DENTAL INSTRUMENTATION

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Veterinary dental nursing procedures

• DENTAL INSTRUMENTATION

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Prophy Kit

• Dental Explorer
• Periodontal Probe
• Dental mirror
• Supragingival scalers
• Subgingival scalers ( curettes )
• Elevators
• Root tip pick
• Extraction Forceps
• Tartar-cracking Forceps
• Buccal retractor
• Periosteal elevator/scalpel blades/sutures
• Needle holders
• Plaque revealing solution/swab

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Periodontal Explorer

• Has a fine, pointed tip
• Particularly useful in gingival pockets
• But be careful not to cause damage
• Feels the tooth surface for
• Roughness
• Indentations Holes
• Can check for open pulp cavities

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Periodontal Probe

• Commonly 1mm graduations
• Pocket depth
• 4-6 measurements per tooth, or
• Run probe along entire pocket
• Normal pockets
• Dog lt 2-3 mm, see vet if 3 mm
• Cat lt 0.5-1 mm, see vet if 1 mm
• Horse lt 3 mm

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Dental Mirror

• Used to check hidden side of tooth
• Un-fogged by blowing air over it
• Also makes a very useful soft tissue retractor

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Manual Descalers
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Manual Descalers

• 2 broad types
• scalers
• Outside gingival pocket only
• curettes
• Inside Outside gingival pocket

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Scalers vs Curettes

• Rounded tip
• Rounded back

• Pointed tip
• Pointed back

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Scaler

• Uses
• Descaling outside gingival pocket only

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Some types of Scaler

• Jacquette scaler (claw type with sickle explorer)
• Interproximal scaler (claw type)
• Offset scaler

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Curette

• Uses
• Descaling inside and outside gingival pocket
• Root planing

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Some types of Curette

• Some curettes are curved in 2 planes
• Permits fit into curvature of gingival pocket
• Angulation of working edge
• 90 (standard)
• 70

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Some types of Curette
Standard90 allows for 2 useful cutting
edgesCurved in 1 plane
Gracey70 allows for 1 useful cutting
edgeCurved in 2 planes
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Using Curette
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Other descalers

• Hoe
• Not often used nowadays

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Holding/Using a Manual Descaler

• Modified pen grip
• Place middle finger closest to point
• Use 6-10 pull strokes per surface

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Modified Pen Grip
Middle finger
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Modified Pen Grip
Middle finger

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Maintenance

• Wash
• use disinfectant
• Dry
• Sharpen
• then rinse again to remove any oil
• Sterilize
• Autoclave
• Store
• Solid tray

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Sharpening

• All dentists stress the importance of having hand
  instruments sharp
• Blunt scaling instruments
• Cause operator fatigue
• Increase time of scaling
• Burnish rather than remove calculus leaving
  simply smooth calculus
• But incorrect or excessive sharpening
• Shortens instrument life

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Can sharpen either

• Edges of the Back
• Using flat stone, or
• Flat of the Front Face
• using the conical stone

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Checking for sharpness

• Use a magnifiying glass
• Use good lighting
• Glare test A dull edge itself reflects light
  whereas a sharp edge doesnt reflect light it
  is only a line separating the two adjacent
  surface reflections
• Test on a plastic/acrylic testing stick (if
  available)
• Pencil thick plastic rod or syringe case
• Approximates finger nail hardness
• Apply and pull instrument at normal scaling angle
• Sharp instrument should grip plastic
• Dull instruments slides easily
• Test along entire cutting edge

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Sharpening principles

• Use fine-grained stone
• Ideally sharpen after each dental
• Stone lubrication
• Helps reduce scratching of instrument
• Helps the sliding movement
• Helps to stop the fine particles of metal
  clogging the stone
• Use a thin layer of either
• Fine oil, or
• Petroleum jelly
• Too much oil obscures the edge
• Can also sharpen without oil (dry stone)
• Metallic particles suspended in oil less likely
  to damage instrument
• Allows for stone autoclaving
• Ideal angle is generally 100-110 degrees but
  varies with the instrument
• Use a secure finger rest
• Use a short stroke
• Prevent grooving of the stone by varying position
  on stone

