HAND
INSTRUMENTS IN
OPERATIVE
DENTISTRY PRESENTED BY-
DR. SANKET HANS PANDEY
PG STUDENT, DEPARTMENT OF CONSERVATIVE DENTISTRY AND ENDODONTICS
CONTENTS
INTRODUCTION
MATERIALS USED
CLASSIFICATION
INSTRUMENT PARTS
INSTRUMENT NOMENCLATURE
INSTRUMENT FORMULA
TYPES OF HAND CUTTING INSTRUMENTS
INSTRUMENT GRASP
SHARPENING OF HAND INSTRUMENTS
INTRODUCTION
A dental instrument is an appliance, or tool by
means of which a dentist performs dental
operations.
Broadly classified as -
a.Hand instruments- instruments that are hand
held when used.
b.Rotary instruments- are operated in a
handpiece which in turn is hand held.
MATERIALS USED
CARBON STEEL
It is harder than stainless steel but corrodes easily and posses more
chance of being fractured due to dropping.
Carbon-1%
Manganeese-0.2%
Silicon-0.2%
Iron- 98.4-98.6%
STAINLESS STEEL
Stainless steel alloy contains 72 to 85% iron, 15 to 25% chromium
and 1 to 2% carbon.
Stainless steel remains bright under most conditions, but loses a keen
edge during use much more quickly than does carbon steel.
Commonly used nowdays due to its more sterlization friendly
properties.
CLASSIFICATION BY
STURDEVANT
HAND INSTRUMENTS
CUTTING NON CUTTING
AMALGAM PROBES
EXCAVATORS CHISELS OTHERS EXPLORERS
CONDENSORS
ORDINARY STRAIGHT KNIVES MIRRORS
HATCHET CURVED ORFILES
HOE BINANGLE SCALERS
ANGLE ENAMEL CARVERS
FORMER HATCHET
SPOON GMT
PARTS OF INSTRUMENTS
HANDLE (c)
SHANK (b)
BLADE (a)
HANDLE
It is the portion of the instrument where the
operator holds the instrument.
They are usually straight and may have serrations
for better grip.
Handles are available in various sizes and shapes.
A variety of handle configurations are available .
Padded handles are said to increase operator comfort and grip
during use.
The standard metal handle has a diameter of approximately ¼
inch (6.4 mm).
(9.5-mm) diameter handle are said to be more ergonomic
and less likely to contribute to the development of carpal tunnel
syndrome.
A handle with an intermediate diameter (5/16 inch or 7.9 mm) is
also available.
The larger diameters are encouraged primarily for dental
hygienists, who spend a large part of their day using hand
instruments. A drawback to the use of larger handles in
operative dentistry is the space they consume in an instrument
tray.
Standard stainless steel handle Padded handle with diameter
with a of 8mm
diameter of approximately 6.4
mm.
Large handle with a dimater of
9.5mm
SHANK
The shank joins the blade to the handle of the
instrument and is angled to keep the working end
of the blade within 2 to 3 mm of the axis of the
handle.
This angulation is intended to provide balance, so
that when force is exerted on the instrument it is
not as likely to rotate, which would decrease the
effectiveness of the blade and could possibly
cause damage to the tooth or soft tissue.
Dr. G.V. Black classified instruments based on the number of
shank angles as
straight
monoangle (one),
bin-angle (two)
triple-angle (three)
quadrangle (four)
Blade/Nib
It is the working part of the instrument. It is
connected to the handle by the shank.
For non-cutting instruments, the working part is
termed the nib and is used to place, adapt and
condense the materials in the prepared tooth.
Depending on the materials being used, the
surface of the nib may be plain or serrated.
NOMENCLATURE
An order name describes that for which an
instrument is used, as for example, excavator,
pluggers, burnishers,
A sub-order name describes where or how
an instrument of a given order is used and is
made by inserting a prefix before the order name.
Examples, hand pluggers push or pull scalers, etc.
CLASS
The class describes the form or shape of the cutting
edge:
a- Chisel
b- Hatchet
c- Hoe
d- Gingival margin trimmer
SUBCLASS
The subclass delineates the angle or angles of the
shank of the instrument:
a- Straight - no angle
b- Mono angle - one angle
c- Bin angle - two angles
d- Triple angle - three angles
Instrument Formula
Given by Dr. G.V. Black.
