46:ScalingandRootPlaning

MaterialinthischapterwasderivedfromPattisonA,PattisonG,MatsudaS:Periodontal
Instrumentation,ed3,PearsonEducation,(inpress).Periodontalinstrumentsaredesignedfor
specificpurposessuchasremovingcalculus,planingrootsurfaces,curettingthegingiva,and
removingdiseasedtissue.Onfirstinvestigation,thevarietyofinstrumentsavailableforsimilar
purposesappearsconfusing.Withexperience,however,cliniciansselectarelativelysmallsetthat
fulfillsallrequirements.ClassificationofPeriodontalInstrumentsPeriodontalinstrumentsareclassified
accordingtothepurposestheyserve,asfollows:
1.Periodontalprobesareusedtolocate,measure,andmarkpockets,aswellasdeterminetheir
courseonindividualtoothsurfaces.
2.Explorersareusedtolocatecalculusdepositsandcaries.
3.Scaling,rootplaning,andcurettageinstrumentsareusedforremovalofbiofilmandcalcified
depositsfromthecrownandrootofatooth,removalofalteredcementumfromthesubgingivalroot
surface,anddebridementofthesofttissueliningthepocket.Scalingandcurettageinstrumentsare
classifiedasfollows:
Sicklescalersareheavyinstrumentsusedtoremovesupragingivalcalculus.
Curettesarefineinstrumentsusedforsubgingivalscaling,rootplaning,andremovalofthesoft
tissueliningthepocket.
Hoe,chisel,andfilescalersareusedtoremovetenacioussubgingivalcalculusandaltered
cementum.Theiruseislimitedcomparedwiththatofcurettes.
Ultrasonicandsonicinstrumentsareusedforscalingandcleansingtoothsurfacesandcurettingthe
softtissuewalloftheperiodontalpocket.41,42,61
4.Periodontalendoscopesareusedtovisualizedeeplyintosubgingivalpocketsandfurcations,
allowingthedetectionofdeposits.
5.Cleansingandpolishinginstruments,suchasrubbercups,brushes,anddentaltape,areusedto
cleanandpolishtoothsurfaces.Alsoavailableareairpowderabrasivesystemsfortoothpolishing.
Thewearingandcuttingqualitiesofsometypesofsteelusedinperiodontalinstrumentshavebeen
tested,83,84,146butspecificationsvaryamongmanufacturers.146Stainlesssteelisusedmostoften
ininstrumentmanufacture.Highcarboncontentsteelinstrumentsarealsoavailableandare
consideredbysomeclinicianstobesuperior.
Eachgroupofinstrumentshascharacteristicfeaturesindividualtherapistsoftendevelopvariations
withwhichtheyoperatemosteffectively.Smallinstrumentsarerecommendedtofitintoperiodontal
pocketswithoutinjuringthesofttissues.109,111,112,163

Thepartsofeachinstrumentarereferredtoastheworkingend,shank,andhandle(Figure461).

Figure461Partsofatypicalperiodontalinstrument.

PeriodontalProbes
Periodontalprobesareusedtomeasurethedepthofpocketsandtodeterminetheirconfiguration.
Thetypicalprobeisatapered,rodlikeinstrumentcalibratedinmillimeters,withablunt,roundedtip
(Figure462).Thereareseveralotherdesignswithvariousmillimetercalibrations(Figure463).The
WorldHealthOrganization(WHO)probehasmillimetermarkingsandasmall,roundballatthetip
(Figure463,E).Ideally,theseprobesarethin,andtheshankisangledtoalloweasyinsertioninto
thepocket.Furcationareascanbestbeevaluatedwiththecurved,bluntNabersprobe(Figure464).

Figure462Periodontalprobeiscomposedofthehandle,shank,andcalibratedworkingend.

