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Introduction

Definition
History
Classification
Cutting instrument
Non cutting
Cutting instrument
MATERIALS
Hardening and Tempering
Heat Treatments
Design
Shank angles
Nomenclature
Formula
Bevels
Cutting instrument applications
Excavators
Chisels

Sharpening
Stationary sharpening
Mechanical sharpening
Instrument grasp
Modified pen. Inverted
.pen
.Palm and thumb
Modified palm and
Cleaning
and Sterilization
.thumb

Non cutting
instrument
Amalgam condenser
Mouth mirror
Others

Introductio
Introductio
n
:Definition
n

. It is hand-powered dental instrument

:History
The early hand-operated
instruments
: characterized by
Large, heavy handles and inferior metal
.
alloys in the
blades
cumbersome, difficult to use, and
. ineffective in many situations

there was no uniformity of


manufacture or
nomenclature, Many dentists made their
own hand
instruments in an effort to
find a suitable
instrument
.
for a specific need
. effective sterilization was a problem

Designs of some early hand instruments

G.V. Black is credited with the


first
acceptable
nomenclature and classification
. of hand instruments
His classification system enabled G.V. Black
both dentists and manufacturers
to communicate more
clearly
and effectively in regard to
.instrument design and function

HAND
INSTRUMENT

cutting

excavators

chisels

Non cutting

others

Amalgam
condenser

ordinary
hatchets

straight

files

hoes

curved

scalers

Angle
formers

bin-angle

carvers

spoons

Enamel
hatchet
Gingival
margin trimmers

mirrors

,explorers
probes

others

MATERIALS

Hand cutting instruments are manufactured from two


.main materials

carbon steel

stainless steel

remains bright
under most
.conditions
when unprotected, itloses a keen edge
during use much
will
more quickly than
.corrode
does carbon steel
Is harder than
.stainless steel

MATERIALS

Tungsten carbide inserts or blades to


provide
more durable cutting edges (brittle).
They may
.be soldered to steel handles
some instruments are made
with carbide to
provide more durable cutting
.edges

MATERIALS

Other alloys of nickel, cobalt, or


chromium are used in the
.manufacture of hand instruments

Stainless Steel

Carbon steel

MATERIALS

ning and Tempering Heat Treatments


To gain maximal benefits from carbon steel or
stainless steel, the manufacturer must submit
them to two heat treatments: hardening and
. tempering

t treatment Furnace

MATERIALS

The hardening heat treatment


hardens the alloy, but it also makes
it brittle, especially when the carbon
.content is high
Heat treatment relieves strains and
increases toughness. the tempering
Heating or flaming of hand instruments
during dental use can alter the original
properties of the alloy and render it
.unserviceable

Design

Most hand instruments


:composed of three parts

a- Blade or nib
b-Shank
c-Handle

Design

a- blade
This is the working part of the
.instrument
Begins at the point which
terminates the
.Each
shankblade has a cutting edge
It
is connected
to the handle by
which
is the
.I.the
t isshank
usually
inof
the
form
of a bevel
working
part
the
instrument
(acute
angle)
cutsinstruments
into the tooth
On nonthat
cutting
e.g.
.structure
condensers
the part corresponding to the blade

Design

b-shank
Connect the handle to the
.working end of the instrument
Normally smooth, round and
.Have
tapered
one or more angles to avoid
twisting of
.the instrument
Hand
instruments must be
.balanced and sharp
Balance allows for the
concentration of
force onto the blade without

Design

Balance is accomplished by designing


the
angle of the shank so that the cutting
edge
of the blade must not be off axis by
more
.than 1-2 mm

:Shank angles

n-angle, bin-angle, triple angle


Instruments with small short
blades may be

Design

Instruments with long blades may


required
two or three angles in the shank to
bring the
cutting edge near to the long axis of
the
. handle
Such shanks are termed contra
.angled