Cutting instruments have formulas describing the dimensions
and angles of the working end. These are placed on the
handle using a code of three or four numbers separated by
dashes or spaces (e.g., 10-8.5-8-14)
The first number indicates the width of the blade or primary
cutting edge in tenths of a millimeter (0.1 mm) .(e.g., 10 = 1
mm)
The second number of a four-number code indicates the
primary cutting edge angle, measured from a line parallel to
the long axis of the instrument handle in clockwise
centigrades. The angle is expressed as a percent of 360
degrees (e.g., 85 = 85% × 360 degrees = 306 degrees)
If the edge is locally perpendicular to the blade, this number is
normally omitted, resulting in a three-number code.
The third number (second number of a three-number code)
indicates the blade length in millimeters (e.g., 8 = 8 mm)
The fourth number (third number of a three number code)
indicates the blade angle, relative to the long axis of the
handle in clockwise centigrade (e.g., 14 = 50 degrees).
INSTRUMENTS
EXCAVATORS
Excavators are
designed for the
excavation and
removal of carious
dentin and for the
shaping of the internal
parts of cavities.
ORDINARY HATCHET
They have the edge of the blade running in a direction
parallel with the handle. They are usually single-planed
bibevelled instruments.
Instrument formula – (3-2-28)
USES-
on anterior teeth for preparing retentive areas
sharpening internal line angles, particularly in preparations for
direct gold restorations.
HOE EXCAVATORS
The hoe excavator has the primary cutting edge of
the blade perpendicular to the axis of the handle.
Used in a PULL motion.
Instrument formula –(4 ½- 1 ½ - 22)
Used for-
planing tooth preparation walls
forming line angles
Commonly used in Class III and V preparations for
direct gold restorations.
ANGLE FORMER
A special type of excavator is the angle-
former.
It is monoangled and has the primary cutting
edge at an angle (other than 90 degrees) to
the blade.
It may be described as a combination of a
chisel and a gingival margin trimmer.
It is available in pairs (right and left)
It is a triple beveled instrument.
They cut in vertical, push or pull motion.
Instrument formula- (12-85-5-8)
Uses -
1. primarily for sharpening line angles and
creating retentive features in dentin in
preparation for gold restorations.
2. It also may be used in placing a bevel on
enamel margins.
SPOON EXCAVATOR
It has a semicircular cutting edge.
The blades are slightly curved, and the cutting edges
are either circular or clawlike.
The circular edge is known as a discoid, whereas the
clawlike blade is termed a cleoid .
The shanks may be bin-angled or triple-angled to
facilitate accessibility.
USES -
used for removing caries
carving amalgam or direct wax patterns.
CHISEL
STRAIGHT CHISEL
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.
The shank and blade of the chisel also may be
slightly curved (Wedelstaedt design) or may be
bin-angled.
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 because a 180-degree turn of the
instrument allows for its use on either side of the
preparation.
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.
The blade with a distal bevel is designed to plane a wall that
faces the blade’s inside surface.
The blade with a mesial bevel is designed to plane a wall that
faces the blade’s outside surface
ENAMEL HATCHET
These are single planed paired instruments (right
and left type)
It can be binangled, triple angled or parallel with
shaft.
Used with push/pull vertical movements.
It is beveled on one side.
Used to cut or cleave undermined enamel in
proximal cavities and on buccal or lingual walls.
GINGIVAL MARGIN
TRIMMER
The gingival margin trimmer is designed to
produce a proper bevel on gingival enamel
margins of proximoocclusal preparations.
It is similar in design to the enamel hatchet except
the blade is curved and the primary cutting edge
is at an angle (other than perpendicular) to the
axis of the blade.
It is made as right and left types.
It also is made so that a right and left pair is either
a mesial pair or a distal pair.
When the second number in the formula is 90 to
100, the pair is used on the distal gingival margin.
When this number is 75 to 85, the pair is used to bevel the mesial
margin.
OTHER CUTTING
INSTRUMENTS
Knives
Files
Cleoid blade
Discoid blade
KNIVES
Knives, known as finishing knives, amalgam knives, or gold
knives, are designed with a thin, knifelike blade that is made in
various sizes and shapes.
Knives are used for trimming excess restorative material on the
gingival, facial, or lingual margins of a proximal restoration or
trimming and contouring the surface of a Class V restoration.
FILES
Files also can be used to trim excess restorative material. They
are particularly useful at gingival margins. Blades of files are
extremely thin, and teeth on cutting surface are short.
The teeth of the instrument are designed to make the file
either a push or a pull instrument.
Files are manufactured in various shapes and angles to allow
access to restorations.
