Identifying Dental Instruments and Preparing Dental Trays Unit 18.7 Dr.

Hale
Medical Technologies Jr. Program

Methods for Setting Up Dental Trays

1. Correct preparation for assisting with dental procedures includes setting up trays of instruments and supplies 2. Various methods are used to set up trays for specific dental procedures 3. Instruments and supplies used are determined by the procedure that will be performed and the personal preference of the dentist.

4. In some areas, trays are set up immediately before use a. Assistant prepares room: cleans, applies barriers, and so forth b. Seats and drapes patient c. Sets up tray with supplies and sterilized instruments

5. In other areas, preset trays are used a. Contents of trays are determined by dentist b. Trays are set up for oral examinations, amalgam, composite, surgical extractions, and other similar procedures 1) Oral examination: patients teeth cleaned and examined, dental radiographs or X-rays may be taken 2) Amalgam and composite

aa.

Two main restorative materials used to repair carious lesions or tooth decay bb. Doctor removes damaged tooth structure and creates an opening called a cavity preparation cc. Amalgam, silver restorative material, or composite, an esthetic restorative material, is placed in the cavity preparation

Cavity Preparation
Radiographs and pictures of lower first Molar showing three canal orifices

Mesial-Buccal and Mesial-Lingual canals

Lesion before cavity preparation

Cavity prep showing dentin

Completed restoration Amalgam Condensers

3) Surgical extraction: removal of a damaged tooth

c. Patient is seated and draped d. Sterilized procedure tray is obtained and placed in room e. If additional instruments or supplies are needed, they can be added to the prepared tray

6. Color coded trays a. Instruments are color coded with tiny bands to denote use for specific procedures b. Examples: red for amalgam, blue for composite, and so forth c. Full set of color coded instruments placed on tray d. Sterilized as one unit

Examples of Color-Coded Trays

Organization of Trays
1. Items on trays should be organized and in proper sequence 2. Usually arranged in order of use 3. After instrument is used, returned to same place on tray in case it is needed again 4. Easier for assistant to locate instruments and increases overall efficiency

Main Parts of a Dental Hand Instrument

1. Blade, nib, or point a. Blade is cutting portion of an instrument b. Nib is the blunt, serrated, or smooth working end of a condensing instrument c. Point is the sharp end used to explore and detect 2. Shank: portion that connects shaft or handle to the blade, nib, or point 3. Shaft: handle of the instrument, usually hexagonal to provide a better grip

Standard Instruments
1. Mouth mirror a. Used to view areas of oral cavity, reflect light on dark surfaces, and retract lips, and so forth for better visibility b. Used in every basic tray set up c. Available in various sizes and with plain or magnifying ends

2. Explorer a. Used to examine the teeth, detect carious lesions, and note other oral conditions b. Available in many shapes and sizes c. May be single or double ended

3. Cotton pliers a. Used to carry objects such as cotton pellets or rolls to and from the mouth b. Some lock, some do not lock c. Also called operating pliers or college pliers

Examples of Cotton Pliers

Cotton Pliers

4. Scalers a. Used to remove calculus (tartar) and debris from the teeth and sub-gingival pockets b. Available in many shapes c. Used mainly for prophylactic (cleaning) or periodontal (gingiva) treatments

5. Periodontal probes a. Used to measure the depth of the gingival sulcus (space between the tooth and free gingiva) b. Has round, tapered blade with a blunt tip marked in millimeters (mm)

Periodontal probe

6. Excavators a. Group of instruments used mainly for removal of caries and refinement of internal opening in a cavity preparation b. Spoons 1) Used to remove soft decay from cavity 2) Cutting instruments with small curve or scoop at the working end

c. Hoes 1) Used primarily on anterior teeth to remove caries and to form line angles 2) Have one or more angles to shaft, with last length forming the blade 3) Also used in scraping, planning, and direct thrust cutting motions

Dental Hoes

d. Hatchets 1) Used to refine internal line angles 2) Used to smooth and shape a cavity preparation 3) Used to remove hard-type caries

Dental Hatchets

7. Chisels a. Used for cutting and shaping enamel b. Enamel hatchet 1) Similar to other hatchets but blade is larger and heavier 2) Blade is beveled on only one side

c. Gingival margin trimmer 1) Special chisel for placing bevels on gingival enamel margins of proximoocclusal cavity preparations 2) Chisel blade is placed at an angle to the shaft, not straight across like a hatched 3) In addition, the blade is curved, not flat like a hatchet

Examples of Gingival Margin Trimmers

Gingival Margin Trimmers

8. Cleoid-discoid carver a. Double ended instrument b. Also available as cleoid or discoid single ended c. Discoid is disc shaped, with cutting edge around the blade d. Discoid is disc shaped, with cutting edge around the blade

