Classification and principles of operation of hand instruments for dental hygiene

Dentists and periodontists all over the world, despite the developed modern technologies, use hand instruments. The use of a professional dental device is the key to successful therapy. Choosing the right tool and size is not an easy task.

Specification

Already in the 7th century, dental instruments were used to get rid of dental deposits. In the 20th century, they were already described in detail and gained well-deserved popularity. Modern dental devices are diverse in configuration, purpose, use, materials:

Dental instruments are classified by functional purpose:

For initial examination

An examination of the oral cavity begins with the use of a dental mirror. A round mirror is attached to the metal handle by a rod. It comes in flat and concave shapes. The flat one allows you to see the oral cavity in full size, the concave one increases the reflection.

The probe helps to assess the condition of the teeth:

• the mouths of the root canals are determined;
• carious depressions are determined and prepared;
• soreness is investigated.

To place additional materials in the patient's oral cavity: pads, rollers, tampons, so that to facilitate dental procedures on the oral mucosa and teeth are used tweezers. With its help, it is also possible to introduce medical solutions in the dental and periodontal cavities, allows you to determine the mobility of the tooth.

For cleansing cavities formed by caries

Cleansing cavities from softened tissues (enamel, dentine), food debris, old or inconsistent fillings, unhardened dental deposits, plaques of the proximal surfaces are produced using an excavator.

The end of the instrument is represented by a pointed spoon with a rod attached to the handle.

For root canal sanitation

Intrachannel cleansing is their main role. The devices are variable in shape, size, material, method of application. By its purpose, this class has its own subclasses.

For filling and reconstructing teeth

The spatula is a metal tool consisting of a handle, ending on both sides with flat rectangular spatulas. Its scope:

• manufacturing of pharmaceutical mixtures;
• preparation of filling material;
• rubbing medication.

Trowels are used when imprinting pads in the form of a paste into previously cleaned carious cavities, sealing material fillings and ensuring a snug fit to the walls of the cavity to form fillings.

Different sizes, one- and two-sided, combined with a corkscrew, ensure the selection of the instrument for each patient.

With a corkscrew, they distribute and form the shape of the seal, the material is tamped tightly to exclude air cavities.

Periodontic instrumentation

This group will be discussed in more detail below.

Principles of working with hand tools

Correctly selected in terms of functionality, shape and size, the dentist's instrument allows you to perform a variety of therapeutic and reconstructive procedures. The specificity of each dental instrument determines its exclusivity for use.

List of requirements for dental instruments:

• must guarantee a high quality level of procedures;
• be comfortable for the patient during treatment;
• correspond to the ergonomic parameters for the dentist when performing various manipulations.

Specialized safety goggles and a mask help prevent particles from entering the dentist's eyes during procedures. Good illumination increases the level of the specialist's actions.

The correct model of the working part, which closely adheres to the edge to the surface, taking into account the individual characteristics, ensures the maximum efficiency of the removal procedure dental plaque. Their density and vastness are taken into account.

To select a high-quality and suitable device for a particular patient, the specialist must have knowledge and certain skills in carrying out such procedures. Manual dental appliances for hygienic cleaning of the tooth surface are diverse in configuration, purpose and principles of use. Let's consider them in more detail.

Tools for removing dental plaque

Dental deposits are found in soft (plaque) and hard (tartar) forms. Taking into account the density, area and location, different devices are used to remove them.

Types of hand tools of this profile:

Using an excavator to carry out the procedure for removing plaque is unacceptable: damage to the deeper layers of the root is inevitable.

Curettes and scalers are often used. All devices are simple enough. Usability is determined by the following parameters:

• the size of the handle (9.5 mm is the best diameter) and its weight;
• special grooves that help to hold the instrument handy and level muscle tension, improve sensitivity when working.

The use of a device suitable for the dentist is an excellent prevention of carpal tunnel syndrome, on the other hand, they increase the effectiveness of tooth cleaning. Functional load leads to the emergence of carpal syndrome. Concomitant symptoms of a pathological deviation:

• decrease in the level of sensitivity;
• low muscle tone;
• pain;
• atrophy of the muscle tissue of the hand;
• paresthesia.

There are additional silicone rings for the handle. They provide additional comfort in use, it is possible to disinfect and sterilize.

The functional rod is an intermediate link between the handle and the working part, which determines the position of the working part (if there is no good visualization).
Its parameters vary, this is of great importance. A short rod is used in the area above the gums, a long rod is used for manipulations in the periodontal cavities.

Minor plaque removed with a more flexible rod, it provides better sensitivity. With an average size and relatively low density, rods of medium flexibility are used. More dense in structure and massive, they lend themselves to processing with a rigid rod.

It is recommended to carry out cleaning from extensive dental calculus with electromechanical devices.

Curettes and sickle-shaped scalers have face and side surfaces. Their assortment varies from powerful - when getting rid of large and extensive deposits, to refined - when carrying out filigree work.

All scalers are identical in structure:

• there are 2 active edges;
• working end;
• face and terminal knee perpendicular to each other.

This configuration allows for comfortable procedures at or above the gum, not under the gum. Suitable for removal massive sediments.

Straight and curved scalers are distinguished by their structure. The former allow you to work from the cheeks, tongue and interproximal areas. Interproximal and oral areas are accessible with curved scalers.