Figure463Typesofperiodontalprobes.A,Marquiscolorcodedprobe.Calibrationsarein3mmsections.B,
UniversityofNorthCarolina15probe,a15mmlongprobewithmillimetermarkingsateachmillimeterandcolor
codingatthefifth,tenth,andfifteenthmillimeters.C,UniversityofMichiganOprobe,withWilliamsmarkings(at1,2,
3,5,7,8,9,and10mm).D,MichiganOprobewithmarkingsat3,6,and8mm.E,WorldHealthOrganization(WHO)
probe,whichhasa0.5mmballatthetipandmillimetermarkingsat3.5,8.5,and11.5mmandcolorcodingfrom3.5to
5.5mm.

Figure464Curved#2Nabersprobefordetectionoffurcationareas,withcolorcodedmarkingsat3,6,9,and12mm.

Whenmeasuringapocket,theprobeisinsertedwithafirm,gentlepressuretothebottomofthe
pocket.Theshankshouldbealignedwiththelongaxisofthetoothsurfacetobeprobed.Several
measurementsaremadetodeterminethelevelofattachmentalongthesurfaceofthe
tooth.Explorers
Explorersareusedtolocatesubgingivaldepositsandcariousareasandtocheckthesmoothnessof
therootsurfacesafterrootplaning.Explorersaredesignedwithdifferentshapesandangles,with
varioususes(Figure465),aswellaslimitations(Figure466).Theperiodontalprobecanalsobe
usefulinthedetectionofsubgingivaldeposits(Figure466,D).

Figure465Fivetypicalexplorers.A,#17B,#23C,EXD1112D,#3E,#3CHPigtail.

Figure466Insertionoftwotypesofexplorersandaperiodontalprobeinapocketforcalculusdetection.A,The
limitationsofthepigtailexplorerinadeeppocket.B,Insertionofthe#3explorer.C,Limitationsofthe#3explorer.D,
Insertionoftheperiodontalprobe.

ScalingandCurettageInstruments
ScalingandcurettageinstrumentsareillustratedinFigure467.

Figure467Thefivebasicscalinginstruments.A,CuretteB,sickleC,fileD,chiselE,hoe.

SickleScalers.
Sicklescalershaveaflatsurfaceandtwocuttingedgesthatconvergeinasharplypointedtip.The
shapeoftheinstrumentmakesthetipstrongsothatitwillnotbreakoffduringuse(Figure468).The
sicklescalerisusedprimarilytoremovesupragingivalcalculus(Figure469).Becauseofthedesign
ofthisinstrument,itisdifficulttoinsertalargesicklebladeunderthegingivawithoutdamagingthe
surroundinggingivaltissues(Figure4610).Small,curvedsicklescalerbladessuchasthe204SD
canbeinsertedunderledgesofcalculusseveralmillimetersbelowthegingiva.Sicklescalersare
usedwithapullstroke.

Figure468Basiccharacteristicsofasicklescaler:triangularshape,doublecuttingedge,andpointedtip.

Figure469Useofasicklescalerforremovalofsupragingivalcalculus.

Figure4610Subgingivaladaptationaroundtherootisbetterwiththecurettethanwiththesicklef,faciall,lingual.

Itisimportanttonotethatsicklescalerswiththesamebasicdesigncanbeobtainedwithdifferent
bladesizesandshanktypestoadapttospecificuses.TheU15/30(Figure4611),Ball,andIndiana
Universitysicklescalersarelarge.TheJaquettesicklescalers#1,2,and3havemediumsizeblades.
Thecurved204posteriorsicklescalersareavailablewithlarge,medium,orsmallblades(Figure46
12).TheMontanaJacksicklescalerandtheNevi2,Nevi3,andNevi4curvedposteriorsickle
scalersareallthinenoughtobeinsertedseveralmillimeterssubgingivallyforremovaloflightto
moderateledgesofcalculus.Theselectionoftheseinstrumentsshouldbebasedontheareatobe
scaled.Sicklescalerswithstraightshanksaredesignedforuseonanteriorteethandpremolars.
Sicklescalerswithcontraangledshanksadapttoposteriorteeth.

Figure4611BothendsofaU15/30scaler.

Figure4612Threedifferentsizesof204sicklescalers.

