Download Periodontal Scaling Instruments (Gracey Curettes and Sickle Scalers)

Periodontal Scaling
Instruments
(Gracey Curettes and Sickle Scalers)
 Periodontal
scaling is the therapeutic
procedure performed by a dentist or
dental hygienist to remove all
mineralized, hardened deposits from
the tooth's surfaces. It is performed
supra and subgingivally and can be
done using a non surgical (closed) or
a surgical (open) approach.
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Based on instrument design, how they
are used, where they are used and how
they work, the following classification
of periodontal scaling instruments is
used.
Periodontal Scaling Instruments
Sickle scalers
 Universal Curettes
 Area Specific Curettes
 Files
 Ultrasonic/Sonic Instruments
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Periodontal Scaling Instruments
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In the category of area specific curettes a sub
classification exists.
Area Specific Curettes
Gracey Curettes
Vision Curettes
Modifications to Gracey Design
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After five or extended series
Mini series
Langer series
Furcation series
Gracey Curettes
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The original Gracey series was
developed in the 1930's by Dr.
Clayton Gracey, a periodontist
at the University of Michigan.
They were designed to provide
better access to root surfaces in
deep pockets.
They feature long shanks and
unique blades, some with bends
improving access to complex
root surface morphology.
Gracey Curettes
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The original series contained
7 double ended instruments
(1/2; 3/4; 5/6; 7/8; 9/10;
11/12; 13/14).
In the 1980's, 2 modified
instruments were added to
the collection (15/16; 17/18).
Gracey Curettes
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Gracey curettes 1/2, 3/4, and 5/6 are used to
scale all tooth surfaces in the anterior sextants.
7/8 and 9/10 are used for scaling the buccal
and lingual aspects of teeth in the posterior
sextants.
11/12 and the 15/16 are used to scale the mesial
aspects of the teeth in the posterior sextant.
13/14 and 17/18 are used to scale the distal
aspects
Gracey Curettes
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Gracey curettes are available in stainless steel
or in carbon steel. Carbon steel requires more
care as it rusts very easily and also wears away
more quickly.
Instruments can come in the form of a solid
one piece instrument (usually stainless steel) or
as a cone socket instrument (usually carbon
steel). With the cone socket instrument, shank
and blade can be unscrewed and replaced.
Gracey Curettes
The design of the
Gracey curettes is unique
in that each end had only
one cutting edge
 It can adapt closely to
the specific tooth surface
for which it is intended.
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Gracey Curettes
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The cutting or useable edge of
the blade is the lower outer
aspect of the blade.
It can be identified by holding
the terminal shank of the end in
question, blade side lower, in a
vertical position and viewing
the blade portion head on.
The blade of the curette is
machined at a 70 degree angle
and the cutting edge exhibits a
curve, which is longer or convex
in relation to the "nonworking" edge.
Gracey Curettes
When adapting the Gracey instruments to
the teeth to perform scaling, the cutting
edge must first be identified and placed
against the surface to be scaled and the
terminal shank should be parallel to that
surface.
 In this position, the ideal working
angulation for calculus removal is
achieved.
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Gracey Curettes
Sickle Scalers
The sickle scaler, primarily used for
supragingival calculus removal, is a very
useful instrument.
 It is often the first instrument used to
remove large, heavy deposits thus
improving access to subgingival area for
other instruments.
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Sickle Scalers
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A number of different sickle scalers are
available in a variety of shapes and sizes.
 Towner
H-15
 Jacquette
 204 S; 204 SD
 Morse
 USC - 128
Sickle Scalers
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They all however have common features
making them suited to the removal of heavy
calculus deposits and working interproximally,
around the contact areas of teeth.
A flat blade cut at a 90 degree angle to the
shank.
 Cutting edges on both sides of the face of the
blade.
 The face of the blade is triangular tapering to a
strong, sharp point at the toe.
 The face of the blade may be straight or curved.
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Sickle Scalers
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It is the sharp pointed toe and the first 1-2 mm
of the lateral cutting edges that perform the
work.
Sickle Scalers
Grasp
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The firm but light hold a dental clinician has on
their instruments is referred to as "grasp".
A proper grasp enables the clinician to maneuver
the instrument around the tooth and correctly
direct pressure application for calculus removal
without damaging the periodontal tissues.
Three specific grasps are used. They are:
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pen grasp
modified pen grasp
palm-thumb grasp.
The modified pen grasp is the most useful.
Fulcrum
The resting of the third finger on a
firm intra- or extraoral site acts as a
fulcrum.
 This improves control of the
instrument and application of forces by
the working end against the tooth.
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Wrist and Arm Motion
The instrument/wrist/ forearm complex
must act as a unit rocking firmly but
smoothly on the fulcrum.
 Wrist twisting or independent finger
movement should be avoided. This would
result in pain, muscle fatigue, and
inflammation of the ligaments and nerves
of the wrist.
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Adaptation
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This refers to the placement of the
working end of the instrument in the
correct relationship to the tooth.
Angulation
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This is the angle formed
by the plane of the tooth
surface and the plane of
the face of the blade.
Efficient cutting
angulation is between 45,
90, and 70 degrees is
considered ideal. Less than
45 degrees is considered
"closed" and more than 90
degrees is considered
"open".
Insertion
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To avoid damaging the soft
tissues when entering the sulcus
with a large, sharp instrument,
the working end is inserted into
the sulcus with the face of the
blade "closed" or flattened to
the tooth surface.
Once in the depth of the pocket
or sulcus, the blade is opened 45
to 90 degrees for working
strokes.
Strokes
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This is the action of the working end on
an instrument as it is moved across a
tooth surface.
Exploratory strokes provide light tactile
feedback from the instrument tip.
Working strokes provide controlled
pressure against a tooth surface using an
appropriate cutting angulation.
Scaling strokes are short pulling strokes
made with firm pressure to remove
increment from root and enamel
surfaces.
Root planning strokes are made to
remove deposits and smooth the root
surface.
Working strokes are ideally a series of
overlapping strokes covering the entire
tooth surface.
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