DISCOID-CLEOID BLADE
The discoid-cleoid instrument is used principally for
carving occlusal anatomy in unset amalgam
restorations.
It also may be used to trim or burnish inlay-onlay
margins. The working ends of this instrument are
larger than the discoid or cleoid end of an
excavator.
NON CUTTING
INSTRUMENTS
1. Amalgam carrier
2. Condensor
3. Burnisher
4. Carver
5. Mouth mirror
6. Explorer
7. Probes
Amalgam Carrier
For dental amalgam restorations, amalgam is placed into the
preparation with an amalgam carrier, an instrument with a
hollow cylinder that is filled with amalgam.
A plunger operated with a finger lever pushes the amalgam out
of the carrier into the preparation.
Amalgam carriers are usually supplied as double-ended
instruments. They are available in several different diameters; for
example,
mini is 1.5 mm;
regular (medium) is 2.0 mm;
large is 2.5 mm; and
jumbo is 3.0 to 3.5 mm.
These are the approximate inside diameters of the cylinders of
amalgam carriers and may vary slightly from manufacturer to
manufacturer.
A poorly packed amalgam carrier may result in amalgam fall out before it
is ejected into the prepared tooth.
After restoration is completed, any remaining amalgam alloy is expelled out from
the carrier into the amalgam well, otherwise carrier will no longer be serviceable if
the amalgam is allowed to harden in the carrier.
CONDENSOR
Condensers are used to compress amalgam or to
push resin composite or glass-ionomer materials
into all areas of the preparation.
The working ends, or nibs, of condensers may be
any shape, but usually they are round with flat
ends .
Condensers can be hand or mechanical in nature.
BURNISHER
Burnishers are used for several functions.
The word burnish is defined as “to make shiny or lustrous, especially by
rubbing; to polish” and “to rub (a material) with a tool for
compacting or smoothing or for turning an edge.
Used to -
to smooth and polish the restoration.
remove scratches left on the amalgam surface by a carving
instrument.
Burnishers have smooth round end and come in single or double
end. Different types of burnishers are available but most
commonly used are
PKT3—designed by Peter K Thomas —Rounded cone-shaped
burnisher.
• Beavertail condenser—narrow type of burnisher.
• Ovoid burnisher
Beavertail Burnisher
The beavertail burnishers are
useful for burnishing margins of cast gold
restorations.
PKT3 (rounded cone-shaped) burnisher,
designed by Peter K. Thomas
as a waxing instrument but useful in
placing direct restorations as well; its
rounded end and cone
used for final condensation of shape allow it to serve most functions that
amalgam and the initial shaping of a small ball-shaped burnisher would serve,
the occlusal anatomy in amalgam. plus others
Carver
Carvers are used to shape amalgam and resin composite
and other toothcolored materials after they have been
placed in tooth preparations.
In general, when a convex amalgam contour is being
carved, a concave-shaped carver facilitates the shaping
or carving. Likewise, a convex carver facilitates carving of
a concave shape.
A convex carver may be used to carve a convex surface;
the surface is carved tangentially, with multiple strokes.
Whether a carver is used to carve amalgam or resin
composite, it is important that the blade be sharp.
The cleoid-discoid (or discoid-cleoid) carvers shown are used
primarily for occlusal carving in amalgam restorations.
The Walls no. 3 carver is useful for carving occlusal surfaces; the
end that is shaped like a hoe is also useful for shaping cusps
and for carving facial and lingual surfaces of large amalgam
restorations.
The Hollenback no. ½ carver is useful for occlusal, proximal, and
axial (facial and lingual) surfaces.
The interproximal carver (IPC) has very thin blades and is
extremely valuable for carving proximal amalgam surfaces near
the interproximal contact area, as well as those surfaces
mentioned for the Hollenback carver.
Frahm’s Carver(DIAMOND CARVER) is to used to carve the
occlusal surface of amalgam restorations.
MOUTH MIRROR
For every procedure performed in the mouth, the
dentist must have clear and distinct vision of the
field
When needed, the mouth mirror allows the
operator to visualize areas of the mouth that he or
she would not otherwise be able to see. It also
allows the operator to maintain a body position
that will reduce health problems associated with
poor posture.
The mouth mirror can also serve as a retractor of
soft tissue (tongue, cheeks, or lips) to aid access
and visualization
For clarity of vision, the reflective surface of the mirror should be
on the external surface of the glass. This type of mirror is called a
front-surface mirror.
Mouth mirrors are usually round and come in a variety of sizes.
