edentulous Stainless-Steel Stock Tray
Dentulous Metallic Stainless Steel and Plastic Stock Tray
Scissors
Curved Scissor
Straight Scissor
Dappen Dish
Spirit Lamp
Chip Blower
Hot Plate
Porcelain Cup with Lid
Dental Flask
Glass Slab and Mixing Spatula
Glass Plate
Mixing Pad and Mixing Spatula
Acrylic Trimmer: Tungsten Carbide
Sandpaper Mandrel
Bard Parker Blade and Handle
Acrylic Trimmer: Mounted Stones
Rag Wheel
Gas Torch
Macintosh Sheet
Lecron Carver
Dental Tray
Patient Bib
Bib Holder
Kidney Tray, Procedure Trays
T-Burnisher
Face-Bow
Parts of Face-Bow
A. U-shaped frame
B. Condylar rods
C. Bite fork
D. Locking device
E. Orbital pointer with clamp.
Articulator
Functions
Purpose of Articulator
Uses of an Articulator
Requirements of an Articulator
Advantages
Limitations
Classification
Articulator Based on Theory of Occlusion
Based on Types of Records used for their Adjustment
Based on Ability to Simulate Jaw Movement
Based on Adjustability of the Articulator
Mean Value Articulator
Components of Articulator
A. Upper member
B. Lower member
C. Incisal guide table
D. Condylar guidance
E. Incisal pin
Surveyor
Types of Dental Surveyor
1. Ney surveyor
2. Jelenko surveyor
3. Williams surveyor
Parts Of Dental Surveyor
1. Horizontal arm
2. Vertical arm
3. Surveying arm
4. Surveying table
5. Cast holder
6. Surveying tools
Dental Handpieces and Accessories
Dental Handpiece
Low-Speed Handpiece
High-Speed Handpiece
Ultrasonic Handpiece
Laser Handpiece
Air-Abrasion Handpiece
Laboratory Handpiece
Handpiece Maintenance
General Considerations
Rotary Cutting Instruments
Dental Burs
Abrasive Materials Used in Dentistry and Their Uses
4. Oral Maxillofacial Surgery Instruments
Diagnostic instruments
Mouth mirror
Uses
Probes
Uses
Laryngoscope
Otoscope or Auriscope
Instrument used for picking up sterile instruments
Cheatle’s Forcep
Instrument Used for Preparing the Surgical Field
Rampley’s Swab Holding Forcep
Collin Tongue Seizing Forcep
Instrument Used to Maintain A Clean Surgical Field
Suction Apparatus
Suction Tubing
Suction Tip (Frazier, Nuober)
Red Rubber Catheter
Suction Catheter
Towel Clips
Instrument To Keep The Mouth Open
Mouth Prop
Doyen’s and Fergussion’s Mouth Gag
Heister’s Jaw Opener
Instruments Used for Injecting Local Anesthetic Agent
Syringe
Conventional Aspirating Syringes
Self-Aspirating Syringe
Disposable Aspiration Syringe
Luer-Lok Disposable Type Syringes
Jet Injectors
Needles
Parts Of Needle
1. Bevel
2. Shank
3. Hub
Instruments Used for Incising the Tissues
Scalpel
Dissecting Scissors
Cautery, Electrocautery
Flap Reflection Instruments
Retractors
Plain Retractors
Langenback Retractor
C-Shaped Retractor (Deaver’s Retractor)
Cat’s Paw Retractor
Coronoid Retractor
Seldin’s Retractor
Obwegessor’s Ramus Retractors
Condylar Retractor
Mastoid Retractor
Malleable Retractor
Chin Retractor
Self-Retaining Retractors
Doyen’s Raspatory (Rib Retractor)
Tongue Depressor
Instruments Used For Holding Soft Tissues
Allis Tissue Forceps
Babcock’s Tissue Forceps
Lane’s Tissue Holding Forceps
Tissue Forceps
Gland Holding Forceps
Nerve Hook
Hemostatic Forceps
Artery Forceps
Mosquito Forceps
Exodontia Armamentarium
Elevators
Indications for Use of Elevators
Rules for Using Elevators
Parts of Elevator
Handle
Shank
Blade
Elevators Commonly Used
Principles of Elevators
I. Lever principle
II. Wedge principle
III. Wheel and axle principle
Straight Elevators: Coupland Elevator, London Pattern Elevator
Cryer Elevator
Winter’s Elevator (Crossbar Elevator)
Pott’s Elevator
Winter Axolever Elevator
London Hospital Pattern Elevator
Extraction Forceps
Parts
Beak
Hinge
Handle
Maxillary Extraction Forceps
1. Maxillary anterior forceps
2. Maxillary premolar forceps
3. Maxillary molar forceps (right and left)
4. Maxillary third molar forceps
5. Maxillary cow horn forceps
6. Bayonet forceps
Mandibular Forceps
1. Mandibular Anterior Forceps
2. Mandibular premolar forceps
3. Mandibular molar forceps
4. Mandibular third molar forceps
5. Mandibular cow horn forceps
Instrument Used to Remove Pathologic Tissues
Curette
Volkmann’s Scoop
Lister’s Sinus Forceps
Bone Cutting Instruments
Rongeur Forceps (Jansen Middleton)
Miller Colburn Bone File
Bone Cutter
Chisel
Osteotome
Mallet
Bone Gouge
Headpiece and Burs
Gigli’s Wire Saw
Rib Shear
Nasal Rasp
Spreader (Smith Spreader)
Fergusson’s Lion Jaw Bone Holding Forceps and Crocodile Bone Holding Forceps
Armamentarium for Treatment of Maxillofacial Trauma
Wire
Hayton William Wire Holder
Wire Cutter
Archbar
Bristow’s Elevator
Rowe’s Zygomatic Elevator
Walshams Forceps
Asch’s Forcep
Rowe’s Disimpaction Forceps
Hayton William’s Forceps
Bone Plates and Screws
Compression Plates
Self-Compression Plates
Instrument for Compression Plating System
Drill Bit
Drill Sleeve
Depth Gauge
Screwdriver
Miniplates (Stainless Steel/Titanium Plates)
Biodegradable Plate and Screws
Screws
Lag Screw
Normal Compression Screw
Armamentarium for Suturing
Mayo-Hegar Needle Holder
Suture Cutting Scissor (Heath’s)
Skin Hook
Drains Used in Oral and Maxillofacial Surgery
Types of Drains
Simple Rubber Catheter
Corrugated Rubber Drain
Infant Feeding Tube
Ryle’s Tube
Foley Catheter
General Anesthetic Instruments
Fuller’s Tracheostomy Tube
Types of Tracheostomy Tube
1. Metallic
2. Synthetic
Different Types of Tracheostomy
Indications for Emergency Tracheostomy
Planned tracheostomy in Oral Surgery
Instrument In Tracheostomy
Endotracheal Tube
Magill’s Forcep
Airway
Oxygen Mask
Anesthesia Machine
5. Periodontal Instruments
Parts of Periodontal Instruments
a. Blade
b. Shank
c. Handle
Classification of Periodontal Instruments
a. For supragingival scaling
b. For subgingival scaling
Hoe scaler
Chisels
Files
Curettes
c. Sonic and ultrasonic instruments
d. Cleaning and polishing instruments
e. The periodontal endoscope
f. Periodontal surgical instruments
Periodontal Probe
Use of Periodontal Probe
Classification
William’s probe
WHO probe or screening probe
Marquis color-coded probe
UNC-15 probe
Michingan “O” probe
Naber’s probe
Maryland moffit
Thermal probe
Florida probing system
Scaling, Root Planning, Curettage Instruments
Sickle Scaler
Hoe Scaler
Chisel Scaler
Curettes
QUETIN Furcation Curettes
Files
Sonic and Ultrasonic Instruments
Polishing Instruments
Rubber Cups
Bristle
Dental Tape
Air Powder Polishing
Periodontical Surgical Instruments
Incisional and Excisional Instruments
Periodontal Knives
Interdental Knives
Bard Parker Handles and Surgical Blades
Surgical Curettes and Sickles
Periosteal Elevators
Tissue Forceps
Surgical Chisels and Hoes
Surgical Files
Schluger Periodontal File
Ochsenbein Chisel
Reverse action chisel (Rhode’s chisel)
Hemostats
Surgical Scissors
Surgical Nippers
Needle Holder
Microsurgical Tissue Pliers and Forceps
EVA System
6. Orthodontic Instruments
Introduction
Classification
Features of Orthodontic Instruments
Classification of Orthodontic Instrument
Separating Pliers or Separator Placing Plier
Band Forming Instruments
Band Cutting Scissors
Mershon Band Pusher
Nylon Band Seater
Band Crimping Plier
Johnson Band Contouring Pliers
Band Pinching Plier
Peak Plier
Double Beak Pliers
Band Removing Pliers
Anterior Band Removing Plier
Oliver Jones Posterior Band Removing Plier
Bracket Positioning Instrument
Boons Gauge
Bracket Positioning Height Gauge
Bracket Holder
Orthodontic Bracket Card
Bracket Removing Plier
Kurz Lingual Bracket Removing Plier
Wire Cutting Instruments
Pin and Ligature Cutter (PLC)
Pin and Ligature Cutter— Angulated
Distal End Cutter
Kurz Distal End Cutter
Hard Wire Cutter
Maun’s Heavy Duty Wire Cutters
Face-bow Bending/Cutting Pliers
Clasp Forming Instrument
Adam’s Plier
Adam’s Clasp Bending Pliers
Arrow Clasp Bending Pliers
Arrow Clasp Former
Adam’s Spring Forming Plier
Arch Forming Instruments
Turret
De La Rosa Contouring Pliers
Bird Beak Plier
Standard Light Wire Plier
Jaraback Light Wire Plier
Angle Wire Bending Pliers
Loop Forming Plier
Nance Loop Forming Pliers
Loop Tie Back Plier
Tweed Loop Forming Plier
Optical Plier
Young Loop Bending Pliers
Weingart Universal Pliers
Universal Plier
Howe Pliers
Three Prong Pliers
Utility Arch Plier
Rose Torquing Plier
Ribbon Arch Plier
Impression Trays
Cheek Retractors
Tongue-away Shield
Tongue Retractor with Saliva Ejector
Intraoral Mirrors
Coon Style Ligator
Ligature Forming Plier
Mosquito Artery Forceps
Mathieu Needle Holder
Straight Shooter Ligature Gun
Ligature Adjuster and Tucker
Speedo Ligature Director
Adjustable Enamel Stripper
Dontrix Gauge
Correx Gauge
Mitchell Trimmer
Nance Tie Back Plier
Hook Crimping Plier
Distal Wire Twister
Lingual Arch Plier
Detailing Step Plier
V-Bending Pliers
Spiral Blade Saw
Schumth Measuring Grid
Tube Converting Plier
7. Miscellaneous Instruments
Protective Shield for Curing Light
Disposables
Fluoride Trays: Disposable
Laboratory Coat
Protective Mask
Protective Glasses/Eye Wear
Examination Gloves
Over Gloves
Nitrile Utility Gloves
Cassette
Indicator Tape and Dispensing Unit
Ultrasonic Cleaning Unit
Sterilisation of Instruments
Methods of Sterilization
Physical Methods
Chemical Methods
Dental Radiography Equipment
Intraoral X-ray Film
Extraoral X-rays: Cephalometric and Panoramic
Bite-wing X-ray Tab
Film Holders: Periapical X-ray
Film Holder—XCP
Lead Aprons
Dental X-ray Unit
X-ray Safelight
X-Ray Rack
X-ray View Laminator
Digital Intraoral Radiography X-ray Unit
Intraoral Sensors for Digital Radiography
Digital Panoramic Imaging Unit and Digital Cephalometric Imaging Unit
Magnification and Headlamp Illumination
Index
Back Cover

Citation preview

Handbook of Instruments in

Dentistry

ii

Instruments in Dentistry

Contributors Purushottam Singh Chauhan

BDS

Sharad Pawar Dental College Datta Meghe Institute of Medical Sciences Wardha, Maharashtra [email protected]

Naveed Khan

BDS

Sharad Pawar Dental College Datta Meghe Institute of Medical Sciences Wardha, Maharashtra [email protected]

Amol Ramchandra Gadbail

BDS, MDS, PhD

(Oral and Maxillofacial Pathology)

Assistant Professor Department of Dental Surgery Indira Gandhi Government Medical College Nagpur, Maharashtra [email protected]

Handbook of Instruments in

Dentistry Purushottam Singh Chauhan

BDS

Sharad Pawar Dental College and Hospital Wardha, Maharashtra

CBS Publishers & Distributors Pvt Ltd New Delhi • Bengaluru • Chennai • Kochi • Kolkata • Mumbai Bhubaneswar • Hyderabad • Jharkhand • Nagpur • Patna • Pune • Uttarakhand

Disclaimer Science and technology are constantly changing fields. New research and experience broaden the scope of infonnation and knowledge. The authors have tried their best in giving information available to them while preparing the material for this book. Although, all efforts have been made to ensure optimum accuracy of the material, yet it is quite possible some errors might have been left uncorrected. The publisher, the printer and the authors will not be held responsible for any inadvertent errors, omissions or inaccuracies. eISBN: 978-93-881-7805-1 Copyright© Authors and Publisher First eBook Edition: 2018 All rights reserved. No part of this eBook may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system without permission, in writing, from the authors and the publisher. Published by Satish Kumar Jain and produced by Varun Jain for CBS Publishers & Distributors Pvt. Ltd. Corporate Office: 204 FIE, Industrial Area, Patparganj, New Delhi-110092 Ph: +91-11-49344934; Fax: +91-11-49344935; Website: www.cbspd.com; www.eduport-global.com; E-mail: [email protected]; [email protected] Head Office: CBS PLAZA, 4819/XI Prahlad Street, 24 Ansari Road, Daryaganj, New Delhi-I I 0002, India. Ph: +91-l l-2328925 9, 23266861, 23266867; Fax: 011-23243014; Website: www.cbspd.com; E-mail: [email protected]; [email protected].

Branches Bengaluru: Seema House 2975, 171h Cross, K.R. Road, Banasankari 2nd Stage, Bengaluru - 560070, Karnataka Ph: +91-80-26771678/79; Fax: +91-80-26771680; E-mail: [email protected] Chennai: No.7, Subbaraya Street Shenoy Nagar Chennai - 600030, Tamil Nadu Ph: +9 l-44-26680620, 26681266; E-mail: [email protected] Kochi: 36/14 Kalluvilakam, Lissie Hospital Road, Kochi - 682018, Kerala Ph: +91-484-4059061-65; Fax: +91-484-4059065; E-mail: [email protected] Mumbai: 83-C, I st floor, Dr. E. Moses Road, Worli, Mumbai - 400018, Maharashtra Ph: +91-22-24902340 - 41; Fax: +91-22-24902342; E-mail: [email protected] Kolkata: No. 6/B, Ground Floor, Rameswar Shaw Road, Kolkata - 700014 Ph: +91-33-22891126 - 28; E-mail: [email protected]

Representatives Hyderabad Pune Nagpur Manipal Vijayawada Patna

Foreword

I

nstrumentation is an important aspect of surgical and dental clinical practice. The instruments have evolved over the period of time in terms of metallurgy, design and cost effectiveness. Many types of instruments are commercially available but it is a big dilemma for the clinician to decide as to which is the best. To optimise the clinical results, choice of proper instruments and its proper and effective utilization is of immense importance. This aspect is badly neglected in the curricula and no structured training is offered. The clinician develops the skill of instrumentation by self-perception or by imitation. The choice of instrument also varies from clinician to clinician as it depends upon the skill and convenience of the individual clinician. A dedicated book on instruments, encompassing the description, indications and guidelines for their proper use, is the need of the hour. It will be of great help to the budding clinicians and provide them adequate guidance for effective and optimum utilization of the instruments facilitating proper execution of skill and enhancing their clinical results. The initiative by my esteemed student, Dr Purushottam Singh Chauhan, in efficiently touching the neglected aspect of instrumentation by bringing out Handbook of Instruments in Dentistry, is indeed very thoughtful, relevant and laudable venture. I am sure it will be of immense help to dental professionals. Rajiv Borle

MDS, FIBOMFS

Vice Chancellor DMIMS (DU), Wardha (Mh)

vi

Instruments in Dentistry

This Page is Intentionally Left Blank

Preface

I

t is a privilege and an honor to have an opportunity to bring out Handbook of Instruments in Dentistry for the undergraduates, postgraduates and clinicians. During and after the BDS course, students and clinicians are using various dental instruments that are part of preclinical and clinical practices. It has been my observation that preclinical and clinical students find it difficult to remember the name, identification, application, and technique to use instruments in various fields of dentistry. Handbook of Instruments in Dentistry has seven chapters for the ease of handling and understanding. • Chapter 1 Dental Chair • Chapter 2 Conservative and Endodontic Instruments • Chapter 3: Prosthodontic Instruments • Chapter 4: Oral Maxillofacial Surgery Instruments • Chapter 5: Periodontal Instruments • Chapter 6: Orthodontic Instruments • Chapter 7: Miscellaneous Instruments.

Colour photographs have been used in all the chapters for basic understanding of the tools for the students. Colour photographs of instruments and illustrations are followed by description which will be useful for the preclinical and clinical practices. Purushottam Singh Chauhan

viii

Instruments in Dentistry

Acknowledgments

T

hank you are two little words which would probably never completely convey the sense of gratitude and regards which I feel for each of the following wonderful people who have made Handbook of Instruments in Dentistry, a reality. I would like to start with one of my colleagues, Dr Naveed Khan, who contributed significantly to the review of the chapters. I express my sincere appreciation to Dr Amol Gadbail; without his tremendous sacrifice and support, this project would not have been possible. My deepest appreciation goes to my family, teacher, friends and juniors. I thanks to all those who helped with the proofreading. The Foreword in this edition was written by Professor (Dr) Rajiv Borle MDS , FIBOMFS , Vice Chancellor, DMIMS (DU) Wardha (Mh), and I am thankful to him for the honour. A special thanks to the team of CBS Publishers & Distributors for the wonderful job in creating a truly remarkable book. I consider myself to be lucky to get proper opportunities at proper time to work and learn. I am thankful to Dr Ashok Pakhan, Dean, Sharad Pawar Dental College, Datta Meghe Institute of Medical Sciences for showing faith in me and providing me suitable environment, facilities, support and encouragement to progress. Purushottam Singh Chauhan

Contents

Contributors

ii

Foreword by Rajiv Borle

v

Preface

vii

1. Dental Chair Definition 1 Evolution of dental chair 1 Types of dental chair 1 Portable 2 Non-portable 2 General dental chair 2 Kids dental chair 3 Surgical dental chair 4 Parts of dental chair 4 General considerations 14 Care and maintenance 14 Chair position 15 Zone operating areas 15

1 Patient positions 16 Chair positions 16 Operating positions 18 Right front position (7 o’clock) 20 Right position (9 o’clock) 20 Right rear position (11 o’clock) 21 Direct rear position (12 o’clock) 21 Considerations while doing patient 21

2. Conservative and Endodontic Instruments Introduction 23 Classification of instruments 23 GV Black’s classification 23 Marzouck classification 25 Parts of hand cutting instruments 26 Handle (shaft) 27 Shank 27 GV Black classification of instruments based on shank design 27

23

Blade 27 Instrument nomenclature (according to GV Black) 28 Instrument formula 28 Three number formula 28 Four number formula 29 Classification of instruments based on their usage 30 Exploratory instruments 30 Mouth mirror 30 Explorers 32

x

Instruments in Dentistry Probes 34 Tweezers or dressing pliers 34 Cutting instruments 35 Excavators 36 Chisels 39 Enamel hatchet 41 Gingival marginal trimmer 41 Other cutting instruments 43 Non-cutting restorative instruments 44 Cement spatula 44 Plastic spatula (agate spatula) 45 Teflon coated plastic and metal instrument 45 Amalgam carrier 46 Condenser 46 Carvers 47 Burnishers 48 Mortar and pestle 48 Glass slab 49 Matrix 49 Ivory no. 1 matrix 50 Ivory no. 8 matrix 51 Tofflemire matrix retainer: Universal matrix 51 Compound supported matrix 54 T-band matrix 54 Precontoured matrix 54 Copper band matrix 55 Automatrix 56 Clear plastic/mylar strips 57 Cellophane strips 57 Transparent plastic crown form matrixes 58 Window matrix 58 Tin foil matrix 59 Preformed transparent cervical matrixes 60

3. Prosthodontic Instruments Heat sources 104 Bunsen burner 104 Alcohol torch 105 Spatula 105 Straight mixing spatula 105 Curved mixing spatula 106 Wax spatula 106 Mixing bowl 107 Rubber bowl 107 Prosthodontic knife 107

Wedges 60 Wooden wedges 60 Plastic wedges 61 Light transmitting wedges 61 Endodontic instruments 62 Classification 62 Group I: Hand-operated instruments 63 Barbed broaches 63 Rasps 64 Reamers 65 Files 66 Engine-driven instruments 74 Gates-Glidden drills 74 Flexogates 76 Peeso reamers 77 Nickel titanium (NiTi) endodontic instruments 77 Greater taper files (GT files) 78 Protaper files 78 Shaping files 80 Finishing files 81 Instruments used for filling root canals 82 Hand spreaders 84 Finger spreaders 84 Hand pluggers 85 Finger pluggers 85 Lentulo spirals 85 Isolation of operating field 86 Rubber dam 86 Dental handpieces and accessories 95 Dental handpiece 95 Handpiece maintenance 100 Rotary cutting instruments 101 Abrasive materials used in dentistry and their uses 102

104 Plaster knife 107 Wax knife 108 Carver 108 Wax carver 108 Impression trays 109 Edentulose stainless steel stock tray 109 Dentulous metallic stainless steel and plastic stock tray 109 Scissors 110

Contents Curved scissor 110 Straight scissor 111 Dappen dish 111 Spirit lamp 112 Chip blower 112 Hot plate 113 Porcelain cup with lid 113 Dental flask 114 Glass slab and mixing spatula 115 Glass plate 115 Mixing pad and mixing spatula 116 Acrylic trimmer: Tungsten carbide 116 Sandpaper mandrel 117 Bard Parker blade and handle 117 Acrylic trimmer: Mounted stones 118 Rag wheel 118 Gas torch 119 Macintosh sheet 119 Lacron carver 120 Dental tray 120 Patient bib 120 Bib holder 121 Kidney tray, procedure trays 121 T-burnisher 122 Face-bow 123 Parts of face-bow 123 Articulator 125 Functions 125 Uses of an articulator 126

Requirements of an articulator 126 Advantages 126 Limitations 127 Classification 127 Articulator based on theory of occlusion 127 Based on types of records used for their adjustment 128 Based on ability to simulate jaw movement 128 Based on adjustability of the articulator 129 Mean value articulator 131 Components of articulator 132 Surveyor 133 Types of dental surveyor 134 Parts of dental surveyor 134 Dental handpieces and accessories 139 Dental handpiece 139 Low-speed handpiece 139 High-speed handpiece 141 Ultrasonic handpiece 141 Laser handpiece 142 Air-abrasion handpiece 143 Laboratory handpiece 144 Handpiece maintenance 144 General considerations 144 Rotary cutting instruments 145 Dental burs 145 Abrasive materials used in dentistry and their uses 146

4. Oral Maxillofacial Surgery Instruments Diagnostic instruments 148 Mouth mirror 148 Uses 148 Probes 149 Uses 149 Laryngoscope 149 Otoscope or auriscope 150 Instrument used for picking up sterile instruments 151 Chetale’s forcep 151 Instrument used for preparing the surgical field 151 Rampley’s swab holding forcep 151

xi

148

Collin tongue seizing forcep 152 Instrument used to maintain a clean surgical field 152 Suction apparatus 153 Suction tubing 153 Suction tip (frazier, nuober) 153 Red rubber catheter 154 Suction catheter 154 Towel clips 155 Instrument to keep the mouth open 156 Mouth prop 156 Doyen’s and Fergussion’s mouth gag 157

xii

Instruments in Dentistry Heister’s jaw opener 158 Instruments used for injecting local anesthetic agent 158 Syringe 158 Conventional aspirating syringes 159 Self-aspirating syringe 160 Disposable aspiration syringe 160 Luer-Lok disposable type syringes 161 Jet injectors 161 Needles 162 Parts of needle 162 Instruments used for incising the tissues 164 Scalpel 164 Dissecting scissors 165 Cautery, electrocautery 166 Flap reflection instruments 167 Retractors 168 Plain retractors 168 Langenbacks retractor 168 C-shaped retractor (Deaver’s retractor) 169 Cat’s paw retractor 169 Coronoid retractor 170 Seldin’s retractor 170 Obwegessor’s ramus retractors 170 Condylar retractor 171 Mastoid retractor 171 Malleable retractor 172 Chin retractor 172 Self-retaining retractors 173 Doyen’s raspatory (rib retractor) 173 Tongue depressor 174 Instruments used for holding soft tissues 175 Allis tissue forceps 175 Babcock’s tissue forceps 175 Lane’s tissue holding forceps 176 Tissue forceps 176 Gland holding forceps 177 Nerve hook 178 Hemostatic forceps 178 Artery forceps 178 Masqito forceps 179 Exodontia armamentarium 180 Elevators 180

Indications for use of elevators 180 Rules for using elevators 180 Parts of elevator 180 Elevators commonly used 181 Principles of elevators 181 Straight elevators: Coupland elevator, London elevator 182 Cryer elevator 183 Winter’s elevator (crossbar elevator) 183 Pott’s elevator 184 Winter axolever elevator 185 London elevator 186 Extraction forceps 186 Parts 186 Maxillary extraction forceps 187 Mandibular forceps 189 Instrument used to remove pathologic tissues 191 Curette 191 Volkmann’s scoop 192 Lister’s sinus forceps 192 Bone cutting instruments 193 Rongeur forceps (Jensen Middleton) 193 Miller Colbourn bone file 194 Bone cutter 194 Chisel 195 Osteotome 196 Mallet 196 Bone gouge 197 Headpiece and burs 197 Burs 198 Gigli’s wire saw 198 Parts 198 Rib shear 199 Nasal rasp 200 Spreader (Smith spreader) 200 Fergusson’s lion jaw bone holding forceps and crocodile bone holding forceps 201 Armamentarium for treatment of maxillofacial trauma 202 Wire 202 Hayton William wire holder 202 Wire cutter 203 Archbar 203 Bristow’s elevator 204 Rowe’s zygomatic elevator 205 Wilsham’s forcep 205

Contents Asche’s forcep 206 Rowe’s disimpaction forceps 206 Hayton William’s forceps 207 Bone plates and screws 208 Compression plates 208 Self-compression plates 209 Instrument for compression plating system 209 Drill bit 209 Drill sleeve 210 Depth gauge 211 Screwdriver 211 Miniplates (stainless steel/ titanium plates) 211 Biodegradable plate and screws 213 Screws 213 Lag screw 214 Normal compression screw 215 Armamentarium for suturing 215 Mayo Hegar needle holder 215 Suture cutting scissor (Heath’s) 216 Skin hook 216

5. Periodontal Instruments Parts of periodontal instruments 230 Classification of periodontal instruments 230 Periodontal probe 231 Use of periodontal probe 231 Classification 232 Scaling, root planning, curettage instruments 239 Sickle scaler 239 Hoe scaler 240 Chisel scaler 241 Curettes 242 QUETIN furcation curettes 245 Files 246 Sonic and ultrasonic instruments 247 Polishing instruments 248 Rubber cups 248 Bristle 249 Dental tape 249 Air powder polishing 250 Periodontical surgical instruments 251

xiii

Drains used in oral and maxillofacial surgery 217 Types of drains 218 Simple rubber catheter 218 Corrugated rubber drain 219 Infant feeding tube 219 Ryle’s tube 220 Foley’s catheter 220 General anesthetic instruments 221 Fuller’s tracheostomy tube 221 Types of tracheostomy tube 222 Different types of tracheostomy 222 Indications for emergency tracheostomy 223 Planned tracheostomy in oral surgery 223 Instrument in tracheostomy 223 Endotracheal tube 224 Magill’s forcep 225 Airway 226 Oxygen mask 227 Anesthesia machine 228

230 Incisional and excisional instruments 251 Periodontal knives 251 Interdental knives 251 Bard Parker handles and surgical blades 252 Surgical curettes and sickles 253 Periosteal elevators 253 Tissue forceps 254 Surgical chisels and hoes 254 Surgical files 255 Schluger periodontal file 255 Ochsenbein chisel 255 Reverse action chisel (Rhode’s chisel) 256 Hemostats 256 Surgical scissors 257 Surgical nippers 258 Needle holder 259 Microsurgical tissue pliers and forceps 259 Eva system 260

xiv

Instruments in Dentistry

6. Orthodontic Instruments Introduction 261 Classification 262 Features of orthodontic instruments 264 Classification of orthodontic instrument 264 Separating pliers or separator placing plier 264 Band forming instruments 265 Band cutting scissors 265 Mershon band pusher 265 Nylon band seater 266 Band crimping plier 266 Johnson band contouring pliers 267 Band pinching plier 267 Peak plier 268 Double beak pliers 268 Band removing pliers 268 Anterior band removing plier 268 Oliver Jones posterior band removing plier 269 Bracket positioning instrument 270 Boons gauge 270 Bracket positioning height gauge 270 Bracket holder 271 Orthodontic bracket card 271 Bracket removing plier 272 Kurz lingual bracket removing plier 273 Wire cutting instruments 273 Pin and ligature cutter (PLC) 273 Pin and ligature cutter— angulated 274 Distal end cutter 275 Kurz distal end cutter 275 Hard wire cutter 276 Maun’s heavy duty wire cutters 276 Face-bow bending/cutting pliers 277 Clasp forming instrument 277 Adam’s plier 277 Adam’s clasp bending pliers 278 Arrow clasp bending pliers 278

261 Arrow clasp former 279 Adam’s spring forming plier 279 Arch forming instruments 280 Turret 280 De la rosa contouring pliers 283 Bird beak plier 284 Standard light wire plier 284 Jaraback light wire plier 285 Angle wire bending pliers 285 Loop forming plier 286 Nance loop forming pliers 286 Loop tie back plier 286 Tweed loop forming plier 287 Optical plier 287 Young loop bending pliers 288 Weingart universal pliers 288 Universal plier 289 Howe pliers 289 Three prong pliers 290 Utility arch plier 290 Rose torquing plier 291 Ribbon arch plier 291 Impression trays 292 Cheek retractors 292 Tongue-away shield 293 Tongue retractor with saliva ejector 293 Intraoral mirrors 294 Coon style ligator 294 Ligature forming plier 295 Mosquito artery forceps 295 Mathieu needle holder 296 Straight shooter ligature gun 296 Ligature adjuster and tucker 297 Speedo ligature director 297 Adjustable enamel stripper 298 Dontrix gauge 298 Correx gauge 299 Mitchell trimmer 299 Nance tie back plier 300 Hook crimping plier 300 Distal wire twister 301 Lingual arch plier 301 Detailing step plier 301 V-bending pliers 302 Spiral blade saw 302 Schumth measuring grid 303 Tube converting plier 304

Contents

7. Miscellaneous Instruments Protective shield for curing light 306 Disposables 306 Fluoride trays: Disposable 307 Laboratory coat 308 Protective mask 309 Protective glasses/eye wear 309 Examination gloves 310 Over gloves 310 Nitril utility gloves 311 Cassette 312 Indicator tape and dispensing unit 312 Ultrasonic cleaning unit 313 Sterilisation of instruments 314 Methods of sterilization 314 Physical methods 314 Chemical methods 315 Dental radiography equipment 321 Intraoral X-ray film 321

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306

Extraoral X-rays: cephalometric and panoramic 322 Bite-wing X-ray tab 323 Film holders: Periapical X-ray 323 Film holder—XCP 324 Lead aprons 324 Dental X-ray unit 325 X-ray safelight 326 X-ray rack 327 X-ray view laminator 327 Digital intraoral radiography X-ray unit 328 Intraoral sensors for digital radiography 329 Digital panoramic imaging unit and digital cephalometric imaging unit 329 Magnification and headlamp illumination 330

Index

333

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1 Dental Chair

Dental chair

DEFINITION

A dental chair is a chair in which patient can sit when he/she is at the dentist so that the dentist can diagnose his/her oral cavity easily. • Modern dental chairs are designed to provide total body support in any chair position. • The patient head is supported by a headrest cushion which elevates the chin and thus reducing strain on neck EVOLUTION OF DENTAL CHAIR

• • • •

Before 1790 barber’s chair 1790 Josiah Flagg—1st adjustable dental chair 1832 James Snell—fully adjustable dental chair 1867 James Morrison—1st modern dental chair TYPES OF DENTAL CHAIR

I. Portable II. Non-portable 1. General dental chair 2. Kids dental chair 3. Surgical dental chair 1

2

Instruments in Dentistry

Portable

• The portable rolled steel construction is lightweight yet strong, making it perfect for portable dentistry. • It is adjustable to five positions, with seat height ranging from 11 to 22 inches. The toe board folds down, allowing this portable dental chair to be used for examination. The included carrying case makes mobility and transportation simple. • No assembly required. Non-portable General Dental Chair

• This clinical equipment comprises an electrically operated, retractable patient seating chair to which compressed air, water line, micromotor, spittoon bowl and an overhead light is attached.