Design

handle(shaft)

he part grasped in the operators hand


Perfectly straight, smooth or eight
.sided
Serrated for better gripping and
control
thein conjunction with the
Handlesofare
.shank
instrument
or
.it may be separable
Separate type is known as conesocket
handle and allows for replacement of
several

Design

mirror
cone-socket handle
(mirror)

nomenclature

Black classified all instruments by


:name according to

ction e.g. scaler, excavator. 1

ner of use e.g. hand condenser. 2


Design of the working end e.g.. 3
spoon
excavator,
sickle
scaler
Shape of the
shank
e.g. mono-. 4
.angle, biangle, contra-angle
These names were combined to form
the
complete description of the

formula

Hand cutting instruments have


formulas
describing the dimensions and
angle of
. the working end
These are placed on the handle
using
a number indicates
The
first
code
of three
four
the
width
of the or
blade
in numbers
tenths
of a mm (e.g. 10 =
separated
.by
1 mm)
or spaces
(e.g.cutting
10-85-8The dashes
second number
primary
.14) angle
edge
measured from a line parallel to the

formula

Instrument shank and


blade design with
.formula

formula

If the edge is perpendicular


,to the blade
this number is omitted
resulting in a 3
.numbers code
The third number indicates
the fourth
blade number indicates the
The
blade
angle
relative
to8the
length
in mm
(e.g.
=8
long
axis of the handle in clockwise
.mm)
centigrade e.g. (14)
Additional number on the handle is
the manufacturers identification
. number

formula

Additional number
should not be confused
with the formula
.number

Bevels

Most hand cutting instruments have on


the end of the blade a single bevel that
forms the primary cutting edge. Two
,Additional
additional edges
two secondary cutting

edges that
extend from the primary cutting
edgeallows
for the
This
cutting in 3 directions;
.length
of the blade
facial
and
lingual walls of the proximal
.cavity
blade design showing primary and secondary cutting edges

Bevels

Bibeveled instrument
have
two bevels that form the
,cutting edge
.e.g. hatched excavator

Bevels

Single beveled
instrument such as
spoon excavator
and gingival
margin trimmer are
used with lateral
.cutting movement

Bevels

Enamel hatchet also as a


single beveled instrument
used with direct cutting
motion, a
planning or lateral cutting
designated for right and
left to
.the instrument formula

Bevels

ight and left bevels


To determine this, the
primary cutting edge is held
.down and pointing away
If the bevel appears on the
right, it is in the right
instrument
of is
the
pair,
The opposite
true
forwhen
the
used
it is moved of
from
.left instrument
theright
pair to
.One
left instrument is used for
work on one side of the
preparation and the other for
the opposite side of the

Bevels

The cutting edge is


perpendicular to the axis
of the handle
.e.g. binangle chisel
Instrument with slight blade
curvature e.g.Wedelstaedt
.chisel

:Applications can be classified into


Hand cutting instrument

Excavators

Chisels

Removal of caries and


.Used
primarily for cutting enamelrefinement of the
internal parts of the
.preparation

CUTTING
CUTTINGINSTRUMENT
INSTRUMENT
APPLICATIONS
APPLICATIONS

Excavators(1)
hatchets
hoes
angle formers
spoons

CUTTING
CUTTINGINSTRUMENT
INSTRUMENT
APPLICATIONS
APPLICATIONS

Hatchet excavator
It has the cutting edge of the blade directed
in the same plane as that of the long axis of
.the handle and is bibeveled

CUTTING
CUTTINGINSTRUMENT
INSTRUMENT
APPLICATIONS
APPLICATIONS

Hatchet excavator
These instruments are used primarily on
anterior teeth for preparing retentive areas
and sharpening internal line angles,
particularly in preparations for direct gold
.restorations

CUTTING
CUTTINGINSTRUMENT
INSTRUMENT
APPLICATIONS
APPLICATIONS

Hoe excavator

IT has the primary cutting edge


of the blade perpendicular to
the axis of the handle

CUTTING
CUTTINGINSTRUMENT
INSTRUMENT
APPLICATIONS
APPLICATIONS

Hoe excavator

This type of instrument is used for


planing tooth preparation walls and
forming line angles. It is commonly used
in Classes III and V preparations for
.direct gold restorations