The most widely used sizes for adults are the no. 4 and no. 5. For
constricted areas in posterior regions of the mouth, when a rubber
dam is in place, a smaller mirror, such as a no. 2, is helpful.
Types of Mouth Mirror
• Front surface reflecting mirror: Here the coating is present
on front surface of the mirror to prevent image distortion.
Rear surface reflecting mirror: It is most commonly used
mirror. In this, coating is present on back side of the mirror
• Plane or flat surface: It provides clear image without
distortion
• Concave surface: It is used to provide different degrees
of magnification, but it causes image distortion
• One sided: Image on one side
• Two sided: Image on either side
Advantage of 2 sided mirror is retraction with indirect vision
simultaneously
EXPLORER
Explorers. Explorers are pointed instruments used to feel tooth
surfaces for irregularities and to determine the hardness of
exposed dentin.
The explorer that is used most often is the shepherd’s hook, or no.
23, explorer.
Another useful shape is a cowhorn explorer, which provides
improved access for exploring proximal surfaces.
The no. 17 explorer is also useful in proximal areas
PROBES
Probes are used in restorative dentistry to determine the
dimensions and features of preparations and restorations.
3 commonly used probes are
Williams probe
PCP 12 probe
PSR probe (periodontal screening and recording)
Main differences between these probes are based upon-
Position of millimeter marking
Differences in diameters
Configuration of marking (notched or painted)
Williams Probe
PCP 12 Probe
PSR Probe
Modified Pen Grasp
• The grasp that permits the
greatest delicacy of touch is the
modified pen grasp
• It is similar, but not identical, to
that used in holding a pen
• The pads of the thumb and of
the index and middle fingers
contact the instrument, while
the tip of the ring finger (or tips
of the ring and little fingers) is
placed on a nearby tooth
surface of the same arch as a
rest.
• The palm of the hand generally is facing away from the operator.
The pad of the middle finger is placed near the topside of the
instrument; by this finger
working with the wrist and the forearm, cutting or cleaving pressure is
generated on the blade.
Inverted Pen Grasp
The finger positions of the inverted pen grasp are the same
as for the modified pen grasp. The hand is rotated,
however, so that the palm faces more toward the
operator .
This grasp is used mostly for tooth preparations employing
the lingual approach on anterior teeth.
Palm-and-Thumb Grasp
The palm-and-thumb grasp is similar to that used for holding
a knife while paring an apple.
The handle is placed in the palm of the hand and grasped by all the
fingers, while the thumb is free of the instrument, and the rest is
provided by supporting the tip of the thumb on a nearby tooth of the
same arch or on a firm, stable structure.
For suitable control, this grasp requires careful use during cutting.
An example of an appropriate use is holding a handpiece for cutting
incisal retention for a Class III preparation on a maxillary incisor
Modified Palm-and-Thumb Grasp
The modified palm-and-thumb grasp may be used when it is
feasible to rest the thumb on the tooth being prepared or the
adjacent tooth.
The handle of the instrument is held by all four fingers, whose
pads press the handle against the distal area of the palm and
the pad and first joint of the thumb. Grasping the handle
under the first joints of the ring finger and little finger provides
stabilization. This grip fosters control against slippage.
Sharpening of hand
instruments
Why to sharpen the instrument?
A dull instrument can-
cause more pain
prolong operating time
difficult to control
reduce quality and precision in tooth preparation
Sharpness Test
Scrape Test
Sharpness of an instrument can be tested by lightly resting the
cutting edge on a hard plastic surface. If the cutting edge
digs in during an attempt to slide the instrument forward
over the surface, the instrument is sharp.
If it slides, the instrument is dull. Only very light pressure is
exerted in testing for sharpness.
Thumbnail Test
Hold the sharpened edge of the instrument at 45 degree to
the thumbnail
Exert mild pressure on the instrument, if it slips along the nail, it is
blunt.
If the instrument shaves or grabs the nail, it is sharp
PRINCIPLES OF SHARPENING
Sharpen instruments only after they have been cleaned and
sterilized.
Establish the proper bevel angle (usually 45 degrees) and the
desired angle of the cutting edge to the blade before placing
the instrument against the stone, and maintain these angles
while sharpening.
Use a light stroke or pressure against the stone to minimize
frictional heat.
Use a rest or guide whenever possible.
Remove as little metal from the blade as possible.
After sharpening, resterilize the instrument along with other
items on the instrument tray setup.
Keep the sharpening stones clean and free of metal cuttings.
THANK YOU