Dental Chair

3

• It is also accomplished by dental stool on which the clinician sits while handling the patient procedures. Kids Dental Chair

4

Instruments in Dentistry

Surgical Dental Chair

Parts of Dental Chair

• • • • • • • • • • • •

Double-articulating headrest back rest Multi-position armrests Pilot lamp/dental light Three-way syringe Suction tube Compressed air–water line Cuspidor Cavity holder Instrument tray Monitor mount tilt and drift Touchpad chair control Operator stools

A. Double-articulating headrest back rest • The double-articulating headrest includes several adjustment features that improve you access to the oral cavity and increase patient comfort.

Dental Chair

5

• Use the glide bar to accommodate a variety of patient heights. Simply pull up or push down on the headrest until it is in the desired position. The gliding headrest cushion provides additional height adjustment. • You can easily adjust the headrest angle using one hand. Press the adjustment lever to position the headrest. Release and the headrest hold its position. B. Multi-position armrests

The armrests are designed to allow easy access for both you and the patient.

6

Instruments in Dentistry

a. Patient entry/exit • Lift the armrest slightly to unlock it, and lower it into the entry/exit position. To reposition the armrest, lift the armrest back into the standard position. b. Working direct • Rotate the armrest toward the toe of the chair, and lower it into the operator access position. To reposition the armrest, lift up and rotate it into the standard position C. Pilot lamp/dental light

• Attached to dental chair focused on mouth of the patient for better visibility during dental treatment. • Used to illuminate the oral cavity or mouth. • Light is positioned 30 to 50 inches from oral cavity. a. Put in place after patient position in dental chair. b. Should be positioned so light illuminates oral cavity but does not shine in patient’s eyes. • Light containns dimmer switches to adjust the intensity of the light. • Prior to procedure, protective barriers are placed on handles and switches of the light. a. Plastic wrap, aluminium foil, or commercial covers are used. b. Barrier must be removed and replaced with clean covers after each patient.

Dental Chair

7

• Frequent cleaning of the light is important. a. All part that is touched must be disinfected after each paint. b. Mild detergent and soft cloth should be used to clean light shield. • All moving parts on light should be lubricated with general all-purpose oil at least once a week. D. Three way-syringe

8

Instruments in Dentistry

• Three-way syringe is a chair side metal syringe connected to an air–water line. • It comprises two buttons; one designated for water spray while the other one is for air spray. • If both the buttons are pressed simultaneously, then the resultant spray is an air–water spray. • It is useful device to cleanse the tooth preparation. E. Suction tube

• There are two main types of dental suctions that dentists use: The saliva ejector and the high volume suction. • The saliva ejector does exactly what its name implies; it sucks saliva out of the mouth. This is the suction pictured at the upper right of this article. Many times dentists will have the patient close down on this suction so that it can suction away any remaining saliva in the patient’s mouth. • The other main type of dental suction that we use is the high volume suction. This suction is so strong that the dental assistant simply holds it close to where the dentist is working and it will suck away any nearby debris, much like a strong vacuum cleaner can suck away crumbs without actually touching them. F. Compressed air–water line • Compressed air is brought to the working unit in a tube line which operated with the help of a foot control.

Dental Chair

9

• The normal pressure at which the airotor handpiece would run is set at around 25–30 psi. • The student has to check periodically the air pressure gauge to regulate the recommended air pressure. • A water line brings in water from the booster bottle, which is periodically refilled with clean water.

10

Instruments in Dentistry

• This water line is integrated with the compressed air line to make it into one singular air-water line. This line contains two-tubes-one, which brings in compressed air while the other brings in the water. G. Cuspidor

• May be installed on some dental units, or a portable unit can be used. • Bowl or cup that can be used to allow patient to expectorate (spit out) particles and water • Most units are automatically flushed with running water. • After each patient, unit must be cleaned and disinfected. • Portable units are frequently sterilized.

Dental Chair

11

H. Cavity holder

• Cavity holder is an extension from the tray holder and would be in close proximity to the operator. • It would hold the following: o Either one/two air–water lines to which airotor handpieces can be attached. o Three-way syringe. o Airmotor/micromotor base to which the latch type contra-angled or straight handpiece can be attached. I. Instrument tray

12

• • • •

Instruments in Dentistry

Holds instrument Holds other materials used by operator Instruments are to be arranged in a sequential order Instruments should always be clean, sterile and functional.

J. Monitor mount tilt and drift

• Chair side monitor mount bring the monitor closer to the patient. So during patient consultations you will able to clearly communicate oral health deficiencies and explain treatment procedures, increasing case acceptance. K. Touchpad chair controls

Dental Chair

13

• Your touchpad chair controls work similarly to the foot switch, but vary depending on your delivery system. • To use and program chair functions on your touchpad, please refer to the Instructions for Use that came with your delivery system. L. Operator stools

14

Instruments in Dentistry

• The design of the stool is important. • It should be sturdy and well-balanced to prevent tipping/gliding away from dental chair. • It should be well-padded with cushion edges and should be adjusted up and down. • A well-designed stool increases operator comfort and reduces fatigue. GENERAL CONSIDERATIONS

• The patient’s head should be rotated according to the need of operator without hesitation. • During working maxillary occlusal surfaces should be perpendicular to the floor and for mandibular occlusal surface should be 45°. • The operator should maintain space between the patient as while reading a book. • There should be reduced contact with that of patient o The operator should never rest his hand on patient’s face o The chest of patient should never be used as trays to keep instruments • The left hand should be kept free to retract using the mouth mirror. CARE AND MAINTENANCE

• The surface of the chair’s seating area is made of synthetic leather. Apply dry wiping or wipe the surface with cloth moistened with either water or diluted neutral detergent for the care. • If the colour of clothing or belt remained on the synthetic leather, wipe it off with cloth moistened with diluted neutral detergent as soon as possible, to avoid its penetration caused by plasticizer. • In case the synthetic leather is wiped with a wet cloth, fully wipe off the moisture. If it remains, hydrolytic degradation may be accelerated. Do not use solvent or bleach.

Dental Chair

15

• Apply dry wiping using a dry and soft cloth to metallic areas. If any metallic area is wetted, wipe off the moisture as soon as possible. It will rust otherwise. Wipe the resin cover with a wet and soft cloth. CHAIR POSITION

• Chair and patient positions are important considerations. Modern dental chairs are designed to provide total body support in any chair position. • Chair position is a very important aspect in the success of a dental treatment. • The correct positioning helps the operator to have a good visibility and accessibility of the oral cavity. • Proper positioning of the patient and the operator, illumination and retraction for optimal visibility are the fundamental pre-requisites to proper dental treatment. • If operator maintains proper position and posture during treatment, the operator is less likely to get strain, fatigue, be more efficient and less chances of getting musculoskeletal disorders. Zone Operating Areas

A. Operator’s zone C. Assistant’s zone

B. Static zone D. Transfer zone

16

Instruments in Dentistry

Following points should be kept in mind in relation to dental chair: • It should be able to provide comfort to the patient. • It should be able to provide the total body support. • Headrest of chair should be attached for supporting patient’s chin and reducing strain on chin muscles. • It should be able to provide maximum working area to the operator. • It should be placed at the convenient location with adjustable control switches. • Foot switches are preferred to improve infection control. Patient Positions

• Patient should be seated so that all his body parts are well-supported. • The patient’s head should always be supported by adjustable/ articulated headrest. • Preferably the patient’s head should be in line with his back. • The chair height should be kept low, backrest should be upright and armrest should be adjustable while making the patient to seat in the dental chair. • Now, the chair can be adjusted to place the patient in reclining position. • Patient position can vary with operator, type of procedure and area of the oral cavity. Chair Positions

• For restorative dental procedures, the most preferred operating positions are: 1. Upright position 2. Almost supine 3. Reclined 45° • The most common patient positions for operative dentistry are almost supine or reclined 45°. The choice of patient position varies with the operator, the type of procedure, and the area of the mouth involved in the operation.

Dental Chair

17

1. Upright position

• This is the initial position of chair from which further adjustments are made. 2. Almost supine

• In this case, chair position is such that head, knees and feet are approximately at the same level. • Patient’s head should not be lower than feet except in case of syncopal attack.

18

Instruments in Dentistry

3. Reclined 45°

• In this position, chair is reclined at 45°. • Mandibular occlusal surface are almost 45° to the floor. Operating Positions

Dental Chair

19

• Once the patient has been comfortably positioned, the dentist and the assistant should sit themselves in the proper positions for treatment. • Usually sitting position is preferred in modern dentistry to relieve stress on operator’s leg and support the operator’s back. • The level of teeth being treated should be placed at the same level as the level of operator’s elbow. • For better understanding, sitting positions of operator are related to a clock. In this clock concept, an imaginary circle is drawn over the dental chair, keeping the patient’s head at the centre of the circle. • Then the numbering to circle is given similar to a clock with the top of the circle at 12 o’clock. • Accordingly the operator’s positions

20

Instruments in Dentistry

A. Right-handed operator’s positions: 7 o’clock, 9 o’clock, 11 o’clock, and 12 o’clock B. Left-handed operator’s positions: 5 o’clock, 3 o’clock and 1 o’clock. Right Front Position (7 o’clock)

1. It helps in examination of the patient 2. Working areas include: a. Mandibular anterior b. Mandibular posterior teeth (right side) c. Maxillary anterior teeth 3. To increase the ease and visibility, the patient’s head may be turned towards the operator. Right Position (9 o’clock)

1. In this position, dentist sits exactly right to the patient 2. Working areas include: a. Facial surfaces of maxillary right posterior teeth b. Facial surfaces of mandibular right posterior teeth c. Occlusal surfaces of mandibular right posterior teeth.

Dental Chair

21

Right Rear Position (11 o’clock)

1. In this position, dentist sits behind and slightly to the right of the patient and the left arm is positioned around patient’s head 2. This is preferred position for most of dental procedures 3. Most areas of mouth are accessible from this position either using direct or indirect vision 4. Working areas include: a. Palatal and incisal (occlusal) surfaces of maxillary teeth b. Mandibular teeth (direct vision). Direct Rear Position (12 o’clock)

1. Dentist sits directly behind the patient and looks down over the patient’s head during procedure. 2. Working areas are lingual surfaces of mandibular teeth. 3. This position has limited application. Right handed operator—3 preferred positions

Left handed operator—3 preferred positions

7 o’clock

5 o’clock

9 o’clock

3 o’clock

11 o’clock

1 o’clock

Considerations While Doing Patient

• While doing work in maxillary arch, maxillary occlusal surfaces should be perpendicular to the floor. • In mandibular arch, mandibular occlusal surface should be oriented 45° to the floor. • Patient’s head can be rotated backward or forward or from side to side for operator’s ease and visibility while doing work. • Maintain proper working distance during dental procedure. This will lead to increase cooperation and confidence in the patient.

22

Instruments in Dentistry

• Operator should not rest forearms on the patient’s shoulders and hands on the face of the patient. • Dentist should not use patient’s chest as an instrument trolley. • The operator should leave left hand free during most of dental procedures for retraction using mouth mirrors or fingers of left hand. • Operator should keep changing position if procedure is of long duration to decrease the muscle strain and fatigue.

2 Conservative and Endodontic Instruments Dental chair

INTRODUCTION

• The term ‘instrument’ refers to a tool, device or implement used for a specific purpose or type of work and is preferred in professional or scientific fields as precision items to perform specific procedures. • In order to perform the intricate or detailed procedures associated with operative dentistry, the dentist must have a complete knowledge of the purpose and application of the many instruments required. o The instruments available o The purpose of the instrument o The position or manner of use o The application of the instrument CLASSIFICATION OF INSTRUMENTS

Hand instruments: These are manually used instruments. Rotary instruments: These are engine-driven instruments. The most commonly employed classification: GV Black’s Classification

1. Cutting instruments a. Hand cutting instruments • Hatchets • Chisels 23

24

2.

3.

4.

5.

6.

Instruments in Dentistry

• Hoes • Excavators b. Rotary instruments • Burs • Stone • Discs Condensing instruments • Pluggers • Hand • Mechanical Plastic instruments • Plastic filling instruments • Cement carriers • Carvers • Burnishes • Spatula Finishing and polishing instruments A. Hand • Orangewood sticks • Polishing points • Finishing strips B. Rotary • Finishing burs • Mounted brushes • Mounted stones • Rubber cups Isolation instruments • Rubber dam • Saliva ejector • Cotton roll holder • Evacuating tips and equipment Miscellaneous instruments • Mouth mirrors • Explorers

Conservative and Endodontic Instruments

• • • •

Probes Scissors Pliers Others

Marzouck Classification

1. Exploring instruments or diagnostic instruments • Mouth mirror • Explorer or probe o Straight probe o Right-angled probe o Arch-shaped (Shephard’s hook) o Interproximal (back action) • Tweezers • Cheek retractors • Separators • Air syringe 2. Isolating instruments • Cotton roll holder • Rubber dam • Saliva ejector • Suction apparatus 3. Hand cutting instruments • Excavators o Spoon excavator o Cleiod o Discoid o Hatchet excavator o Hoe • Chisels o Straight chisel o Mono angle chisel o Triple angle chisel • Special type of chisels or modified chisels o Wedelstaedt chisel

25

26

Instruments in Dentistry

• Enamel hatchet • Gingival marginal trimmer • Angle former 4. Restoring instruments • Mixing instruments o Cement spatula o Agate spatula • Plastic carrying/filling instruments • Packing instruments o Amalgam carrier • Condensing instruments o Round condenser o Parallelogram condenser • Burnishing instruments o Ball-shaped o Egg-shaped o Conical-shaped • Carving instruments o Hollenback carver o Diamond carver o Wards carver 5. Miscellaneous instruments • Matrices and retainers • Scissors PARTS OF HAND CUTTING INSTRUMENTS

• Hand cutting instruments are composed of three parts:

• Handle or shaft • Shank • Blade

Conservative and Endodontic Instruments

27

Handle (Shaft)

• It is the portion of the instrument where the operator grasps or holds the instrument. • They are usually straight and may have serrations for improved grip. • Padded handles are said to increase operator comfort and grip during use. • The standard metal handle has a diameter of approximately one-fourth of an inch (6.4 mm). Shank

• The shank joins the handle to the blade and has one or more angles. • The shank is angled to keep the working end of the blade within 2.0–3.0 mm of axis of the handle. This angulation provides balance, so that whenever force exerted onto the instrument it is not likely to rotate or slip from the point of contact. Contrangling of the instrument thus helps in: i. Balance ii. Better access iii. Clearer view GV Black Classification of Instruments Based on Shank Design

1. 2. 3. 4. 5.

Straight Monoangle Biangle Triple angle Quadrangle

BLADE

• Working end of the instrument which has the nib or cutting edge. • It is the functional end of cutting instrument, which begins at the angle terminates the shank and ends in the cutting edge. In noncutting instruments, the working end

28

Instruments in Dentistry

is termed nib and is used to place, adapt and condense the materials in the prepared tooth. i. Cutting edge: This produces the cutting action of the instrument in the form of a bevel with different shapes. ii. Blade angle: It is the angle between long axis of the blade and long axis of the shaft. iii. Cutting edge angle: It is the angle between the margin of the cutting edge and long axis of the shaft. INSTRUMENT NOMENCLATURE (ACCORDING TO GV BLACK)

1. Order: Purpose or function of the instrument, e.g. excavator 2. Suborder: Position or manner of the instrument, e.g. pull, push 3. Class: Form of the working end, e.g. chisel, hatchet 4. Subclass: Shape of the shank, e.g. monoangle, biangle Order: Suborder: Class: Subclass:

Purpose of the instrument Position or manner of use Form of working end Shape of the shank

INSTRUMENT FORMULA

• GV Black also developed a numeric formula to describe the dimensions and angles of the working end of a hand cutting instrument. This is called instrument formula. Three Number Formula

• For instruments in which the primary cutting edge (at the end of the blade) is at a right angle to the long axis of the blade, GV Black developed a formula that has three numbers.

Conservative and Endodontic Instruments

29

First number: Blade width: Of the blade in 1/10th of a mm Second number: Blade length: Length of the blade in mm. Third number: Blade angle: Angle made by the blade relative to the long axis of the handle in centigrades. Four Number Formula

• For instruments in which the primary cutting edge (at the end of the blade) is not a right angle to the long axis of the blade. GV Black designed a four number formula. Unit I: Blade width: This denotes the width of the blade expressed in 1/10th of a millimeter. Unit II: Blade length: This indicates the length of the blade expressed in millimeters. Unit III: Blade angle: This represents the angle of the blade relative to the instrument expressed in centigrade.

30

Instruments in Dentistry

1 centigrade = 1/100th of a circle, i.e., 1/100 × 360 = 3.6° So 1 centigrade = 3.6° • Most instruments have a three number formula. • Some instruments like gingival margin trimmer and right angle former have the cutting edge other than at right angles to the blade. For these instruments a fourth unit is added. Unit IV: Primary cutting edge angle: This denotes the angle between the cutting edge and the long axis of the handle of the instrument. This is also expressed in centigrades. • The two instruments which have a four number formula. 1. Gingival marginal trimmer 2. Angle former CLASSIFICATION OF INSTRUMENTS BASED ON THEIR USAGE

i. Exploratory instruments ii. Cutting instruments iii. Non-cutting restorative instruments Exploratory Instruments

1. 2. 3. 4.

Mouth mirror Explorer Probes Tweezers/dressing plier

Mouth Mirror

• Mouth mirror is a diagnostic instrument that has a handle, shank and a mirror attached to a round metal disc at one end. • It has a mirror head top and detachable handle.

Conservative and Endodontic Instruments

31

Uses • Indirect vision: To see areas of the mouth not accessible with direct vision. • Retraction: Help in retraction of the cheek to provide better direct view and access during the procedure. • Transillumination: Light reflection from the mouth mirror enables proper view of areas which cannot be seen through direct light. • Tissue protection: Guards the tongue and cheek against accidental injury from rotary operating instruments like the bur. Type of mirrors i. Front surface mirror

• The coating is present in the front surface of the mirror. This prevents distortion and gives a clearer image. However, the surface coating is prone to degradation and accidental wear. ii. Back surface mirror

• The coating is present on the back side of the mirror. This is the most conventionally used mouth mirror.

32

Instruments in Dentistry

i. Plane mirror

• This is the more commonly used mirror which provides distortion free images. ii. Concave surface:

• This provides various degrees of magnification. The drawback is its tendency to distort the image view. i. One side mirror

• Mirror is place on one side of the circular metal disc with the reverse side being made of metal. ii. Twin-sided mirror: Both sides have mirrors which aids in indirect vision even while retracting tissues. Explorers

Conservative and Endodontic Instruments

33

Explorer is mainly diagnostic instrument which is formed of three parts: a. Handle b. Shank c. Exploring tip Types of explorers: There are four types of explorers:

1. Straight explorer: This explorer has a mild curvature near the exploring tip. 2. Arch explorer (Shepherd’s hook): This has a semicircular or an arch-shaped working end with exploring tip at a right angle to the handle. 3. Cow horn or pigtail explorer: This has a smaller arch/ semicircle than the arch explorer. 4. Interproximal explorer (Briault’s probe): In this explorer the shank has two or more angles and the exploring tip is used for • Detecting proximal carious lesion. • Assessing marginal fit of restorations. • Removing excess restorative material while shaping the occlusal embrasure in proximal cavities.

34

Instruments in Dentistry

Probes

• Sharp pointed hand instrument used to explore teeth and restoration surfaces in order to detect caries, overhanging edges and other defects. • May be single ended or double ended. Uses • Exploring lesion. • For detecting and assessing carious lesion in the tooth. • Detecting demineralized dentin. • Releasing debris from the tooth. • Removing slight excess fill up around cavo-surface margins. • Identifying hypersensitive areas in the tooth. • Assessing marginal fit of the restoration. Types • Straight probe. • Interproximal probe. • No. 2 cow horn (arch explorer). • No. 17 back action. • No. 23 Shepherd’s hook. • Orban-type explorer. Tweezers or Dressing Pliers

• Hand instrument with two narrow and pointed, straight or curved beaks used to grasp small objects.

Conservative and Endodontic Instruments

35

Consist of: • 2 long arms • Locking device. • Other end remains apart. Uses • Useful in carrying things to and from mouth. • Carrying cotton rolls, cotton pledges, sponge pellets to and around the cavity. • Carrying saliva soaked cotton rolls from the oral cavity to the waste disposal unit. Locking Tweezer • May have a locking device to maintain the beaks in a closed position until released. • This avoids the unnecessary anxiety of the operator at the possibility of slippage whatever is carried by the tweezer. Cutting Instruments

1. Excavators a. Ordinary hatchet (bibevelled) b. Hoe excavator c. Angle formers d. Spoon excavator i. Cleoid excavator ii. Discoid excavator 2. Chisels a. Chisel i. Straight chisel ii. Monoangle chisel iii. Biangle chisel iv. Wedelstaedt chisel b. Enamel hatchet c. Gingival marginal trimmer 3. Other cutting instruments a. Offset hatchet b. Triangular hatchet d. Files e. Knives

36

Instruments in Dentistry

Excavators

a. Ordinary hatchet (bibevelled)

• An ordinary hatchet excavator has the cutting edge of the blade directed in the same plane as that of the long axis of the handle. • It is the bibevelled instrument. • It is used primarily in the anterior teeth for preparing and sharpening line angles. • It is used particularly in direct gold restoration and hence now not commonly used. b. Hoe excavator

• Hoe excavator has the primary cutting edge of the blade that is perpendicular to the axis of the handle. • Used to planing tooth preparation walls and forming line angles.

Conservative and Endodontic Instruments

37

• Commonly used to plane the pulpal floor in amalgam cavity preparation. • Single plane instrument which cuts in four movements— vertical, pull /push, right and left. c. Angle former

• Angle former is a special type of excavator available in pairs (right and left). • It is monoangle with right or left beveling. • They cut vertical push and pull motion. • It is used for sharpening line angles and creative retentive features in dentin in parathion for gold restorations. • It is triple bevelled, two on lateral surfaces and one at the tip and hence has three cutting edges. d. Spoon excavator • A spoon excavator is a doubled plane instrument and is usually paired. • It has a semicircular cutting edge.

38

Instruments in Dentistry

• Blades are slightly curved and shank may be biangled or triple angled to facilitate accessibility. • It is used for removing carious dentin and for carving amalgam or direct wax patterns. i. Discoid spoon excavator

• This has discoid or disc-shaped blades with cutting edges extending around the periphery. • They were used for removal of carious dentin but presently used for carving amalgam and wax. ii. Cleoid spoon excavator

• Cleoid spoon excavator has a claw-like blade. • It is a double-planed instrument with lateral cutting movements.

Conservative and Endodontic Instruments

39

Chisels

i. Straight chisel

• Straight chisel has a straight shank and blade with the bevel on only one side. • Primary cutting edge of chisel is perpendicular to the long axis of the handle. • It is used with straight thrust force, push motion. • Primary used for cutting enamel. ii. Monoangle chisel

Similar to straight chisel except that the blade is at an angle to the handle • May be mesial or distal bevelled. • Distally bevelled is also referred as contra-bevelled or reverse bevelled. • Reverse bevelled end of the chisel is usually marked with an indented ring on the shaft or shank.

40

Instruments in Dentistry

iii. Biangle chisel

• Biangle chisel has two angles in the shank. • It is also mesially or distally bevelled. • It is used to cleave undermined enamel. iv. Triple angle chisel

• Triple angle chisel has three angles in its shank. • It is mainly used to flatten the pulpal floor. • It is mesially or distally bevelled. v. Wedelstaedt chisel

• Wedelstaedt chisel is similar to straight chisel except for a slight vertical curvature in its shank.

Conservative and Endodontic Instruments

41

• It is bevelled on the one side only. • It may be mesially bevelled or distally bevelled. • It is used for cleaving undermined enamel and for shaping walls especially in the proximal surface of anterior teeth. Enamel Hatchet

• Enamel hatchets are single planed paired instruments (right and left types). • It can be biangled, triple angled or parallel with the shaft. • They are single planed and are used with push/pull vertical movements. • It is bevelled on one side. • Used for smoothening buccal and lingual walls of proximal box. • Used for breaking enamel of proximal box. • Used for smoothening gingival seat (lateral scraping motion). Gingival Marginal Trimmer

• •

•

This is a paired double plane instrument. GMT is similar in design to the enamel hatchet, except that the blade is curved, and the bevel for the cutting edge at the end of the blade is always on the outside of the curve with the face of the instrument being on the inside of the curve. It is available as double ended (right and left) mesial or distal pair.

42

Instruments in Dentistry

• The GMTs are designed to produce o Proper bevel on gingival enamel margins of proximoocclusal preparations. o Roundening or beveling of the axiopulpal line angle. • They are used in lateral scrapping motion.

Clinical Note: 1. Of the cutting edge tips, if the tip that is closer to the shaft forms an acute angle, it is the mesial GMT and if it forms an obtuse angle, it is identified as a distal GMT. 2. If the second number of the instrument formula is 75–85, then it is mesial GMT. 3. If the second number of the instrument formula is 90–100, then it is distal GMT. 4. The mesial 75-distal 100 pairs of GMTs are used for inlayonlay cavity preparations. 5. The mesial 85-distal 90 pairs of GMTs are used for amalgam cavity preparation.

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Other Cutting Instruments

I. Offset hatchets • Instruments in which blade is rotated by 45° from the plane of the long axis of the instrument. • Used to create and shape specific angulations for cavity walls, especially in areas of difficult access. II. Triangular chisel

• Blade is triangular in shape with the base away from the shaft. • Has a terminal cutting edge like straight chisel. III. Knives • They are also known as finishing knives, amalgam knives or gold knives and are designed with a thin knife like a blade which is made in various size and shape. • They are used for trimming excess restorative material on the gingival, facial or lingual margins of a proximal restoration. • They are used in scrape-pull motion. Types: • Black’s knife

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Instruments in Dentistry

• Wilson’s knife

IV. Files

• Files are used to trim excess restorative material particularly at gingival margins • The blades of the files are thin and have serrations known as teeth on the cutting surface. • These teeth are designed to be used in push-pull motion. Non-cutting Restorative Instruments Cement Spatula

• Cement spatula are mixing instruments, which have a flat and wide working end with blunt edges.