Curettes.
Thecuretteistheinstrumentofchoiceforremovingdeepsubgingivalcalculus,rootplaningaltered
cementum,andremovingthesofttissueliningtheperiodontalpocket(Figure4613).Eachworking
endhasacuttingedgeonbothsidesofthebladeandaroundedtoe.Thecuretteisfinerthanthe
sicklescalersanddoesnothaveanysharppointsorcornersotherthanthecuttingedgesofthe
blade(Figure4614).Thereforecurettescanbeadaptedandprovidegoodaccesstodeeppockets,
withminimalsofttissuetrauma(seeFigure4610).Incrosssection,thebladeappearssemicircular
withaconvexbase.Thelateralborderoftheconvexbaseformsacuttingedgewiththefaceofthe
semicircularblade.Therearecuttingedgesonbothsidesoftheblade.Bothsingleanddoubleend
curettesmaybeobtained,dependingonthepreferenceoftheoperator.

Figure4613Thecuretteistheinstrumentofchoiceforsubgingivalscalingandrootplaning.

Figure4614Basiccharacteristicsofacurette:spoonshapedbladeandroundedtip.

AsshowninFigure4610,thecurvedbladeandroundedtoeofthecuretteallowthebladetoadapt
bettertotherootsurface,unlikethestraightdesignandpointedendofasicklescaler,whichcan
causetissuelacerationandtrauma.Therearetwobasictypesofcurettes:universalandarea
specific.
UniversalCurettes.
Universalcuretteshavecuttingedgesthatmaybeinsertedinmostareasofthedentitionbyaltering
andadaptingthefingerrest,fulcrum,andhandpositionoftheoperator.Thebladesizeandtheangle
andlengthoftheshankmayvary,butthefaceofthebladeofeveryuniversalcuretteisata90
degreeangle(perpendicular)tothelowershankwhenseenincrosssectionfromthetip(Figure46
15,A).Thebladeoftheuniversalcuretteiscurvedinonedirectionfromtheheadofthebladetothe
toe.TheBarnhartcurettes#12and56andtheColumbiacurettes#1314,2R2L,and4R4L
(Figures4616and4617,A)areexamplesofuniversalcurettes.Otherpopularuniversalcurettes
aretheYoungerGood#78,McCalls#1718,andtheIndianaUniversity#1718(Figure4617,B).

Figure4615Principaltypesofcurettesasseenfromthetoeoftheinstrument.A,Universalcurette.B,Graceycurette.
NotetheoffsetbladeangulationoftheGraceycurette.

Figure4616A,Doubleendedcurettefortheremovalofsubgingivalcalculus.B,Crosssectionofthecuretteblade
(arrow)againstthecementalwallofadeepperiodontalpocket.C,Curetteinpositionatthebaseofaperiodontal
pocketonthefacialsurfaceofamandibularmolar.D,Curetteinsertedinapocketwiththetipdirectedapically.E,
Curetteinpositionatthebaseofapocketonthedistalsurfaceofthemandibularmolar.

Figure4617A,Columbia#4R4Luniversalcurette.B,YoungerGood#78,McCalls#1718,andIndianaUniversity
#1718universalcurettes.

AreaSpecificCurettesGraceyCurettes.
Graceycurettesarerepresentativeoftheareaspecificcurettes,asetofseveralinstruments
designedandangledtoadapttospecificanatomicareasofthedentition(Figure4618).These
curettesandtheirmodificationsareprobablythebestinstrumentsforsubgingivalscalingandroot
planingbecausetheyprovidethebestadaptationtocomplexrootanatomy.

Figure4618ReducedsetofGraceycurettes.Lefttoright,#56,#78,#1112,and#1314.

DoubleendedGraceycurettesarepairedinthefollowingmanner:Gracey#12and34:Anterior
teethGracey#56:AnteriorteethandpremolarsGracey#78and910:Posteriorteeth:facialand
lingual
Gracey#1112:Posteriorteeth:mesial(Figure4619)

Figure4619Gracey#1112curette.Notethedoubleturnoftheshank.

Gracey#1314:Posteriorteeth:distal(Figure4620)

Figure4620Gracey#1314curette.Notetheacuteturnoftheblade.

