DHYG 311 Principles of Instrumentation Area Specific Curettes

DHYG 311
Principles of Instrumentation
Area Specific Curets
Deborah L. Cartee, RDH, MS
–Discuss the rationale for removing hard
deposits from the teeth
–Determine the different methods for
removing hard deposits from the teeth
–Discuss the procedures that should proceed
calculus removal
–Determine which hand instruments are used
for calculus removal
–Determine the parts of area specific curets
(Gracey Curets)
–Evaluate the distinct characteristics of area
specific curets
–Identify which Gracey curets are in the
UMSOD scaling cassette
–Determine the correct cutting edge of the
area specific curet
–Understand the proper adaptation, insertion,
angulation, and activation of the area specific
–Evaluate successful instrumentation
Why Remove Calculus?
Calculus removal is critical to
periodontal health because:
• The porous surface provides a
mechanism for plaque attachment.
• It holds inflammatory toxic byproducts of plaque in contact with
gingival tissues.
How is calculus removed?
Scaling - the removal of calculus from
all tooth surfaces coronal to the
junctional epithelium
• supragingival scaling - removal of
calculus coronal to the free gingival
• subgingival scaling - removal of
calculus apical to the free gingival
margin but coronal to the junctional
Root Planning
The removal of remaining specks of
calculus, plaque,
endotoxins/lipopolysaccharides, etc.
The division between scaling and root
planning is arbitrary.
The ultimate goal is to create a
smooth tooth surface.
Periodontal Debridement
The treatment of gingival and periodontal
inflammation through mechanical removal
of tooth and root surface irritants to the
extent that the adjacent soft tissues
maintain or return to a healthy,
noninflammed state.
–Supragingival debridement
–Subgingival debridement
The goal of periodontal debridement is
return of tissue health.
When can I start Scaling?
• After:
Medical history/vital signs - to determine
contraindications to treatment and identify
factors to be considered when developing the
treatment plan
Extraoral/intraoral exam - to determine
contraindications to treatment and identify
factors to be considered when developing the
treatment plan
Periodontal probing - to determine the location,
distribution, shape, and depth of pockets
Exploring - to determine the location,
distribution, and amount of calculus
Which hand instruments can be used
for calculus REMOVAL?
• Area Specific (Gracey)
• Universal
• Sickle
• Hoe
• Chisel
• File
Area Specific curets
• Cross section
The top row of instruments are instruments found in your cassette:
Where each instrument is used:
Area Specific curets
• Parts of the Area Specific curets
–Working end (blade)
• back
• lateral surface
• face
• cutting edge
Area Specific curets
• Characteristics
Set of instruments; each designed for
specific areas and surfaces
Only one cutting edge is used for each
working end
Curved in two planes (up and to the side)
Offset blade (70 to 80 degrees to the shank)
Gracey Instruments:
 Site
 Types:
– 1/2
– Regular
– 7/8
– Rigids
– 11/12
– Minis
– 13/14
– After- Fives
Area Specific curets
• Determining the correct cutting edge
• Lower shank should be parallel to the long
axis of the tooth
• The face will be close to the tooth and
only partially seen if the correct end is
selected. The entire shiny face will be
seen and a sharp cutting edge will be
towards the gingiva if the incorrect end is
Area Specific curets
–Posterior teeth
• Gracey 11/12 for buccal, lingual, and mesial
surfaces of molars and premolars - insert at
distal line angle and use into mesial col area
• Gracey 13/14 for posterior distals - it has a
very angulated shank which allows for
adaptation to molar and premolar distals.
Insert at the distal line angle and use into
the distal col area.
–Anterior teeth
• Gracey 1/2 for anterior teeth - one end is
designed for use on the surface toward the
operator, the other end is designed for use
on the surfaces away from the operator.
Area Specific curets: Adaptation
– Objective: to keep the cutting edge on the tooth. This
will decrease trauma and increase effectiveness of
calculus removal.
– Keep the lower 1/3 of the cutting edge in contact with
varying tooth contours.
– Maintain adaptation by rolling the handle.
– More than the lower 1/3 of the cutting edge can be
adapted on the buccal and lingual surfaces.
– Once you reach the line angles only the lower 1/3
should contact the tooth. If the middle 1/3 is
contacting the tooth then the lower 1/3 will be into
soft tissue.
Area Specific curets
Do not overcompensate by only using the toe of
the instrument. You will not be able to remove
calculus with the toe.
When working subgingivally you will not be able to
see the blade. The handle position will provide a
cue to blade position.
The handle should be parallel or close to parallel
with the long axis of the tooth.
If the handle is perpendicular to the long axis,
the toe will be directed toward the junctional
Area Specific curets
• Insertion
– Face needs to be flat against the tooth (0º)
– Insert to the base of the pocket.
(45o – 90o)
Area Specific curets: Angulation
Refers to the angle between the face of the
blade and the tooth surface
Insert at 0º; reach base of sulcus; establish
working angulation of 45º -90º
To decrease or close angulation - move the
lower shank towards the tooth.
To increase or open angulation - move the
lower shank away from the tooth
For heavy deposits the angulation should be
close to 90º. For finishing strokes of root
planning the angulation should be close to
Area Specific curets
• Lateral Pressure
–The pressure of the instrument
against the tooth surface during
–Light, Moderate or Heavy pressure
Area Specific curets: Activation
Exploratory stroke is used to detect and
evaluate. A light grasp is needed for
maximum tactile sensitivity with the
exploratory stroke.
If calculus or roughness is detected then a
working stroke should be activated. The
working stroke requires a short, powerful pull
stroke. Must have a good fulcrum and firm
grasp. Engage the apical portion of the
deposit with a vertical or oblique stroke. Use
wrist (not finger) motion.
Working strokes should begin short and
powerful. They should become longer and
lighter as deposits are removed.
Area Specific curets
• Evaluation
– Use mirror, air, and explorer to evaluate
– Tissue response should also be used to
determine effectiveness (10-14 days).
Determine how many teeth you can complete in the
time allotted
ALWAYS start with the most posterior tooth in the
quadrant- Distal surface
– Begin with the 13/14 and complete distobuccal area of the
– Then complete the buccal to mesial surfaces with the 11/12
– NOW: with the same sequence (13/14, 11/12) complete
lingual surfaces
 When
you have completed the teeth originally
planned, move onto the remaining teeth in that
 Keep
in mind that you must keep an eye on the clock
so that all the surfaces of a tooth are completed
BEFORE you dismiss your patient.
 Sometimes
that means you can only complete one
tooth in the given time, or you might be able to
complete all the teeth in the quadrant.
 Consider the following when planning:
– Tenacity of the deposit (How difficult to remove?)
– Patient management (Are they a talker? Sensitive?)