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• They are available in different sizes and different degrees of stiffness at their tips for mixing zinc oxide eugenol, zinc phosphate, zinc polycarboxylate cements, glass inomer cement and calcium hydroxide liners. • Made of o Stainless steel. o Used for manual mixing of cements supplied as powder and liquid. Plastic Spatula (Agate Spatula)

• They are nonmetallic spatula made of plastic. • Commonly used for mixing glass ionomer cement on a paper pad. Teflon Coated Plastic and Metal Instrument

• The working end of this plastic and metal instrument is coated with Teflon so that the composite resin does not sticks on to the instrument. • It helps both in carving and placement of the composite resins on to the tooth structure.

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Instruments in Dentistry

Amalgam Carrier

• Amalgam carriers are used to insert the mixed amalgam into the prepared cavity. • It has a hollow cylinder into which the triturated dental amalgam can be loaded. • Both single- and double-ended carriers are available. • Double-ended carriers are plugger operated with a finger level that pushes the amalgam into the prepared cavity. • Available in various sizes: Mini, regular, large and jumbo. Condenser

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• Condensers are used for compacting amalgam or direct gold into the prepared cavity. • They can also be used to push glass ionomer cement or resin composite into the prepared cavity. • The working end or nibs of the condensers may be round, triangular, parallelogram or elliptical in shape. • The most commonly used ones in narrow or conservative cavities. Carvers

• Carvers are used to shape amalgam and resin composite materials after they have been placed in the tooth preparation. a. Hollenback carver or Wards C carver

• Double-ended biangled instrument which is used to remove excess amalgam to the natural tooth contour. • It is also used for carving inlay wax during fabrication of inlay and onlay. b. Diamond carver—Frahm’s carver

• Bibevelled cutting edges. c. Cleoid-discoid carver

• Used primarily for occlusal carving of amalgam restorations.

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Instruments in Dentistry

d. Interproximal carver

• It has very thin blades and is valuable for carving proximal amalgam surfaces near the interproximal contact area. Burnishers

• Burnishing is defined as the process to make a material shiny or lustrous especially by rubbing. • They are used to make the surface of the restoration smooth, shiny and polished. • They are also used to contour metal bands so as to provide the desire contours of the restoration. • They are double-ended instruments with angulated shanks. • Nibs are smooth faced and has different shaped—ball shaped, egg shaped or conical shaped. Mortar and Pestle

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• Mortar is thick like a bowl and pestle is thin like a pensile. • Used to mix the alloy powder and mercury to make a homogenous mixture. Glass Slab

• Glass slab is used for mixing cement powder and liquid carried out on a glass slab using a stainless steel spatula. Matrix

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Instruments in Dentistry

Ivory no. 1 Matrix

• Used to restore one proximal surface of a posterior tooth. • Available in various sizes. • Matrix attached to retainer via a wedge-shaped projection. • As the adjusted screw is rotated clockwise, the wedge shaped projections engage the tooth at the embrasures of the unprepared proximal surface. • Clinically it is dial for restoring a unilateral class II cavity especially when the contact on the unprepared side of the involved tooth is very tight.

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Ivory no. 8 Matrix

• Band encircles the entire crown of the tooth. • Used to restore both proximal surfaces. Tofflemire Matrix Retainer: Universal Matrix

• It is also known as the universal matrix. • It is the most popular used system for restoring class II amalgam restoration. • It consists of the following parts:

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Instruments in Dentistry

A. Smaller outer nut: Used to tighten the spindle, to hold the matrix band. B. Large inner nut: Used to change the size of the matrix band by adjusting the position to fit a specific tooth. C. Rotating spindle: A straight screw used to secure the matrix band. D. Frame: Hold the part of matrix retainer together. E. Guide slot: Diagonal slot where the matrix band is placed and is secured by the spindle. F. Head: Extensions that aid in the positioning of the matrix band in left, right or anterior/universal position. Types: Different types of tofflemire retainer available are: • Universal/straight • Contra-angle • Contra-angle junior 1. Universal tofflemire retainer Function of each part 1. Head: It accommodates the matrix band and U shaped. It has a closed end and an open end which contains the

Conservative and Endodontic Instruments

2. 3. 4. 5.

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guide slot. The open end of this outer guide slot should be held facing the operator while insertion of the matrix band into the retainer and should always be facing gingivally during the insertion of the matrix around the tooth. Guide slot: It has a diagonal slot for placing the matrix band. Rotating spindle: It adjusts the distance between the head and the guide slot and is used in adjusting the loop size of the matrix. Large inner nut: It adjusts the loop size and secures or releases the band for tooth. Smaller outer nut: It helps in adjusting pointed spindle to the locking vise.

Types of bands

a. No. 1 tofflemire band: Also referred to as the universal band. b. No. 2 tofflemire band: Also called the MOD band which has two extensions projecting at its gingival edge to allow matrix application in teeth with very deep gingival margins in the proximal aspects of the tooth.

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Instruments in Dentistry

c. No. 3 tofflemire band: It is also used for MOD cavities and has deeper gingival margins. Compound Supported Matrix

• Custom made matrix/anatomical matrix. • Employs 5/16 inch wide, 0.002 inch thick stainless steel band cut to a length such that it wraps around the 1/3 of the facial and lingual side beyond the prepared proximal side. • Band is wedged and stabilized by applying softened impression compound facially, lingually and occlusally on the adjacent tooth. T-band Matrix

• Performed t-shape stainless steel matrix band is used without a retainer. • Long arm is bent to surround the tooth and it overlaps the short arm which is then bent over the long arm, thus retains the shape. • Band is supported by wedging and low fusing compound. Precontoured Matrix

• Small, precontoured dead soft metal matrixes in various size held in place by a flexible metal ring. It is used for

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both amalgam and composite restorations, e.g. Palodent bitine matrix system, composite-tight matrix system. Copper Band Matrix

• Various sizes are available and are selected according to the diameter of the tooth. • Used in badly broken down teeth especially those receiving pin-amalgam restoration and complex class II cavities. • Provides excellent contour but is time consuming.

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Instruments in Dentistry

Automatrix

• Retainerless matrix system indicated for complex amalgam restorations. • It has a. Automatrix bands of various thickness and selected according to the height of the tooth.

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b. Automate II tightening device that adjusts the matrix band loop. c. Shielded nippers to remove the band from the tooth after restoration. • It is convenient to use but expensive. Clear Plastic/Mylar Strips

• These are matrixes for 9 tooth-coloured restoration as they allow light to be transmitted during polymerization of composite resins. Also used for glass ionomer restorations. • Band should extend at least 1 mm beyond the gingival and incisal margins of the cavity preparation. • Stabilized by the wooden or light transmitting wedges. Cellophane Strips

• Transparent strips thinner than Mylar strips can be used for class V, class III, class IV restoration.

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Instruments in Dentistry

Transparent Plastic Crown form Matrixes

• Indicated for large class IV cavities and oblique fractures of anterior teeth. • Available in various sizes and contours for anterior teeth. • Suitable crown form is selected to fit the tooth and the cavity 1 mm beyond the prepared margins. • Bulk of the composite resin is loaded into the crown form, positioned over the tooth and light curing is done. • Crown form matrixes are expensive. Window Matrix

• It is a modification of tofflemire matrix and is used for class V amalgam restorations.

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• A window is cut smaller than the cavity and applied around the tooth using contra-angled tofflemire retainer. Tin Foil Matrix

• Indicated for class V restoration with glass ionomer cements.

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Instruments in Dentistry

• Band is preshaped and cut to extend 1 mm circumferentially beyond cavity margins and peeled after the setting of restoration. • Not used for resin cements. Preformed Transparent Cervical Matrixes

• Indicated for class V restoration with composite resin and resin modified GICs. • It is available in various contours. • It has a knob which helps to the matrix on to tooth by a tweezer. Wedges Wooden Wedges

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• Wooden wedges are easy to trim, adapt well, absorb moisture well to provide adequate stabilization. • There are ready-made and custom-made wedges which are available in different shapes and sizes. • Premier sycamore wedges are shaped to impart physiologic contour to the matrix and are colour coded. • Approximately 1/5 inch of a toothpick or a tongue blade is cut to form custom-made wedges. Plastic Wedges

a. Normal wedge • Similar to the wooden wedges in configuration and usage (image) b. Wave-shaped wedges • Flexible tip allows easy placement and spring back to seal both buccal and lingual embrasures. • Curve profile ensures ease of placement without piercing the gingival. • Wave shape wedges come in three sizes: Small (white), medium (pink) and large (purple). Light Transmitting Wedges

• Light transmitting wedges are transparent wedges which can transmit light into the proximal cavity region and is

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Instruments in Dentistry

used to ensure the polymerization of esthetic tooth coloured composite restoration. ENDODONTIC INSTRUMENTS Classification

The endodontic instruments can be classified on the basis of their method of use: • Group I: Hand-operated endodontic instruments. These include broaches, files and reamers. • Group II: Nonrotary endodontic instruments used with a handpiece. These include engine driven instruments and ultrasonic and sonic instruments. • Group III: Rotary endodontic instruments used with a handpiece. These include low-speed instruments in which the latch type of attachment is used to retain them in the low speed handpieces. Gates-glidden drills and Peaso Reamers are part of this group. This group also includes the rotary nickel–titanium instruments.

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Group I: Hand-operated Instruments Barbed Broaches

Diagrammatic picture of a broach and rasp:

Pulp extirpation using broach:

There are two types: 1. Smooth broaches: • These are free of barbs. • Previously they were used as path finder, but at present flexible files are used for this.

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Instruments in Dentistry

2. Barbed broaches: • These are the oldest intracanal instruments with specification by ANSI No. 63 and ISO No. 3630-1. • These have ADA specification No. 6 • Broaches are short handled instruments meant for single use only. • These are made from round steel wires. The smooth surface of wire is notched to form barbs bent at an angle from the long axis. • Broach does not cut the dentin but can effectively be used to remove cotton or paper points which might have lodged in the canal. • Broach should not be forced apically into the canal, as its barbs get compressed by the canal wall. While removing this embedded instrument, barbs get embedded into dentin and broach may break on applying pressure. Uses of broach • Extirpation of pulp tissues. • Removal of cotton or paper points lodged in the canal. • Loosen the necrotic debris from canal. Rasps

• They have ADA specification No. 63. • Rasp have similar design to barbed broach except in taper and barb size. Barb size is larger in broach then rasp. • They are used to extirpate pulp tissue. Broach • Barb extends to half of its core diameter, making it weaker instrument. • Less taper (0.007–0.010 taper/mm) • Barbs are very fine and longer

Rasp • Barbs extend to one-third of the core, so it is not as weak as barbed broach • More taper (0.015–0.020 taper/ mm) • Barbs are blunt, shorter and shallower

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Reamers

Triangular blank and lesser number of flutes in reamer:

Reamer has lesser number of flutes than file: • Reamers are k-type instruments (manufactured by Kerr company), which are used to ream the canal. They cut by inserting into the canal, twisting clockwise one quarter to half turn and then withdrawing, i.e. penetration, rotation and retraction.

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Instruments in Dentistry

• Reamers have triangular blank and lesser number of flutes than files. Number of flutes is ½–1/mm, while in files the flutes are 1½–2½/mm. • Though reamer has fewer numbers of flutes than file, cutting efficiency is same as that of files because more space between flutes causes better removal of debris. • Reamer tends to remain self-centred in canal resulting in less chances of canal transportation. Files

• Files are the instruments used during cleaning and shaping of the root canals for machining of the dentin. Since Kerr manufacturing company was first to produce them, the files were also called K-files. Commonly used files 1. K-file 2. K-flex file 3. Flexo-file 4. Triple flex files 5. Flex-R file 6. Hedstrom file

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Difference between files and reamers

1. 2. 3. 4.

Cross-section Area of cross-section Flutes Flexibility

5. Cutting motion

6. Preparation shape 7. Transport of debris

7. 8. 9. 10.

Files

Reamers

Square More More (1½–2/mm) Less

Triangular Less Less (½–1/mm) More (because of less work hardening) Rotation and retraction

Reshaping penetration (push and pull) Usually ovoid Poor because of tighter flutes

Round Better because of space present in flutes

Safety H-file S-file C + Files Golden medium Files

a. K-files

Square or triangular cross-section of a K-file:

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Instruments in Dentistry

• They are triangular, square or rhomboidal in crosssection, manufactured from stainless steel wire, which is grounded into desired shape. • K-files have 1½ to 2½ cutting blades per mm of their working end. • Tighter twisting of the file spirals increases the number of flutes in files (more than reamer). • Triangular cross-sectioned files show superior cutting and increased flexibility than the file or reamers with square blank.

Disadvantages of K-files 1. Less cutting efficiency 2. Extrusion of debris periapically. b. K-flex Files

Rhombus cross-section of K-flex file • They were introduced by Kerr manufacturing company in 1982. It was realized that square blank of file results in total decrease in the instrument flexibility. To maintain shape and flexibility of these files, K-flex files were introduced. • K-flex files are rhombus in cross section having two acute angles and two obtuse angles.

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• Two acute angles increase sharpness and cutting efficiency of the instrument. • Two obtuse angles provide more space for debris removal. Also the decrease in contact of instrument with canal walls provides more space for irrigation. • They are used in filing and rasping motion. c. Flexo files

• These are similar to the K-flex files except that they have triangular cross section. This feature provides them more flexibility and thus ability to resist fracture. • The tip of file is modified to non-cutting type. • They are made up to NiTi. • Flexo files have more flexibility but less of cutting efficiency. d. Triple flex Files • They are made up of stainless steel and are triangular in cross section. • They have more flutes than reamers but lesser than K-files.

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e. Flex-R-files/Roane files

• Flex-R-files are made by removing the sharp cutting edges from the tip of instrument. The noncutting tip enables the instrument to traverse along the canal rather than gouge into it. • This design reduces the ledge formation, canal transportation and other procedural accidents when used with balanced force technique. • Another feature of flex-R file is presence of triangular cross-section which provides it flexibility to be used in curved canals. • They are made up of NiTi and cut during anticlockwise rotary motion. f. Hedstrom files (H-files)

Diagrammatic view of Hedstrom file • Hedstrom files have flutes which resemble successively triangles set one on another.

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• They are made by cutting the spiral grooves into round, tapered steel wire in the same manner as wood screws are made. This results in formation of a sharp edge which cuts on removing strokes only.

• Hedstrom files cut only when instrument is withdrawn because its edges face the handle of the instrument.

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Instruments in Dentistry

• When used in torquing motion, their edges can engage in the dentin of root canal wall and causing H-files to fracture. • Rake angle and distance between the flutes are two main features which determine working of the file. • H-files have positive rake angle, i.e. its cutting edge is turned in the same direction in which the force is applied which makes it dig into the dentin making it more aggressive in cutting. • Hedstrom files should be used to machine straight canals because they are strong and aggressive cutters. Since they lack the flexibility and are fragile in nature, the H-files tend to fracture when used in torquing action. Advantages of H-files 1. Better cutting efficiency 2. Push debris coronally Disadvantages of H-files 1. Lack flexibility 2. Tend to fracture 3. Aggressive cutter g. Safety Hedstrom File

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• This file has non-cutting safety side along the length of the blade which reduces the chances of perforations. The non-cutting side is directed to the side of canal where cutting is not required. The non-cutting side of safety file prevents lodging of the canals. h. S-file

• It is called ‘S’ file because of its cross-sectional shape. • S-File is produced by grinding, which makes it stiffer than Hedstrom file. This file is designed with two spirals for cutting blades, forming double helix design. • S-file has good cutting efficiency in either filling or reaming action, thus this file can also be classified as a hybrid design. i. C+ Files • C+ files are used for difficult and calcified canals. They have better buckling resistance than K-files. • They are available in sizes 8, 10 and 15 of length 18, 21 and 25 mm.

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Instruments in Dentistry

j. Golden medium files 1. These files were described by Weine. They come under intermediate files provided with half sizes between conventional instruments. 2. They are available in sizes from 12–37 like 12, 17, 22, 27, 32 and 37. 3. They are used for narrow canals. 4. They are formed by cutting 1 mm from the tip of instrument. In this way no. 10 file can be converted to no. 12 and 15 to no. 17 and so on. Engine-driven Instruments Gates-Glidden Drills

• Traditional engine driven instruments include GatesGlidden drills which have flame-shaped cutting point mounted on long thin shaft attached to a latch type shank.

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• Gates-Glidden drills are available in a set from 1 to 6 with the diameters from 0.5 to 1.5 mm. • Due to their design Gates-Glidden drills are side cutting instruments with safety tips.

• They should be used at the speed of 750–1500 rpm in brushing strokes. • Safety design of Gates-Glidden drills is that its weakest part lies at the junction of shank and shaft of the instrument. If its cutting tip jams against the canal wall, fracture occurs at the junction of shank and the shaft but not at the tip of the instrument. This makes the easy removal of fractured drill from the canal. • They can be used both in crown down as well as step back fashion.

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Instruments in Dentistry

Number

Diameter at cutting tip

1

0.50 mm

2

0.70 mm

3

0.90 mm

4

1.1 mm

5

1.3 mm

6

1.5 mm

Uses of Gates-Glidden Drills 1. For coronal flaring during root canal preparation. 2. During retreatment cases or post space preparation for removal of gutta-percha. 3. During instrument removal, if used incorrectly for example using at high rpm, incorrect angle of insertion, forceful drilling, and the use of Gates-Glidden can result in procedural accidents like perforations, instrument separation, etc. Flexogates

• Flexogates are modified Gates-Glidden. They are made up of NiTi and have non-cutting tip. • They are more flexible and used for apical preparation. • Flexogates can be rotated continuously in a handpiece through 360°. • These instruments have many advantages over the traditional instruments in that they allow increased debris removal because of continuous rotation, smoother and faster canal preparation with less clinician fatigue.

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Advantages of flexogates 1. Safe non-cutting guiding tip. 2. Safety design, i.e. its breakage point is 16 mm from the tip, so once fractured, it can be easily retrieved. 3. Flexible, so used in curved canals. Peeso Reamers

• They are rotary instruments used mainly for post space preparations. • They have safe ended non-cutting tip. • Their tip diameter varies from 0.7 to 1.7 mm. • They should be used in brushing motion. Disadvantages of using peeso reamers are: 1. They do not follow the canal curvature and may cause perforation by cutting laterally. 2. They are stiff instruments. 3. They have to be used very carefully to avoid iatrogenic errors. Number

Diameter at cutting tip

1

0.70 mm

2

0.90 mm

3

1.1 mm

4

1.3 mm

5

1.5 mm

6

1.7 mm

Nickel Titanium (NiTi) Endodontic Instruments

• When using the stainless steel files, occurrence of procedural errors cannot be avoided specially in case of curved canals.

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Instruments in Dentistry

• Deviation from the original shape, ledge formation, zipping, stripping and perforations are the common problems which are seen in curved canals. • But the super elasticity of NiTi alloy allows these instruments to flex more than the stainless steel instruments before exceeding their elastic limit, thereby allowing canal preparation with minimal procedural errors. Advantages of NiTi alloys • Shape memory • Super elasticity • Low modulus of elasticity • Good resiliency • Corrosion resistance • Softer than stainless steel Disadvantages of NiTi files • Poor cutting efficiency. • NiTi files do not show signs of fatigue before they fracture. • Poor resistance to fracture as compared to stainless steel. Greater Taper Files (GT Files)

• The GT rotary instruments possess a U-shaped file design with ISO tip sizes of 20, 30 and 40 and tapers of 0.04, 0.06, 0.08, 0.10 and 0.12. • Accessory GT files for use as orifice openers of 0.12 taper in ISO sizes of 35, 50, 70 and 90 are also available. • The maximum diameter of these instruments is 1.50 mm. • Recommended rotational speed for GT files is 350 rpm. • Negative rake angle of these files makes them to scrape the dentin rather than cutting it. Protaper Files

• It was introduced by D Cliff Ruddle, Dr Johan West, Ben John and Dr Pierre.

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• ProTaper means progressively taper. A unique feature of the ProTaper files is each instrument has changing percentage tapers over the length of cutting blades. This progressively tapered design improves flexibility, cutting efficiency and the safety of these files. • Recommended speed for their use is 150–350 rpm. • The ProTaper file has a triangular cross-section and is variably tapered across its cutting length.

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Instruments in Dentistry

• Convex triangular cross-section of this instrument decrease the friction between the blade of file and the canal wall and it increases its cutting efficiency. • ProTaper file has modified guiding tip which allows one to follow canal better. • Variable tip diameters of ProTaper file allows it to have specific cutting action in defined area of canal without stressing instrument in other sections. • ProTaper file has a changing helical angle and pitch over their cutting blades which reduces the instrument from screwing into the canal and allows better removal of debris. • ProTaper file acts in active motion, this further increases its efficiency and reduces torsional strain. • Length of file handle is reduced from 15 to 12.5 mm which allows better access in posterior areas. • The ProTaper system consists of just three shaping and three finishing files. Shaping Files

• These are termed Sx, S1 and S2. • Shaping and finishing files

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Sx • No identification ring on its gold colored handle • Shorter length of 19 mm • D0 diameter is 0.19 mm • D14 diameter is 1.20 mm • There is increase in taper up to D9 and then taper drops off up to D14 which increases its flexibility • Use is similar to Gates-Glidden drills or orifice shapers. S1 • Has purple identification ring on its handle • D0 diameter is 0.17 mm and D14 is 1.20 mm • Used to prepare coronal part of the root. S2 • Has white identification ring on its handle • D0 diameter is 0.20 mm and D14 is 1.20 mm • Used to prepare middle third of the canal. Finishing Files

• Three finishing files F1, F2, F3 are used to prepare and finish apical part of the root canal.

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Instruments in Dentistry

F1 • Yellow identification ring • D0 diameter and apical taper is 20 and 0.07. F2 • Red identification ring on handle • D0 diameter and taper is 25 and 0.08. F3 • Blue colored ring on handle • D0 diameter and taper is 30 and 0.09. • Each instrument has decreasing percentage of taper from D4 to D14. This improves flexibility and decrease the potential for taper lock. Instruments used for Filling Root Canals

• Spreaders and pluggers are the instruments used to compact the gutta-percha into root canal during obturation.The use of instrument depends on the technique employed for obturation.

• Earlier there used to occur the discrepancy in spreader size and shape with the gutta-percha points but in 1990, ISO/ADA endodontic standardization committee recommended the size of 15–45 for spreaders and 15–140 for pluggers.

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Instruments in Dentistry

1. Spreaders • Hand spreaders • Finger spreaders 2. Pluggers • Hand pluggers • Finger pluggers 3. Lentulo spirals Hand Spreaders

• They are made from stainless steel and are designed to facilitate the placement of accessory gutta-percha points around the master cone during lateral compaction technique. • These spreaders do not have standardized size and shape. • They are not used routinely because excessive pressure on the root may cause fracture of root. Finger Spreaders

• They are shorter in length which allows them to afford a great degree of tactile sense and allow them to rotate freely around their axis. • They are standardized and color coded to match the size of gutta-percha points. • They can be manufactured from stainless steel or nickel titanium.

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Hand Pluggers

• They consist of diameter larger than spreader and have blunt end. • They are used to compact the warm gutta-percha vertically and laterally into the root canal. • They may also be used to carry small segments of guttapercha into the canal during sectional filling technique. • Calcium hydroxide or MTA-like materials may also be packed into the canals using pluggers. Finger Pluggers

• They are used for vertical compaction of gutta-percha. They apply controlled pressure while compaction, and have more tactile sensitivity than hand plugger. Lentulo Spirals

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Instruments in Dentistry

• They are used for applying sealer cement to the root canal walls before obturation. • They can be used as hand or rotary instruments. o Various designs of instrument holders and gauzes are available commercially for operator’s convenience.

Isolation of operating field Rubber Dam

Advantages of using a rubber dam • It is raincoat for the teeth. • It helps in improving accessibility and visibility of the working area. • It gives a clean and dry field while working. • It protects the lips, cheeks and tongue by keeping them out of the way. • It helps to avoid unnecessary contamination through infection control.

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• It protects the patient from inhalation or ingestion of instruments and medicaments. • It helps in keeping teeth saliva free while performing a root canal so that tooth does not get decontaminated by bacteria present in saliva. • It improves the efficiency of the treatment. • It limits bacterial laden splash and splatter of saliva and blood. • It potentially improves the properties of dental materials. • It provides protection of patient and dentist. Disadvantages • Takes time to apply • Communication with patient can be difficult • Incorrect use may damage porcelain crowns/crown margins/ traumatize gingival tissues • Insecure clamps can be swallowed or aspirated Contraindications of use of rubber dam • Asthmatic patients • Allergy to latex • Mouth breathers • Extremely malpositioned tooth • Third molar (in some cases) Rubber dam equipment 1. Rubber dam sheet 2. Rubber dam clamps/retainer 3. Rubber dam forceps 4. Rubber dam frame/holder 5. Rubber dam punch 6. Rubber dam stamp /template 7. Other retainers Rubber dam accessories 1. Lubricant/petroleum jelly 2. Dental floss 3. Rubber dam napkin

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Instruments in Dentistry

Rubber dam sheet

• The rubber dam is available in size 6 × 6 squares and colors are usually green, blue and black. It is available in three thicknesses, i.e. light, medium and heavy. The middle grade is usually preferred as thin is more prone to tearing and thickest more difficult to apply. Latex free dam is necessary as number of patients is increasing with latex allergy. Flexi Dam is latex free dam of standard thickness with no rubber smell. Thickness of rubber dam sheet Thin Medium Heavy Extra heavy Special heavy Rubber dam clamps

— — — — —

0.15 mm 0.2 mm 0.25 mm 0.30 mm 0.35 mm

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Parts of rubber dam clamp:

• Rubber dam clamps, to hold the rubber dam on to the tooth are available in different shapes and sizes. Clamps mainly serve two functions: o They anchor the rubber dam to the tooth. o Help in retracting the gingiva. • Rubber dam clamps can be divided into two main groups on the basis of jaw design. o Bland o Retentive Bland clamps • Bland clamps are usually identified by the jaws, which are flat and point directly towards each other. In these clamps, flat jaws usually grasp the tooth at or above the gingival margin. They can be used in fully erupted tooth where cervical constriction prevents clamp from slipping off the tooth. Retentive clamps • As the name indicates, these clamps provide retention by providing four-point contact with the tooth. In these, jaws are usually narrow, curved and slightly inverted which displace the gingivae and contact the tooth below the maximum diameter of crown.

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Instruments in Dentistry

• Both flanges are further subdivided into: o Winged o Wingless • Rubber dam clamp can also be divided on the basis of material used. 1. Metallic 2. Non-metallic 1. Metallic: Traditionally, clamps have been made from tempered carbon steel and more recently from stainless steel. 2. Non-metallic: Non-metallic is made from polycarbonate plastic. An advantage of these clamps over metallic is radiolucency. • A good length of dental floss should always be passed through the holes in the clamp as a security in case it is dropped in the mouth or the bow fractures. Rubber dam forceps

• Rubber dam forceps are used to carry the clamp to the tooth. They are designed to spread the two working ends of the forceps apart when the handles are squeezed together. The working ends have small projections that fit into two corresponding holes on the rubber dam clamps. The area between the working end and the handle has a sliding lock device which locks the handles

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in positions while the clinician moves the clamp around the tooth. It should be taken care that forceps do not have deep grooves at their tips or they become very difficult to remove once the clamp is in place. Rubber dam frame

• Rubber dam frames support the edges of rubber dam. They have been improved dramatically since the old style with the huge “butterflies”. Modern frames have sharp pins which easily grip the dam. These are mainly designed with the pins that slope backwards. • Rubber dam frames serve the following purposes: 1. Supporting the edges of rubber dam 2. Retracting the soft tissues 3. Improving accessibility to the isolated teeth. • Rubber dam frames are available in either metal or plastic. • Plastic frames have advantage of being radiolucent. As we see when taut, rubber dam sheet exerts too much pull on the rubber dam clamps, causing them to come loose, especially clamps attached to molars. To overcome this problem, a new easy-to-use rubber dam frame (Safe-T-Frame) has been developed that offers a secure fit without stretching the rubber dam sheet. Instead, its “snap-shut” design takes advantage of the clamping effect on the sheet, which is caused when its two mated frame members are firmly pressed together. In this way, the sheet is securely attached, but without being stretched. Held in this manner, the dam sheet is under less tension, and hence, exerts less tugging on clamps— especially on those attached to molars.

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Rubber dam punch

• Rubber dam punch is used to make the holes in the rubber sheet through which the teeth can be isolated. The working end is designed with a plunger on one side and a wheel on the other side. This wheel has different sized holes on the flat surface facing the plunger. The punch must produce a clean cut hole every time. Two types of holes are made, single and multi-hole. Single holes are used in endodontics mainly. If rubber dam punch is not cutting cleanly and leaving behind a tag of rubber, the dam will often split as it is stretched out. Rubber dam template

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• It is an inked rubber stamp which helps in marking the dots on the sheet according to position of the tooth. Holes should be punched according to arch and missing teeth. Rubber dam accessories

• A lubricant or petroleum jelly is usually applied on the undersurface of the dam. It is usually helpful when the rubber sheet is being applied to the teeth. Dental floss

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• It is used as flossing agent for rubber dam in tight contact areas. It is usually required for testing interdental contacts. Wedjets

• Sometimes wedjets are required to support the rubber dam. Rubber dam napkin

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• This is a sheet of absorbent materials usually placed between the rubber sheet and soft tissues. It is generally not recommended for isolation of single tooth. Dental Handpieces and Accessories

Rotary instruments are used to complete different functions in the cutting, polishing, and finishing of tooth structure and the restoration process. Dental Handpiece

The handpiece is the most frequently used piece of machinery in dentistry. It provides power to a rotary instrument that is used to complete the actual cutting or polishing of tooth structure and castings. Low-speed handpiece

Design • Straight in appearance. • Standard length and “shorty”. • Speed range from 10,000 to 30,000 rotations per minute (rpm). • Powers the rotary instrument in both a forward and a backward motion.