SingleendedGraceycurettescanalsobeobtainedasetofthesecurettescomprises14
instruments.Althoughthesecurettesaredesignedtobeusedinspecificareas,anexperienced
operatorcanadapteachinstrumentforuseinseveraldifferentareasbyalteringthepositionofhisor
herhandandthepositionofthepatient.
TheGraceycurettesalsodifferfromtheuniversalcurettesinthatthebladeisnotata90degree
angletothelowershank.ThetermoffsetbladeisusedtodescribeGraceycurettesbecausetheyare
angledapproximately60to70degreesfromthelowershank(seeFigure4615,B).Thisunique
angulationallowsthebladetobeinsertedintheprecisepositionnecessaryforsubgingivalscaling
androotplaning,providedthatthelowershankisparallelwiththelongaxisofthetoothsurfacebeing
scaled.
Areaspecificcurettesalsohaveacurvedblade.Whereasthebladeoftheuniversalcuretteiscurved
inonedirection(Figure4621,A),theGraceybladeiscurvedfromheadtotoeandalsoalongthe
sideofthecuttingedge(Figure4621,B).Thusonlyapullstrokecanbeused.Table461listssome
ofthemajordifferencesbetweenGracey(areaspecific)curettesanduniversalcurettes.
TABLE461
ComparisonofAreaSpecific(Gracey)andUniversalCurettes

GraceyCurette

UniversalCurette

Areaof

Setofmanycurettesdesignedforspecific

Onecurettedesignedforallareasand

use

areasandsurfaces.

surfaces.

CuttingEdge

Onecuttingedgeusedworkwithouter

Bothcuttingedgesusedworkwitheither

edgeonly.

outerorinneredge.

Curvedintwoplanesbladecurvesup

Curvedinoneplanebladecurvesup,not

andtotheside.

totheside.

Blade

Offsetbladefaceofbladebeveledat60

Bladenotoffsetfaceofbladebeveledat

angle

degreestoshank.

90degreestoshank.

Use

Curvature

ModifiedfromPattisonG,PattisonA:Periodontalinstrumentation,ed2,Norwalk,CT,1992,Appleton
&Lange.

Figure4621A,Universalcuretteasseenfromtheblade.Notethatthebladeisstraight.B,Graceycuretteasseen
fromtheblade.Thebladeiscurvedonlytheconvexcuttingedgeisused.

Graceycurettesareavailablewitheitherarigidorafinishingtypeofshank.TherigidGraceyhas
alarger,stronger,andlessflexibleshankandbladethanthestandardfinishingGracey.Therigid
shankallowstheremovalofmoderatetoheavycalculuswithoutusingaseparatesetofheavy
scalers,suchassicklesandhoes.Althoughsomecliniciansprefertheenhancedtactilesensitivity
thattheflexibleshankofthefinishingGraceyprovides,bothtypesofGraceycurettesaresuitablefor
rootplaning.
RecentadditionstotheGraceycurettesethavebeentheGracey#1516and1718.TheGracey
#1516isamodificationofthestandard#1112andisdesignedforthemesialsurfacesofposterior
teeth(Figure4622).ItconsistsofaGracey#1112bladecombinedwiththemoreacutelyangled
#1314shank.Whentheclinicianisusinganintraoralfingerrest,itisoftendifficulttopositionthe
lowershankoftheGracey#1112sothatitisparallelwiththemesialsurfacesoftheposteriorteeth,
especiallyonthemandibularmolars.ThenewshankangulationoftheGracey#1516allowsbetter
adaptationtoposteriormesialsurfacesfromafrontpositionwithintraoralrests.Ifalternative
fulcrums,suchasextraoraloroppositearchrests,areused,theGracey#1112workswellandthe

new#1516isnotessential.TheGracey#1718isamodificationofthe#1314.Ithasaterminal
shankelongatedby3mmandamoreaccentuatedangulationoftheshanktoprovidecomplete
occlusalclearanceandbetteraccesstoallposteriordistalsurfaces.Thehorizontalhandleposition
minimizesinterferencefromopposingarchesandallowsamorerelaxedhandpositionwhenscaling
distalsurfaces.Inaddition,thebladeis1mmshortertoallowbetteradaptationofthebladetodistal
toothsurfaces.

