Instruments in operative

dentistry and instrumentation

 Instruments in operative
dentistry and instrumentation

Dr/ Reham M. Attia

A wide range of specific instruments hand/rotary is required
for preparation and cutting of tooth, and for other operative
procedures.

Metals Used for Manufacturing Cutting

Instruments ?
 Metals Used for Manufacturing
Cutting Instruments

The Carbon
Stainless Steel
Steel

Soft steel Hard steel

 instrument is
heated to 815°C in
oxygen free
Hardening environment and
heat then quenched in a
treatment solution of oil. By
hardening
Heat treatment, the alloy
becomes brittle.
Treatment
of Materials instrument is heated
at 176°C and then
Tempering quenched in solutions
heat of oil, acid or mercury.
treatment Tempering heat
treatment is done to
relieve the strains and
increase the toughness
of alloy.
CLASSIFICATION OF INSTRUMENTS

Classification given by G. V. Black :

This classification is based according to use of

the instrument.
Cutting instrument
Hand Rotary
Hatchets burs

Chisels Stones

Hoes Others

Excavators

others
Condensing instrument
Condensing
instruments

Hand mechanical
Plastic instruments
Plastic filling instrument

Cement carriers

Carvers

Burnishers

Spatulas
Finishing and polishing instruments :

Finishing and polishing

instruments

Hand
Orangewood Rubber Finishing Polishing Rotary
sticks strips points
cups

Mounted Mounted Finishing

stones brushes brushes
Isolation instruments:
– Rubber dam frame clamps, forceps and punch
– Saliva ejector
– Cotton roll holder
– Evacuating tips and equipment
 PARTS OF HAND CUTTING INSTRUMENTS
Each hand instrument is composed of three parts:

 Handle or shaft
 Shank
 Blade or nib.
 Cutting edge
or face
Handle or Shaft

The handle is used to hold the instrument.

 The handle can be small, medium or large,
smooth or serrated for better grasping to increase
friction for hand gripping and developing
pressure.
 Earlier, instruments had handles of quite large
diameter that were to be grasped in the palm of
the hand.
 Now-a-days, instrument handles are smaller in
diameter for ease of their use.
 It is straight
 Available in various sizes and shapes- small,
medium, large diameter
 Instrument formula incorporated on it
 Manufacturing kit number incorporated on it
 Handle is either continuous with shank or separable
 Shank
Connects the shaft with the blade or working point
or nib.
 It usually extends from its connection
with the shaft to where the blade begins.
 Smooth, round, tapered and contrangled
 It is here where any angulation of the
instrument can be placed.
 Have one or more bends to avoid the
instrument from having tendency to twist
in use where force is applied
CONTRANGLING & BALANCE  CONTRANGLE
Refers to shank in which two or more angles are
necessary to bring working end into near alignment
(within 1 to 2mm) the axis of handle.
Blade :

Functional end of the instrument bearing the

cutting edge.
For non-cutting instruments the part corresponding to
the blade is termed as

―nib‖
Working surface or the end of the nib is known as the

―face‖
Cutting edge:

It is the working part of the instrument. It is

usually in the form of a bevel shapes.

Bevel may be :

bevel

Regular bevel Reverse bevel

Distal to the shaft Mesial to the shaft
Bevel may be :

Single
beveled
Bibeveled

Triplebeveled
Circumferentially
beveled
 Nomenclature for the Instruments:
G.V. Black has given a way to describe
instruments for their easier identification
similar to biological classification.
 Order: Function or purpose of the instrument, e.g.
excavator, condenser
 Suborder: Position, mode or manner of use, e.g. push, pull
 Class: Design or form of the working end, e.g. hatchet,
spoon excavator
 Subclass: Shape of the shank, e.g. binangle, contra-angle.
Naming of an instrument generally moves from 4 to 1.
Sometimes, the suborder is omitted due to variable
and non-specific use of the instrument. For example, the
instrument will be named according to the classification as
biangle enamel hatchet or biangle spoon excavator.
 Instrument Formula:
 The formula is usually printed on
the handle consisting of a code of
three or four numbers separated by
spaces.
3 unit instrument formula: Cutting edge of the
instrument is at a right angle to the blade.
 3 unit instrument formula: Cutting edge of
the instrument is at a right angle to the blade.
The first number of the formula indicates
Width of the blade or primary cutting edge in tenths
of a millimeter
Second number indicates Length of the blade
in millimeter.
Third number indicates Angle the blade forms
with the axis of the handle in centigrade
The first number of the
formula indicates width of
the blade or primary cutting
edge in tenths of a millimeter
Second number
indicates length of the
blade in millimeter.
Third number indicates
angle the blade forms with the
axis of the handle in centigrade
 4 unit instrument formula: Where cutting edge of
the instrument is at an angle other than a right
angle to the blade.