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Uses Clinical • Removal of soft decay and finishing of cavity preparations. • Finishing and polishing of restorations. • Coronal polishing and removal of stains. • Porcelain adjustments. • Root canal treatment. Laboratory • Trimming and contouring of temporary crowns. • Trimming and relining of removable partials and dentures. • Trimming and contouring of orthodontic appliances. Low-speed attachments Straight attachments • Long-shank laboratory bur • Prophylaxis angle attachments Contra-angle attachment • Latch-type rotary instruments • Mandrel Prophylaxis angle

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• Used during polishing procedures to hold the prophylaxis cup and bristle brush • Two types • Plastic disposable “prophy” angle • Metal “prophy” angle High-speed handpiece

Design • One-piece unit with a slight curve. • Operated by air pressure. • Operates at speeds as high as 450,000 rpm. • Maintains a water-coolant system. • Friction-grip locking system for rotary instruments. • Fiberoptic lighting. Uses • Removal of decay. • Removal of old or faulty restorations. • Reduction of the crown portion of a tooth in preparation for a crown or bridge. • Preparation of an outline and retention grooves for a new restoration. • Finishing or polishing of a restoration. • Sectioning of a tooth during a surgery.

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Ultrasonic handpiece

Design • Attaches to the dental unit. • Powered by electricity. • Primarily used for prophylaxis appointments. • Attachments similar in appearance to scaling instruments. • Delivers a pulsating spray of water. Uses • Removal of calculus. • Removal of stains. • Removal of bonding materials from the tooth surface after orthodontic appliances is removed. • Removal of cement after orthodontic bands is removed. Laser handpiece:

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Design • Laser light beam, conducted through a fiberoptic cable, instead of rotary instruments. • Resemblance to a standard handpiece. • Water-coolant system. • Air-coolant system. Uses • Cauterizing soft tissue. • Vaporizing decayed tooth structure. Advantages • Usually painless. • Generally no need for anesthesia. • Speed of procedure. Disadvantage • Cannot be used on teeth with existing restorations. Air-abrasion handpiece:

Design • Small version of a sandblaster. • High-pressure delivery of aluminum oxide particles through a small probe. Uses • Preparation of teeth for sealants. • Removal of external stains. • Class I through class VI preparations. • Endodontic access. • Crown margins.

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• Preparation of the tooth surface for the cementation of a cast restoration (e.g. crown or veneer). • Preparation of teeth for sealants. • Removal of external stains. • Class I through class VI preparations. • Endodontic access. • Crown margins. • Preparation of the tooth surface for the cementation of a cast restoration (e.g. a crown or veneer). Laboratory handpiece

Design • Operates at speeds as high as 20,000 rpm. • Uses laboratory burs. • Greater torque than that of handpieces used intraorally. Handpiece Maintenance

General considerations • Wear personal protective equipment and follow universal precautions. • Clean debris from the external surface.

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Clean the internal components of the handpiece. Handpiece must be dry before being packaged. Wrap the handpiece for sterilization. Sterilize the handpiece. Wipe the light port on the fiber-optic with an alcohol swab to remove any excess lubricant.

Rotary Cutting Instruments

Dental burs

Three basic parts to a rotary instrument

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Shank: Portion that fits into the handpiece. • Straight shank • Latch type shank • Friction grip shank Neck: Portion of the rotary instrument that connects the shank and the head. Head: The cutting, polishing, or finishing portion. • Rotary instruments with sharp cutting head. Uses: • Tooth preparation. • Excavation of decay. • Finishing cavity walls. • Finishing restoration surfaces. • Taking out old fillings. • Finishing crown preparations. • Separating crowns and bridges. • Adjusting and correcting acrylic temporaries. ABRASIVE MATERIALS USED IN DENTISTRY AND THEIR USES

• Abrasive materials are mainly minerals which are used in finishing and polishing a restoration, abrasive materials are used to remove the uneven or rough surface on the surface of restorative materials which will lead to debris accumulation and decrease the surface smoothness.

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• These dental abrasive material particles coat the surface of the burs and act on the tooth or restorative materials by rotation of the bur using a handpiece. Some abrasive materials are used in the form of paste and others as Polishing Strips. Here is a list of abrasive materials in dentistry and their respective uses: • Natural diamond: Used for ceramic and resin-based composite materials • Synthetic diamond: Used on tooth structures, ceramic materials and resin-based composite materials • Arkansas stone: For fine grinding of tooth enamel and metal alloys • Chalk: To polish tooth enamel, gold foil, amalgam and plastic materials • Corundum (white stone): For grinding metal alloys • Abrasives: On composite materials • Emery: For finishing metal alloys or acrylic resin • Garnet: For grinding metal alloys and acrylic resin materials • Pumice: Polishing tooth enamel, gold foil, dental amalgam and acrylic resins • Quartz: Finish metal alloys and to grind dental enamel • Sand: Grinding of metal alloys and acrylic resin materials • Zirconium silicate: Component of dental prophylaxis paste • Cuttle: Polishing of metal margins and dental amalgam restorations • Kieselguhr: Filler in hydrocolloid impression materials • Silicon Carbide: Metal alloys, ceramics and acrylic resin materials • Aluminium oxide: For adjusting Dental Enamel, for finishing metal alloys, resin-based composites and ceramic materials • Tin oxide: Polishing agent for polishing teeth and metallic restorations

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3 Prosthodontic Dental chair Instruments

Heat Sources Bunsen Burner

• Dental alcohol torches and lamps are very useful in a dental lab where sterilizing instruments are essential. • Using dental alcohol torches in denture fabrication to melt wax or compound material is probably the most common use for these products. • Alcohol torches and lamps feature high temperature flames with no odors. • This is a relatively inexpensive method for sterilization and fabrication. 104

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• Dental alcohol torches and lamps use denatured alcohol. • Some vendors sell dental alcohol torches that have been used for decades by dentists; these cast precise pinpoint flames to blowtorch type flames and are meant for duration and repeated use. • Laboratory vendors also sell alcohol torches and lamps that are more of the disposable variety. • The type of torch or lamp chosen depends on personal preference as well as intended use. Alcohol Torch

• Produces a needle-point flame with gentle pressure on the weighted plastic bottle. May also be used as an alcohol lamp, 5" high. Spatula Straight Mixing Spatula

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Instruments in Dentistry

• Straight mixing spatula is used for mixing dental plaster and dental stone. • The blade of the metallic spatula is straight with a rounded end. • The handle is made of plastic. Curved Mixing Spatula

• Curved mixing spatula is used for mixing alginate. • The blade of the metallic spatula is curved with a rounded end. • The curved helps in the mixing of the alginate material. Wax Spatula

• Wax spatula is an instrument used for carving the molten wax during the wax up procedures. • Wax spatula has two ends, one end has a broad scoop to take molten wax and the other end has a pointed end for carving purpose.

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Mixing Bowl Rubber Bowl

• Rubber bowl is used for the manipulation of plaster, stone, alginate. • It is available in different sizes. • It is made of stiff and flexible rubber. Prosthodontic Knife Plaster Knife

• • • •

Plaster knife is used in trimming of plaster models. The blade of the plaster knife is metallic. The handle is made of plastic. It can be also used during the manipulation of other gypsum products.

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Wax Knife

• Wax knife is used commonly during fabrication of wax occlusion rims, teeth arrangement, and wax up procedures and for finer manipulation of dental plaster during procedures like mounting and flasking. • It has knife-like end on one side for cutting wax and the other end has a scoop used for carrying the molten wax and manipulating curved wax surfaces. Carver Wax Carver

• Wax carver is an instrument used for carving the wax pattern of the tooth. • The carver has two ends, one end is a scoop used for scooping out wax and the other end has a sharp blade end for carving the pattern in wax. • Frequent heating of the wax carver may cause bluntness of the carving tip. • Wax carver is also used in finer manipulation of gypsum products.

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Impression Trays

• These are metal trays which are used to carry the impression material into the mouth and give support to the impression material so that there is a good impression (or) a replica of the oral cavity. Edentulose Stainless Steel Stock Tray

• Edentulous stainless steel stock tray is used for making impression of edentulous patients with impression compound. • It is a prefabricated, nonperforated impression trays made of stainless steel. • The impression tray has a carrier for carrying the impression material and a handle for positioning and handling the impression. • The lower tray is U-shaped to accommodate the tongue, whereas the upper tray is shaped to accommodate the palate and alveolar ridge. Dentulous Metallic Stainless Steel and Plastic Stock Tray

• Dentulous metallic stainless steel stock tray is used for making impression of dentulous patients.

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Instruments in Dentistry

• It is a prefabricated perforated impression trays made of stainless steel with perforations which aids in the retention of impression material such as alginater. Scissors Curved scissor

• Curved scissor is used for cutting of shellac base plate during the fabrication of temporary record base. • The curved scissor has a curved beak.

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Straight Scissor

• Straight scissor is used for manipulation of temporary record base materials. • The straight scissor has a straight beak. Dappen Dish

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Instruments in Dentistry

• Dappen dish is used for mixing small amounts of selfcurved acrylic resin. • It is also used for dispensing small amounts of separating medium like sodium alginate. Spirit Lamp

• Spirit lamp has metallic container with a provision for placing the wick and a metallic cap to close the wick. • Spirit is poured into the container and a cotton wick is inserted into it. • It gives a continuous noncarbon flame. • It is during the chair side clinical procedures for heating of instruments like carver, wax knife. Chip Blower

• Chip blower is commonly in wax up procedures to direct the flame in the area of the wax that needs to be softened and polished. • It is a mechanical hand blower.

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Hot Plate

• Hot plate is used for uniform reduction of occlusion rim. • It has a broad metal plate with a plastic handle. Porcelain Cup With Lid

• A porcelain cup is used for mixing heat cure and self cure acrylic resin material. • When the polymer and monomer material is shifted into the porcelain cup, the cup is closed with the lid to prevent evaporation of monomer.

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Instruments in Dentistry

Dental Flask

• Dental flask is used for investing the waxed denture in dental plaster for processing into acrylic denture. • The dental flask consists of three components, namely the base, the body and the lid. • There are orienting prong in the base and corresponding notches in the base which will help in assembling the base and the body.

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Glass Slab And Mixing Spatula

• Glass slab and mixing spatula is used for mixing zinc oxide euginol impression material and light body elastomeric impression material. • The blade of mixing spatula is about 5 cm in length and flexible. Glass Plate

• A square glass plate is used as a template during the setting artificial teeth.

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Mixing Pad And Mixing Spatula

• The mixing pad and spatula is used for mixing light body elastomeric impression material and zinc oxide eugenol impression material. • The mixing pad is made of oil impervious paper. • The mixing pad has two distinct lines marked with numbers marked for taking equal length of the base paste and reactor paste. • The mixing spatula has a long stiff broad blade and a plastic handle. Acrylic Trimmer: Tungsten Carbide

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• Acrylic trimmer is a motor driven tool used for trimming the acrylic resin. • It is available in various form and sizes. • It is used during the gross trimming of the acrylic dentures after processing of the dentures. Sandpaper Mandrel

• Sandpaper mandrel is a motor driven tool used for holding the sandpaper during the finishing procedures involving denture base resins. Bard Parker Blade and Handle

• Bard Parker blade is a sharp sterile and can be fixed into a handle. • It is used for trimming excess material during manipulation like impression compound and self-cure acrylic resin.

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Acrylic Trimmer: Mounted Stones

• Acrylic trimmer is a motor-driven tool used for trimming and smoothening the surface of acrylic dentures. • It is available in various forms and sizes. Rag Wheel

• Rag wheel is made of crocus cloth which is attached to a lathe machine. • Rag wheel is medium for impregnating polishing or finishing material like rouge, tin oxide and pumice. • It is used for polishing acrylic partial and complete dentures.

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Gas Torch

• Gas torch is a self-igniting hand flame torch. Gas torch gives a continuous noncarbon flame. The gas torch is filled with butane gas which is commercially available. • Gas torch is used during fabrication of shellac record bases, fabrication of wax occlusion rim and for chair side heating of instruments like wax carver and wax knife. Macintosh Sheet

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Instruments in Dentistry

• This is a rubbery material, which is very rigid and is used to keep the surroundings clean from the work done. Lacron Carver

• It is an instrument which has a blade on one side and a scoop like thing on the other side of it. It is an instrument used in dental anatomy practical where we have to carve teeth out of the wax blocks. Dental Tray

• To provide an area specific for instruments • Characteristics: Different designs for different procedures, e.g. hygiene tray, operative tray, surgical tray. Patient Bib

• To prevent materials, debris, fluids from contacting the patient • Characteristics: Differs in colours, shapes and designs; has a protective liquid barrier.

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Bib Holder

• To attach the patient bib around the patient’s neck • Characteristics: Disposable snap/adhesive clips • Alligator clip (not disposable) Kidney Tray, Procedure Trays

• They are used for holding and transporting drugs and devices such as swabs, dressing, syringes, needles, instruments, etc., and as trays in the procedure kits. • Used to hold waste arising from medical, nursing or dental procedures, e.g. human tissue, blood or other body fluids.

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Instruments in Dentistry

T-burnisher

• The T-ball burnisher has a T-shape at its working end, and one of the ends of the T-shape is shaped like a ball. The ball-end dental burnisher is usually used as a probe to find specific orodontal margins. • The round end of the ‘T’-burnisher is used to palpate the tissue anterior to posterior vibrating line (by checking the compressibility, in width and depth). And locate the hamular notch.

a. Locating pterygomaxillary notch with T-burnisher. b. Are of compressibility in posterior palatal seal. c Marked posterior vibrating line.

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Face-bow

• A calliper like device which is used to record the relationship of the maxillae and/or mandible to the temporomandibular joints. Parts of Face-bow

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A. B. C. D. E.

Instruments in Dentistry

U-shaped frame Condylar rods Bite fork Locking device Orbital pointer with clamp.

A. U-shaped frame • It is a U-shaped metallic bar that forms the main frame of the face-bow. • All other components are attached to the frame with the help of clamps. • This assembly is large enough to extend from the region of the TMJ to at least 2 to 3 inches anterior to the face and wide enough to avoid contact with the sides of the face. • This records the plane of the cranium. B. Condylar rods • These are the two small metallic rods on either side of the free end of the U-shaped frame that contacts the skin over the TMJ. • They help to locate the hinge axis or the opening axis of the temporomandibular joint. C. Bite fork • This is a U-shaped plate, which is attached to the occlusal rims while recording the orientation jaw relation. • It is attached to the frame with the help of a rod called the stem. D. Locking device • This is a part of face-bow helps to attach the bite fork to the U-shaped frame. • This also supported the face-bow, occlusal rim and casts during articulation. • It consists of a transfer rod and transverse rod. The U-shaped frame is attached to the vertical transfer rod. The position of this transfer rod can be locked with a thumb screw.

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E. Orbital pointer • It is designed to mark the anterior reference point (infraorbital notch) and can be locked in position with a clamp. It is present only in the arbitrary face-bow. Articulator

• It is a mechanical instrument that represents the temporomandibular joints and jaw members, to which maxillary and mandibular casts may be attached to simulate some or all-mandibular movements.

Functions

• It allows most of the prosthetic work to be done in the absence of the patient. Purpose of Articulator

• To hold the maxillary and mandibular cast in a determined fixed relationship. • To stimulate the jaw movements like opening and closing. • To produce border movements (extreme lateral and protrusive movements).

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Uses of an Articulator

• To diagnosis the state of occlusion in both the natural and relationship dentitions. • To plan dental procedures based on the relationship between opposing natural and artificial teeth, e.g. evaluation of the possibility of balanced occlusion. • To aid in the fabrication restorations and prosthodontics replacements. • To correct and modify completed restorations. • To arrange artificial teeth. Requirements of an Articulator

• • • • • • • • • •

Hold cast in correct horizontal relationship. Hold cast in correct vertical relationship. Should be easily removable and re-attachable. Should provide positive anterior vertical stop (incisal pin). Should open and close in hinge movement. Should be made of non-corrosive and rigid material that resist wear and tear. Should not be bulky. Moving part should move without any kind of friction. Should accept face-bow transfer record. Non-moving part should be of rigid construction.

Advantages

• Properly-mounted casts allow the operator to visualize the patient’s occlusion, especially from the lingual view. • Patient cooperation is not a factor when using an articulator once the appropriate interocclusal records are obtained from the patient. • Refinement of complete denture occlusion in mouth is extremely difficult because of shifting denture bases and resiliency of the supporting tissue. This difficulty is eliminated when articulators are used. • Reduce chair time, patient’s appointment time.

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Limitations

• Articulator may be made of metal or plastic. Metal articulator shows errors in tooling or errors resulting from metal fatigue. • The articulator may not exactly simulate the intraborder and functional movements of the mandible. • Errors in jaw relation procedures are reproduced as errors in denture occlusion. Classification

1. 2. 3. 4.

Based on the theories of occlusion. Based on the type of inter-occlusal records used. Based on the ability to simulate jaw movement. Based on the adjustability of the articulator.

Articulator Based on Theory of Occlusion

A. Bonwill theory articulators

• Designed by WGA Bonwill. • According to the teeth move in relation to each other as guided by the condylar and the incisal guidances. • Also known as the Theory of equilateral triangle according to which the distance between the condyles is equal to the distance between the condyles and the midpoint of the mandibular incisors.

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Instruments in Dentistry

• Equilateral triangle is formed between the two condyles and the incisal point. B. Conical theory articulator • Proposed by Rhe Hall • It proposed that the lower teeth move over the surfaces of the upper teeth as over the surface of a cone, generating an angle of 45° with the central axis of the cone tipped 45° to the occlusal plane. C. Spherical theory articulator • The articulator was devised by GS Monson. • This theory proposed that lower teeth move over the surface of the upper teeth as over a surface of sphere with a diameter of 8 inches. • The center of sphere located in the region of glabella. The surface of the sphere passed through the glenoid fossa and along through articulating eminences. Based on Types of Records used for their Adjustment

A. Inter-occlusal record adjustment: Articulator adjusted by some kind of inter-occlusal records. These records are made of base plate wax, plaster of Paris, zinc oxide eugenol or cold cure acrylic. B. Graphic record adjustment: Graphic records consist of records of the extreme borders position of mandibular movements. These are capable of accurately reproducing the border movement of mandible. C. Hinge axis location for adjusting articulators: A transographic record can be used to record the accurate location of hinge axis in an articulator. Based on Ability to Simulate Jaw Movement

A. Class I • Simple articulators capable of accepting a single static registration. • Only vertical motion possible.

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• Used in cases of tenative jaw relation. • For example, slab articulator, Barndoor articulator. B. Class II • Articulator which permits horizontal and vertical motion but they do not orient the movement to TMJ with a facebow • Three types Type a

Type b

Type c

Limited eccentric motion, e.g. mean value articulator

Limited eccentric motion possible based on theories of arbitrary motion, e.g. Monsoon’s and Hall’s articulator

Limited eccentric motion possible based on engraving records obtained from the patient, e.g. House’s articulator

C. Class III • Permit horizontal and vertical movements. • Two types: Type a

Type b

They accept a static protrusive registration and they use equivalents for other types of motion, e.g. Hanau h, Hanau II Bergstrom articulator.

They accept static lateral protrusive registration and they use equivalents for other types of motion, e.g. Panadent, trubite, Teledyne Hanau University series.

D. Class IV • Articulator accepts three-dimensional dynamic registrations. They are capable of accurately reproducing the condylar pathway for each patient. Based on Adjustability of the Articulator

A. Non-adjustable B. Semi-adjustable C. Fully-adjustable

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Instruments in Dentistry

A. Non-adjustable

• They can open and close in a fixed horizontal axis. • Have a fixed condylar path along which the condylar ball can be moved to simulate lateral and protrusive jaw movement. B. Semi-adjustable • They have adjustable condylar path, adjustable lateral condylar paths, adjustable incisal guide tables and adjustable intercondylar distances. • Two types:

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Arcon articulator

Non-arcon articulators

• In this the condylar element is attached to the lower member of the articulator and the condylar guidance is attached to the upper member. This articulator resembles TMJ.

In these, the articulators have the condylar element attached to the lower member. This articulator is reverse of the TMJ.

C. Fully adjustable articulator • Capable of being adjusted to follow the mandible movement in all directions. • These articulators have a number of readings which can be customised for each patient. • They do not have condylar guidance. • Instead have receptacles in which acrylic dough can be contoured to form a customised condylar and incisal guidance. • For example, Stuart instrument gnathoscope, simulator by E Granger. Mean Value Articulator

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Instruments in Dentistry

• It is non-adjustable articulator. • Designed using fixed dimensions, which are derived from average distance between the incisal and condylar guidance of the population. • Condylar guidance equivalent to glenoid fossa is attached to the lower member and condylar element equivalent to mandibular condyle is attached to the upper member, hence it is a non-acron articulator. Components of Articulator

A. B. C. D. E. A.

Upper member Lower member Incisal guide table Condylar guidance Incisal pin Upper member • It is a tringular frame with the base of the trinagle placed posteriorly. • The apex of triangle contains a provision to accommodate the incisal pin. • Two condylar elements are seen projecting on either side of the base of the triangle. • They articulate with the condylar guidance of the lower member.

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• The maxillary cast is attached to the upper member during articulation. B. Lower member • L-shaped frame with horizontal and vertical arms. • The horizontal arm is triangular in shape and corresponds to the upper member. • The apex of the triangle of the horizontal arm contains the incisal guide table. • The vertical arm is rectangular containing the condylar guidance slot at the upper position. C. Incisal guide table • It is defined as ‘that part of the articulator which maintains the incisal guide angle’ GPT. • The incisal guide table gives the incisal guidance of the articulator. • It can be describe as a very short cylindrical whose upper surface is concave. • The vertical rod should rest on the centre of the incisal guide table during articulation. • The incisal guide angle is fixed and non-customizable. D. Incisal pin • It helps to keep a fixed distance between the upper and lower members at the anterior end. • The vertical rod has a pointed tip, which should rest on the center of the incisal guide table during articulation. • The tip of the incisal guide pin is the anterior reference points in this articulator. • The incisal egde of the maxillary incisors at the midpoint of the occlusal rim should touch the tip of the incisal pin during articulation. Surveyor

• “An instrument used in the construction of a removable partial denture to locate and delineate the contours and relative positions of abutment teeth and associated structures”.

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Types of Dental Surveyor

1. Ney surveyor 2. Jelenko surveyor 3. Williams surveyor Parts Of Dental Surveyor

1. 2. 3. 4. 5. 6. 1.

Horizontal arm Vertical arm Surveying arm Surveying table Cast holder Surveying tools Surveying plate form • It is metal plate parallel to the floor where a cast holder can be placed • It forms the base of surveyor onto which all the other components are attached and supported.

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2. Surveying table (cast holder) • It is stand placed over the surveying plate form • The stand has place and table to place a cast • The cast can be locked in any position on the table with help of a locking device • The table is attached to the base with help of ball and socket joint facilitate to tilt the table

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3. Vertical arm

• Arises vertically from the surveying plate form. • Make a support for horizontal and surveying arm. 4. Horizontal arm • Extend horizontally from the top of vertical arm. • Support the surveying arm as it is free end.

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5. Surveying arm

• It extends vertically from the free end of the horizontal arm, it is parallel to the vertical arm • The lower end of this arm has a mandrel into which tools used for surveying can be locked in. 6. Surveying tools

A. Carbon markers • It is used for draw surveying line which determined the height of contour of the teeth B. Undercut gauges • Undercut gauges are used to measure the depth and the location of the undercuts on the analyzed tooth in three dimensions.

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Instruments in Dentistry

• Stewart states the availability of undercut gauges in three standard sizes, namely 0.010 inch, 0.015 inch and 0.020 inch. McCracken states the availability of undercut gauge at 0.010, 0.020 and 0.030. C. Analyzing rod

• • • •

It is solid cylinder metal rod. It is a first tool to be used during surveying. It is used to determine the parallelism of tooth surface. Act as like tangent to the convex surface of object being surveyed. • It helps to analyze the location of height of contours. D. Wax trimmer (knife)

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• Used to directly trim the excess wax while surveying the wax patterns. • Eliminate and block out undercut parallel to path of insertion. DENTAL HANDPIECES AND ACCESSORIES

Rotary instruments are used to complete different functions in the cutting, polishing, and finishing of tooth structure and the restoration process. Dental Handpiece

The handpiece is the most frequently used piece of machinery in dentistry. It provides power to a rotary instrument that is used to complete the actual cutting or polishing of tooth structure and castings. Low-speed Handpiece

Design • Straight in appearance. • Standard length and “shorty”. • Speeds range from 10,000 to 30,000 rotations per minute (rpm). • Powers the rotary instrument in both a forward and a backward motion. Uses Clinical • Removal of soft decay and finishing of cavity preparations.

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• • • •

Instruments in Dentistry

Finishing and polishing of restorations. Coronal polishing and removal of stains. Porcelain adjustments. Root canal treatment.

Laboratory • Trimming and contouring of temporary crowns. • Trimming and relining of removable partials and dentures. • Trimming and contouring of orthodontic appliances. Low-speed attachments Straight attachments • Long-shank laboratory bur • Prophylaxis angle attachments Contra-angle attachment • Latch-type rotary instruments • Mandrel Prophylaxis angle • Used during polishing procedures to hold the prophylaxis cup and bristle brush

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• Two types o Plastic disposable “prophy” angle o Metal “prophy” angle High-speed Handpiece

Design • One-piece unit with a slight curve. • Operated by air pressure. • Operates at speeds as high as 450,000 rpm. • Maintains a water-coolant system. • Friction-grip locking system for rotary instruments. • Fiberoptic lighting. Uses • Removal of decay. • Removal of old or faulty restorations. • Reduction of the crown portion of a tooth in preparation for a crown or bridge. • Preparation of an outline and retention grooves for a new restoration. • Finishing or polishing of a restoration. • Sectioning of a tooth during a surgery. Ultrasonic Handpiece

Design • Attaches to the dental unit. • Powered by electricity.

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• Primarily used for prophylaxis appointments. • Attachments similar in appearance to scaling instruments. • Delivers a pulsating spray of water. Uses • Removal of calculus. • Removal of stains. • Removal of bonding materials from the tooth surface after orthodontic appliances is removed. • Removal of cement after orthodontic bands is removed. Laser Handpiece

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Design • Laser light beam, conducted through a fiberoptic cable, instead of rotary instruments. • Resemblance to a standard handpiece. • Water-coolant system. • Air-coolant system. Uses • Cauterizing soft tissue. • Vaporizing decayed tooth structure. Advantages • Usually painless. • Generally no need for anesthesia. • Speed of procedure. Disadvantage • Cannot be used on teeth with existing restorations. Air-abrasion Handpiece

Design • Small version of a sandblaster. • High-pressure delivery of aluminum oxide particles through a small probe. Uses • Preparation of teeth for sealants. • Removal of external stains. • Class I through class VI preparations. • Endodontic access. • Crown margins. • Preparation of the tooth surface for the cementation of a cast restoration (e.g. crown or veneer).

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Preparation of teeth for sealants. Removal of external stains. Class I through class VI preparations. Endodontic access. Crown margins. Preparation of the tooth surface for the cementation of a cast restoration (e.g. a crown or veneer).

Laboratory Handpiece

Design • Operates at speeds as high as 20,000 rpm. • Uses laboratory burs. • Greater torque than that of handpieces used intraorally. Handpiece Maintenance General Considerations

• Wear personal protective equipment and follow universal precautions. • Clean debris from the external surface. • Clean the internal components of the handpiece.

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Handpiece must be dry before being packaged. Wrap the handpiece for sterilization. Sterilize the handpiece. Wipe the light port on the fiber-optic with an alcohol swab to remove any excess lubricant.

Rotary Cutting Instruments Dental Burs

Three basic parts to a rotary instrument

Shank: Portion that fits into the handpiece. • Straight shank • Latch type shank • Friction grip shank

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Neck: Portion of the rotary instrument that connects the shank and the head. Head: The cutting, polishing, or finishing portion. • Rotary instruments with sharp cutting head. Uses • Tooth preparation. • Excavation of decay. • Finishing cavity walls. • Finishing restoration surfaces. • Taking out old fillings. • Finishing crown preparations. • Separating crowns and bridges. • Adjusting and correcting acrylic temporaries. ABRASIVE MATERIALS USED IN DENTISTRY AND THEIR USES

• Abrasive materials are mainly minerals which are used in finishing and polishing a restoration, abrasive materials are used to remove the uneven or rough surface on the surface of restorative materials which will lead to debris accumulation and decrease the surface smoothness. • These dental abrasive material particles coat the surface of the burs and act on the tooth or restorative materials by rotation of the bur using a handpiece. Some abrasive materials are used in the form of paste and others as polishing strips.