CUTTING
CUTTINGINSTRUMENT
INSTRUMENT
APPLICATIONS
APPLICATIONS

Hoe excavator

Some sets of cutting


instruments contain hoes with
longer and heavier blades, with
the shanks contra-angled. These
are intended for use on enamel
.or posterior teeth

CUTTING
CUTTINGINSTRUMENT
INSTRUMENT
APPLICATIONS
APPLICATIONS

Angle former excavator

It is mon-angled and has the


primary cutting edge at an
angle (other than 90 degrees)
to the blade. It is available in
pairs (right and left )

CUTTING
CUTTINGINSTRUMENT
INSTRUMENT
APPLICATIONS
APPLICATIONS

Angle former excavator

It is used primarily for sharpening


line angles and creating retentive
features in dentin in preparation for
.gold restorations
It also may be used in placing a bevel
on enamel margins

CUTTING
CUTTINGINSTRUMENT
INSTRUMENT
APPLICATIONS
APPLICATIONS

Spoon excavator
Its blades are slightly curved, the
shanks may be bin-angled or triple.angled to facilitate accessibility
Spoon excavators
discoid
the cutting edges.are circular

cleoid
the cutting edges.are claw like

CUTTING
CUTTINGINSTRUMENT
INSTRUMENT
APPLICATIONS
APPLICATIONS

binangled
spoon

tripleangled
spoon

CUTTING
CUTTINGINSTRUMENT
INSTRUMENT
APPLICATIONS
APPLICATIONS

Cleoid spoon

CUTTING
CUTTINGINSTRUMENT
INSTRUMENT
APPLICATIONS
APPLICATIONS

Discoid spoon

CUTTING
CUTTINGINSTRUMENT
INSTRUMENT
APPLICATIONS
APPLICATIONS

Chisels(2)
straight, slightly
curved, or bin-angle

enamel hatchets
gingival margin trimmers

CUTTING
CUTTINGINSTRUMENT
INSTRUMENT
APPLICATIONS
APPLICATIONS

straight, slightly
curved, or bin-angle

The straight chisel has a straight shank


and blade, with the bevel on only one side.
Its primary edge is perpendicular to the
.axis of the handle

CUTTING
CUTTINGINSTRUMENT
INSTRUMENT
APPLICATIONS
APPLICATIONS

straight, slightly
curved, or bin-angle

The shank and blade of the chisel


also may be slightly curved
(Wedelstaedt design)

CUTTING
CUTTINGINSTRUMENT
INSTRUMENT
APPLICATIONS
APPLICATIONS

straight, slightly
curved, or bin-angle

The shank and blade of


the chisel also may be
.bin-angled

CUTTING
CUTTINGINSTRUMENT
INSTRUMENT
APPLICATIONS
APPLICATIONS

straight, slightly
curved, or bin-angle

The force used with all these chisels


.is essentially a straight thrust
There is no need for a right and left
type in a straight chisel, since a 180degree turn of the instrument allows
for its use on either side of the
.preparation

CUTTING
CUTTINGINSTRUMENT
INSTRUMENT
APPLICATIONS
APPLICATIONS

straight, slightly
curved, or bin-angle

The bin-angle and Wedelstaedt


chisels have
the primary cutting edges in a
plane perpendicular to the axis of
the handle and may have either a
distal bevel or a mesial (reverse)
.bevel

CUTTING
CUTTINGINSTRUMENT
INSTRUMENT
APPLICATIONS
APPLICATIONS

straight, slightly
curved, or bin-angle

The blade with a distal bevel is


designed to plane a wall that
faces the blade's inside surface

CUTTING
CUTTINGINSTRUMENT
INSTRUMENT
APPLICATIONS
APPLICATIONS

The blade with a mesial bevel is


designed to
plane a wall that
faces the blade's outside surface

CUTTING
CUTTINGINSTRUMENT
INSTRUMENT
APPLICATIONS
APPLICATIONS

enamel hatchet
It is a chisel similar in design to
the ordinary hatchet excavator
except that the blade is larger,
heavier, and is beveled on only one
side
It has its cutting edges in a plane
that is parallel with the axis of the
.handle