Figure4622Gracey#1516.NewGraceycurette,designedformesioposteriorsurfaces,combinesaGracey#1112
bladewithaGracey#1314shank.(A.Pattison)

ExtendedShankCurettes.
Extendedshankcurettes,suchastheAfterFivecurettes(HuFriedy,Chicago),aremodificationsof
thestandardGraceycurettedesign.Theterminalshankis3mmlonger,allowingextensioninto
deeperperiodontalpocketsof5mmormore(Figures4623and4624).OtherfeaturesoftheAfter
Fivecuretteincludeathinnedbladeforsmoothersubgingivalinsertionandreducedtissuedistention
andalargediameter,taperedshank.AllstandardGraceynumbersexceptforthe#910(i.e.,#12,
#34,#56,#78,#1112,or#1314)areavailableintheAfterFiveseries.TheAfterFivecurettesare
availableinfinishingorrigiddesigns.Forheavyortenaciouscalculusremoval,rigidAfterFive
curettesshouldbeused.Forlightscalingordeplaquinginaperiodontalmaintenancepatient,the
thinner,finishingAfterFivecuretteswillinsertsubgingivallymoreeasily.

Figure4623AfterFivecurette.Notetheextra3mmintheterminalshankoftheAfterFivecurettecomparedwiththe
standardGraceycurette.A,#56B,#78C,#1112D,#1314.(A.Pattison)

Figure4624ComparisonofAfterFivecurettewithstandardGraceycurette.RigidGracey#1314adaptedtothedistal
surfaceofthefirstmolarandrigidAfterFive#1314adaptedtothedistalsurfaceofthesecondmolar.Noticetheextra
longshankoftheAfterFivecurette,whichallowsdeeperinsertionandbetteraccess.(A.Pattison)

MiniBladedCurettes.
Minibladedcurettes,suchastheHuFriedyMiniFivecurettes,aremodificationsoftheAfterFive
curettes.TheMiniFivecurettesfeaturebladesthatarehalfthelengthoftheAfterFiveorstandard
Graceycurettes(Figure4625).Theshorterbladeallowseasierinsertionandadaptationindeep,
narrowpocketsfurcationsdevelopmentalgrooveslineanglesanddeep,tight,facial,lingual,or
palatalpockets.Inanyareainwhichrootmorphologyortighttissuepreventsfullinsertionofthe
standardGraceyorAfterFiveblade,theMiniFivecurettescanbeusedwithverticalstrokes,with
reducedtissuedistention,andwithouttissuetrauma(Figure4626).

Figure4625ComparisonofAfterFivecuretteandMiniFivecurette.TheshorterMiniFiveblade(halfthelength)
allowsincreasedaccessandreducedtissuetrauma.

Figure4626ComparisonofstandardrigidGracey#56withrigidMiniFive#56onthepalatalsurfacesofthe
maxillarycentralincisors.MiniFivecurettecanbeinsertedtothebaseofthesetightanteriorpocketsandusedwitha
straightverticalstroke.StandardGraceyorAfterFivecuretteusuallycannotbeinsertedverticallyinthisareabecause
thebladeistoolong.(A.Pattison)

InthepasttheonlysolutioninmostoftheseareasofdifficultaccesswastousetheGraceycurettes
withatoedownhorizontalstroke.TheMiniFivecurettes,alongwithothershortbladedinstruments
relativelyrecentlyintroduced,openanewchapterinthehistoryofrootinstrumentationbyallowing
accesstoareasthatpreviouslywereextremelydifficultorimpossibletoreachwithstandard
instruments.TheMiniFivecurettesareavailableinbothfinishingandrigiddesigns.RigidMiniFive
curettesarerecommendedforcalculusremoval.Themoreflexible,shanked,finishingMiniFive