 First number: Width of the blade in tenths of a

millimeter.

 What is the difference ?

Fourth number: Angle
the cutting edge forms
with the axis of the handle
in centigrade.
 Fourth Second
number of 4 number of 3
unit formula unit formula
 Fourth number of 4
unit formula

Second number of 3
unit formula
 4 unit instrument formula: Where cutting edge of
the instrument is at an angle other than a right
angle to the blade.

 First number: Width of the blade in tenths of a

millimeter.
 Second number: Angle the cutting edge forms with
the axis of the handle in centigrade.
 Third number: Length of the blade in millimeter.
 Fourth number: Angle the blade forms with the axis
of the handle in centigrade.
Ex.: Gingival marginal trimmer & angle former.
 2 Cutting edge angle

1 Blade width

34 Blade Angle

2
3 Blade length
Types (families) of hand
cutting instruments:
1.Chisels:
 Cutting edge of the instrument is
at a right angle to the axis of the
instrument.

 Used for planning or cleaving enamel.

Types of chisels ?
a-Straight chisel:-
- No bend in shank
- Single beveled/ Triple beveled.
- Minimal accessibility.
- Used with push stroke or lateral scraping
action.

.
b- Mono angle chisel:-
- Blade is shorter as compared to straight
chisel.
- Single angle in the shank to enhance the
convenience form.
- Used with push stroke or lateral scraping
action.
c- Hoe:-
c- Hoe:-
Difference between mono angle chisel and hoe:-
- If the angle of the blade is less than 12.5 centigrade, it is mono
angle chisel and if it is more than 12.5 centigrade, it is hoe.
- Used with pull stroke.
- Use:- To define line and point angles.
- Class III and V preparations for direct filling gold restorations.
d- Binangle chisel:
- Two angles in the shank.
- Used to cleave or split undermined
enamel.
- Reverse bevel instrument.

e- Triple angle chisel:-

- Used to flatten the
pulpal floor.
2-Hatchet
- Cutting edge of the instrument is parallel
(or nearly parallel) to the axis of the
instrument.
- Cutting edge of the instrument is at right
angle to the axis of blade.
- Mono angled
- Length of blade is very small
a- Enamel hatchet:-
- Cutting edge of the instrument is parallel
to the axis of the instrument
- Cutting edge of the instrument is at right
angle to the axis of blade.
- Binangle hatchet
- Monobeveled
- Paired instrument
- Bevel on right side – Right side
instrument- Bevel on left side – Left side
instrument
 Uses:
- Used with push stroke (planing or direct
cutting motion as well as lateral cutting
motion).
- 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).
b- Gingival marginal trimmer:-
- Cutting edge of the instrument is parallel to
the axis of the instrument.
- Cutting edge of the instrument is at an angle
other than a right angle to the blade
- Modified hatchet
- Binangle instrument
- Monobeveled
Two pairs of gingival marginal
trimmer
Mesial pairs right and left
Distal pairs right and left
- 4 unit instrument formula
- Mesial pair – 10- 80- 6- 8 (< 80)
- Distal pair – 10- 95- 6- 8 (> 95)
- Used to give gingival cavo surface bevel.
- Used for rounding or beveling axio- pulpal
line angle.
Excavator
Spoon excavator:-
Modified hatchet
Spoon excavator:-
Modified hatchet.
Double ended instrument.
Binangle/ Triple-angle instrument.
Paired (right and left).
Double plane instrument.
Circumferentially beveled.
Cutting edge either circular (discoid) or
claw like (cleoid).
.
Use:-
- Spooning or scooping of softened
carious material.
- Carving amalgam or direct wax
patterns
Specially designed hand cutting
instruments:
Angle former

4 unit instrument formula

- Paired instrument- right and left
- 3 cutting edges (blade is beveled on
the sides as well as the end).
Wedelstaedt chisel
Shank and blade are curved
- Beveled on one side of blade only.
- If bevel is on the side towards the
curvature of the shank:- Mesially
beveled- Away from the curvature of the
shank:- Distally beveled
Off- angle hatchet: -
- Instruments in which blade is rotated by 45
degrees 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.