CUTTING
CUTTINGINSTRUMENT
INSTRUMENT
APPLICATIONS
APPLICATIONS

enamel hatchet
It is used for cutting enamel and
comes as right or left types for
use on opposite sides of the
.preparation

CUTTING
CUTTINGINSTRUMENT
INSTRUMENT
APPLICATIONS
APPLICATIONS

gingival margin trimmer

Similar in design to enamel


hatchet except the blade is
.curved
:Right and left types

Right pair is for either a mesial


or distal
Left pairmargins
is for a mesial or distal margin
.gingival

CUTTING
CUTTINGINSTRUMENT
INSTRUMENT
APPLICATIONS
APPLICATIONS

gingival margin trimmer

CUTTING
CUTTINGINSTRUMENT
INSTRUMENT
APPLICATIONS
APPLICATIONS

gingival margin trimmer

When the second number in the


formula is 90-100, it is used for
.distal gingival margins
When this number is 75-85, the
pair is used
.to bevel the mesial margins
and 75 pairs for steep margins 100
for inlay
preparation while 90-85 for slight

CUTTING
CUTTINGINSTRUMENT
INSTRUMENT
APPLICATIONS
APPLICATIONS

gingival margin trimmer

:Uses of GMT
Beveling of the gingival margins
.of proximoocclusal preparations
Beveling of the axiopulpal line
.angle

CUTTING
CUTTINGINSTRUMENT
INSTRUMENT
APPLICATIONS
APPLICATIONS

gingival margin trimmer

Performing a gingival lock


(reverse bevel), placed on the
.gingival seat
e.g. GMT 100 for the distal and
.GMT 75 for the mesial

cutting
cutting instrument
instrument
sharpening

The cutting edge of the hand


instrument should always be kept
sharp as dull
:.instruments
may
Loss of control
.1 cause
. More pain .2
Prolonged time for the operative .3
.procedure
Reduce the quality and precision of .4
tooth

cutting
cutting instrument
instrument
sharpening

Stationary sharpening stone e.g.


.Arkansas stone, silicon carbide

sharpening

Mechanical sharpener; moves


at low
speed while the instrument is
held at the
opposite angle and supported
by a rest
i.e. easier and less time
.consuming

Mechanical sharpener

There are four grasps used with


the hand
:instruments
.Modified pen
.Inverted pen
.Palm and thumb
.Modified palm and thumb
With each grasp proper rest and
guard is
.important

It is similar to that used in holding a


pen except
that the thumb, index and middle
fingers contact
the instrument while the tips of the
ring
and little
The palm
of the hand is facing
fingers
are the
placed on the working
away from
...operator
tooth as a rest

pen grasp

Modified pen grasp

If the hand is rotated so that


the palm
.faces more toward the operator
If is used in the lingual and
labial surfaces
.of anterior teeth

inverted pen grasp

The handle of the instrument is


placed on the palm of the hand and
grasped by all the
fingers while the thumb is free of the
instrument and rest on the nearby
.tooth of the same arch

Palm and thumb grasp

The same as in palm and


thumb grasp but the thumb
is rested on the tooth being
.prepared
.Used in the upper arch

Modified palm and thumb grasp

A proper instrument grasp must


include a firm
rest (support) to steady the hand
during
.operative procedures
The support may be gained from
.hard tissue
Soft tissue rest or too distant hard

Indirect rest may be gained by


using the
index finger of the opposite hand to
rest
.on the shank of the instrument
The operating hand rests on the
opposite
hand which rests on stable oral
.structures

Instrument
Instrument guards
guards

The use of interproximal


wedges to protect soft tissues
from contact with sharp rotary
.cutting instruments

