Instrumentation

**** Note : The reference for this lecture in " The Art and Science " book has too many pages ,and more information than what the doctor needs us to know ,so she announced that we don't have to study all the information there .However ; we should read all the details about the instruments that will be mentioned later in this lecture ,and she said that the exam will have questions not only from the lecture but what is mentioned in the book ,too ! Dental Instruments are divided into two types: 1- Hand instruments: instruments that are used by hands. 2- Rotary Instruments: e.g. Hand-piece with burs.

Slide No.2: Hand Instruments are made from Carbon steel or Stainless steel .
Carbon steel is brittle (easy to break) and susceptible to corrosion which is considered to be disadvantages of it. The instruments have to be sterilized after every use which will expose it to air and water, thus it's very important for it to be resistant to corrosion. In the other hand, Stainless steel does not tarnish or corrode, but it won't maintain a sharp cutting edge. Instruments have to be sharp for a long period of time, but after few uses of a stainless steel instrument it won't be sharp anymore which is considered a disadvantage as it should maintain sharpness for a long period of time. To overcome these problems they have made the whole instrument from stainless steel (handle and shank), but the nib which is the cutting /working
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edge is made from Carbon steel that will be painted ( ) with a material that resists corrosion . Some Instruments are one ended instruments and others are double ended. Double ended instruments have two working sides e.g. the Condenser; where usually one side is larger than the other so that we can use it in larger areas than the other. ***MOST OF THE INSTRUMENTS ARE DOUBLE ENDED.

Instruments can be classified into: 1- Cutting Instruments; this is used in cutting

the tooth structure. 2- Non-cutting Instruments; which have other uses such as condensing or manipulation of the material. In this picture above, the instrument in the left is a hand cutting instrument that is called "Hatchet ", and on the right is a non-cutting instrument which is "the condenser".

Slide No.3: Parts of the hands instruments:

Any hand instrument has three parts: 1- Blade or Nib (working end); when the working end of the hand instruments is used for cutting it's called "Blade". But when it is a noncutting instrument it's called "Nib ".

In the picture above, this is a double ended amalgam carver that is used to cut amalgam, so the working end is called a blade. But for example the working end in the condenser doesnt used for cutting so it's called a nib.

The name of the working end depends if it's Hand cutting Blade Or Non-cutting end Nib

The working end (blade or Nib) forms 45 angle with the shank, which is the best degree for easy manipulation of the instrument.

2- Shank; connects the handle to the blade /nib .It used to transform forces that is applied on the instrument to the blade/nib. 3- Handle; is used to hold, stabilize and control the instruments.

In the picture above there are 1 handle, 2 shanks, and 2 blades/nibs.

***Most of the instruments are striated for better stabilization and control, but if they are smooth they will easily slip from our hand.

Slide No.4:
Now, we will start talking about some of the instruments that you will use either in the lab or in your practice after graduation:

Hatchet (Enamel Hatchet):

It's a popular instrument that you may use in private clinics after graduation, but unfortunately it's unavailable neither in the lab nor the university clinic!!

It is double ended; has cutting ends in both sides. Right and left cutting ends to use in both sides of the preparation, one is used in the mesial side and the other is used in the distal side. It's often used in class 2 cavity preparation in buccal and lingual walls. It's used to remove unsupported enamel. You've noticed that in class 1 cavity preparation we only used the rotary instruments (hand piece, burs) , but sometimes specially in class 2 cavity preparation we will use hand cutting instruments because we will be very close to the adjacent tooth, and because you can't control the rotary instruments well, you may hit the adjacent tooth.

The best instrument to use in removing unsupported enamel without hitting the adjacent tooth is the Hatchet; which is a hand cutting instrument.

Slide No.5:

Gingival Marginal Trimmer; is another instrument that is used

to cut unsuported enamel on the gingival margin .

*** Note: this instrument is unavailable in our labs but you may use it in the clinic after graduation. It is double ended. Mesial & distal gingival marginal trimmers. Right and left cutting ends. It usually comes in a set (two instruments together) ;one for the mesial side of the tooth and the other for the distal side ,and each one has double ended one for the buccal surface and the other for the lingual surface in order to trim the unsupported enamel in the gingival margins in class 2 .

Mainly used in Class 2 Cavity Preparation

Slide No.6:

Spoon Excavator :
It's named Spoon because in cross sections it looks like a spoon, Excavator because it's used for excavation (removal) of soft dentine.

Right and left cutting spoons. They are used for removal of carious tooth structure and soft dentin. ***We will use this instrument in the last lab in this semester, when we remove caries from a natural tooth. It's mainly used for removal of soft dentine ,and Dr Ghada personally uses it for amalgam carving in class 2. "She will teach us how to carve the marginal ridges in class 2 with it". It has different shapes, long-shaped, round and oval shapes but all of them in cross sections look like a spoon.

Slide No.7:

Amalgam Condenser:
It is used to compress amalgam in all areas of the preparation. We dont use it in cutting the tooth structure so it is Hand Non-Cutting instrument.

 It may also be used to adapt Resin composite material. It has different shapes, but what make it special is that it has a flat end (Nib) for condensation of the amalgam in the cavity or to adapt composite. (You can't say to condense composite because it can't be condensed) .. We will talk about Composite adaptation later through the semester. Double ended , the small end is used in small parts of the cavity and the larger end is used for larger parts .The small end is used at the beginning to condense the amalgam inside the cavity ,then the large end is used when we reach the top.