The decisive factor is the location of the teeth with which the work is carried out:

1. When manipulating the surface of the chewing teeth, double-sided paired configurations are always used.
2. The frontal part is characterized by the use of a double-sided curved scaler. The disadvantage of this device is the high risk of injury to the dentist's hand. Therefore, a modification was developed - a one-sided curved scaler.
3. The curved tool is difficult to use when cleaning extensive deposits of the frontal area. It seems more convenient to use a double-sided straight scaler, which has straight areas. This type of scalers is used in pediatric dentistry.
4. When cleaning the surface of the chewing teeth, a double-sided curved and double-sided straight scaler is used. It is they who provide the best access.
5. If it is necessary to carry out procedures in the subgingival region, a device with an elongated terminal rod is used.

Treatment periodontitis ineffective without a procedure curettage (mechanical cleaning of periodontal pockets). The procedure is performed using a curette.

Functional meaning of the rounded end:

• getting rid of medium-sized gingival deposits, including the furcania area;
• removal of cement, granulation tissue of the periodontal pocket, epithelial layer that has grown into the pocket.

By application, universal and zone-specific curettes are isolated into separate groups.

The universal curette has 2 sharp cutting edges, parallel to each other, which are closed with a rounded end. The reverse side is rounded. The blade is semicircular in cross-section. The face and the terminal bar are perpendicular to each other.

This structure provides the curette with access to most of the specific areas. Simultaneous application of two edges is possible. The reverse rounded side of the working part repeats the shape of the bottom of the periodontal pocket, fits 60-70 to the tooth surface.

Gracie curettes (zone specific) are the most popular hand aids among periodontists. They make different areas of the tooth surface accessible.

The standard zone-specific curette allows procedures in periodontal pockets up to 4 mm.

It is characterized by:

• working surface of a semicircular section, with 1 sharp edge;
• rounded tip and back;
• terminal knee and blade are located at an angle of 70 to each other;
• the terminal rod is parallel to the dental axis.

Deposits firmly attached to the surface of the tooth root are removed with a hoe, chisel or rasp.

The rasp has a double-sided working area:

1. Numerous cutting edges (inclined 90-105).
2. Absolutely smooth in order to preserve closely spaced tissues and enamel.

Main destination:

• changes in the contour of the bone crest during periodontal surgery;
• getting rid of extensive tartar.

The disadvantages of the device include:

• limited sensitivity of the hand;
• poor adaptability to the dental surface;
• defects on the surface;
• sharpening is difficult.

Large supragingival deposits are removed with a chisel. Single incisal edge, straight or curved shoulder. The cutting edge is angled at 45 °.

The only cutting edge of the hoe is sharpened at 45 °. Modification of the curvature of the working part allows the removal of calculus tightly connected to the tooth surface from the distal, medial, lingual and buccal surfaces. They are able to penetrate into the periodontal pocket up to 3 mm without damaging it. The main disadvantage is the curvature, which does not make it possible to reach the bottom of the canal and injures the soft tissues.

Curettes Gracie

Periodontists and general dentists note the effectiveness of Gracie Curette. Almost 80 years ago, Dr. Clayton Gracie and Hugo Friedman demonstrated a dental kit for the treatment of periodontal disease. This innovative type of curette expanded the areas available for deposit release.

Subsequently, the design was taken as the basis for development by the Hjo-Fridi company when creating curettes in deep (more than 5 mm), deep and narrow pockets.

The blades of such curettes have the following characteristics:

• unique blade shape with one cutting edge (bottom);
• cutting edge and terminal rod with an angle of inclination of 70 ° (for a universal curette - 90 °);
• semicircular section with rounded tip and back.

Each curette has a unique knee design. Variety of bends and knee angles allow for greater adaptability of the blade to the surface. Treating each specific area requires different curettes (Figure 3).

All Gracie curettes have their own unique functionality. Using the correct curette for specific types of teeth and surfaces ensures the effectiveness and ease of the procedure.

Sharpening the toolkit

The cutting edge becomes dull over time. There is a need for sharpening.

Use of a sharp tool in work:

1. Increases the success and efficiency of the dental plaque removal procedure.
2. Reduces procedure time.
3. Promotes increased tactile sensitivity.
4. Reduces specialist fatigue.

Sharpening is carried out manually or using special devices.

The need for manual sharpening is determined by:

• high intensity of exploitation. The ideal option is to sharpen after each sterilization before the next use;
• by the method of holding the cutting side along a plexiglass stick - the sharp edge leaves a mark;
• visual inspection of the sharpness with the help of light - the sharp edge does not reflect light.

Hand sharpening is carried out with sharpening stones of natural and artificial origin. The main types of sharpening stones are presented in the table:

Name	Origin	Grain structure	Purpose
Arkansas	Natural	Small	Can be used systematically or for sanding after coarser sharpening. Oil is used for lubrication.
"India"	Synthetic	Average	With its help, they change the shape of the working part or sharpen a very blunt toolkit. Oil is used as a lubricant.
Ceramic	Synthetic	Small	Suitable for regular use, coarse grinding. Can be used with water or dry.
Composite	Synthetic	Large	Adapted for coarse sharpening, tool configuration changes. Use with water.

Compliance with the angle of inclination is the main rule of sharpening. The biggest challenge for sharpening is the rasp.

Attention! Carrying out the sharpening procedure without familiarizing yourself with the rules for its implementation, without experience or specialist advice is fraught with a violation of the functionality of the tool.

Sharpening by hand should be done by an experienced technician: damage is possible. The procedure is quite lengthy and tedious. This necessitates the use of portable grinders. The object is held firmly in place while maintaining the original tilt angle.

The working surface becomes thinner when sharpening. The tool becomes brittle and traumatic. The use of such a tool in work is unacceptable. Inspection and rejection should be carried out regularly.

All hand-held dental appliances have an individual lifespan and suitability. Responsible attitude to the condition of the instrument, ensuring its correct storage and sterilization is the key to the successful work of the dentist.