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Here is a list of abrasive materials in dentistry and their respective uses: • Natural diamond: Used for ceramic and resin-based composite materials • Synthetic diamond: Used on tooth structures, ceramic materials and resin-based composite materials • Arkansas stone: For fine grinding of tooth enamel and metal alloys • Chalk: To polish tooth enamel, gold foil, amalgam and plastic materials • Corundum (white stone): For grinding metal alloys • Abrasives: On composite materials • Emery: For finishing metal alloys or acrylic resin • Garnet: For grinding metal alloys and acrylic resin materials • Pumice: Polishing tooth enamel, gold foil, dental amalgam and acrylic resins • Quartz: Finish metal alloys and to grind dental enamel • Sand: Grinding of metal alloys and acrylic resin materials • Zirconium silicate: Component of dental prophylaxis paste • Cuttle: Polishing of metal margins and dental amalgam restorations • Kieselguhr: Filler in hydrocolloid impression materials • Silicon carbide: Metal alloys, ceramics and acrylic resin materials • Aluminum oxide: For adjusting dental enamel, for finishing metal alloys, resin-based composites and ceramic materials • Tin oxide: Polishing agent for polishing teeth and metallic restorations

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4 Oral Maxillofacial Surgery Instruments Dental chair

DIAGNOSTIC INSTRUMENTS Mouth Mirror

• Mouth mirror is a diagnostic instrument that has a handle, shank and a mirror attached to a round metal disc at one end. • It has a mirror head top and detachable handle. Uses

• Indirect vision: To see areas of the mouth not accessible with direct vision. • Retraction: Help in retraction of the cheek to provide better direct view and access during the procedure. • Transillumination: Light reflection from the mouth mirror enables proper view of areas which cannot be seen through direct light. • Tissue protection: Guards the tongue and cheek against accidental injury from rotary operating instruments like the bur. 148

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Probes

• Sharp pointed hand instrument used to explore teeth and restoration surfaces in order to detect caries, overhanging edges and other defects. • May be single ended or double ended. Uses

• • • • •

Exploring lesion. For detecting and assessing carious lesion in the tooth. Detecting demineralized dentin. Releasing debris from the tooth. Removing slight excess fill up around cavo-surface margins. • Identifying hypersensitive areas in the tooth. • Assessing marginal fit of the restoration. Laryngoscope

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• Laryngoscope is design for doing direct laryngoscopy directly viewing the vocal cord and to pass on endotracheal tube into the larynx under vision. • Parts: Handle, blade with bulb. • Size of blade: Neonate (infant), pediatric (child) adult and extra large. The handle is a hollow cylinder, containing two 1.5° volt batteries. • It is generally right angle to the blade. • The blade may be attached to the handle with a hook. Otoscope or Auriscope

• It is a medical device which is used to look into the ears. Health care providers use otoscopes to screen for illness during regular check-ups and also to investigate when a symptom involves the ears. With an otoscope, it is possible to see the outer ear and middle ear. • Otoscopes consist of a handle and a head. The head contains a light source and a simple low-power magnifying lens, typically around 8 diopters. The distal (front) end of the otoscope has an attachment for disposable plastic ear spatula. The examiner first straightens the ear canal by polling on the pinna and then inserts the ear speculum side of the otoscope into the external ear. It is important to brace the hand holding the

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otoscope against the patient’s head to avoid injury to the ear canal by placing the index finger or little finger against the head. The examiner can then look through a lens on the rear of the instrument and see inside the ear canal. INSTRUMENT USED FOR PICKING UP STERILE INSTRUMENTS Chetale’s Forcep

• It is a long angulated instrument that is used for picking of sterile instrument from a tray or linen from the drum. • Stored in container containing an antiseptic solution like savlon. • The solution must be changed every day. INSTRUMENT USED FOR PREPARING THE SURGICAL FIELD Rampley’s Swab Holding Forcep

• An instrument with long blades, expanded at the ends forming an oblong tip with central fenestration and transverse serrations.

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• To hold a swab and clean the area of operation. • To swab the throat, when there are profuse secretion in an unconscious patient. • To press on tonsilar bed to arrest hemorrhage. • To hold tongue and give anterior traction and thus preventing tongue fall and airway obstruction. Collin Tongue Seizing Forcep

• Similar to sponge/swab holding forcep in appearance. • Shorter in size with biconvex blades. • Shape of blade is round with central fenestration, which is needle of the swab holder forceps with transverse serration. Uses • To hold the tongue in unconscious patient. • To retract the tongue in operation on the floor of the mouth or of the salivary glands. Disadvantage • Excessive pressure leads to necrosis of tongue. INSTRUMENT USED TO MAINTAIN A CLEAN SURGICAL FIELD

• For removal of blood and saliva from the oral cavity and keep operating field clean.

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Disadvantages of sponging • Time consuming. • Interrupt the operating procedure. • May push foreign material into the wounds. • May traumatize the tissues. • It seldom provides adequate elimination of blood to give clear view of the operation. Suction Apparatus

Types I. Suction is created by a running stream of water. II. Suction is created by a vacuum pump run by an electric motor. Advantage • Automatically discharging blood and saliva into the waste drain. Disadvantages • Noisy and require special plumbing if installed permanently. • The electrical operated pump is quiet and readily moved about. It can be mounted on a trolley and moves around. • A single or two bottles can be connected. Suction Tubing

• Connected to the suction apparatus at one end and the suction tip on the other end. • Made of red rubber or silicone polymer. • The latter is better as it is transparent and can be autoclaved. Suction Tip (Frazier, Nuober)

• The instruments, which are introduced into the surgical field for maintaining a clean field by sucking away blood, flushing solution, debris, cystic fluid, pus and secretions.

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• Frazier suction tip has a blade in the handle for better control and a hole to control the suction speed. A stylet is provided to clean the lumen if there is clogging. Tip may be straight or angulated. • Commonly used no. 4 or no. 5 suction tips. Red Rubber Catheter

• Simple tube like made up of latex rubber. • Blunt tip with perforation available in difference sizes. • To relieve the retention of suction tip for suction. Suction Catheter

• • • •

Polyvinyl polymer Transparent tube. Available in different sizes. One end blunt with perforation at the side.

Use • Instead of suction tip to pass through the nostrils or oropharynx to clean the airway for intubation/extubation.

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Towel Clips

It is of two types: a. Pinchter type b. Forceps type (Backhaus towel clips) a. Pinchter type: Spring joint (Doyen’s cross action towel clip)

b. Forceps type: Box joint (Backhaus towel clip)

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Tips • Pointed, curved towards each other and overlap one another. Uses 1. To hold the corners of the draping sheets during an operation. 2. To hold the tongue (as an alternative to tongue holding forceps) 3. To stabilized the suction tubes, motor cable or other wires to the drapes. Sterilization • Autoclave, boiling for 1/2 hour. INSTRUMENT TO KEEP THE MOUTH OPEN Mouth Prop

Two types: Rubber, metal

• • • • •

To keep the mouth open during surgery under GA. In surgery under LA, intraoral prolong procedure. During epileptic attack, to avoid injury to tongue. Trismus. OSMF

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o Vertical blocks having a concave surface on either of its ends to fit the maxillary and mandibular teeth. o Three or four blocks of varying vertical heights connected by a chain. o The operator can choose the block according to the required extent of oral opening. Metal • Two blades connected by a stout steel pillar. • Two blades lined on their tooth facing surfaces to prevent slippage and injury to tooth. • Blades are not parallel, they are divergent to adapt itself to the divergence of jaw in open position. Sterilization • Autoclaving • Boiling—metal props. Doyen’s and Fergussion’s Mouth Gag

• Doyen’s Mouth Gag

• Fergussion’s Mouth Gag

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• To keep the mouth open in a patient under GA, during surgeries of the oral cavity, tonsils and pharynx. • Flat blades with serration which rest on the occlusal surface of teeth. • Handle has catch that is fixed at the required opening. Uses • To open the mouth forcefully. • For exercise after TMJ ankylosis surgery. Heister’s Jaw Opener

• To forcibly open the mouth. • Two flat blades applied between maxilla and mandible. Uses • To force the mouth in trismus to infection, muscle spasm, trauma to TMJ. • Active exercise after surgery for TMJ ankylosis, OSMF. INSTRUMENTS USED FOR INJECTING LOCAL ANESTHETIC AGENT Syringe

• Local anesthesia is injected in tissue to anesthetize the nerve at the site of operation with the help of syringes and needle.

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• Syringes for introduction of local anesthesia are of the following types: a. Conventional aspirating syringes b. Self-aspirating syringe c. Disposable aspiration syringe d. Luer-Lok disposable type syringes e. Jet Injectors Conventional Aspirating Syringes

• It is side loading metal cartridge syringe. • A sealed 1–8 ml-glass cartridge fist into the syringe before the needle is attached to the syringe, the position of the syringe is retracted and the cartridge is inserted.

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• The needle is then affixed to the threaded portion of the syringe. • To unload the syringe the cartridge is pulled away from the needle as the position is retracted. The cartridge then falls from the syringe. Common problems • Leakage due to improper attachment. • Breakage of cartridge due to excessive pressure. • Surface deposits due to improper cleaning after previous use. Sterilization • Autoclave after thorough washing and removal of all debris. Self-aspirating Syringe

• This relies on the elasticity of the rubber diaphragm of the anesthetic cartridge to produce negative pressure necessary for aspiration. • No harpoon to be imbedded into the plunger of the cartridge. So, breakage of the glass during loading of syringe is less. Disposable Aspiration Syringe

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• Composed of sterile, disposable, needle syringe barrel combination and a reusable plastic barbed piston section. • After the protective cap is removed from the syringe barred, the LA cartridge is inserted. The position section with thumbing is then affixed. • On completion of the anesthetic injection, all but the piston section are discarded. Luer-Lok Disposable Type Syringes

• Aspiration syringes of the glass Luer-Lok or disposable type available in sizes of 3, 5, 10, 20 and 50 ml to be attached to a 22 or 23 or 26 gauge needle. • Luer-Lok needle of suitable length for intraoral, extraoral and other deep injections. • The disposable syringes are available in variable sizes in presterilized packages. Jet Injectors

• Most popular jet injection is syrijet. • Spring loaded instrument with 1–8 ml cartridge of LA solution.

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• On release of trigger a volume 0.05 to 0.2 ml of solution is expelled at 2000 pound per square inch. • Before using, the mucosa is prepared with an anesthetic solution and dried with gauze. • The head of instrument is positioned so that the solution will be discharged perpendicular to the mucosal surface with which it is held in firm, steady contact. Uses • To produce topical anesthesia. • To produce infiltration anesthesia. • For nasopalatine, anterior palatine and long buccal nerve block. Needles

Parts of Needle

1. Bevel 2. Shank 3. Hub

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4. Syringe adaptor end. 5. Syringe end of needle. • Needles are of different sizes, different gauges. The gauge denotes the diameter of the lumen of the shank. • The length of the needle is measured from the hub to the point of the bevel. • Needles are made of platinum, stainless steel, indoplatinum or platinum ruthenium. • The stainless steel needle is the most widely used. Advantages • Rigid enough. • Maintains sharp point • Inexpensive • Breakage is rare. • Available in different sizes, gauges • Withstands boiling and autoclaving without corroding or weakening. Gauge: Gauge denoted the diameter of the lumen of the shank.

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The gauge of needle is indicated by number. Higher gauge number denoted smaller diameter. Gauge

Diameter

20 gauge

0.81 mm

21 gauge

0.72 mm

22 gauge

0.64 mm

23 gauge

0.57 mm

24 gauge

0.51 mm

25 gauge

0.45 mm

Needle with Luer-Lok hub for attachment to the Luer-Lok glass or disposable syringes. INSTRUMENTS USED FOR INCISING THE TISSUES Scalpel

Two parts: Blade and blade handle Bard Parker blade handle (BP handle)

• • • •

Various sizes of handles. Most commonly used handle is no. 3. Handle has slot for blade. Blade should be held with the help of needle holder or an artery forceps while fitting the blade to handle. • Use-pen grip.

Oral Maxillofacial Surgery Instruments

Blade: Different no. and shape

• • • •

No. 10—for making skin incision No. 11—for stab incision (e.g. to drain an abscess). No. 12—for mucogingival procedures. No. 15—for intraoral surgery.

Dissecting Scissors

• Mayo dissecting scissors (straight)

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• Mayo dissecting scissors (curved)

• For soft tissue dissection in deeper layer. • Sharp, pointed for dissection and blunt pointed for bandage or dressing cutting. • Blunt nose to undermine tissues. • Side cutting edge to cut the tissue. Sterilization: Autoclave. Cautery, Electrocautery

Types 1. Monopolar 2. Bipolar

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1. Monopolar consists of high frequently AC generation Parts: Regular Foot control Electrode • Indifferent • Active Contact between the patient’s skin and indifferent electrode usually by a wet cloth wrapped to an electrode. Principle The large, flat steel plate or the indifferent electrode act as the earth. The active electrode is a fine tip. Due to large difference between the sizes of two electrodes, a high current density is generated around the active electrode, resulting in a heating effect. Function • Coagulation. • Cutting (never for skin incision). FLAP REFLECTION INSTRUMENTS

1. Periosteal elevators (Molt no. 9, Howarth’s, Dial’s) • Used for reflecting the mucoperiosteum. Commonly used for: • Molt’s: Broad end one side, the other side is pointed or triangular.

• Howarth’s:

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• Broad end—one side flat and sharpened other side. • The pointed end is used to release the dental papilla between the teeth. • Broad end is used for elevating the mucoperiosteal flat from the bone. • Broad end as a soft tissue reflector. Methods for reflecting the periosteum from the flap: After the soft tissue have been incised around the necks of the teeth and through the interproximal space, the periodontal fibers being severed. The spear point of elevator is inserted into interproximal space with concavity facing bone. • Push stroke is given with the broad end of the elevator and is the most efficient stroke to reflect the periosteum from the bone. • Pull stroke/scrape stroke is most likely to tear the periosteum and should be used carefully. RETRACTORS

Types I. Plain retractors II. Self-retaining retractors Plain Retractors Langenbacks Retractor

• Long handle and L-shaped blade. • Difference sized and blade width. • Single ended and double ended.

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Uses • To retract the soft tissue flap (skin and subcutaneous tissue). • To retract incision edges. • To allow proper exposure to deep structures. • To retract vessels and nerves. C-Shaped Retractor (Deaver’s Retractor)

• Long handle double-ended retractor. • Blade is C-shaped. • Mostly used in abdominal surgeries. Cat’s Paw Retractor

• • • •

Instrument resembles a cat’s paw. Thin metallic double-ended/single-ended instrument. Blade has prongs that are curved blade. To retract small amount of tissue.

Disadvantage: Excessive force may lead to perforation/tear in the flap.

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Coronoid Retractor

• Forked working end. • Fork engages anterior border of ramus/coronoid process. Uses: To retract soft tissue flaps over the anterior border of ramus during coronoidectomy and saggital split osteotomy. Seldin’s Retractor

• Similar to periosteal elevator • Leading edge dull and blunt. • Only used for soft tissue retraction. Obwegessor’s Ramus Retractors

• Similar to Langenback’s retractor except edges of retracting blades forkes. Forming a V-shaped notch to engage anterior border or ramus of mandible.

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Uses • To retract soft tissue along anterior border of ramus during sagittal split or ramus osteotomy. • To retract the tissue during cronoidectomy. • The cannel provides space for bur. Condylar Retractor

• • • •

Special retractors—double ended. Similar appearance to tongue depression. Narrower blade tip C-shaped hook. This slipped under the ankylosed mass to retract and protect the media soft tissue during TMJ surgery. • It has finger grip at the middle of the handle to hold the retractor in position. Mastoid Retractor

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• Hemostatic. • It is used to retract soft tissue flap during mastoidectomy. • Also used during thyroid surgery. Malleable Retractor

• It is an atraumatic retractor. • It can be moulded according to contour of the site. • Used for retraction of orbital content. Chin Retractor

• Prong engages lower of border of mandible in symphysis region. • It is used for retraction of the soft tissue over the chin during symphysis plating and genioplasaty.

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Self-retaining Retractors

• Blade is shaped like plain retractors. • Blade held apart by locking racks (Thomson Walker’s retractor) • Set on a frame on which it can be moved and adjusted in position by screws (Cameron’s self-retaining retractor). Uses • Used in abdominal surgery. • Self-retaining skin retractors are also available which has blade with curved forks. Blade held apart by locking racks and keeps the skin flaps apart. Doyen’s Raspatory (rib retractor)

• Handle—polygonal in shape for better grip. Blade directly spring from the handle.

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• Blade ends in curved fashion like a hook and the inner surface is sharp for separating the periosteum. Uses: To elevate to inner periosteum of rib during the rib resection for rib grafting. Tongue Depressor

• L-shaped with broad, smooth blade to depress or retract the tongue. Uses • To depress the tongue during the endotracheal intubation and extubation. • For inspection of oral cavity, tonsils and pharyngeal wall. • To depress the tongue during surgery in oral cavity. • To retract the cheek.

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INSTRUMENTS USED FOR HOLDING SOFT TISSUES

• To hold the soft tissues of the body Allis Tissue Forceps

• Short and light instrument. • Tips: Slightly angulated for better grip of tissues provided with interlocking teeth. • Blade is straight. Uses • To hold thin and delicate structures like skin, deep facia, fibrous capsule or muscles. • To retract and hold the tissue margins and skin edges. • To provide tension during tissue dissection. Babcock’s Tissue Forceps

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• Light instrument with curve blades. • Blade is fenestrated and has a transverse bar which is transversely serrated. • Handle with catches provide least trauma to soft tissue. Uses • To hold delicate structures. • To hold enlarged lymph nodes or glandular tissue. Lane’s Tissue Holding Forceps

• Long, stout instrument. • Tip is providing with interlocking teeth. • Blades are curved and fenestrated for accommodation of good amount of tissues. • The handle has catches. Use • To hold tough structures like the skin, course muscle. May be used as a mild retractor. Tissue Forceps

Micro-Adson, Gillies, Adson Type A. Plain tissue forceps B. Toothed tissue forceps

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• To hold tissue during the process of dissection and suturing. • Spring like action. • Blades are serrated transversely on the inner aspect. • Toothed— tooth at ate tip. Uses • The plain forceps having no tooth at the tip for holding delicate structure like delicate muscles, fascia and facial skin. • Plain forceps to hold blood vessels or nerve. • Toothed forceps—to old tough structures like course muscles, keratinized tissue. • To hold the needle while suturing. Gland Holding Forceps

A. Swab holder type

• No serration on the blade.

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B. Kocher’s type

• Two spikes in each blade to engage the tissues. Uses • To hold salivary gland, submandibular and sublingual gland. • To hold enlarged lymph nodes. • To hold tumors during excision. Nerve Hook

• Similar to bone owl except, it has a relatively blunt tip with broad curve at the tip. • Tip with eye which can pass a suture. Uses • Neurectomy • To tie nerve comes in the opening field. Hemostatic Forceps Artery Forceps

• Known as hemostatic forceps because these are used for catching both arteries and veins. • Catch hold of bleeding vessels cut during the surgery.

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• Unidirectional, transverse serration on the blades of the hemostat to prevent the vessel from slipping. • The vessel is crushed between the blades and hemostasis is achieved. • Catch in handle—vessel may be hold and clamped. Types: According to size and shape • Large—straight • Medium—curved • Small Uses • Achieved hemostasis by catching the blood vessels by crushing the vessels or by ligating or cauterizing them. • To hold the end ligature. • As tissue forceps for holding subcutaneous tissue. • To drain an abscess by Hilton’s method. • To pick up necrotic tissue, granulation tissue, foreign bodies, tooth/root piece, small fragments of bone, etc. Mosquito Forceps

• This is small curved artery forceps. • Small in size. • Delicate. Uses: Same as artery forceps.

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EXODONTIA ARMAMENTARIUM Elevators Indications for Use of Elevators

• To reflect the periosteum. • Removal of teeth: In case of impacted teeth, malposed teeth, extensively decayed teeth. • Removal of roots: Root fractured at gingival level, root fractured at mid-length, root fractured at the apical end. Rules for Using Elevators

• • • •

Never use an adjacent tooth as a fulcrum. Never use the buccal plate at the gingival line as fulcrum. Never use the lingual plate at the gingival line as fulcrum. Always use finger guards, protect the patient in case the elevator “slips”. • When cutting through intercepted bone, take care not to engage the root of an adjacent tooth. • Always elevate from the mesial side of the tooth.

Parts of Elevator

• Handle—may be continued or at right angle to the shank. • Shank—connects the handle and blade. • Blade—working tip that transmit forces to the tooth, root and bone.

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• Blade o Straight or gauge type o Triangular type o Pick type Elevators Commonly Used

• Straight elevators o Coupland elevator o Apexo elevator • Angular elevators o Cryers elevator o London elevator • Crossbar elevators o Handle is at right angle to the shank o Winter’s elevator Principles of Elevators

Three principles of elevators are: I. Lever principle II. Wedge principle III. Wheel and axle principle Lever principle • Most frequently used. • The position of fulcrum is between the effort (E) and the resistance (R). • The effort arm is at one side of the fulcrum must be longer than the resistance arm. • Mechanical advantage—3:1

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Wedge principle • Apexo elevators are the specially designed elevator only used as a wedge principle. • The wedge elevator is forced between the root of the tooth and the investing bony tissue parallel to the long axis of the root. • Mostly used conjunction with lever and/or wheel and axle principle. • The wedge is movable inclined plane, which overcomes large resistance at right angles to applied force. • The sharper the angle of the wedge, the less effort required. • Mechanical advantage—2.5 Wheel and axle principle • Modified form of lever principle. • The effort is applied to the circumference of a wheel, which turns the axle to raise a weight. • The force applied at the tip of elevator to elevate the tooth/root is 4.6 times more than the force applied at the handle. • Sole principle and in some cases with lever principle. • Mechanical advantage—4.1 Straight Elevators: Coupland Elevator, London Elevator

• For luxation of the teeth which are impacted malposed or badly carious. • The blade has concave surface on one side that faces the tooth to be elevated. • Sometime the blade can be at an angle to the shank, allowing the instrument to the areas of the instrument to reach the posterior areas of the oral cavity.

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Cryer Elevator

• It is 3 straight elevators with a triangular blade. • The working tip is angulated with one convex and another flat surface. • The flat surface is the working side and it faces the tooth/ root to be removed. • It is based on lever and the wedge principle. Uses • For removal of root broken at gingival line or middle third of its length from maxilla. • For removal of roots stumps of mandibular molars when one root is removed and the other left behind. • Two separate elevators are available for the mesial and distal roots. • The working blade is introduced into the empty socket and moved towards the remaining root piece. Winter’s Elevator (Crossbar Elevator)

• • • •

Shank is at right angle to the handle. Working tip-triangular and at angle to the shank. The blade has a convex and flat surface. The flat surface is working surface and is placed facing the tooth to be elevated. • It works on wheel and axle principle with wedge principle.

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Uses • Removal of broken root stump of mandibular molars. • For removal of apical third of mandibular molar. The force exerted on the handle of crossbar elevation will be reflected 4.6 times more at the tip of the blade. Precaution • Controlled force should be used. • Proper support to the mandible as the forces can cause fracture of mandible. Pott’s Elevator

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• • • •

Shaft is at right angle to the handle. Blade is at angle to the shaft. Blade—straight and serrated at the concave surface. Concave surface is to be faced toward the tooth/root to be removed. • Used for removal of root stump broken at middle third of its length and/or apical third of mandibular molar. • Works on wedge principle in conjunction with wheel and axle principle. • Controlled forces are applied. Winter Axolever Elevator

• Paired elevator. • Blade has a convex and flat surface. • Flat surface is a working end and is placed facing the tooth to be elevated. • Work on wheel and axle principle. • Applied from mesial end from buccal direction.

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London Hospital Pattern Elevator

• This is similar to Cryer’s elevator. • Its blade is at an angulation to the shank. • Blade: Flat with convex and flat surface. All the elevators are sterilized by autoclaving. They can be sterilized by boiling but this will decrease the efficiency of the tip of elevator after long time. Extraction Forceps

• Design to deliver the teeth from the socket. Parts

• • • •

Handle—cross hatching for firm grip. Beak—serration at inner side for better grip on tooth. Applied along the long axis of the tooth. Applied below the cementoenamel junction (CEJ) of the tooth. • Firm grip should be taken before giving any movements. • Labiolingual or buccolingual movements for all teeth (single rooted and multirooted teeth). • Mesiodistal movements and rotary movements only for single rooted teeth.

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Maxillary Extraction Forceps

• Handle and beak are at 180° to each other—straight line. 1. Maxillary anterior forceps

• Identical beak, closed, straight, flat and broad. • Beaks designed to conform to facial and lingual root contour just to cervical line. • Universal (both beaks same designed fit equally well on facial and lingual) for right and left quadrants. For Canine: • Curvature to handle. • Concave side—palm grip. Basic Forceps: • Incisors • Labial movement • Mesial rotation • Canine • Labiopalatal movement • Removal in labial direction 2. Maxillary premolar forceps

• Identical beak concave on the side facing the operator. • Beaks—broad and open. • Curvature—to give access to the premolars and to prevent trauma to lower lip and lower anterior teeth.

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3. Maxillary molar forceps (right and left)

• Each beak has different design to adapt to the maxillary molar roots that different anatomically on the buccal and palatal. • Rounded beak contours to palatal root. • Pointed beak contours to bifurcation of mesial–buccal and distal–buccal root. Buccal, palatal movement 1st and 2nd molar Removal in the buccal direction 4. Maxillary third molar forceps

• Beak design to conform to facial and palatal root contour just apical to cervical line. • Universal (both beaks same designed—fit equally well on facial and lingual) for right and left quadrants. 5. Maxillary cow horn forceps • One beak single pointed tip, other bifid pointed tip. • Each beak has different design to adapt to the maxillary molars that different anatomically on the buccal and palatal.

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• Beak with single projection contours to bifurcation of mesial—buccal and distal—buccal roots. • Beak with two projection contours to palatal root. 6. Bayonet forceps

• • • •

Identical, pointed, angulated, closed beaks. Length—vary (long to short). Thick and thin beaks. Used to posterior root stumps: Single root removal.

Mandibular Extraction Forceps

• Handle and beaks are at right angle to each other. 1. Mandibular Anterior Forceps • Rivet joint. • Identical, broad, closed beaks.

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• Direction of force—labioligual and mesiodistal. • Beaks designed to conform to facial and lingual root contour just apical to cervical line. • Universal (both beaks same design—fit equally well on facial and lingual) for right and left quadrants. 2. Mandibular premolar forceps

• Identical broad open beaks. • Direction of force: Buccolingual and mesiodistal. 3. Mandibular molar forceps

• Broad, identical, pointed beaks, like a narrow. • Buccolingual movement. 4. Mandibular third molar forceps

• Beaks are modified for access. • Handle parallel to sagittal plane during use. • Sterile by autoclave.

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5. Mandibular cow horn forceps

• Beaks designed to conform to facial and lingual root contour just apical to cervical line. • Universal (both beaks same design—fit equally well on facial and lingual) for right and left quadrants. • Pointed beaks contour to bifurcation area of mesial and distal root. • Beak appears like cow horn, hence the name. • Used to extract molar which are grossly carious and have very little crown structure left which will crumble under force of a molar forcep. INSTRUMENT USED TO REMOVE PATHOLOGIC TISSUES Curette

The term ‘curette’ comes from the French word cures, meaning to cleanse. • This is an instrument used to clean a boney cavity or soft tissue tract to remove any pathological tissue in them.

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Indications • Exploratory instrument to remove tooth particles or debris from socket sat the time of extraction. • To enucleate cyst, granuloma, intraosseous tumors. • To remove small sequestra. Contraindications • Not to be used in acute infection. • In presence of pus. • To remove granuloma or to stimulate bleeding after extraction of deciduous teeth. Volkmann’s Scoop

• To scrape the contents of cavity similar to currents single ended, double ended. • Working end more pronounced as a scoop. Uses • To collect the contents from a sinus tract, chronic abscess cavity on fistula. • To scrape or curette bony cavities due to cystic/tumours lesion or osteomyelitic lesion. • To scoop out the cancellous bone for grafting. • To introduce graft material or antiseptic powder into the surgical area. Lister’s Sinus Forceps

• Straight, long, slender instrument with narrow blade. • Blade serrated transversely at tip.

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• No catch. • Tip is rounded and bulbous. Uses • To open abscess by Hilton’s method to break the loculae. • To hold the small piece of gauze between the blade to clean a cavity. • To dissect out sinus and/or fistulous tract. BONE CUTTING INSTRUMENTS Rongeur forceps (Jansen Middleton)

• • • •

Curved handles: Spring action. Spring increases the force application. Double spring (Jensen), one spring (Blumenthal). When the handles are released, the instruments automatically open up.

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• Tip is angulated forward to the handle and has a concave and beaks are sharp. • Can be one side cutting (Blumenthal), both side and end cutting. Uses • To remove a large amount of bone at the time of extraction. • To nibble sharp bony margins following simple or surgical extraction of teeth, surgical procedure alveloplasty (trim sharp bony ridge). • To peel off thinned out bone present over the cystic, tumors pathology. Miller Colburn Bone File

• To smoothen sharp bony margins present in the surgical field. • Double ended—one end long curved working end and another non-working end. • Working ends have horizontal serration. Uses • Unidirectional pull stroke. Precaution • Regular cleaning to prevent clogging by bone debris and reduce sharpness of the instrument. Bone Cutter

Similar to Rongeur forceps • Spring action. • Sharpe blade edges. • Side cutting action.

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Uses • To trim sharp bony margins. • To trim sharp ridge projection during alveoloplasty. Chisel

• • • • •

Unibevelled for cutting bone. Rounded on square handle. Long flat working tip. Working edge—bevel on side, sharp and flat. Different width of blade: Mostly 3 mm and 5 mm wide chisels are used to split the bone in controlled fashion. Length—Eastman pattern—7½ inches. 8½ inches. Other types—Read’s chisel/Coupland’s chisel. • To smoothen the bone, bevel is kept facing away the bone. • To cut the bone, bevel is kept facing the bone. Uses • To remove chips of bone in transalveolar extraction. • To split the tooth in difficult extraction. • Tungsten carbide tipped or tungsten steel osteotome/ chisels to cut hard bone.

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Osteotome

• • • • •

Bibevelled. Narrow wedge—Sharpe end. Cut in direction in line with the blade. To split apart two segments of bone. To splitting teeth.