Cleaning
Cleaning and
and
Sterilization
Sterilization

Cleaning
Cleaning and
and
Sterilization
Sterilization

All instruments need to be cleaned and th


.dried before they are sterilized

Cleaning
Hand Scrubbing

Ultrasonic
Cleaning

Automated
Washer

Hand Scrubbing-1
Advantages
Effective if performed properlyDisadvantages
.Increases chances for operator injuryIncreases spread of contamination.through splatter
.Labor-intensiveNeed proper care of scrub brush-

Ultrasonic Cleaning-2
Advantages
.Safer than hand scrubbingEffectively cleans all.instruments
Reduces chances for spread of
.contaminants through splatter
Allows
for more efficient useDisadvantages
of
staff time
Microorganisms
mayaccumulate in cleaning
.solution
Ultrasonic cleaning will notremove hardened Permanent
cement. (Solution: remove

Automated Washer-3
Advantages
.Safer than hand scrubbingReduces chances for spread of contaminants of .contaminants through splatter and aerosols
.Allows for more efficient use of staff time .Effectively cleans instruments Disadvantages
Not all instruments are compatible with automated .washers
Please see manufacturer's instructions for detailed .requirements

process by which an article, surface or


medium is freed of all living
.microorganisms
Most dental offices have a designatedarea for instrument reprocessing that
is separate from the dental treatment
room. This is ideal, since cleaning,
sterilizing and storing instruments in
the same room where the delivery of
patient care is provided increases the
.risk of cross-contamination

Some instruments and materials.are single use only


Single-use items should be,segregated in the operatory
and those that are sharp
or otherwise pose a risk of injury
must be discarded into a sharps
. container
Items without risk, such asa saliva ejector, can be thrown into
To prevent accidental injury with.the trash
the contaminated instruments,
special handling should be used to
transport the instruments to the
.cleaning and sterilization area

Although heavy-duty gloves(utility gloves) may feel more


awkward than examination gloves,
they provide extra protection while
handling instruments during the
cleaning, rinsing, drying,
packaging and sorting procedures
that take place during instrument
reprocessing
utility gloves

Sterilization
Steam pressure sterilization (autoclave)
Chemical vapor pressure sterilization
( chemiclave)
Dry heat sterilization (dryclave )
Ethylene oxide sterilization

Sterilization with steam underpressure is performed in a steam


.autoclave
For a light load of instruments, thetime required at 250'F (121 C) is a
minimum of 15 minutes at 15 lbs of
Time
for wrapped instruments.pressure
can be reduced to 7 minutes if
the temperature is
raised to approximately 273 F
(134 C) to give30 pounds of

xample of a steam pressure sterilizer (autoclave)

Advantages of Autoclaves

Autoclaving is the most rapid andeffective method for


sterilizing cloth surgical packs and
. towel packs
.Automated models are availablealthough they still can be misusedor fail almost as often as
nonautomated ones; they must be
evaluated
with a biologic spore test monitoring
.system

Disadvantages of autoclaves
Items sensitive to the elevated temperature can not be
. autoclaved
Autoclaving tends to rust.carbon steel instruments

Sterilization by chemical vapor underpressure is performed in a


.Chemiclave
Chemical vapor pressure sterilizersoperate at 270 F (131 C) and 20
. pounds of pressure
They are similar to steam sterilizersand have a cycle time of approximately
.half an hour

. Advantages of Chemiclaves
Carbon steel and other corrosion-sensitive burs, instruments, and
pliers are said to be sterilized
.without rust or corrosion
.Disadvantages of Chemiclaves
Items sensitive to the elevated. temperature will be damaged
Instruments must be lightly packaged inbags obtained from the sterilizer
.manufacturer
Towels and heavy cloth wrappings ofsurgical instruments may not be
.penetrated to provide sterilization
Routinely use biologic spore test-