4- Triangular chisel:-
- Blade is triangular in shape with the base away
from the shaft.
- Has a terminal cutting edge like straight chisel
Other instruments:-
Knives:- Finishing knives, Amalgam knives, or
Gold knives.
Used for trimming excess restorative material
on the gingival, facial or lingual margins of a
proximal restoration or trimming and
contouring the surface of class V restorations.
Files:- Used for smoothening of overhanging
restorations (amalgam and gold).
Non cutting hand instruments
 Diagnostic instruments

a- Mouth mirror
b- Explorer
c- Forceps
 a- Mouth mirror
Is an instrument having a mirror head top and a
detachable handle also called as odontoscope.
Uses:-
 Indirect illumination: Mouth mirror could be held at
an angle to reflect the light onto the working area.
 Retraction: Mirror head used to retract
the patient’s lip or check or tongue so
that the clinician is able to view tooth
surfaces and protects the tissues from
injury.
 Indirect vision.
 Guard.
Trans illumination- Only maxillary and
mandibular anterior teeth can be
transilluminated.
 a.Explorer:
Sharp pointed hand instrument used to
explore teeth and restoration surfaces in
order to detect caries, overhanging edges
and other defects
Uses:-
- Exploring lesion (plunt or sharp ?)
- For detecting and assessing carious lesion in the
tooth(plunt or sharp ?)
- Detecting demineralized dentin.
- Releasing debris from the tooth.
- Removing slight excess fill up around cavo-
surface margins
- Identifying hypersensitive areas in the tooth
Types of Explorer
Straight explorer:
It is bent perpendicular to
the handle.it is used for
examining occlusal surfaces
of teeth.
Shepherd’s Hook or
curved explore or arch
explorer: It has semilunar
shaped working tip
perpendicular to the handle.
it is used for examining
occlusal surfaces
Interproximal explorer/Briault
explorer/Back action probe:
is explorer has two more angles in
the shank with working tip-pointed
towards the handle.
Cow horn/pigtail explorer: It has
smaller arch than curved
Forceps: Hand instrument with two
narrow and pointed, straight or curved
beaks used to grasp small objects
Restoring instruments
a- Mixing instruments
b- Amalgam carrier
c- Condensing instruments
d- Carver
e- Burnisher
a.Mixing instruments:- Cement spatula
Spatulas:-
- Flat and wide nibs with blunt edges
- Used for manual mixing of cements
supplied as powder and liquid.
b- Amalgam carrier:-
 Amalgam carrier is an instrument used for
carrying mixed amalgam to the cavity.
 Hollow tip of an amalgam carrier is inserted
into the mixed amalgam to pack the carrier
with amalgam
 It is then carried into the cavity and plunger
is pressed injecting cylindrical pellets of
amalgam
c- Condensing instruments
Condensers are used to deliver the restoration to
the tooth preparation and properly condense it.
 The hammer-like working end of condenser
should be large enough to pack the restoration
without sinking into it.
 Condensers come in single and double-ended
designs
 they are available in differently shaped and sized
working ends like round, triangular or
parallelogram, which may be smooth or serrated
 Condensers can be hand or mechanical in nature
a.Carvers
 Sharp cutting edges present in
carvers are used to shape and
form tooth anatomy from a restorations
Carvers come in different shapes and sizes
in double ended designs Many carvers are
designed for carving specific tooth
surfaces
For example, interproximal and hollenback
carvers are used for carving proximal
surfaces and discoid cleoid and diamond-
shaped carvers are used for carving occlusal
surfaces
Burnisher
 Burnishers are the kind of instruments
which make the surface shiny by rubbing
They are used to smoothen and polish the
restoration and to remove scratches present
on the amalgam surface after its carving
Burnishers have smooth rounded working
ends and come in single and double ended
types .
Different types of burnishers are
available but most commonly used are
 PKT3—designed by Peter K Tomas
 Rounded -shaped burnisher.
 Beavretail burnisher —narrow type of
burnisher.
 Ovoid burnisher—comes in various sizes
such as 28, 29, 31.
Beavretail
 Instrument grasps:

Correct instrument grasps are

important for achieving success in
operative procedures.
 Commonly used instrument grasps
in operative dentistry.
Modified pen grasp
Inverted pen grasp
Palm and thumb grasp
Modified palm and thumb grasp

.
 Finger rests
 The finger rest helps to stabilize the hand
and the instrument by providing a firm
rest to the hand during operative
procedures.
 Finger rests may be intraoral or extraoral.
Intraoral finger rests:
– Conventional: the finger rest is just near or
adjacent to the working tooth
– Cross-arch: the finger rest is achieved from
tooth of the opposite side but of the same arch
– Opposite arch: the finger rest is achieved from
tooth of the opposite arch
– Finger on finger: rest is achieved from index
finger or thumb of nonoperating hand.
Extraoral finger rest:
It is used mostly for maxillary posterior teeth.
- Palm up: Here rest is obtained by resting the back of
the middle and fourth finger on the lateral aspect of
the mandible on the right side of the face.
-Palm down: Here rest is obtained by resting the front
surface of the middle and fourth fingers on the lateral
aspect of the mandible on the left side of the face
 Sharpening of hand instruments: A sharp
instrument cuts more precisely and quickly than
dull instruments
 Methods of sharpening
Manual sharpening
Mechanical sharpening
Hand piece sharpening