curettesareappropriateforlightscalinganddeplaquinginperiodontalmaintenancepatientswith
tightpockets.AswiththeAfterFiveseries,theMiniFivecurettesareavailableinallstandardGracey
numbers,exceptthe#910.
TherecentlyintroducedMicroMiniFiveGraceycurettes(HuFriedy,Chicago)havebladesthatare
20%thinnerandsmallerthantheMiniFivecurettes(Figures4627and4628)Thesearethe
smallestofallcurettes,andtheyprovideexceptionalaccessandadaptationtotight,deep,ornarrow
pocketsnarrowfurcationsdevelopmentaldepressionslineanglesanddeeppocketsonfacial,
lingual,orpalatalsurfaces.Inareasinwhichrootmorphologyortight,thintissuepreventseasy
insertionofotherminibladedcurettes,theMicroMiniFivecurettescanbeusedwithverticalstrokes
withoutcausingtissuedistensionortissuetrauma.

Figure4627MicroMiniFiveGraceycurettes.Lefttoright,#12,#78,#1112,#1314.

Figure4628ComparisonofGraceycuretteblades.Lefttoright,MicroMiniFive#78,MiniFive#78,Standard#78.

TheGraceyCurvettesareanothersetoffourminibladedcurettestheSub0andthe#12areused
foranteriorteethandpremolars,the#1112isusedforposteriormesialsurfaces,andthe#1314for
posteriordistalsurfaces.Thebladelengthoftheseinstrumentsis50%shorterthanthatofthe
conventionalGraceycurette,andthebladehasbeencurvedslightlyupward(Figure4629).This
curvatureallowstheGraceyCurvettestoadaptmorecloselytothetoothsurfacethananyother
curettes,especiallyontheanteriorteethandonlineangles(Figure4630).However,thiscurvature
alsocarriestheriskofgougingorgroovingintotherootsurfacesontheproximalsurfacesofthe
posteriorteethwhentheGraceyCurvette#1112or1314isused.Additionalfeaturesthatrepresent
improvementsonthestandardGraceycurettesareaprecisionbalancedbladetipindirectalignment
withthehandle,abladetipperpendiculartothehandle,andashankclosertoparallelwiththe
handle.

Figure4629GraceyCurvetteblade.Thisdiagramshowsthe50%shorterbladeoftheGraceyCurvettesuperimposed
onthestandardGraceycuretteblade(dottedlines).NoticetheupwardcurvatureoftheCurvettebladeandbladetip.
(RedrawnfromPattisonG,PattisonA:Periodontalinstrumentation,ed2,Norwalk,Conn,1992,Appleton&Lange.)

Figure4630GraceyCurvetteSub0onthepalatalsurfaceofamaxillarycentralincisor.Thelongshankandshort,
curved,andbluntedtipmakethisasuperiorinstrumentfordeepanteriorpockets.Thiscuretteprovidesexcellentblade
adaptationtothenarrowrootcurvaturesofthemaxillaryandmandibularanteriorteeth.(A.Pattison)

Formanyyears,theMorsescaler,aminiaturesickle,wastheonlyminibladedinstrumentavailable.
However,theminibladedcuretteshavelargelyreplacedthisinstrument(Figure4631).

Figure4631Comparisonofthreedifferentminibladedinstrumentsdesignedforuseonthemaxillaryandmandibular
anteriorteeth.A,HuFriedyMiniFive#56B,HuFriedyCurvetteSub0C,HartzellSub0.(A.Pattison)

LangerandMiniLangerCurettes.
TheLangerandMiniLangercurettesareasetofthreecurettescombiningtheshankdesignofthe
standardGracey#56,1112,and1314curetteswithauniversalbladehonedat90degreesrather
thantheoffsetbladeoftheGraceycurette.ThismarriageoftheGraceyanduniversalcurette

designsallowstheadvantagesoftheareaspecificshanktobecombinedwiththeversatilityofthe
universalcuretteblade.TheLanger#56curetteadaptstothemesialanddistalsurfacesofanterior
teeththeLanger#12curette(Gracey#1112shank)adaptstothemesialanddistalsurfacesof
mandibularposteriorteethandtheLanger#34curette(Gracey#1314shank)adaptstothemesial
anddistalsurfacesofmaxillaryposteriorteeth(Figure4632).Theseinstrumentscanbeadaptedto
bothmesialanddistaltoothsurfaceswithoutchanginginstruments.ThestandardLangercurette
shanksareheavierthanafinishingGraceybutlessrigidthantherigidGracey.Langercurettesare
alsoavailablewitheitherrigidorfinishingshanksandcanbeobtainedintheextendedshank(After
Five)andminibladed(MiniFive)versions.