Slide No.8:

Carvers:
Are Cutting hand instruments which are used in cutting amalgam, because when we apply amalgam in the tooth we have to re-gain the normal shape of the tooth by carving the amalgam. Why it is important to retain the shape of the tooth ? 1- For the Function. 2- Occlusion ;if the amalgam is highly set it will cause problems in the occlusion ( high occlusion) .In the other hand if the restoration was less than what we want, it will cause something that is called post eruption ,because if the tooth doesnt face the opposing tooth to stop it, it will continue to erupt.

 Most popular carver for carving the occlusion surfaces has a double ended oval shaped and round shaped so that the round head is used to carve the occlusal surface and the oval head for the marginal ridges. What we have is used to carve the occlusal surface not the marginal ridges, for this reason we will use a spoon excavator for the marginal ridges.

Slide No.9:

Burnishers:
Hand Non-Cutting instruments. It is used : 1. To burnish (smooth) amalgam restorations. 2. To shape the metal matrix band when doing class 2. 3. To condense amalgam at the margins. 4. To adapt composite in posterior resin composite restorations. It has different shapes, oval head, or it looks like American football or rounded head. It is double ended; usually one end is smaller than the other.

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Slide No.10:

Amalgam Carrier (Amalgam Gun):

*** The one in the picture differs a little bit from what we have as this one is double ended but ours are one ended. It's usually double ended so that you can carry amalgam in both ends in order to be faster. Usually one end is larger than the other so you can put small amount in one area and larger amount in other areas. It is used to carry amalgam from the dappen dish outside to inside the cavity.

Slide No.11:

Plastic Instruments:
They are NOT made of plastic, they are stainless steel instruments. They are called "plastic" because they are used in esthetic materials (Composite and Glass Inomer Cement) which are plastic materials. Are used to adapt composite in class 3,4 ,5 composite restoration .

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Slide No.12:

Cement Spatulas:
Used in mixing the materials (luting cements and liners).

Slide No.13:

Other Instruments:
*** They are usually called the Exam Kit, which is used for patient examination. This kit has three main instruments: Mouth Mirror, the head of the mirror usually is separated from the handle, as sometimes the mirror get scratched so we just replace it and keep the handle .

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 The Dental probe: Is double ended as some areas are difficult to be reached by one end but easier with the other. It is used to detect the cavity preparation; sharpness of the cavity walls and the depth of the cavity It is used to detect caries (mainly), but there are some controversially about this use!! Why Is That? The caries starts by demineralization and white spot lesion formation; where the surface area is mineralized but the subsurface area is demineralized, so there is a chance for a reverse action. Thus sometimes if you use the probe in detecting the early lesion you may break the surface area and cause a cavity; and by that you remove the chance for incipient caries or white spot lesion to be remineralized . However; as a dentist the first thing you do to detect caries is handling the mirror in the left hand and the probe in the right hand.

Forceps or tweezers :
Is used to handle things to or out from the oral cavity such as cotton roles and so on.

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 Periodontal probe (perio probe):

-- Is graded and can be used to look for pockets or to know the depth of the cavity. -- It is not a main instrument; it's just a measurement instrument that helps you to know how much 0.5mm is.

Slide No.14:

Rotary Instrument:
Air driven hand pieces, they are not connected directly to electricity; i.e .the electricity is connected to a compressor which will produce air that will drive the hand piece. Rotary Instruments are divided into: Low speed hand piece. High speed hand piece. Low speed hand piece has a speed equals to 10,000-15,000 rpm. It's used for removal of caries and bad dentine (not for enamel removal, but we use it in the lab to remove enamel because we are working on plastic teeth). Enamel is the hardest tissue in the human body that can NOT be removed with a low speed instrument. Plus low speed hand-piece can be used for smoothening the tooth and finishing restoration.

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 It has different attachments: latch (you have to move the latch to the side then put the bur, and finally return the letch to its first position), or friction grip (you put the bur and click it inside,so that it will fix there by friction ) High speed hand-piece is friction grip

On real teeth we have to use high speed hand-piece, so please try to get highquality plastic teeth to use high speed on them.

Slide No.15:

*** The instrument in the picture is an old one. High speed hand-piece has a speed equals to 100,000 rpm .(The difference is big between high and low speed ) It is used for cavity preparation (cutting Enamel). The hand-piece that we use is friction grip hand piece.

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Slide No.16:

Burs (The cutting part):

Burs are milling devices and function by chip removal of tooth structure (Its action is chipping the tooth structure to prepare the cavities). The Burs are about 4 mm in length. It is made by Tungsten carbide (that what we use) or it can be made from another material which is Diamond material (we will use it for cavity preparation in crowns and bridges). Their heads are composed of a number of metal cutting blades and must rotate counterclockwise. In Low speed Hand-piece we can control the rotation either clockwise or counterclockwise .But It must be counterclockwise to be cutting, because in clockwise direction it will not cut. In High speed Hand-piece we dont have the choice to change the direction, it's always counterclockwise.

The End Done By: Enas Salameh

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