Hand Activation and Ultrasonic Instrumentation

Introduction

• Hand Activated Instruments: Refers to manual instrumentation, using tools learned in pre-clinic.
• Ultrasonic Instrumentation: Refers to tools like Cavitron or piezo used for debridement.
• Purpose: Main reason for debridement is improving periodontal health and preventing gingivitis or periodontal disease.

Choosing the Type of Instrumentation

• Use a mix of hand and ultrasonic methods for heavy calculus.
• Always supplement ultrasonic with manual hand instrumentation.

Basic Instrument Design

• Handle: The part held by the practitioner.
• Shank: The area between the handle and working end.
• Working End: Comes in contact with the tooth.
• Types of Shank:
  • Functional Shank: From first bend to working end.
  • Terminal Shank (Lower Shank): From last bend to working end.
• Handle Materials: Can be solid or hollow; textured or smooth. Hollow and textured handles are preferable for comfort and reduced cramping.

Types of Instruments for Specific Uses

• Angled Shank: Better for accessing deep pockets on posterior teeth.
• Long Shank: Useful for deep periodontal pockets.
• Instrument Classifications:
  • Assessment Instruments: Includes mirror, probe, and explorer.
  • Treatment Instruments: Includes instruments for calculus removal, scaling, debriding, and root planing.

Mirrors

• Types:
  • Front surface: Clear reflection, but scratches easily.
  • Concave surface: Magnified image.
  • Flat surface: Least scratching.
• Functions: Retraction, indirect vision, illumination, transillumination.

Explorers and Probes

• Explorers: Detect calculus, caries, and restoration margins.
• Probes: Specific probes like the neighbor's probe for furcation involvement.
• Types of Probes:
  • Marquis Probe: Marked every 3mm.
  • Williams Probe: Difficult to read.
  • UNC Probes: Detailed measurements up to 12 or 15mm.
  • Nova Tech Probe: Angular, for distal surfaces.

Treatment Instruments

• Curettes: Universal and area-specific (Gracey curettes).
  • Universal: 90-degree shank, double cutting edges.
  • Gracey: 70-degree shank, single cutting edge.
• Choosing Instruments: Tailored based on calculus type (light, moderate, heavy).

Instrument Care and Sharpening

• Sharpening: Use stones like Arkansas, India, or ceramic.
• Instrument Breakage: Procedures for retrieving broken tips.

Fulcrum and Instrument Insertion

• Fulcrum: Important for stability, can be intraoral or extraoral.
• Angulation: Varies for insertion and calculus removal.
  • Insertion: Close to 0 degrees.
  • Removal: Ideally 60-80 degrees.

Ultrasonic Instrumentation

• Mechanisms of Action: Mechanical movement, irrigation, cavitation, acoustic micro streaming.
• Differences:
  • Cavitron (Magnetostrictive): All surfaces active.
  • Piezo: Only lateral sides active.
• Types of Inserts:
  • Standard: For moderate to heavy calculus.
  • Slim: For light calculus.

Usage Best Practices

• Water Spray: Fine mist with droplets for maximum efficiency.
• Insertion Angle: 0 degrees for ultrasonic instruments; 60-80 degrees for manual.
• Work by Section: More efficient than working by quadrant.