Figure4632LangercurettescombineGraceytypeshankswithuniversalcuretteblades.Lefttoright,#56,#12,and
#34.(A.Pattison)

SchwartzPeriotrievers.
TheSchwartzPeriotrieversareasetoftwodoubleended,highlymagnetizedinstrumentsdesigned
fortheretrievalofbrokeninstrumenttipsfromtheperiodontalpocket(Figures4633and4634).
Theyareindispensablewhentheclinicianhasbrokenacurettetipinafurcationordeeppocket.138

Figure4633SchwartzPeriotrievertipdesigns.Thelongbladeisforgeneraluseinpockets,andthecontraangledtip
isforuseinfurcations.(FromPattisonG,PattisonA:Periodontalinstrumentation,ed2,Norwalk,CT,1992,Appleton&
Lange.)

Figure4634BrokeninstrumenttipattachedtothemagnetictipoftheSchwartzPeriotriever.(FromPattisonG,Pattison
A:Periodontalinstrumentation,ed2,Norwalk,CT,1992,Appleton&Lange.)

PlasticandTitaniumInstrumentsforImplants.
Severaldifferentcompaniesaremanufacturingplasticandtitaniuminstrumentsforuseontitanium
andotherimplantabutmentmaterials.Itisimportantthatplasticortitaniuminstrumentsbeusedto
avoidscarringandpermanentdamagetotheimplants*(Figures4635,4636,and4637).

Figure4635Plasticprobe:Colorvue(HuFriedy,Chicago).

Figure4636NewImplacareIIimplantinstruments(HuFriedy,Chicago)Theseimplantinstrumentshaveautoclavable
stainlesssteelhandlesandfivedifferentconesocketplastictipdesigns.Shownhere:A.NewBarnhart56curettetips
B.NewLanger12curettetips

Figure4637TitaniumImplantCurettes(ParadiseDentalTechnologies,Missoula,MT).Lefttoright,Barnhart#56,
Langer#12,andNEB128BL5Mini.

HoeScalers.
Hoescalersareusedforscalingofledgesorringsofcalculus(Figure4638).Thebladeisbentata
99degreeanglethecuttingedgeisformedbythejunctionoftheflattenedterminalsurfacewiththe
inneraspectoftheblade.Thecuttingedgeisbeveledat45degrees.Thebladeisslightlybowedso
thatitcanmaintaincontactattwopointsonaconvexsurface.Thebackofthebladeisrounded,and
thebladehasbeenreducedtominimalthicknesstopermitaccesstotherootswithoutinterference
fromtheadjacenttissues.

Figure4638A,Hoescalersdesignedfordifferenttoothsurfaces,showingtwopointcontact.B,Hoescalerina
periodontalpocket.Thebackofthebladeisroundedforeasieraccess.Theinstrumentcontactsthetoothattwopoints
forstability.

Hoescalersareusedinthefollowingmanner:
1.Thebladeisinsertedtothebaseoftheperiodontalpocketsothatitmakestwopointcontactwith
thetooth(seeFigure4638).Thisstabilizestheinstrumentandpreventsnickingoftheroot.
2.Theinstrumentisactivatedwithafirmpullstroketowardthecrown,witheveryeffortbeingmade
topreservethetwopointcontactwiththetooth.
McCalls#3,4,5,6,7,and8areasetofsixhoescalersdesignedtoprovideaccesstoalltooth
surfaces.Eachinstrumenthasadifferentanglebetweentheshankandhandle.Files.
Fileshaveaseriesofbladesonabase(Figure4639).Theirprimaryfunctionistofractureorcrush
largedepositsoftenaciouscalculusorburnishedsheetsofcalculus.Filescaneasilygougeand
roughenrootsurfaceswhenusedimproperly.Thereforetheyarenotsuitableforfinescalingandroot
planing.Minibladedcurettesarecurrentlypreferredforfinescalinginareaswherefileswereonce
used.Filesaresometimesusedforremovingoverhangingmarginsofdentalrestorations.