Hollenbach Carver

9. Plastic filling instruments (PFIs) a. Double ended instrument with packing end and cutting end b. Used to shape and condense a restorative material while it is still malleable or capable of being shaped or formed c. Also used with cements before setting occurs d. Most have a small condenser at one end and a paddle like blade at the other end

10.Amalgam instruments a. Used mainly with amalgam restorations b. Amalgam carrier 1) Used to carry small masses of freshly mixed amalgam to the cavity preparation 2) Available as lever type or plunger type carrier

Amalgam Carriers

c. Amalgam carver 1) Used to carve or shape freshly placed amalgam t restore tooth to natural anatomy 2) One example is Hollenback carver d. Condenser plugger 1) Used for condensing and packing amalgam into prepared cavity 2) Ends may be serrated or plain

Condenser Pluggers

e. Matrix retainer and band 1) Retainer is used to hold band in place 2) Matrix band is short strip of steel or other metal not affected by mercury 3) Used to form a wall around a cavity so amalgam can be packed into place 4) Plastic matrix strips are used with composite restorative material

Matrix Retainer & Band Placement

11.Burnishers a. Contain working points in shape of balls or beaver tails b. Used primarily to burnish (adapt) the margins of gold restorations to a better fit c. Also used to polish other metals

Burnishers

12.Plastic composite instruments a. Set of plastic instruments used with composite b. Metal instruments can discolor composite 13.Surgical instruments a. Very numerous depending on type of oral surgery performed b. Main instruments used in surgical extractions

c. Other specific instruments and supplies such as chisels, hemostats, needle holders, and suture materials might also be used d. Surgical forceps 1) Also called extracting forceps 2) Used to extract or remove teeth 3) Different ones each for specific tooth to be extracted

Surgical Forceps

e. Periosteal elevators 1) Used for lifting the mucous membrane and tissue covering the bone 2) Double ended instrument with a blade at each end f. Root elevators 1) Various types, shapes, and sizes 2) Used to loosen tooth out of its socket

Periosteal Elavators

Root Elevators

g. Root tip picks 1) Straight or contra-angled 2) Used to remove small tips from a socket such as a root tip or piece of bone h. Rongeur forceps 1) Used to trim or cut bone tissue 2) Tips of forceps may be round or square 3) Tough sharp blade extends around both sides and end of the tips

Rongeur Forceps

i. Lancet 1) Similar to scalpel and blade 2) Used to lance and incise or cut tissue j. Bone/surgical chisels 1) Used for cutting bone structure in oral cavity 2) Some used by hand, others require use of surgical mallet

Types of Bone Chisels

Guidelines for Preparing Surgical Trays

1. Use only items that are usually needed 2. Placing instruments and supplies that are needed occasionally on the tray can decrease efficiency and crowd the items 3. Certain items usually stored in assistants cart a. Drape and clips b. Dental bases, cements, and restorative materials

c. Extra cotton products or dressings d. Instruments used for specific problems or procedures

Examples of Tray Set-Ups

1. Prophylactic or general examination tray a. Used for basic examination and cleaning of teeth b. Supplies and instruments on tray include 1) Mouth mirror, explorer, pliers 2) Scalers 3) Periodontal probe for an adult 4) Prophylactic cups, paste, and brushes 5) Fluoride treatment supplies

2. Amalgam restoration tray a. Used for amalgam restoration b. Include basic instruments and supplies c. Add amalgam carriers, condenser pluggers, carvers

3. Composite or esthetic restoration tray a. Used for placement of composite or esthetic restoration b. Include basic instruments and supplies c. Add plastic composite instruments, fine brush

4. Surgical extraction tray a. Used to remove or extract teeth b. Include basic instruments and supplies c. Instruments added vary depending on type of extraction d. Usually add extracting forceps, root-tip elevators, root-tip picks, periosteal elevators, Rongeur forceps, lancets, bone chisel, and a needle holder with suture materials

Surgical Extraction Tray

Basic Principles for Preparing Dental Trays

1. Lay out general patient equipment such as records, X-rays, patient drape and clips 2. Prepare handpieces for use a. Make sure all in good working order b. Add sterile tips, barriers, and so forth 3. Place basic instruments and supplies on tray

4. Add specific instruments for procedure being done a. Put instruments in order of use b. Leads to increased efficiency and organization 5. Prepare dental cements and bases, mixing pads, and mixing instruments

6. Add additional equipment that might be used such as prophy paste, fluoride trays, matrix bands, wooden wedges, finishing strips, articulation paper, etc 7. Add supplies for rubber dam (device used to keep oral cavity dry), anesthesia supplies, and special items to tray

8. Review procedure and check tray to be sure all items present 9. Remember that equipment, supplies, and instruments used will vary from doctor to doctor follow your doctors preferences