Uses • Various osteotomy procedures. • Biopsy bone lesions. • Removal of recontouring of the bone. Mallet

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• • • •

Steel Lead Wood Similar to hammer used for giving controlled tap on the chisel, osteotome or gouge. • Should be used with a loose, free swinging movement of the wrist that give maximum speed to the head of the mallet without introducing the weight of the body to the below. Bone Gouge

• Round handle. • Blade sharp working tip concave on the inner side. • Long working area. Uses • To remove cancellous graft material, during grafting procedure. • To make window in the anterior wall of maxillary sinus for access to the maxillary sinus during Caldwell luc procedure. • To remove irregular pieces of bone. Headpiece and Burs

• Quicker method of bone removal by drilling the bone at high speed. • Either sealed bearing handpieces or surgical handpieces with extra ball bearings used as ordinary handpieces which overheat after prolong cutting so continuous water flow during cutting is necessary.

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Burs

Stainless steel or carbide bur. Different length and shapes (fissure, round, tapering bur) • Carbide bur cut more efficiently because they have a wider clearance between the blades which are more sharp. • Irrigation of bur with sterile saline during bone cutting is essential both for lubrication and cleaning of bur blades, to improve vision and in order to avoid bone damage due to overheating. Uses • To round off sharp margins after extraction and minor surgical procedures. • To aid in bone removal or splitting the tooth, during surgical removal of impacted teeth. • To round off sharp ridges during surgical removal of impacted teeth. • To round off sharp ridge during alveoloplasty. • To perform oteotomy cuts. • To release bony ankylosis. • To make the bony windows for access to cystic cavities, tumor. • To perform resection of the maxilla and mandible. Gigli’s Wire Saw Parts

• Gigli’s wire saw • Two handles introducer and guide.

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• The wire saw is made up of stands of stainless steel twisted together, so that it requires a sharp, barbed, cutting edge. • Handles are bars of stainless steel with hooks to be attached to loops and the ends of the wire saw. • When moved to and fro along its long axis, it cuts the bone. • The saw used to and cut the mandible in mandibular resection procedure. • Care must be taken to protect the soft tissues, while using the instrument. Rib Shear

• Working on nut cracker principle. • Visceral blade—blunt and introduced from beneath the rib.

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• Parietal blade—sharp and cut through the rib against the support of visceral blade. • Handles—ridged for better grip. Uses • Used for rib cutting in procedure of rib grafting. Nasal Rasp

• To separate the nasal septum and anterior nasal spine from the maxilla during Le Fort l osteotomy or premaxillary osteotomy. • Flat, thin blade with sharp, edges. • Edges have slit that engage ANS (anterior nasal spine). • It can be straight or curved. Spreader (Smith Spreader)

• Three blades: Separated by spring action. • Used to separate bony fragment after completion of osteotomy cuts. • Used to check position of fragments during fracture of maxilla during BSSO procedure.

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Fergusson’s Lion Jaw Bone Holding Forceps and Crocodile Bone Holding Forceps

• Named according to appearance of the beaks sides. • Beaks have toothed margins to allow a good grip on the bone. Uses • To hold a bone during open reduction of a fracture. • To hold maxilla/ mandible during maxillectoy/mandibulectomy.

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ARMAMENTARIUM FOR TREATMENT OF MAXILLOFACIAL TRAUMA Wire

• Usually 26 gauge wire is used in oral surgery (0.45 mm). • Other: 28 gauge, 30-gauge wires (0.35 mm). Uses • To stabilize dentoalveolar fractures. • To perform intermaxillary ligation. • To splint the arch bar to the teeth. • Transosseous wiring, suspension wiring. Hayton William Wire Holder

Oral Maxillofacial Surgery Instruments

• Similar to needle holder. • Except heavy tip and no vertical serrations. Wire Cutter

• Like bone cutter. • One side cutting edge. • Lighter than bone cutter. Archbar

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Many types of prefabricated archbar • Erich’s archbar • Jelenko archbar • Winter archbar • Rigid type: 18 gauge thick stainless steel half round • German silver bar Erich’s archbar most commonly used: • The stainless steel strip with incorporated hooks on it. • Malleable and can be adapted to the contour of maxillary and mandibular arch and fixed to the teeth by wires • Semirigid fixation Uses • To stabilize dento-alveolar fractures. • To stabilize maxillary or mandibular fractures that is to be treated by closed reduction. To provide means for IML. • German silver bar: 1/8 inch (3 mm) half round bar notches cut on the bar with the edge of a file. • Archbars should be cut to the required length and bent in required shape. The arch bar is wired to successive teeth on each side. Each wire may pass over the bar mesially, around the tooth and under the bar distally before the ends are twisted together to fix the arch bar. Bristow’s Elevator

• To reduce the zygomatic fracture. Made up of stainless steel. Parts: Handle Shaft—curved/straight Blade—blunt and flat • Concavity of instrument facing outwards.

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Uses • To reduce zygomatic fracture using Gilli’s temporal approach Sterilization: Dry heat/boiling autoclaving Rowe’s Zygomatic Elevator

• Instrument with blade and an oval handle, same as Bristow’s elevator with additional lifting handle, which attached elevated with additional lifting handle, which attached by a strong hinge with a stop near the origin of other handle. • One hand is placed with the wrist fully pronated and the palmar surface placed over the handle. This hand is used to guide the instrument into position. The other hand is placed on lifting handle. Uses: To reduce zygomatic fracture using Gilli’s temporal approach Walshams Forceps

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• To manipulate the fractured nasal segments • Two blades—one padded another unpadded. Both are curved. • The unpadded blade is passed up the nostril and/or nasal bone and/or associated fragments of the frontal process of maxilla are secured between it and the padded blade externally. The fragments are manipulated into their correct position. Asch’s Forcep

• To reduce the fracture of nasal bone and to align the nasal septum • Both blades are unpadded. • The blades are passed on either side of nasal septum and the vomer and perpendicular plate of the ethmoid are torn out. • If possible septal cartilage is then grasp and repositioned in its groove in the vomer. • To reduce nasal bone fracture, one blade is inserted in the nostril, holding the mesial aspect of the nasal bone and the other blade is kept externally holding the lateral aspect of nasal bone. Rowe’s Disimpaction Forceps

• A pair of Rowe’s disimpaction forceps is used for disimpacting the maxilla in Le Fort fractures. It consists of straight unpadded blade and a curved padded blade.

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• The unpadded blade is passed up a nostril and padded blade enters the mouth and grips the palate. • The operator stands behind the patient and grasps the handles of each of the forceps and manipulated the fragments into position. Uses • To disimpact the maxilla in fresh Le Fort fractures, malunited fractures. • To check for free movements of maxilla after Le Fort osteotomy procedure. Hayton William’s Forceps

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• Two widely divergent curved beaks that engage the maxilla behind the tuberosity. • Usually used in conjunction with the Rowe’s disimpaction forceps to mobilize the maxilla. Bone Plates and Screws

A. Compression Plates B. Miniplates • Made up of stainless steel and titanium • Available in various sizes, lengths and shapes Compression Plates

• All compression plates include at least two pear-shaped holes. The widest diameter of hole lies near the fracture line. The screw is inserted into the narrow part and at final tightening its head comes to rest in a wider diameter.

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• There is a tendency to apply a tension band at the level of alveolar before tightening the screws. Disadvantage: More bulk volume. Self-compression Plates

Advantages • Corrosion resistance. • Biocompatible and well-tolerated by the tissues. • Different sizes and shapes. • Four hole plates length: 31 mm/35 mm /40 mm /50 mm. • Five hole or six hole plates length: 61 mm and 72 mm. • Angled plate for angle fracture. • Plate comprises a retention half and a compression half. • Retention half—two or more circular retention hole (by which adapted plates are initially firmly attached to one fragment by screws). • Compression half—oblong sliding hole is not initially fully tightened and accordingly during process of compression allows only parallel approximation of fragments without lateral dislocation. • Oblong hole-bevel: 27 or 45° both—86 kpa. • To cause the displacement of the plate away from the screw and producing compression • The plates are fastened to the bone by the way of special bone screws with almost horizontal thread throughout the length of the shaft. • Sizes: 8 to 20 mm length. INSTRUMENT FOR COMPRESSION PLATING SYSTEM Drill Bit

• 2 mm in diameter to form a pilot hole for the screw. • Bits for dental handpieces and pistol grip drill.

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Drill Sleeve

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• To guide the drill centrally in the plate hole and protect the soft tissue. • Screw tap—to cut the thread in the bone for the screw Depth Gauge

• To establish the depth of hole to select appropriate length of screw. Screwdriver

• With screw holding attachment and without for final tightening of the screw. • Plates should be positioned towards the lower border of mandible to avoid injury by the screw to the inferior alveolar nerve and teeth roots. Miniplates (Stainless Steel/Titanium Plates)

• Monocortical fixation. • Nowadays widely used. • Different shapes and sizes available.

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For example, 4 hole continuous, 4 hole with gap, 5 hole continuous plates, 6 hole continuous plates, t-shaped, l-shaped, v-shaped, boat-shaped, etc. Advantages • Minimum thickness. • Reasonable malleability. • Desirable shape. • Made up of stainless steel and titanium—different sizes, shapes and instrumentation. • Monocortical fixation various shapes and lengths. • Thickness of plates—1 mm. Width—3.8 mm to 2.4 mm (varies). • Diameter of hole—varies 1.2 mm, 1.5 mm, 2.1 mm and 7 mm, etc. • Distance between two holes—2.8 mm. • Bevel near the hole—30°. • Screw to fix miniplates: Stainless steel screw. • Different head diameter: 1.5 mm, 2.0 mm, 2.5 mm, 2.7 mm. • Length of screws: 6 mm, 8 mm, 10 mm, 12 mm, etc. • Distance between two threads—0.8 mm. Complications • Fracture of plate (rare). • Infection. • Rejection of plate. • Delayed union/malunion. • Malocclusion. Indications • All kinds of mandible fractures. • In edentulous patient. • In medically compromised patient. • In zygomatico maxillary complex fracture. • Airway obstruction, onco-operative patients. • Established case of non-union on malunion orthognathic surgery, bone grafting radical surgery, etc.

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Advantages • Easy availability. • Least toxic, more compatible to body tissue. • Adequate strength and less costly. Disadvantage • Semirigid due to monocortical fixation. Biodegradable Plate and Screws

• Obwegeser (1993) has presented a screw which has been cut from lyophilized tibia, useful to transfix the other fractured bone. • Getter (1972)—use of plates made of polylactic acid. Subsequently strength of these plates was increased by use of fabric woven in polycolic acid. • Ewers Forster (1985)—used plate of polydioxygen which was compression moulded. Disadvantages • Two bulky plates. • During degradation a marked collection of fluid occurs at the site and resulting in unacceptable clinical swelling. Screws

• Normal screw with latches at equal distance available in different sizes and diameters.

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Stainless steel • Different diameters of head varies from 1.5 mm, 2 mm, 2.5 mm, 2.7 mm, etc. • Different lengths—4 mm, 6 mm, 8 mm, 10 mm, 12 mm, etc. Uses • To fix bone plates to the fractured bone of stabilization of fractured segment. • Long screw can be used alone in oblique fractured to reduce it. • Hole is drilled in the outer cortex and slightly larger than the threaded part of screw. • While tightening the head of screw engage in the outer plate and the oblique fracture is compressed. Lag Screw

Indications • In treatment of oblique fractures whereby one cortex of mandible is split longitudinally from the other for some distance through the cancellous bone. • No additional instrument. • Threaded on half the shaft only the reminder nearest the head smooth. Precautions • The screw must engage and penetrate the lingual cortex and since the screw is threaded for only half of its length, the lingual cortex is drawn toward the buccal cortex.

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• Once the screw head has engaged the bone on lateral aspect, further tightening produces compression between two fragments. Normal Compression Screw

It is used for the treatment of oblique fracture. • Drill bit—3.5 mm. Diameter drill sleeve—3.5 mm diameter countersink. • First hole with 3.5 mm drill in outer fragment. • Then smaller 2.0 mm diameter drill is inserted in outer fragment and hole is bored in inner fragment. • The screw is tightened which engage the lingual cortex and further tightening will pull two fragments together, and held pressure as the head engages tightly. Instrument used in plating set • Plate bending pliers; flat nose pliers 13.5 cm long for adaptation of plate. • Plate holding forceps to hold the plate during the screw fixation and drilling the hole. • Screw driver with screw holding device. ARMAMENTARIUM FOR SUTURING Mayo-Hegar Needle Holder

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• • • •

Stainless steel instrument Straight, stout instrument with shorter working tip Blade is shorter and stronger than the homeostasis The working tip—cross hatch serration with a single vertical serration to grip the needle • The handle has catch • Usually a six or eight inch needle holder is mostly used • Sterilization—autoclave, boiling for 1 hour Suture Cutting Scissor (Heath’s)

• For cutting the suture ends • Can be straight or curved and angulated or non-angulated • Angulations at the joints or at tip to facilitate access to the posterior area of oral cavity • Long delicate handles and short cutting edges Skin Hook

• A skin hook is a small medical instrument that is used to grasp, hold, and position delicate soft tissues during the

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suturing phase of a surgical procedure. It may have one or two very thin curved hook at the end of the tool and is often used with a needle holder during suturing to reduce the damage to the fragile tissue being stitched closed. Skin hooks are used in many different medical procedures that require the gentle maneuvering of skin and soft tissue, including corrective surgical procedures on the eyes, suturing facial skin, and stitching the delicate individual layers of the skin. • The prongs of the skin hook instrument can be customized according to the procedure performed. Some type of this surgical equipment has hook that are very sharp and thin. Other skin hooks feature prongs that are thick and have a dull tip. The skin hook may have single prong or double prongs. Prongs are often classified as extra fine standard or delicate; the classification enables the surgical preparation team to select the most appropriate instrument for the procedure. • One type of skin hook is small surgical instrument called a thumb forcep, more commonly known as twisters. As the grasping portion of the tweezers small hooks are added in place of teeth—like projections that are often present on the end of instrument. The hooks are able to move very delicate thin soft tissue without leaving marks or causing damage by compressing the tissue. Preventing damage from the suturing process may speed the healing time of the skin and other soft tissues. • The handle on thumb forceps skin hook may be long or short depending on the procedure the tool is being used in a surgeon with large hands may prefer the longer handled twizer-shaped skin hooks. Areas that are usually difficult to access may be successfully sutured with long handled skin hook.

DRAINS USED IN ORAL AND MAXILLOFACIAL SURGERY

• Drainage is the provision of the mechanical means for removal of contents of the body organs, cavities or tissues.

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Need for establishing drainage • Obliteration of dead space • Removal of foreign and harmful material from the body • To evacuate fluid/blood/urine collection in any body cavity Indications • Abscess cavities with thick, shaggy walls • Surgical defects where postoperative collection of blood /inflammatory fluid is expected • Urine retention • Osteomyelitic lesions where drainage is established for necrotic tissue and inflammatory exudates. Functions • To allow for pus fluid collection, blood to escape from the body cavities • To allow for local introduction of antibiotics. Types of Drains Simple Rubber Catheter

• Traumatic tip as it is rounded with hole on side • Used for suctioning in oropharynx and also endotracheal tube and tracheostomy tube • May also be used for bladder decompression when tube not required indwelling • Used for drainage of abscess.

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Corrugated Rubber Drain

• Sheet of rubber with corrugation on its surface to prevent blockage • Multiple holes are usually made in the drain to prevent from getting obstructed • Outer end of drain is secured to the skin by sutures • Best for subcutaneous plane and deep layer of wound • Used to drain dead space, abscesses • Rubber may evoke tissue reaction Infant Feeding Tube

• Nontoxic, radiopaque polyvinyl chloride long tubes with blunt tip with multiple openings, other end has a stopper.

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Ryle’s Tube

• Long tube with blunt end with multiple opening introduces via nasal route. • Length 75 cm and diameter 8 mm • Lead balls are present at the end for radiographic detection • Multiple holes are present on sides to prevent the blockage • 50 cm—tube in stomach • 60 cm—tube in pylorus • 70 cm—tube in duodenum Uses: • Used for nasogastric feeding and lavage • For aspiration of contents of stomach Confirmation test for Ryle’s tube in stomach • Air pushed with syringe followed by auscultation in epigastrium • Place tube in water blow cheek for bubbling • Aspiration of stomach content • Radiograph of chest and abdomen Foley Catheter

• Self-retaining catheter • To evacuate bladder • Tip is blunt with 2–3 opening and balloon present

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• Other end has two tubes: Wider for urine passage and narrower—to inflate and deflate the balloon • Balloon is inflated with 5–30 ml of normal saline • Used for indwelling bladder catheterization • In oral surgery it is used to reduce orbital floor fracture GENERAL ANESTHETIC INSTRUMENTS Fuller’s Tracheostomy Tube

• Tracheostomy is an operation for making an opening into the trachea to bypass an obstruction in the upper respiratory track and insertion of a tube into this tracheal opening through an incision in neck.

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Types of Tracheostomy Tube

1. Metallic • Fuller’s bivalve tube. • Parker’s angled tube. • Durham’s lobster tail tube. 2. Synthetic • Ordinary rubber tube. • Portex tracheostomy tube. • Morrant Baker cuffed rubber tube. • Fuller’s bi-valve metallic tube—mostly user and available outer and an inner tube. • Outer tube: Shield has two opening on either side for fixation by threads with neck and central circular hole, which admit the inner tube. The outer tube is split in its length from its middle, for introduction into the tracheostomy opening. • Inner tube: Curved slightly and longer than outer tube, narrow at its beginning, two rings to the tube during introduction or withdrawal. Different Types of Tracheostomy

• High tracheostomy—trachea is opened above the isthmus of the thyroid gland. • Medium tracheostomy—trachea is opened at the level of the isthmus of the thyroid gland.

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• Low tracheostomy—trachea is opened below the isthmus. Indications for Emergency Tracheostomy

• • • • •

Diphtheritic laryngitis. Foreign body in larynx. Acute laryngeal edema. Acute bulbar palsy. In case of severe head injury where airway is obstructed.

Planned tracheostomy in Oral Surgery

• In case of TMJ ankylosis surgery. • In severe facial trauma where nasal and oral intubation not possible. Instrument In Tracheostomy

a. Double and blunt tracheal dilator

• To retract the structures in front of trachea.

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b. Sharp and blunt tracheostomy hook • To fix the trachea—sharp hook. • To retract the isthmus upward during dissection—blunt hook. c. Bowl by blunt tracheal dilator • Curved tip and low handles. • Spring action. • Used to dilate the tracheal incision for smooth introduction of tracheostomy tube. Endotracheal Tube

• It is especially designed tube with one end straight and the other being oblique cut. Beveled end enters the trachea through the larynageal inlet. • Introduced via oral and nasal route. • Sizes: 2, 2.5, 3, 3.5, 5, 4, 10, 10.5 (different internal diameter in mm). • Two types: Plain and cuffed. • Made of a plastic—PVC, red rubber or latex they may be disposable or reusable.

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• The cuffs may be of low volume—high pressure or high volume—low pressure types. Magill’s Forcep

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• It is the equipment used for guiding an endotracheal tube, from the pharynx. Also used • To pack the throat with a roller gauge. • To pack up a broken or dislodged tooth or any foreign material. • To pass the Ryle’s tube. Airway

• Oral and nasopharyngeal airway to resuscitate the unconscious patient of trauma. • Small curved tube with a plate at the outer part of the tube. • It is available in different sizes and lengths for adult and pediatric patient.

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• It is made of either soft rubber material or firm plastic— polyvinyl chloride. • It is inserted after depression of tongue by the tongue depressor or it is directly inserted upwards up to soft palate and then reversed downwards. • It is used in unconscious patient, conscious patient cannot tolerate it. Oxygen Mask

• Mask is an integral part of any anesthetic breathing during the induction phase or any resuscitation procedure. • A mask allows administration of gases from the breathing system, without introducing any invasive apparatus into the patient’s airway. It is placed on the patient’s face covering the mouth and nose. Parts: Connector or Mount • Body • Edge or seal Size: 1, 2, 3, 4, 5

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• Connector is of hard rubber or plastic on metal. It is the mount to which a breathing system is attached. • The body is made of rubber, plastic or silicone. • The edge or seal is the part that comes in contact with the face. Anesthesia Machine

• It is equipment, by which the operator can desired concentration of a mixture of anesthetic agents in an inhalational form with oxygen. • Simple anesthesia machine consists of a metallic frame, having a facility to connect central pipelines as well as cylinders of gases like oxygen, nitrous oxide, air, etc. flow meters, vaporizers and a facility to deliver high flow of oxygen flush. • It has a working platform to keep various drugs and small equipment and a tray on the top to keep various monitors.

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• Anesthesia machine can be of either intermittent flow or continuous flow variety. • In the intermittent flow machines, there is demand valve. These machines are ablating nowadays. • In continuous flow machines oxygen, nitrous oxide, etc. have individual flow meters. • Vaporizers are meant for setting desired percentage output concentration of the liquid, an anesthetic agent, like halothane, isoflurane, etc. • Flow meter for gases and vaporizers for liquid anesthetic agents is gas agent specific.

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5 Periodontal Instruments

Dental chair

Periodontal instruments are designed for specific purposes, such as removing calculus root surfaces, curetting the gingival wall or removing diseased tissue. Parts of Periodontal Instruments

a. Blade b. Shank c. Handle

Classification of Periodontal Instruments

• Diagnostic instruments o Periodontal probes o Explorers • Scaling, root planning, Curettage instruments 230

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a. For supragingival scaling • Sickle scaler, cumine universal scaler, posterior jacquette scaler, Morse scaler, surface scaler, Cingulum scaler. b. For subgingival scaling • Hoe scaler • Chisels • Files • Curettes c. Sonic and ultrasonic instruments. d. Cleaning and polishing instruments. e. The periodontal endoscope f. Periodontal surgical instruments • Excisional and incisional instruments • Surgical curettes and sickles • Periosteal alevators • Surgical chisels • Hoes files, • Scissors and nippers. PERIODONTAL PROBE

A typical probe is a tapered rod-like instrument calibrated in millimetres with a blunt, rounded tip. Use of Periodontal Probe

A. Assess the periodontal status for preparation of a treatment plan • Classify the disease as gingivitis or periodontitis by determining whether the bone loss has occurred and whether the pockets are gingival or periodontal. • Determine the extent of inflammation in conjunction with overall gingival inflammation. Bleeding on probing is an early sign of inflammation in the gingiva. B. Make a sulcus and pocket survey • Examine the shape, topography and dimension of sulci and pockets.

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• Measure and record probing depths. • Determine the clinical attachment level. C. Make a mucogingival determinations • Determine relationship of gingival margin, attachment level and mucogingival junction. • Measures width of attached gingiva • Roll test to locate mucogingival junction D. Make other gingival determinations • Evaluate gingival bleeding on probing and prepare a index. • Measure the extent of visible gingival recession. • Detect anatomic configuration of roots, subgingival deposits and root irregularities that complicate instrumentation. For this, the probe is used in conjunction with the explorer. E. Evaluate success and completeness of treatment • Evaluate post-treatment tissue response to professional treatment on an intermediate, short term basis as well as at periodic maintenance examinations. • Evaluate patients self-treatment through therapeutic disease control procedures Classification

Periodontal probes may be divided into: • First generation probes are conventional, and hand held probes, e.g. o William’s periodontal probe o UNC-15 probe o University of Michigan O probe o Marquis color coded probe o WHO probe o Naber’s probe • Second generation probes are pressure-sensitive probes. It has been shown that with forces up to 30 gm the probe tip remains within junctional epithelium and forces up to 50 gm are necessary to diagnose osseous defects. This

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probe did solve many problems of the conventional probes, but lacked tactile sensitivity, e.g. o Vive-valley o Viva care TPS probe. • Third generation probes are computerized probes. Gibbs et al designed Florida probe, e.g. o Foster Miller probe o Toronto automated probes, which can detect the cemento-enamel junction. • Fourth generation probes are the three-dimensional probes in which sequential probe positions are measured. • Fifth generation probes are ultrasonographic probes which provide painles probing to the patient. The guidance path is predetermined in these probes. There are three types of periodontal probes. They are: o Calibrated periodontal probes o Naber’s furcation probe o Computer assisted probes William’s probe

• Marking at 1, 2, 3, 5, 7, 8, 9, 10 mm • Color and non-coding WHO probe or screening probe • Prescribed in 1978. • The probe was designed for two purposes: o Measurement of pocket depth. o Detection of subgingival calculus. • Used in the assessment of CPITN (community periodontal index for treatment needs) • Weight = 5 gm

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• 0.5 mm ball at tip • Mm marking at 3.5, 8.5, 11.5 mm • Color coding from 3.5 to 5.5 mm

Marquis color-coded probe

• Calibration in 3 mm sections

Periodontal Instruments

UNC-15 probe

• 15 mm long • Marking at each mm • Color coding at 5, 10, 15 mm Michingan “O” probe

• With Williams markings, or • With marking at 3, 6, 8 mm Naber’s probe

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• It is used to determine the extent of furcation involvement on a multi-rooted teeth. • It has a curved working end for accessing the furcation area. • The end is blunt so that it will not harm soft tissues. • Most of the Naber’s probe does not have markings. • The depth of insertion of the probe into the furcation area determines the degree of furcation involvement. • Accurate horizontal detection • Most of Naber’s probe do not have markings • A few have markings at 3, 6, 9 and 12 mm. Probing technique • The probe should be inserted parallel to the vertical axis of the tooth and “walked” circumferentially around each tooth to detect the areas of deepest penetration. • To detect an interdental crater the probe should be placed obliquely from both the facial and the lingual surface to explore the deepest point of the pocket located beneath the contact point. • To detect furcation involvement in multi-rooted teeth, use of specially designed Naber’s probe allows an easier and more accurate exploration of the horizontal component of furcation lesion. Maryland moffit

• With William’s marking at 1, 2, 3, 5, 7, 8, 9, 10 mm • Ball end

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Thermal probe

• Thermal probes are sensitive diagnostic devices used for measuring early inflammatory changes in the gingival tissues. • One of the commercially available systems, the PerioTemp Probe enables the calculation of temperature differential (DT, with a sensitivity of 0.1o C) between the pocket probed and its subgingival temperature. • This temperature differential is useful because it allows consideration of differences in core temperature between individuals. • Subgingival temperature at diseased sites is increased compared with healthy sites. • There always exists a natural anteroposterior temperature gradient existing within the dental arches. • Mandibular sites were reported to be warmer than the maxillary sites.

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• Temperature increases with probing depth due to increase in cellular and molecular activity caused by increased periodontal inflammation with increasing probing depth. Florida probing system

• The Florida probing system was developed using the NIDCR criteria. • This automated probe system consists of probe hand piece, digital readout, foot switch, computer interface and computer. • The end of the probe tip is 0.4 mm in diameter which reciprocates through a sleeve, and the edge of the sleeve provides a reference by which measurements are made. • These measurements are made electronically and transferred automatically to the computer when the foot switch is pressed. • Constant probing force is provided by coil springs inside the probe handpiece and digital readout.

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Advantages o Precise electronic measurements o Computer storage of data o Constant probing force Disadvantages • Lack tactile sensitivity. • Underestimation of deep probing depths by the automated probe SCALING, ROOT PLANNING, CURETTAGE INSTRUMENTS

For supragingival scaling • Sickle scaler • Cumine universal scaler • Posterior jacquette scaler • Morse scaler • Surface scaler • Cingulum scaler For subgingival scaling • Hoe scaler • Chisels • Files • Curettes Sickle Scaler

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• These 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. These are primarily used to remove supragingival calculus. • 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. • Small, curved sickle blades such as 204SD can be inserted under ledges of calculus a few millimeters below the gingival. Types of scalers 1. Different blade size. 2. Different blade design curved, or straight. 3. Different shank type • Straight shanks are designed for use on anterior teeth and premolars. • Angled shanks adapt to posterior. Uses • Coronal and supragingival scaling only, due to large blade • Removal of supragingival deposits especially below contacts in anterior region. Method: Pull stroke • Thin, triangular cross section, point to tip, double cutting edge and working tip. • Pointed tip increases root surface roughness • Straight for anterior and curved for posterior • Single end or double end. Hoe Scaler

• Hoe scalar are used for scaling of ledges or rings of calculus. • The blade is bent at a 99° angle; the cutting edge is formed by the junction of the flattened terminal surface with the

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inner aspect of the blade. The cutting edge is beveled at 45°. Use • Removal of ledges or heavy rings of calculus supra and subgingival • Planning and smoothening root surface • Remove calculus remnants • Remove heavy deposits on distal of terminal molar Method: Pull stroke • Cutting edge bevelled at 45° • Blade bent at 99°, back of blade is rounded. • 2 contact point with tooth. Chisel Scaler

• The chisel scaler designed for the proximal surfaces of teeth too closely spaced to permit the use of other scalers. It is usually used in the anterior part of the mouth. • It is a double ended instrument with a curved shank at one end and a straight shank at the other

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Use • Proximal of anterior teeth • Remove tenacious subgingival deposits Method: Push stroke horizontally from labial to lingual. • Double ended • Curved and straight shanks on ends with 45° bevel Curettes

• A curette is the instrument of choice for removing deep subgingival calculus, root planing altered cementum 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 sickle scalers and does not have any sharp points or corners other than the cutting edge of the blade General characteristics (design) • Rounded toe, no sharp points, can be inserted into deep pockets with minimal soft tissue trauma. • In cross section, the blade appear semicircular (spoonshaped blade) Types of curette 1. Gracey curette (area-specific curette) 2. Universal curette 1. Gracey curette (area-specific curette)—double-ended gracey curette are paired in the following manner • Gracey #1–2: For anterior teeth

Periodontal Instruments

• Gracey #3–4: For anterior teeth

• Gracey #5–6: For anterior teeth

• Gracey #7–8: For posterior teeth; facial and lingual

• Gracey #9–10: For posterior teeth; facial and lingual

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• Gracey #11–12: For posterior teeth; mesial

• Gracey #13–14: For posterior teeth; distal

• Gracey #15–16 and 17–18: #15–16 is a modification of #11–12, #17–18 is modification of #13–14. It has a shank elongated by 3 mm. o Gracey #15–16

o Gracey #17–18

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Function • Easier insertion and adaptation in any area where root morphology or tight tissue prevents full insertion of standard Gracey or after Five blade: o Deep, narrow pockets o Furcations o Developmental grooves o Line angles o Deep, tight pockets. Advantages 1. Can be used easily with vertical strokes 2. With reduced tissue distention 3. And without tissue trauma. 2. Universal curette

• One curette design for all areas and surfaces • Both cutting edges used, work is done with outer and inner edge. • Curved in one plane, blades curved up and not to the side. • Not offset, face of blade beveled at 90p to the shank. QUETIN Furcation Curettes

• These are actually hoes with a shallow, half moon radius that fits into root or floor of the furcation.