Figure4639Chiselscaler(A)andfilescaler(B).

ChiselScalers.
Thechiselscaler,designedfortheproximalsurfacesofteethtoocloselyspacedtopermittheuseof
otherscalers,isusuallyusedintheanteriorpartofthemouth.Itisadoubleendedinstrumentwitha
curvedshankatoneendandastraightshankattheother(seeFigure4639)thebladesareslightly
curvedandhaveastraightcuttingedgebeveledat45degrees.

Thechiselisinsertedfromthefacialsurface.Theslightcurveoftheblademakesitpossibleto
stabilizeitagainsttheproximalsurface,whereasthecuttingedgeengagesthecalculuswithout
nickingthetooth.Theinstrumentisactivatedwithapushmotionwhilethesideofthebladeisheld
firmlyagainsttheroot.QutinFurcationCurettes.
TheQutinfurcationcurettesareactuallyhoeswithashallow,halfmoonradiusthatfitsintotheroof
orfloorofthefurcation.Thecurvatureofthetipalsofitsintodevelopmentaldepressionsontheinner
aspectsoftheroots.Theshanksareslightlycurvedforbetteraccess,andthetipsareavailablein
twowidths(Figure4640).TheBL1(buccallingual)andMD1(mesialdistal)instrumentsaresmall
andfine,witha0.9mmbladewidth.TheBL2andMD2instrumentsarelargerandwider,witha1.3
mmbladewidth.

Figure4640Qutinfurcationcurettes:BL2(larger)andBL1(smaller).(A.Pattison)

Theseinstrumentsremoveburnishedcalculusfromrecessedareasofthefurcationwherecurettes,
eventheminibladedcurettes,areoftentoolargetogainaccess.UsingminibladedGraceycurettes
andGraceyCurvettesintherooforfloorofthefurcationmayunintentionallycreategougesand
grooves.TheQutininstruments,however,arewellsuitedforthisareaandlessenthelikelihoodof
rootdamage.DiamondCoatedFiles.
Diamondcoatedfilesareuniqueinstrumentsusedforfinalfinishingofrootsurfaces.Thesefilesdo
nothavecuttingedgesinstead,theyarecoatedwithveryfinegritdiamond(Figure4641).Themost
usefuldiamondfilesarethebuccallingualinstruments,whichareusedinfurcationsandalsoadapt
welltomanyotherrootsurfaces.

Figure4641Diamondfiles.A,#1,2(Brasseler,Savannah,GA)B,#3,4(Brasseler).C,SDCN7,SDCM/D7.(A.
Pattison)

Newdiamondfilesaresharplyabrasiveandshouldbeusedwithlight,evenpressureagainsttheroot
surfacetoavoidgougingorgrooving.Whenviewingtherootsurfacewiththedentalendoscopeafter
alltactilelydetectabledepositsaregone,smallembeddedremnantsofcalculusintherootsurface
canbeobserved.Diamondfilesareusedsimilartoanemeryboardtoremovetheseminute
remnantsofcalculusfromtheroot,creatingasurfacethatisfreeofallvisibleaccretions.Diamond
filescanproduceasmooth,even,clean,andhighlypolishedrootsurface.Diamondfilesmustbe
usedcarefullybecausetheycancauseoverinstrumentationoftherootsurface.Theywillremovetoo
muchrootstructureiftheyareusedwithexcessiveforce,arepoorlyadaptedtorootmorphology,or
usedtoolonginoneplace.Diamondfilesareparticularlyeffectivewhenusedwiththedental
endoscope,whichrevealsresidualdepositsanddirectsthecliniciantotheexactareafor
instrumentation.UltrasonicandSonicInstruments.