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Curette sharpening

• Start with the 110 degree angle
• Because the instruments edge is curved to
  contour to teeth one needs to successively work
  along the edge in a series of overlapping strokes
• Start with the end nearest the shank
• Use slow, steady pull strokes that start at
  cutting edge and end at the rounded back
• Gracey curettes are sharpened on one edge only
  and around the toe
• Can use a hand sharpening cone to sharpen the
  flat edge (the face)

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Curette sharpening
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Accurate sharpening - flat
110
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Accurate sharpening - conical
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Sharpening Stones

• Arkansas best stone finer grain
• Lubricate stone first lightly
• or use stone dry
• Move stone or instrument

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Sterilisation of descalers

• Instruments should be free of oil (after
  sharpening)
• Oil protects microorganisms from sterilisation
• Use soap and water if required

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Protecting

• Protect and sharp ends of instruments by
• Placing in dedicated containers
• Can use a hard instrument tray or a soft
  instrument pack
• Covering ends with drip tubing

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Dental (Root) elevators

• Various sizes
• Some also have wing-like projections

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Extraction forceps

• Grip tooth to extract
• Small, medium large
• Only after tooth loosened
• Can also use to remove gross calculus carefully

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Root Tip Pick

• Used to remove root tips
• Various shapes and sizes

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Periosteal Elevator

• Used to lift (scrape) gingiva or oral mucosa off
  bone
• Many shapes rounded, squared or oblique ends
• Have a flat sharp edge and a rounded back for
  detaching mucosa or periosteum from bone

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Bone Curette

• Used to clean out sockets after removing infected
  roots
• Spoon shaped end

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Scalpel

• Used to sever the epithelial attachment of the
  gingiva to the tooth
• Angled at 45 deg to the long axis of the tooth to
  get around widened part of crown (the enamel
  bulge)  

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Types of Machine Descalers

• Ultrasonic
• Sonic
• Rotosonic

Electricity driven
Air driven
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Principles of Machine descalers

• A vibrating tip
• Hard tissues shattered by vibrations
• Soft tissues scoured by bubbles (if enough power)
• This bubble formation called cavitation
• Vibrating tip and tooth need to be cooled by a
  jet of water

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Ultrasonic Machine descalers

• Can be classified by
• How tip is made to move
• How tip actually moves

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How ultrasonic tips made to move

• Magnetorestrictive
• Fig-8 movement
• Ovoid movement (Odontoson, iM3 42-12)
• Piezoelectric
• Linear movement

IM 42-12
Piezo type
Magneto type
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How ultrasonic tips move

• Oval

Figure-8
Curved-line
Most versatile, works equally at all angles
Need to reposition
Need to reposition hammers tooth
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Benefits of Machine Descalers

• Quick
• Less anaesthetic time

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Risks of Machine Descalers

• Can cause overheating of tooth
• Heat destruction (thermal necrosis) of dentin
  pulp
• Prevented by water jet
• But water needs to
• flow properly, and
• reach the heated area
• Can cause gouging of enamel
• If point of tip is used

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Ultrasonic tip water supply

• Various tips can be used
• Most have water coming out at a point away from
  the tip
• Broader spray
• Some have water coming out at the very tip
• Some of these can be used in gingival pocket
  (subgingivally)

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Ultrasonic and Subsonic scalers

• Vibrating tip produces bubbles which release
  energy as bubbles burst
• Energy removes plaque/calculus
• Tip vibrates at 15,000 - 30,000 Hz
• Cool with water as generate lot heat
• Do not leave on tooth gt 10-15 seconds

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Benefits of Machine Descalers

• Quick

IM 42-12
Magneto type
Piezo type
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Other Dental Systems

• These are rotating devices (unlike an Ultrasonic
  system)
• They are used primarily for
• Cutting teeth/bone
• Polishing teeth
• Some attachments also permit
• Scaling teeth (Sonic Rotosonic)

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Electric-Driven Dental Systems