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• The curvature of the tip also fits into developmental depressions on the inner aspects of the roots. The shanks are slighty curved for better access and the tips are available in two widths. • These remove burnished calculus from recessed areas of the furcation where even the mini-bladed curettes are often too large to gain every access. Files

File is an instrument used to crush calculus deposits. • They are also used to roughen the surface of burnished calculus deposits to facilitate removal of deposits with a curet. • They can easily gouge and roughen root surfaces when used improperly. • Thus not suitable for fine scaling and root planing.

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SONIC AND ULTRASONIC INSTRUMENTS

• Ultrasonic and sonic instruments may be used for removing plaque, scaling, curetting and removing stain. The vibrations in ultrasonic tip range from 20000 to 45000 cycle/second. • Vibrations in sonic tip range from 2000 to 6500 cycle per second • The two types of ultrasonic units are magnetostrictive and piezoelectric. • In magnetostrictive units the pattern of vibration of the tip is elliptic, which means that all sides of the tip are active and will work when adapted to the tooth. • In piezoelectric units the pattern of vibration of the tip is linear, or back and forth, meaning the two sides of the tip are the most active.

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POLISHING INSTRUMENTS

Rubber Cups

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• Consist of rubber with or without webbed configurations in the hollow interior. Used in the handpiece for prophylaxis. • A good cleansing and polishing paste that contain fluoride should be used and kept moist to minimize friction heat. Bristle

• Available in wheel and cup shapes. • Used in prophylaxis angle with a polishing paste. Dental Tape

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Instruments in Dentistry

• Dental tape with polishing paste is used for polishing proximal surface that are inaccessible to other polishing instruments. Air Powder Polishing

• Air powder polishing is used with a specially designed handpiece. • This device is called Prophy-jet. It delivers air powder slurry of warm water and sodium bicarbonate for polishing. • It is very effective for the removal of extrinsic stains and soft deposits. Disadvantages: Tooth substance can be lost, damage to gingival tissue is transient and insignificant clinically, but amalgam restorations, composite resins and cements can be roughened. Contraindications: Patents with medical histories of respiratory illness, hypertension, and patients on medications affecting the electrolyte balance are contraindicated.

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PERIODONTICAL SURGICAL INSTRUMENTS

These are classified as: • Excisional and incisional instruments • Surgical curettes and sickles • Periosteal elevators • Surgical chisels • Surgical files • Scissors • Needle holders Incisional and Excisional Instruments

• Knives are basic instruments and can be obtained with both fixed and replaceable blades. • Gingivectomy knives, e.g. Kirkland knifes • Interdental knives, e.g. Orban knife #1–2, Merrifield knife #1, 2, 3 and 4 • Surgical blades, e.g. #12D, 15, 11 and 15C Periodontal Knives

• The kirkland knife is representative of knives typically used for gingivectomy.These knives can be obtained as either double-ended or single-ended instruments. • The entire periphery of these kidney-shaped knives is the cutting edge. • kirkland knife Interdental Knives

• The orban knife #1–2 and the merrifield knive #1, 2, 3 and 4 are knives used for interdental areas.

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Instruments in Dentistry

• These spear-shaped knives having cutting edges on both sides and are designed with either double-ended or single-ended blades. • Orban knife

• Merrifield knive

Bard Parker Handles and Surgical Blades

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• Bard Parker handle is used for cutting gingival tissue and making surgical incisions • Scalpel blades of different shapes and sizes are used in periodontal surgery. The most common blades are #11, 12D, 15, 15C. • The #12D blade is a beak-shaped blade with cutting edges on both sides, allowing the operator to engage narrow, restricted areas with both pushing and pulling cutting motions. Surgical Curettes and Sickles

• Larger and heavier curettes and sickles are often needed during surgery for the removal of granulation tissue, fibrous interdental tissues, and tenacious subgingival deposits. • The Prichard curette and the Kirkland surgical instruments are heavy curettes, whereas the Ball scaler #B2–B3 is a popular heavy sickle. The wider, heavier blades of these instruments make them suitable for surgical procedures. Periosteal Elevators

• These are needed to reflect and move the flap after the incision has been made for flap surgery. • The Woodson, Glickman and Prichard elevators are welldesigned periosteal instruments.

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Tissue Forceps

• Used to hold the flap during suturing. • Used to position and displace the flap after the flap has been reflected. Surgical Chisels and Hoes

• Chisels and hoes are used during periodontal surgery for removing and reshaping bone. • The hoe has a curved shank and blade, this instrument has a fish tail shaped with blade with a pronounced convexity in its terminal portion.

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• The cutting edges is beveled with a rounded edges and projects beyond the long axis of the handle to preserve the effectiveness of the instrument when the blade is reduced by sharpening. Surgical Files

• Used interproximally. File surfaces on both sides allow for push or pull application. Schluger Periodontal File

• Used interproximally. File surfaces on both sides allow for push or pull application. Ochsenbein Chisel

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Instruments in Dentistry

• The Ochsenbein #1–2 is a useful chisel with a semicircular indentation on both sides of the shank that allows the instrument to engage around the tooth and into the interdental area. Reverse action chisel (Rhode’s chisel)

• Designed for use with a pull stroke, it is ideal for removing bone adjacent to the tooth without causing trauma, and is especially useful on the distal of last molars. Hemostats

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• A hemostat (also called a hemostatic clamp, arterial forceps, or pean after Jules-Émile Péan) is a surgical tool used in many surgical procedures to control bleeding. • The hemostat has handles that can be held in place by their locking mechanism. • The locking mechanism is typically a series of interlocking teeth, a few on each handle that allow the user to adjust the clamping force of the pliers. When locked on, the force between the tips is approximately 40 N. Surgical Scissors

• 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. Goldman-Fox #16 scissors  Curved

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Instruments in Dentistry

 Straight

• The Goldman-Fox #16 scissors are with a curved beveled blade with serrations and the nippers. Characteristics o Long handles with thumb and finger rings. o Short cutting edge with straight or curved blades. Surgical Nippers

• Serve same purpose as scissors. • They are also used for contouring the architectural form and for forming interdental sluiceways.

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Needle Holder

• Used to suture the flap at the desired position after surgical procedure has been completed. • The castroviejo needleholder is used for delicate precise techinques that require quick and easy release and grasp of the suture. Microsurgical Tissue Pliers and Forceps

• Microsurgery may be defined as a refinement in operative technique by which visual acuity is improved through magnification.

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Instruments in Dentistry

• In addition to use of magnification and reliance on traumatic technique microsurgery entails the use of specially constructed microsurgical instruments to minimize trauma. • To permit primary wound closure, microsutures in the range of 6-0 to 9-0 are required to approximate the wound edge. EVA SYSTEM

• It is the most efficient and least traumatic instruments for correcting overhanging or over contoured proximal alloy and resin restorations are the motor-driven diamond files of the EVA prophylaxis instrument. • These files come in symmetric pairs are made of aluminum in the shape of a wedge protruding from a shaft, one side of a wedge is diamond coated and the other side is smooth.

6 Orthodontic Instruments

Dental chair

INTRODUCTION

• Orthodontics is the study of diagnosis, prevention and treatment of irregularities of the teeth and jaws. • Orthodontic instruments are used in conjunction with fixed and removable appliances. • For orthodontist, it is essential to know that the instruments that have to use routinely. It is expected to increase the working knowledge of the orthodontist and also prevent the misuse of more delicate instrument. • Stainless steel and tungsten carbide are two materials routinely used for cutting edges of the instrument. • The advantages of tungsten carbide tips over the stainless steel are o More durability o Precise cutting performance o Sharp cutting edge o Three times more stiffer than stainless steel o Resistance to scratches o The cutting edge maintains sharpness and alignment o Extra grip o Disadvantage is brittle of the material (tungsten carbide) 261

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Classification

• Instrument used for placement of separator o Separator placement plier • Band preparation instruments o Band cutting scissor o Jhonson band contouring plier o Band pinchable plier o Mershon band pusher o Nylon band seater o Band crimping plier o Double beak plier • Band removing plier o Anterior band removing plier o Posterior band removing plier • Bracket positioning instruments o Boons gauge o Bracket positioning height gauge o Direct bonding bracket holder o Orthodontic bracket card • Bracket removing plier o Anterior bracket removing plier o Posterior bracket removing plier o Kurz lingual bracket removing plier • Wire cutting instruments o Pin and ligature cutter o Distal end wire cutter o Kurz distal end cutter o Heavy wire cutter o Maun’s heavy duty wire cutter o Face bow bending or cutting plier • Clasp forming instruments o Adams plier o Adams clasp bending plier o Adams clasp former o Adams spring forming plier

Orthodontic Instruments

• Arch forming instruments o Turret o Dela rosa arch countouring plier o Bird beak plier o Standard light wire plier o Jaraback light wire plier • Loop forming plier o Nance loop forming plier o Loop tie back plier o Tweed loop forming plier o Optical loop forming plier o Young’s loop bending plier • Utility plier o Howe plier o Three prong plier o Utility arch plier o Rose torquing plier o Ribbon arch plier • Others o Impression trays o Intraoral mirrors o Cheek retracter o Tongue separator with saliva ejector o Dontrix gauge o Correx gauge o Coon style ligator o Ligature forming plier o Mosquito forceps o Mathew needle holder o Straight shooter ligature gun o Ligature tucker o Speedo ligature director o Mitchell trimmer o Adjustable enamel stripper

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o o o o o o o o o o

Nance tie back plier Hook crimping plier Lingual arch plier Distal wire twister Detailing step bending plier V bending plier Kurz first and second order bending fork Spiral blade saw Schumth measuring grid Tube converting plier

Features of Orthodontic Instruments

• • • • • • • •

Stainless steel: Extremely corrosion resistance. Cutting inserts and tips; made of hard metal. Tungsten carbide tips: Stiffer and denser than steel Shape and screw joints: Ergonomically design to meet any orthodontic requirement Gold brazing: For longer instrument life Rounded tips: For patient and safety Serration on working ends: To improve grip Bow out handles: Comfortable handling

CLASSIFICATION OF ORTHODONTIC INSTRUMENT

Classification of orthodontic instrument was based on the sequential procedures carried out during orthodontic treatment, right from the separation of teeth for banding till debonding and debanding procedures up to completion of orthodontic treatment. Separating Pliers or Separator Placing Plier

• Separating plier or separator placing plier is made up of stainless steel with spring back action • It is used for expanding elastics separators or separating rings before positioning them interdentally

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• Barrel-shaped tip prevents slippage of the module, reduce the risk of tissue damage • Angled beaks facilitate easier placement of elastics separator in anterior and posterior areas. Band Forming Instruments Band Cutting Scissors

• It is available in either in straight or curved pattern and long and short cutting edge pattern. • It is made from especially hardened stainless steel with tungsten carbide inert cutting tip. • It is used for cutting thin metal bands or band material. Mershon Band Pusher

• Handle is cylindrical and working end is serrated • It is used to push bands so as to seat them and/or adapt them to the exact contour of the teeth

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Instruments in Dentistry

• A hollow anatomically formed grip handle makes the band pusher light and the serrated rectangular tip provides for a good transfer of force when positioning bands. Nylon Band Seater

• Band seater is available in various shapes and are generally made of high impact plastics or wood. • The biting surface is generally tin inlay. Its shape is round, square or triangular (allow easy access to interproximal area) with aserrated surface finish. • Square tip allow maximum grip and prevent slippage. • It is used for patient to bite on the surface with the tin inlay tip resting on the lug or the band edge. Band Crimping Plier

• It is used to contour the gingival surface of performed bands to provide better tooth anatomy.

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Johnson Band Contouring Pliers

• The Johnson band contouring plier is ideal for contouring and adapting bands. • Beaks are tapered with slight bow. One beak is concave while the other is convex allowing re-contouring of bands • It can be used to recontour band edges that soothing get bent during band placement. Band Pinching Plier

• Beaks are in triangular passion with inner surface had serrated for better control of band material • It is used for pinching of bands during band preparation • It has two types: Curved and straight • Curved (45°) pinchable plier used for lower band preparation, straight is used for upper band preparation.

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Instruments in Dentistry

Peak Plier

• It is used for preparation of bands to the tooth • Contour fitting to the side of tooth is aided by the concave surface or depression at the outer ends of each of the band clamping portion. • The purpose of the elevated edge is to provide a friction contact with a portion of the material of the strip to prevent it from slipping in the use of plier in the operation of forming a band around a tooth. Double Beak Pliers

• It is made of stainless steel, the double beak pliers are used for forming bands in mouth • These are available separately for anterior and posterior band fabrications • These were of immense importance when all teeth used to be banded.

Band Removing Pliers Anterior Band Removing Plier

• It has a narrow groove into which the incisal edge of the anterior tooth is placed and the sharp end is inserted gingival to the gingival extension of anterior band.

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Oliver Jones Posterior Band Removing Plier

• It is used to remove posterior metal bands with maximum patient comfort • The tip is postured in middle of the pad for easy removal of bands • A plastic padded tip and sharp removing beak with slight pressure allow easy band removal

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Instruments in Dentistry

• Plastic head rest the occlusal surface of tooth and the sharp tip below the gingival contour of the band. The pressure at handles causes the band to lift off the tooth. Bracket Positioning Instrument Boons Gauge

• It is the most frequently used bracket positioning aid. • It is made of stainless steel • It accurately measures height of bracket placement from the incisal edge at 3.5, 4, 4.5 and 5 mm • Flat surface rest on incisal/occlusal surface of tooth. Simplifies seating the bracket on the teeth with exactly the right distance between bracket slot and incisal edge with pencil lead or metal tips. Bracket Positioning Height Gauge

• This device simplifies the seating of brackets on the teeth with exactly the right distance between the bracket slot and incisal edge

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• It is generally made of aluminium or stainless steel • It accurately measures height of bracket placement from the incisal edge at 2, 2.5, 3, 3.5, 4, 4.5, 5 and 5.5 mm Bracket Holder

• It holds any type of bracket from a wide twin to a single one • Reverse action type handle which on pressing the handle open up the beaks • Beaks are diamond-shaped with serrations to grip the bracket • Flat end of the handle used to press the beaks into position for bonding Orthodontic Bracket Card

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Instruments in Dentistry

• It is used to organise and hold or orthodontic brackets to facilitate quick bracket placement • Each circle on the card corresponds to a particular tooth in the mouth • Brackets are placed corresponding to the tooth to be bonded • Tape on the back of the card helps to keep the brackets in place Bracket Removing Plier

A. Anterior Bracket Removing Plier

B. Posterior Bracket Removing Plier

• Bracket removing plier are used for removing bonded brackets • The wide tips wedge between both the edges of the base of the bracket and the tooth surface (incisal-gingival direction), easily lifting off the brackets

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• Available in two forms as straight (for anterior debonding) and with 60° angled tip (which allows better access to posterior areas) • Anterior debonding plier is also used for removal of adhesive remnant on enamel surface after bracket removal Kurz Lingual Bracket Removing Plier

• It is designed to fit the design of lingual brackets under 6th lingual hooks and bite turbos • This instrument incorporates a state-of-the-art spring mechanism to improve durability and has an increased arm radious to allow for better movement • It is used to removal of lingual brackets and bite turbos Wire Cutting Instruments Pin and Ligature Cutter (PLC)

• The cutting edge is made from stainless steel or tungsten carbide which is placed mesial to the beaks • They are especially designed for accuracy right to the tip, for smooth cutting of soft ligature wires and lock pins and elastomerics. It cannot be used on ligature more than 0.015 mm in diameter as it damages the cutting edge.

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Instruments in Dentistry

Pin and Ligature Cutter—Angulated

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• PLC with 45° and 90° angled cutting tips for easy cutting of ligatures especially in the posterior areas in the lingual technique. Distal End Cutter

• The distal end cutter is capable of cutting arch wires up to 0.56 × 0.70 mm/0.022" × 0.028" both intraoral and extraoral methods • It is used exclusively for cutting the distal end of wire protruding out of the molar turbes • It had a ‘safety’ mechanism to hold the cut arch wire so it does not fall into the patient mouth Kurz Distal End Cutter

• It is similar to distal end cutter, but difference is that it was designed with long body so it can reach back into depth of mouth.

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Instruments in Dentistry

Hard Wire Cutter

• Hard wire cutters have hard metal tips or tungsten carbide tips. • These are heavier and larger than the pin and ligature cutters • These are used to cut all wires up to 0.020’’ round Maun’s Heavy Duty Wire Cutters

• Heavy wire cutters are also called heavy gauge side cutters. They are capable of cutting wires of up to 1.3 mm diameter. These are used mainly in the laboratory purpose.

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Face-bow Bending/Cutting Pliers

• The face-bow bending pliers are ideal for bending and cutting the outer bows of a face bow. These can be used to bend wires up to a diameter of 1.8 mm. Clasp Forming Instrument Adam’s Plier

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Instruments in Dentistry

• Adam’s plier is used in the fabrication of the Adam’s clasp and has two smooth rectangular beaks • Made of a hard stainless steel with or without TC tip, that is harder than the wires that they will be used to form • The distance between hinge pin and the tips of the beaks is short • The sides of the beaks are flat and edges of the grasping surface of the beaks are sharp and textured, inner surface must not be polished but also must not be serrated or grooved. • When the beaks are closed, the tips should be a gap at the hinge tapering evenly to contact at the tips • The gap at the hing should be 0.06 mm. This insures that a 1.0 mm wire can be held firmly, the surface of the beaks then being parallel. • When a wire is gripped at the tips of the beaks, there is no tendency for the wire to slip out of the pliers. • It is also used for adjustment of headgear and facebow. Adam’s Clasp Bending Pliers

• Adam’s clasp bending pliers are special pliers for easy forming of adam’s clasp in one step. • It can be used for wires up to the diameter of 1 mm. Arrow Clasp Bending Pliers

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• Arrow clasp bending pliers are used to bend the arrow clasp, so that the arrow head can engage the retentive undercut. • It is used for wires up to the diameter of 0.7 mm. Arrow Clasp Former

• Arrow clasp former is used for hard wires up to 0.7 mm/ 0.028’’. • It forms the clasp of the shape and small stops in the archwire. Adam’s Spring Forming Plier

• It is used to adjust springs on orthodontic removable appliances. • It can be used to smooth and contour archwires • It has two beaks, one beak is rounded, and the other is square/flat ended.

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Instruments in Dentistry

Arch Forming Instruments Turret

• It is used for preparation of arch wires with or without torque adjustment • It is available in six different versions and colors—blue, black, gold, silver, purple, green. • The wire slotted body is made of stainless steel. A. Turret-blue

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• It is used for forming rectangular arch wires 0.016’’ up to 0.0215’’ B. Turret-black

• It is used for forming rectangular arch wires with torque adjustments: 0-10-16-23 . • For use only with wire: 0.016’’ × 0.022’’. C. Turret-gold

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Instruments in Dentistry

• It is used for forming a rectangular arch wires with torque adjustments: 0 -7-10-13-16 . • It is used for use only with wire: 0.018’’. D. Turret-silver

• It is used for forming a rectangular arch wires with torque adjustments: 0-7-10-13-16 . • It is used for use only with wire: 0.022’’. E. Turret-purple

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• It is used for forming a rectangular arch wires with torque adjustments: 0-10-16-23 . • It is used for use only with wire: 0.016’’ × 0.016’’. F. Turret-green

• It is used for forming a round arch wires: 0.014’’ -0.016’’0.020’’. De La Rosa Contouring Pliers

• The de la rosa as it is frequently called, has guiding grooves for forming round and square arches 0.016’’, 0.018’’, 0.020’’ and 0.022’’ • It helps to accentuate the curvature in the arch wire.

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Instruments in Dentistry

Bird Beak Plier

• An extremely popular and versatile utility plier designed for working round wire up to 0.030’’ (0.76 mm) in diameter. • The round beak is precision ground to a perfect cone (0.025 at the tip). • The pyramid beak is exactly 0.025 mm wide at the tip and 90° angled is ground on the sides to allow for wire. • Beaks are parallel at 0.020’’ opening. • Working edges are carefully bevelled and diamond honed to prevent scoring Standard Light Wire Plier

• Longer, more gradually tapered beaks than bird beaks plier • A round beak with a cone tip of 0.025 and apyramid tip with 9° angled grounds on the sides to allow for wire spring back. • Slender beaks make it easier to bend small diameter loops the working edges are carefully bevelled to prevent the wire scoring.

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• It comes with and without serration on its flat beak. • It can be used for arch form and spring preparation • It is used for hard wires up to 0.5 mm or 0.020’’ diameter. Jaraback Light wire Plier

• The jaraback light wire plier has a shape, which is slightly different from the original light wire plier. • It has 3 sets of precision grooves accurate banding and closing loops. Flat tip is serrated for firm gripping. • Serve the same function and can be used to bend spring hard wires up to 0.5 mm or 0.020’’ diameter. Angle Wire Bending Pliers

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Instruments in Dentistry

• This sturdily constructed plier has hard tips and the beaks are cone and pyramid shaped. • It is available in two beak lengths—short and long. Loop Forming Plier Nance Loop Forming Pliers

• Nance loop forming plier is ideally suited for fanning different loops and adjusting reshaped arches for the fixed appliance technique. • It has four-step beaks which are ideal for bending loops of different sizes in both round rectangular wires. • Both end of thin blades are fully reduced and stepped in 3 mm, 4 mm, 5 mm and 6 mm for various size loop forming. All working edges are carefully bevelled to avoid wire damage. • This plier can bend wires up to a diameter of 0.7 mm or 0.028". Loop Tie Back Plier

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287

1. It is four-step plier (2 mm, 3 mm, 4 mm, 5 mm, step lengths) automatically forms loop on wire up to 0.020" with one motion. 2. Closing loops are easily made to desired height. Tweed Loop Forming Plier

• Multiple loops of the same dimension and omega loop can be easily bent with this plier. • Round beak has three-step sections of 0.045, 0.060 and 0.075 inch diameter. • Cylindrical beak is electro-etched to prevent wire slippage. • Concave beak has slight parallel serrations to hold wire at 90° angle while forming loops. • Replacement tips with allen wrench available. • Maximum wire capacity 0.021 × 0.028. Optical Plier

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Instruments in Dentistry

• It had one round and one concave beak for bending round and edgewise wire up to 0.28" without nicking. • It forms stop in any type of wire. • It is also useful for loop tie back and Gable bends. Young Loop Bending Pliers

• Young loop bending plier is universal plier for different size loops. • It provides a uniform dimension to the loops. • It is used for hardwires up to 0.7 mm or 28 inches. Weingart Universal Pliers

• The Weingart plier is used to guide and moves the archwire in and out of placement and bending the archwire ends. • The bend in the beak facilitates easy grasping of the archwire and guiding into buccal tubes. • It has accurately closing serrated tips. • It is capable of bending hard wires up to a diameter of 0.5 mm /0.020".

Orthodontic Instruments

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Universal Plier

• Universal plier for bending wires up to 0.9 mm (0.35") or cutting up to 0.7 mm (0.28"). Howe Pliers

Straight howe

Curved howe

These are mainly of two types: 1. Straight howe. 2. Curved howe. • Straight howe pliers are pliers have long, slender lip-safe tips. They are used to hold arch wires. The special tip

290

Instruments in Dentistry

design makes these pliers also suited to seating individual anterio bands. • Curved howe pliers are also utility pliers with long, slender, curved lip-safe tips, which increase its efficiency in posterior areas. • The tips are bent at 40° for better access. Three Prong Pliers

• The three prong plier has three precision aligned tips, which ensures consistent bends in lingual bars and wires. • It is capable of bending wires up to a diameter of 0.030". • It is also used for the activation of the quad-helix appliance. Utility Arch Plier

• Special design with 3 mm step for accurate utility arch construction. • The notches in the plier beak crimp the preformed arch wires into proper position.

Orthodontic Instruments

291

Rose Torquing Plier

• These pliers are generally used in pair of applying labial or lingual torque (single or multiple) to arch wires. • Parallel grip prevents crushing of wires. • They can be used for wires up to the diameter of 0.56–0.70 mm or 0.022"–0.028". Ribbon Arch Plier

• Ideal for the bending square and rectangular wire up to 0.0215 × 0.028. Edges are reduced and hardened, to prevent wire scoring and to preserve a smooth contact area with the wire. • Blades are parallel when opened to 0.020, to ensure accurate 90 bends. • Maximum wire capacity: 0.0215" × 0.028".

292

Instruments in Dentistry

Impression Trays

• It is used to hold impression material. • It can be perforated for better retention and high flange for record full sulcus depth. • It had a handle for better grasp during placement and removal. Cheek Retractors

• It is used retract cheeks and lips for better visibility. • It is often used when bonding of brackets and taking intraoral photographs and during bonding of brackets. • Available in small, medium sizes. • Available in wingless and interconnected wire design. • Available in transparent and various colors.

Orthodontic Instruments

293

Tongue-away Shield

• Tongue-away shields are moulded from a soft, resilient plastic or from expanded polystyrene that can be safely disposed of after each patient. • Restrict the tongue to prevent moisture contamination and alleviates patient fatigue by offering occlusal support during bonding procedures. • Vertical shield is offset to provide adequate tongue space. • Surface of bite blocks are angulated and serrated for retention. • Hole in bite blocks facilitate placement and removal with a bird-beak plier, permit attachment of a safety string or allow insertion of saliva ejector. Tongue Retractor with Saliva Ejector

294

Instruments in Dentistry

• It provides dry working field that keeps the tongue away from lingual surface of teeth and isolated them from saliva contamination. • It allows the enough space and access to place the indirect bonding material. Intraoral Mirrors

• • • •

It is made up of glass or stainless steel material. It aids in visibility when taking intraoral photographs. It is often used in conjunction with cheek retractors. Different sizes and shap are available.

Coon Style Ligator

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295

• The ligator is used for fast ligating of the complete arch, i.e. tie long ligatures into a ‘figure-of-eight’. • The ‘Y’ shape tip simplifies the twisting of the ligature. • It can be used for ligature wire up to 0.3 mm/0.012" diameter. Ligature Forming Plier

• It is used for easy band into ligature wire for preparation of performed pattern. Mosquito Artery Forceps

296

Instruments in Dentistry

• Mosquito forceps are used for placing elastic ligatures and tightening the ligature wire around brackets. • It is available in straight and curved (45) end pattern. • Beaks are serrated for better grasp. Mathieu Needle Holder

• Mathieu needle holder has a convenient and practical design and is ideal for ligation. • It has serrated tips (2.5 mm), which allow better gripping of the thin ligatures and elastomeric modules. • The handle lock has a locking mechanism and a spring mechanism that helps the operator to quickly open and close the pliers. Straight Shooter Ligature Gun

• Straight shooter ligature gun made up of thermoplastic material, it provides a safe, convenient, hygienic means of applying elastomeric ligature to edgewise brackets. • It eliminates the possibility of haemostats or other instruments causing soft tissue damage due to ligatures breaking or slipping off tie wing. • Two sizes of straight shooter are available. The mini bracket shooter is for mini and single-wing brackets and the twin bracket shooter for standard, twin-size brackets.

Orthodontic Instruments

297

Ligature Adjuster and Tucker

• Ligature adjuster and tucker is usually a double ended or single ended instrument. • Notch in working end allows operator to apply pressure to arch wire to bend it into bracket slot. • It is used to tuck the cut ends of the ligature wires so that they do not hurt soft tissues. Speedo Ligature Director

• Double ended stainless steel for placing and removing elastic ligatures. It reduces stress on newly bonded brackets during ligation.

298

Instruments in Dentistry

Adjustable Enamel Stripper

• It is especially designed and developed for easy, efficient removal and recontouring of the interproximal tooth enamel, for the widening of contact points or for the removal of overhanging fillings. • Steel strips feature grit on one side only. Dontrix Gauge

• Measures the force of coil springs, arch wires and elastics 1 ounce (28 grams) up to 16 (450 grams) ounces. • Marked in one ounce increments. (1 ounce = 28.3495 grams) • The shaft calibrated on both ends for measuring either tension or stress by reversing the gauge. • It used by placing hook end to which type of material force is measured and check the calibrated value on chart.

Orthodontic Instruments

299

Correx Gauge

• It is also used for measuring tensile and compressive forces. • It records the forces in grams. • It is available in three variations of force measuring designs. Type 1: 25–250 grams Type 2: 50–500 grams Type 3: 100–1000 grams Mitchell Trimmer

• It is used after placement of orthodontic bends to remove excess cements.

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Instruments in Dentistry

• It can also be used after rebounding brackets in the removal of excess cements with a conventional headpiece and a deboning bur. Nance Tie Back Plier

• It is multipurpose specialty plier used for easily forming stops, tie beaks or Adam’s clasp for retainers. Hook Crimping Plier

• It is used for crimping of hooks to the archwire. • Two grooved inserts maintain a firm grip on the tube as it is delivered to the arch wire. • Securely crimps the tube at the three points to prevent the end from flaring. • Lower beaks are thinner to accommodate curvature of arch hook.