Chemical vapor pressure sterilizer (Chemicl

Is an excellent means ofsterilization sharp instrument but


rubber and plastic material can not
.be sterilized by this method
Dry heat sterilizers for use in-dental offices are available, but all
that is necessary is an oven that
will
maintain that
a temperature
of It imperative
all debris be
160C(320F)
removed from an instrument
before it placed in a dry heat
.sterilizer
Holding period : 160C(320F),1*

Advantages of this method


is an excellent means of sterilization sharp-1
.instrument
. instrument not corrode or rust-2
Disadvantages
a lower temperature or a shorter period will-1
.not produce the desired result
The higher temperature of a dry-heat-2
sterilizer means that paper will scorch and
.plastic will melt
some hand pieces can not be sterilized by-3
this method

Cox rapid heat transfer dry heat sterilizer

Ethylene oxide sterilization is thebest method for sterilizing


complex instruments and delicate
. materials
ethylene oxide gas is toxic for allviruses and bacteria at room
temperature on exposure for 8-10
.hr at elevated temperature
this method requires rather.expensive equipment

om temperature ethylene oxide sterilizer

BOILING WATER
Boiling water does not kill spores and*
cannot sterilize
instruments. However, heat can reach
and kill blood borne pathogens in places
that liquid sterilants and disinfectants
. used at room temperature cannot reach
Boiling is a method of high-level*
disinfection that has been used when
actual sterilization cannot be achieved
(e.g., in case of a sterilizer breakdown)

Various new methods of sterilization**


are under investigation and
. development
The microwave oven has majorlimitations for sterilizing metal items,
by either damaging the machine or not
.reaching all sides of the instruments

microwave oven

Ultraviolet light is not highlyeffective against RNA viruses such as


HIV and is not very effective against
bacterial spores

Ultraviolet light

Incomplete exposures of all surfaces andpoor penetration of oil and debris are other
.limitations
Ultraviolet irradiation may be useful forsanitizing room air to help control
.tuberculosis bacteria

After the instrument are sterilized,-1


they are placed in proper place in a
.dry condition
The portions of dental cabinet-2
designated for hand instrument
.contain grooved glass or metal trays
These instrument containers must-3
.be kept in clean and aseptic condition
hey should also contain protective medium
.cutting edges of the instrument

: The purpose of this

Sterilizing carbon steel


instruments by any of (cold
disinfection, boiling water,
steam under pressure
(autoclave) causes
minimizing
these rust,
problems
discoloration,
andare
.available
.corrosion
electroplate the instrument. This-1
affords protection, except
on the blade, where use and
.sharpening remove the plating

use of rust inhibitors, which are- 2


.soluble alkaline compounds
is to remove the instruments-3
promptly at the end of the
recommended sterilizing period, dry
them thoroughly, and place them in
the instrument cabinet or on the
.tray setup

Non cutting instrument


Amalgam condenser
Mouth mirror
others

It is a dental instrument used for


compacting silver amalgam while in a
plastic state, used for restoring teeth
to a natural contour.
Condensers come in single- and doubleended designs. They have various shaped
and sized working ends, which may be
.smooth or serrated

Various Amalgam condensers

mouth mirror or dentist's mirror is an


. instrument used in dentistry
The head of the mirror is usually
round, and the most common sizes
used are the No. 4 and No. 5. A No. 2
is sometimes used when a smaller
mirror is needed, such as when
working
onimportant
back teeth with
a dental
its most
functions
are:
. allowing
dam in place
indirect vision by the

dentist .
reflecting light onto desired
surfaces.
retraction of soft tissue.

. A. Carvers
After the amalgam is condensed, it
must then be carved to approximately
. the same original tooth structure
Carvers have sharp cutting edges that
are used to shape, form, or cut tooth
. anatomy into amalgam restorations

Carvers

.B. Burnishers
When the carving is complete, the
.dentist may use burnishers
used to
. smooth and polish the restoration
remove scratches left on the amalgam
. surface by a carving instrument

Burnishers

C. disposable brush

used with etching and bonding


procedures associated with
composite resins is a disposable
. brush with a reusable handle
aiding in good infection control practices.

. Disposable brush and handle

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