• Use a motor to drive bur, disk or polishing cup
  at low speeds lt30,000 rpm
• Single/separate units
• High torque, slow rotation, mild vibration
• Lot heat water to cool

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Individual Electric Units

• Cutting
• Very slow cutting
• Polishing
• Ok for this
• Cheaper than air-driven systems
• Slow
• /- water cooling

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Air-Driven Dental Systems

• Use if large case load
• Produce high pressure from a compressor to
  produce speeds gt 400,000 rpm used for extraction/
  root canal work etc, burs used
• Also come with low speed handpiece lt 20,000 Hz
  and hence produces less damage to tooth surface
  and used for polishing or cutting dentine
• Has 3 way air /water syringe wash away debris
  etc
• Produces less heat so no water needed for cooling
• Can use under gingival sulcus
• Can use with rotosonic scalers

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Vet Base Air-Driven Systems
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Rotosonic descaler
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Rotosonic descaler

• 6 sided burs that fit into the high speed air
  driven handpiece
• Rotated at 300,000 rpm dislodges calculus from
  enamel
• Use lightly or else destroys enamel
• Can use in a healthy gingival sulcus?
• Not generally recommended (cause post-dental pain
  in people)

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Golden Rules

• Never use the point end on
• lt 10 seconds per tooth at one time
• But unlimited time if IM3 42-12
• lt 2 seconds in gingival pocket
• But unlimited time if IM3 42-12
• Light pressure
• Adequate water flow

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Drilling/Cutting

• Can be done with either
• Electric-Driven Dental Units
• Air-Driven Vet Base Air driven Systems

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The Vet Base Air-Driven Systems
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The Vet Base Air-Driven Systems
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Care of ultrasonic handpieces

• Dont drop (v expensive)
• Rod can be replaced if broken

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Care of air-driven handpieces

• Dont drop (also v expensive)
• Lubricate daily
• Spray into handpiece (not air line)
• Spray into 2nd largest hole
• 2nd largest hole is air input into handpiece
• (Largest hole is air ouptut)
• Can be autoclaved but this may shorten life

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High Low Speed Handpieces
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High-Speed Handpiece

• Used for cutting drilling teeth bone (mainly)
• Very fast but less power
• Needs regular lubrication
• Can be autoclaved

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Slow-Speed Handpiece

• Used for polishing (mainly)
• Powerful (high torque, i.e. difficult to stall)
• Can easily overheat tooth
• Collar controls
• Forward Reverse
• Speed

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Air/Water Handpiece

• Water spray
• press water button
• Air spray
• press air button
• Mist Spray
• press air and water buttons together

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Dental burs

• Uses
• Cutting (tooth/bone)
• Smoothing (fillings)
• Parts
• Shank
• Working End
• Made of
• steel, stainless steel, tungsten carbide, steel
  coated in diamond grit

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Bur Shank Types

• Friction Grip (Long Short)
• Latch Grip

Latch grip
Friction grip (lge)
Friction grip
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Cutting (Fissure) Bur Ends

• Straight
• Taper
• Round
• Pear
• Inverted Cone

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Crosscut variation

• Crosscut
• Horizontal notching
• e.g. crosscut fissure bur

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Finishing burs

• Used to
• Smooth fillings, cappings etc
• Smooth bone spurs
• Smooth enamel

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Prophy Paste

• More abrasive than homecare products
• Use soft cup
• Can leave on tooth 2-5 seconds to help dissipate
  heat
• Wash off

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Oscillating-type Prophy Attachment
Prophy Cup
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Fluoride Gel

• Usefulness ?
• Dogs and cats less prone to cavities than humans
• Does at least desensitize teeth
• Blown off at end of dental
• Apply last thing

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Cutting teeth in the good ol days
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Plaque Revealer
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2 kinds of Elevators Curettes

• Elevator
• Root
• Dentistry
• Periosteal
• Dentistry Orthopaedic surgery
• Curette
• Descaling
• Dentistry
• Bone
• Dentistry Orthopaedic surgery

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The End