Orthodontic Instruments

301

Distal Wire Twister

• It is used for cinchback bend in the arch wire. • Simply insert the tip over the distal end of the arch wire and twist in the desired direction. Straightening cinchback bends are done with equal efficiency, thus reducing the time required for changing arch wires. These are available in two sizes. • The small (1 mm internal diameter) is ideal for wire sizes up to 0.018 round and square sizes up to 0.016 × 0.016. • The large (2 mm) will accommodate round wire up to 0.020, square wire up to 0.018 × 0.018, and rectangular wire up to 0.021 × 0.025. Lingual Arch Plier

• It is designed to form double and triple bends in either 0.030" (0.076 mm) or 0.036" (0.091 mm) wire for inserting lingual sheaths. (TPA and lingual arch preparation). Detailing Step Plier

• It has double-sided offset beaks permits bayonet bends. • Automatically forms a bayonet-style step bend, up or down, in or out, without disengaging the arch wire.

302

Instruments in Dentistry

• It produces right hand and left hand step up or step down at ¼, ½, ¾ or 1 mm increments. V-Bending Pliers

• It is used for putting permanent centreline, anti-shift gable bends and positive stops anywhere in nickel titanium arches. Spiral Blade Saw

• It is used to place horizontal and vertical cut in diagnostic model for preparation of tooth section in kesling diagnostic setup.

Orthodontic Instruments

303

• Blades are available in various lengths. • Most commonly 0.004 inch cutting width (fine), 12 inch length is used.

Schumth Measuring Grid

304

Instruments in Dentistry

• Made of plexiglads, for symmetric measurements of dental arch on plaster casts, in millimeters. • Grid screen dimension 60 × 60 × 10 mm. • This screen is printed red with a 1 × 1 cm scale on one side and the other side in black with a 1 × cm 2 mm scale. • When the red and black scales are in alignments, parallax errors are not present and accurate measurements can be taken. Tube Converting Plier

• It is used for the conversion of convertible molar tube into bracket. Procedure: Step 1: Insert instrument into the mouth with the side mechanism parallel to the arch plane and the handles pointing outward. Step 2: With handle wide open (slide bar tip fully retracted) align and insert tip into arch wire slot of buccal tube.

Orthodontic Instruments

305

Close handle slowly until anchor tip of pliers is firmly supported on distal end of the buccal tube. Step 3: Maintaining instrument alignment, close handles slowly and steadily, driving the slide bar tip into the arch wire slot. The convertible cap will peel away, converting the buccal tube to molar bracket. Step 4: If the slide bar tip is adjusted for partial conversion, open the plier handles fully and carefully remove the instrument from the patient’s mouth. If the tip is bound up in the arch wire slot, slowly pivot the entire instrument outward to free the tip. The partially converted cap can be securely grasped with utility pliers, rotated distally to beak away the attachment and removed from the patient’s mouth. Replacing the slide bar tip: Open pliers handle to retract slide tip half way and hold this position. Remove the slide bar retaining screw. • Grasp the tip with an utitity pliers, rotate upward and remove the tip. • Insert a fresh tip, replace and tighten retaining screw securely.

306

Instruments in Dentistry

7 Miscellaneous Instruments

Dental chair

Protective Shield for Curing Light

• Orange color: Blocks harmful light to operator’s and assistant’s eyes. • Protective shield also available on curing light and/or paddle shield. Uses: • To protect operators and assistant’s eyes during curing stage of light-cured material. Disposables

• Cotton roll holder for mandibular arch o One cotton roll is placed on the buccal side of the teeth, and the other is placed on the lingual side of the teeth. • Disposable bite block 306

Miscellaneous Instruments

307

• Cotton rolls • Dry aids for keeping mouth dry o Dry aid is placed on the buccal mucosa—inside the cheek—opposite the maxillary second molar near the Stensen’s duct to absorb the saliva originating from the parotid gland. Fluoride Trays: Disposable

308

Instruments in Dentistry

• Variety of disposable trays and fluoride available. • Fluoride treatment is usually given to children at their 6 month check up appointment. Uses • To fill trays with fluoride. • To prevent decay by mineralizing the teeth. Laboratory Coat

• Disposable or cloth (cloth gown must be made of polyester and cotton in accordance with state and federal regulations) • Cuffed long sleeves • Closer at neckline • Moisture resistant (against contamination by liquids)

Miscellaneous Instruments

309

Uses • To protect clothing, surgical scrubs, and skin during patient care and sterilization proceeds to prevent contamination from blood and body substances. Protective Mask

• Dome shaped or flat. • Protective mask must cover nose and mouth. Uses • To protect against chemicals, airborne, bacteria, and viruses during processing of instruments for sterilization. • To protect against airborne pathogens, bacteria, and virus and against scrap filling material during all phase of patient treatment. Protective Glasses/Eye Wear

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Instruments in Dentistry

• Extend to sides, top and bottom of eyes for complete protection. • Variety of styles available—some styles are larger to fit over prescription glasses. Uses • To protect against chemicals, airborne pathogens, bacteria and viruses during processing of instruments for sterilization. • To protect against airborne pathogens, bacteria and viruses during patient care and against scrap-filling material during restorative and rinsing phases of patient treatment. Examination Gloves

• Latex or vinyl • Nonsterile gloves worn for most dental procedures; sterile gloves may be worn for surgical procedures; various sizes available. Uses • To wear during patient care • To wear as a protective barrier • To wear during treatment room disinfection Over Gloves

• Lightweight clear gloves • Not to be worn for dental procedures • Various sizes available

Miscellaneous Instruments

311

Uses • To wear over examination gloves when living the patient • To wear as a protective barrier over examination gloves so as not to cross contaminate. Nitrile Utility Gloves

• • • •

Chemical resistant Puncture resistant Ribbed for nostril grip Range of sizes and colors

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Instruments in Dentistry

Uses • To protect hand during processing of instruments for sterilization procedures. • To wear for preparation and handling of chemicals. Cassette

• Available in metal and resin • Color coded • Range of sizes Uses • To use for instruments as tray setup • To use for instruments sterilization Indicator Tape and Dispensing Unit

• Available in pre-printed tray setup procedures • Available with color coding • Available blank for labelling tape with procedure and/or instrument content

Miscellaneous Instruments

313

Uses • To secure wrap on outside of cassette • To use outside cassettes or sterilization pouches to indicate exposure of instruments to a certain temperature—color will change on the tape. Ultrasonic Cleaning Unit

• Reduces risk of exposure to pathogens during the cleaning stage of the sterilization process. Uses • To remove debris and bio-burden from instruments.

314

Instruments in Dentistry

Sterilisation of Instruments

Sterilization • It is a process by which an article, surface or medium is made free of all microorganisms either in vegetative or spore form. Disinfection • Destruction of all pathogens or organisms capable of producing infections but not necessarily spores. • All organisms may not be killed but the number is reduced to a level that is no longer harmful to health. Antiseptics • Chemical disinfectants which can safely applied to living tissues and are used to prevent infection by inhibiting the growth of microorganisms. Asepsis • Technique by which the occurrence of infection into an uninfected tissue is prevented Uses of Sterilisation • Sterilisation of materials, instruments used in surgical and diagnostic procedures. • Sterilisation of media and reagents used in the microbiology laboratory. • Food and drug manufacturing to ensure safety from contaminating organisms. Methods of Sterilization Physical Methods

1. Sunlight 2. Heat • Dry heat • Moist heat 3. Filtration 4. Radiation

Miscellaneous Instruments

315

Chemical Methods

• Alcohols • Aldehydes • Phenols • Halogens • Oxidizing agents • Salts • Surface active agents • Dyes • Vapor phase disinfectant 1. Sunlight • Active germicidal effect due to its content of ultraviolet rays. • Natural method of sterilisation of water in tanks, rivers and lakes. 2. Heat Principle • Dry heat kills the organism by o denaturation of the bacterial proteins o oxidative damage o toxic effect of elevated levels of electrolytes. Dry Heat A. Red heat B. Flaming C. Incineration D. Hot air oven A. Red heat • Materials are held in the flame of a bunsen burner till they become red hot. o Inoculating wires or loops o Tips of forceps o Needles

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Instruments in Dentistry

B. Flaming:

• Materials are passed through the flame of a bunsen burner without allowing them to become red hot. o Glass slides o Scalpels o Mouths of culture tubes C. Incineration • Materials are reduced to ashes by burning. • Instrument used was incinerator. • Soiled dressings • Animal carcasses • Bedding • Pathological material

Miscellaneous Instruments

317

D. Hot air oven

• Most widely used method • Electrically heated and fitted with a fan to even distribution of air in the chamber. • Fitted with a thermostat that maintains the chamber air at a chosen temperature. • Temperature and time: o 160°C for 2 hours. o 170°C for 1 hour o 180°C for 30 minutes.

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Instruments in Dentistry

Uses of hot air oven • Glassware like glass syringes, Petri dishes, pipettes and test tubes. • Surgical instruments like scalpels, scissors, forceps, etc. • Chemicals like liquid paraffin, fats, etc. Precautions • Should not be overloaded • Arranged in a manner which allows free circulation of air • Material to be sterilized should be perfectly dry. • Test tubes, flasks, etc. should be fitted with cotton plugs. • Petridishes and pipetts should be wrapped in paper. • Rubber materials and inflammable materials should not be kept inside. • The oven must be allowed to cool for two hours before opening, since glass ware may crack by sudden cooling. Disadvantages of dry heat sterilization • Less reliable than autoclaving • Large temperature difference may arise within device. • Sharp instruments get dulled • Many materials do not tolerate dry heat Moist heat A. Autoclave

Miscellaneous Instruments

319

• Autoclave is a pressurized device designed to heat aqueous solutions above their boiling point at normal atmospheric pressure to achieve sterilization. Auto — self Clavis — self-locking device • The use of saturated stem under pressure is considered the most practical and effective method of sterilisation. • When steams come in contact with the instrument to be sterilised, it condenses almost instantly and releases latent heat quickly denatures vital cell proteins. • The condensed water provides a moist environment for killing bacteria. • Saturated steam under pressure a moist environment for killing bacteria. • Saturated steam under pressure is even more efficient because incising the pressure in a container of stem increases the boiling point of water. • So the new entering a close container gradually becomes hotter. This is the principle of an autoclave. Types of autoclave 1. High vacuum type: Air is evacuated from the chamber by a pump prior to the entry of stem 2. Downward displacement type: Air is evacuated by the stem in an autoclave, the instruments are exposed to 121°C for 15–20 min at 15 psi pressure. Flash sterilisation: At a temperature of 134°C and pressure of 32 psi, the time required for sterilisation is 3½ minutes. This is called flash sterilisation. Advantages of autoclave • This is the most effective form of destruction of all forms of microbial life • Temperature can be accurately controlled • Heating and penetration controlled • Most economical sterilisation technique • Short sterilisation time

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Instruments in Dentistry

• No remnants of any toxic residue on the instruments after sterilisation Disadvantages • Causes corrosion of delicate instruments • Unsuitable for sterilisation of greases, oil or powders • Rubber and plastic materials may damaged or melt • Autoclave should be loaded properly, otherwise it may not be effective Uses • Useful for materials which cannot withstand high temperature • To sterilize culture media, rubber material, gowns, dressings, gloves, etc. Radiation

• Ionizing radiations • Non-ionizing radiations Ionizing radiations 1. X-rays 2. Gamma rays

Miscellaneous Instruments

321

3. Cosmic rays • Gamma radiation is commercially used for sterilisation of disposable items (cold sterilisation). Nonionizing radiation • Wavelengths greater than 1 nm • Excites electrons, causing them to make new covalent bonds o Affects 3-D structure of proteins and nucleic acids • UV light causes pyrimidine dimers in DNA • UV light does not penetrate well • Suitable for disinfecting air, transparent fluids, and surfaces of objects Dental Radiography Equipment Intraoral X-ray Film

• Outside covering of film—soft plastic or paper (both waterproof) • Sheet of lead foil to stop the radiation from extending beyond the film • Black paper to protect the film from light penetration X-ray film • Film: Single or double film • Commonly taken X-rays: Front and back view

Instruments in Dentistry

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Sizes

• • • • •

Size #0: Taken on children under 3 Size #1: Anterior and posterior periapical X-ray Size #2: Periapical and bite-wing X-ray Size #3: Long X-ray usually taken on children Size #4: Occlusal projections usually taken on children

Uses • To use to project the patient’s teeth through X-ray onto the film • To use for intraoral projection Extraoral X-rays: Cephalometric and Panoramic

• Film is placed in a cassette outside the mouth. 1. Cephalometric radiograph—shows bony and soft tissue areas of the facial profile. 2. Panoramic radiograph—shows panoramic view of maxillary and mandibular teeth on one X-ray. Uses • To use to project the patient’s teeth through X-ray onto the film • To use for extraoral projection

Miscellaneous Instruments

323

Bite-wing X-ray Tab

• Stick on or slip on tab • Tab or wing is placed on the occlusal and patient bites on the tab secure the X-ray. Uses • To use to take a bite-wing X-ray projection Film Holders: Periapical X-ray

324

Instruments in Dentistry

• Hold film for anterior and posterior teeth projection: Plastic that can be sterilized. Uses • To position and hold an X-ray in patient’s mouth for periapical X-ray • To allow patient to bite on holder to keep X-ray in place while positioning the position indicating device and exposing the film Film Holder—XCP

• Red: Holds film for bite-wing projection • Blue: Holds film for anterior teeth projection • Yellow – Holds film for posterior teeth projection • Slot hold film in place Uses • To position and hold an X-ray in patient’s mouth for periapical and bite-wing X-ray using parallel technique • To allow patient to bite on holder to keep X-ray in place while positioning the position indicating device and exposing the film

Miscellaneous Instruments

325

Lead Aprons

• Lead apron • Lead apron with collar to project thyroid area • Lead apron poncho for front and back protection Uses • To placed on patient for protection against scattered X-ray during exposure of X-ray film Dental X-ray Unit

326

Instruments in Dentistry

• Parts: Tube head, X-ray unit • Control panel for the X-ray unit and button to expose the film are outside patient’s treatment room. On some machines, you may adjust the exposure time that the X-ray is exposed. • Other machines adjust the exposure time, kilovoltage peak (kVp), and milliamperage mA. • Follow standard precaution and cross-contamination protocol when exposing and processing film. Barriers should be used on X-ray head, position indicator device (PID), and panel where X-ray button is pushed. Also follow manufacture recommendation for disinfection. Uses: • To expose film with radiation that is generated in the X-ray unit. X-ray Safelight

• The processing room should have both white illumination and safelighting. Safelighting is low-intensity illumination of relatively long wavelength (red) that does not rapidly affect open film but permits one to see well enough to work in the area. • To minimize the fogging effect of prolonged exposure, the safelight should have a 15 watt bulb and should be mounted at least 4 feet above the surface where opened films are handled. • A new type of safelight uses a cluster of 20 red-emitting diodes, thus not needing a filter.

Miscellaneous Instruments

327

X-ray Rack

• Panoramic rack and individual single X-ray racks • Various sizes of rack available

Uses • To place undeveloped-ray on the rack in the darkroom with only the safelight prior to putting rack in developer • To place film on rack without touching each other • Keep X-ray on rack through the entire process: Develop, rinse, fix, wash, and dry X-ray View Laminator

• Various sizes and styles of view laminators. Also referred to as view box. Uses • To view X-ray for diagnosis

328

Instruments in Dentistry

Digital Intraoral Radiography X-ray Unit

Parts 1. Tube head 2. X-ray unit with digital panel • Digital radiographs use less radiation than conventional X-ray • Network to computers in all areas of the dental office • Immediate imaging available Uses • To take digital intraoral X-ray without film or without processing the film • To project the image of the teeth by digitally projecting radiation onto an electronic sensor and then to computerized imaging system

Miscellaneous Instruments

329

Intraoral Sensors for Digital Radiography

• Different styles and systems of sensors and digital radiography available • Some sensors have wire connecting to computer, and some sensors do not have wire but are put into a specially designed computer after exposure. Digital Panoramic Imaging Unit and Digital Cephalometric Imaging Unit

• Digital panaromic imaging unit

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Instruments in Dentistry

• Digital cephlometric imaging unit

• Digital radiographs use less radiation than conventional X-ray • Network to computers in all areas of the dental office • Immediate imaging available Uses • To take digital panaromic X-ray without film or without processing the film • To project the image of maxillary and mandibular teeth by digital projecting radiation onto an electronic sensor and then to computerized imaging system Magnification and Headlamp Illumination

• Another key to the success of clinical operative dentistry is visual acuity. The operator must be able to see clearly to attend to the details of each procedure. The use of magnification facilitates attention to detail and does not adversely affect vision. • Magnifying lenses have a fixed focal length that often requires the operator to maintain a proper working distance, which ensures good posture. Several types of

Miscellaneous Instruments

331

magnification devices are available, including bifocal eyeglasses, loupes, and surgical telescopes. • The use of such magnification devices also provides some protection from eye injury. To further improve visual acuity, headlamps are recommended in operative dentistry. Their greatest advantage is the light source being parallel to the clinician’s vision, eliminating shadows at the operating field. Current headlamps use light-emitting diode (LED) technology and produce whiter light than conventional tungsten halogen light sources.

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Index

A Abrasive materials used in dentistry and their uses 102, 146 Acrylic trimmer mounted stones 118 tungsten carbide 116 Adam’s clasp bending pliers 278 Adam’s plier 277 Adam’s spring forming plier 279 Adjustable enamel stripper 298 Air powder polishing 250 Air-abrasion handpiece 143 Airway 226 Alcohol torch 105 Allis tissue forceps 175 Amalgam carrier 46 Anesthesia machine 228 Angle wire bending pliers 285 Anterior band removing plier 268 Arch forming instruments 280 Archbar 203 Armamentarium for suturing 215 Arrow clasp bending pliers 278 Arrow clasp former 279 Artery forceps 178 Articulator 125 Articulator based on theory of occlusion 127 Asche’s forcep 206 Automatrix 56

B Babcock’s tissue forceps 175 Band crimping plier 266

Band cutting scissors 265 Band forming instruments 265 Band pinching plier 267 Band removing pliers 268 Barbed broaches 63 Bard Parker blade and handle 117 Bard Parker handles and surgical blades 252 Based on ability to simulate jaw movement 128 adjustability of the articulator 129 types of records used for their adjustment 128 Bib holder 121 Biodegradable plate and screws 213 Bird beak plier 284 Bite-wing X-ray tab 323 Blade 27 Bone cutter 194 Bone cutting instruments 193 Bone gouge 197 Bone plates and screws 208 Boons gauge 270 Bracket holder 271 Bracket positioning height gauge 270 Bracket positioning instrument 270 Bracket removing plier 272 Bristle 249 Bristow’s elevator 204 Bunsen burner 104 Burnishers 48 Burs for bone cutting 198

333

334

Instruments in Dentistry

C Care and maintenance of instruments 14 Carver of prosthodontics 108 Carvers of conservative and endodontics 47 Cassette 312 Cat’s paw retractor 169 Cautery, electrocautery 166 Cellophane strips 57 Cement spatula 44 Chair positions 15, 16 Cheek retractors 292 Chemical methods of instrument sterilization 315 Chetale’s forcep 151 Chin retractor 172 Chip blower 112 Chisel 195 Chisel scaler 241 Chisels used in conservative and endodontics 39 Clasp forming instrument 277 Classification of endodontics instruments 62 instruments based on their usage 30 orthodontic instruments 262 periodontal instruments 230, 232 prosthodontic instruments 127 Clear plastic/mylar strips 57 Collin tongue seizing forcep 152 Components of articulator 132 Compound supported matrix 54 Compression plates 208 Condenser 46 Condylar retractor 171 Considerations while doing patient 21 Conventional aspirating syringes 159 Coon style ligator 294 Copper band matrix 55 Coronoid retractor 170 Correx gauge 299 Corrugated rubber drain 219 Crocodile bone holding forceps 201

Cryer elevator 183 C-shaped retractor (Deaver’s retractor) 169 Curette 191, 242 Curved mixing spatula 106 Curved scissor 110 Cutting instruments 35

D Dappen dish 111 De la rosa contouring pliers 283 Definition of dental chair 1 Dental burs 145 Dental flask 114 Dental handpiece 95, 139 Dental handpieces and accessories 95, 139 Dental radiography equipment 321 Dental tape 249 Dental tray 120 Dental X-ray unit 325 Depth gauge 211 Detailing step plier 301 Diagnostic instruments of oral surgery 148 Different types of tracheostomy 222 Digital intraoral radiography X-ray unit 328 Digital panaromic imaging unit and digital cephalometric imaging unit 329 Direct rear position (12 o’clock) 21 Disposable aspiration syringe 160 Disposables 306 Dissecting scissors 165 Distal end cutter 275 Distal wire twister 301 Dontrix gauge 298 Double beak pliers 268 Doyen’s and Fergussion’s mouth gag 157 Doyen’s raspatory (rib retractor) 173 Drains used in oral and maxillofacial surgery 217 Drill bit 209 Drill sleeve 210

Index

E Edentulose stainless steel stock tray 109 Elevators 180–182 Enamel hatchet 41 Endodontic instruments 62 Endotracheal tube 224 Engine-driven instruments 74 Eva system 260 Evolution of dental chair 1 Examination gloves 310 Excavators 36 Exodontia armamentarium 180 Exploratory instruments 30 Explorers 32 Extraction forceps 186 Extraoral X-rays: Cephalometric and panoramic 322

F Face-bow 123 bending/cutting pliers 277 Feature of orthodontic instruments 264 Fergusson’s lion jaw bone holding forceps 201 Files 66, 246 Film holders periapical X-ray 323 XCP 324 Finger pluggers 85 Finger spreaders 84 Finishing files 81 Flap reflection instruments 167 Flexogates 76 Fluoride trays: Disposable 307 Foley’s catheter 220 Four number formula 29 Fuller’s tracheostomy tube 221

G Gas torch 119 Gates-Glidden drills 74 General anesthetic instruments 221 General considerations 14, 144 General dental chair 2 Gigli’s wire saw 198 Gingival marginal trimmer 41

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Gland holding forceps 177 Glass plate 115 Glass slab and mixing spatula 49, 115 Greater taper files (GT files) 78 Group I: Hand-operated instruments 63 GV Black’s classification 23 of instruments based on shank design 27

H Hemostatic forceps 178 Hand pluggers 85 Hand spreaders 84 Handle (shaft) 27 Handpiece maintenance 100, 144 Hard wire cutter 276 Hayton William wire holder 202 Hayton William’s forceps 207 Headpiece and burs 197 Heat sources of prosthodontic instruments 104 Heister’s jaw opener 158 Hemostats 256 High-speed handpiece 141 Hoe scaler 240 Hook crimping plier 300 Hot plate 113 Howe pliers 289

I Imaging unit 329 Impression trays 109, 292 Incisional and excisional instruments 251 Indications for emergency tracheostomy 223 use of elevators 180 Indicator tape and dispensing unit 312 Infant feeding tube 219 Instrument for compression plating system 209 Instrument formula 28 Instrument in tracheostomy 223 Instrument nomenclature (according to GV Black) 28

336

Instruments in Dentistry

Instrument to keep the mouth open 156 Instrument used for filling root canals 82 for holding soft tissues 175 for incising the tissues 164 for injecting local anesthetic agent 158 for picking up sterile instruments 151 for preparing the surgical field 151 to maintain a clean surgical field 152 to remove pathologic tissues 191 Interdental knives 251 Intraoral mirrors 294 Intraoral sensors for digital radiography 329 Intraoral X-ray film 321 Isolation of operating field 86 Ivory no. 1 matrix 50 Ivory no. 8 matrix 51

J Jaraback light wire plier 285 Jet injectors 161 Johnson band contouring plier 267

K Kidney tray, procedure trays 121 Kids dental chair 3 Kurz distal end cutter 275 Kurz lingual bracket removing plier 273

L Laboratory coat 308 Laboratory handpiece 144 Lacron carver 120 Lag screw 214 Lane’s tissue holding forceps 176 Langenbacks retractor 168 Laryngoscope 149 Laser handpiece 142 Lead aprons 325 Lentulo spirals 85 Ligature adjuster and tucker 297 Ligature forming plier 295

Light transmitting wedges 61 Lingual arch plier 301 Lister’s sinus forceps 192 London elevator 186 Loop forming plier 286 Loop tie back plier 286 Low-speed handpiece 139 Luer-Lok disposable type syringes 161

M Macintosh sheet 119 Magill’s forcep 225 Magnification and headlamp illumination 330 Malleable retractor 172 Mallet 196 Mandibular forceps 189 Marzouck classification 25 Masqito forceps 179 Mastoid retractor 171 Mathieu needle holder 296 Matrix 49 Maun’s heavy duty wire cutters 276 Maxillary extraction forceps 187 Mayo Hegar needle holder 215 Mean value articulator 131 Mershon band pusher 265 Methods of sterilization 314 Microsurgical tissue pliers and forceps 259 Miller Colbourn bone file 194 Miniplates (stainless steel/titanium plates) 211 Mitchell trimmer 299 Mixing bowl 107 Mixing pad and mixing spatula 116 Mortar and pestle 48 Mosquito artery forceps 295 Mouth mirror 30, 148 uses 148 Mouth prop 156

N Nance loop forming pliers 286 Nance tie back plier 300 Nasal rasp 200

Index Needle holder 259 Needles 162 Nerve hook 178 Nickel titanium (NiTi) endodontic instruments 77 Nitril utility gloves 311 Non-cutting restorative instruments 44 Non-portable 2 Normal compression screw 215 Nylon band seater 266

O Obwegessor’s ramus retractors 170 Ochsenbein chisel 255 Oliver Jones posterior band removing plier 269 Operating positions 18 Optical plier 287 Orthodontic bracket card 271 Osteotome 196 Other cutting instruments 43 Otoscope or auriscope 150 Over gloves 310 Oxygen mask 227

P Part of dental chair 4 dental surveyor 134 elevator 180 face-bow 123 hand cutting instruments 26 needle 162 periodontal instruments 230 Patient bib 120 Patient positions 16 Peak plier 268 Peeso reamers 77 Periodontal knives 251 Periodontal probe 231 Periodontical surgical instruments 251 Periosteal elevators 253 Physical methods of instrument sterilization 314

337

Pin and ligature cutter (PLC) 273 angulated 274 Plain retractors 168 Planned tracheostomy in oral surgery 223 Plaster knife 107 Plastic spatula (agate spatula) 45 Plastic stock tray 109 Plastic wedges 61 Polishing instruments 248 Porcelain cup with lid 113 Portable chair 2 Pott’s elevator 184 Precontoured matrix 54 Preformed transparent cervical matrixes 60 Principles of elevators 181 Probes uses 34, 149 Prosthodontic knife 107 Protaper files 78 Protective glasses/eye wear 309 Protective mask 309 Protective shield for curing light 306

Q QUETIN furcation curettes 245

R Rag wheel 118 Rampley’s swab holding forcep 151 Rasps 64 Reamers 65 Red rubber catheter 154 Requirements of an articulator 126 Retractors 168 Reverse action chisel (Rhode’s chisel) 256 Rib shear 199 Ribbon arch plier 291 Right front position (7 o’clock) 20 Right position (9 o’clock) 20 Right rear position (11 o’clock) 21 Rongeur forceps (Jensen Middleton) 193 Rose torquing plier 291 Rotary cutting instruments 101, 145 Rowe’s disimpaction forceps 206

338

Instruments in Dentistry

Rowe’s zygomatic elevator 205 Rubber bowl 107 Rubber cups 248 Rubber dam 86 Rules for using elevators 180 Ryle’s tube 220

Surgical files 255 Surgical nippers 258 Surgical scissors 257 Surveyor 133 Suture cutting scissor (Heath’s) 216 Syringe 158

S

T

Sandpaper mandrel 117 Scaling, root planning, curettage instruments 239 Scalpel 164 Schluger periodontal file 255 Schumth measuring grid 303 Scissors 110 Screwdriver 211 Screws 213 Seldin’s retractor 170 Self-aspirating syringe 160 Self-compression plates 209 Self-retaining retractors 173 Separating pliers or separator placing plier 264 Shank 27 Shaping files 80 Sickle scaler 239 Simple rubber catheter 218 Skin hook 216 Sonic and ultrasonic instruments 247 Spatula 105 Speedo ligature director 297 Spiral blade saw 302 Spirit lamp 112 Spreader (Smith spreader) 200 Standard light wire plier 284 Sterilisation of instruments 314 Straight elevators: Coupland elevator, London elevator 182 Straight mixing spatula 105 Straight scissor 111 Straight shooter ligature gun 296 Suction apparatus 153 Suction catheter 154 Suction tip (frazier, nuober) 153 Suction tubing 153 Surgical chisels and hoes 254 Surgical curettes and sickles 253 Surgical dental chair 4

T-band matrix 54 T-burnisher 122 Teflon coated plastic and metal instrument 45 Three number formula 28 Three prong pliers 290 Tin foil matrix 59 Tissue forceps 176, 254 Tofflemire matrix retainer: Universal matrix 51 Tongue depressor 174 Tongue retractor with saliva ejector 293 Tongue-away shield 293 Towel clips 155 Transparent plastic crown form matrixes 58 Tube converting plier 304 Turret 280 Tweed loop forming plier 287 Tweezers or dressing pliers 34 Types of dental chair 1 dental surveyor 134 drains 218 tracheostomy tube 222

U Ultrasonic cleaning unit 313 Ultrasonic handpiece 141 Universal plier 289 Use of periodontal probe 231 Uses of an articulator 126 Utility arch plier 290

V V-bending pliers 302 Volkmann’s scoop 192

Index

W

X

Wax carver 108 Wax knife 108 Wax spatula 106 Wedges 60 Weingart universal pliers 288 Wilsham’s forcep 205 Window matrix 58 Winter axolever elevator 185 Winter’s elevator (crossbar elevator) 183 Wire 202 Wire cutter 203 Wire cutting instruments 273 Wooden wedges 60

X-ray rack 327 safelight 326 view laminator 327

Y Young loop bending pliers 288

Z Zone operating areas 15

339