Operative Dentistry 1: DEN 030

Student Activity Sheet #9

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

Lesson title: Instruments and Equipments Materials:

Lesson Objectives: black ballpen, study model, any
At the end of the day, you will be able to​: hand instruments, mobile phone
● Identify Hand Cutting Instruments for Tooth Preparation camera
● Determine the importance of Identifying Hand Cutting References:
instruments for Tooth preparation during Clinical Practice. Sturdevant’s Art and Science of
● Demonstrate how to do the Hand Instrument Technique Operative Dentistry 5​th​ Edition
Chapter 7
https://pocketdentistry.com/6-instru
ments-and-equipment-for-tooth-pre
paration/

Productivity Tip:
Good day! You are about to start your module. Do short stretching and breathing exercises. After you are
done, sit down, be comfortable and say a short prayer. You are now ready to start your work. Enjoy and
learn!

A. LESSON PREVIEW/REVIEW
1) Introduction (2 min)
The removal and shaping of tooth structure are essential aspects of Operative dentistry. Initially, this
was a difficult process accomplished entirely by the use of hand instruments. The introduction of rotary,
powered cutting equipment was a truly major advance in dentistry. Modern high-speed equipment has
eliminated the need for many hand instruments for tooth preparation. Nevertheless,
hand instruments remain an essential part of the armamentarium for quality operative dentistry.
2) Activity 1: What I Know Chart (Part 1)
Let’s track your learning. Reflect on the questions found in the second column and write your answers
and thoughts in the first column, “What I know”- this will be a record of your background experience on
the main ideas in this lesson. Leave the third column: What I Learned blank at this time.

What I Know Guide Questions: What I learned:(Activity 4)

1. What are the instruments and

equipment used for tooth
preparation?

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2. What is the importance of

knowing this instrument and
equipment as future Clinicians?

3. What are the functions of

these instruments and
equipment for tooth
preparation?

B. MAIN LESSON
1.) Activity 2: Content Notes (13 min)
Read and study the illustrations carefully. Highlight key points to absorb the concepts clearly.
Please refer to the text book for an in-depth study.
Modern hand instruments, when properly used, produce beneficial results for the operator and the patient.
Some of these results can be satisfactorily achieved only with hand instruments and not with rotary
instruments. Preparation form dictates some circumstances in which hand instruments are to be used,
whereas accessibility dictates others.
Terminology and Classification
❖ Categories
The hand instruments used in the dental operatory may be categorized as (1) cutting (excavators, chisels, and
others) or (2) non-cutting (amalgam condensers, mirrors, explorers, probes). Excavators may be subdivided
further into ordinary hatchets, hoes, angle formers, and spoons. Chisels are primarily used for cutting enamel
and may be subdivided further into straight chisels, curved chisels, bin-angle chisels, enamel hatchets, and
gingival margin trimmers. Other cutting instruments may be subdivided as knives, files, scalers, and carvers. In
addition to the cutting instruments, a large group of non-cutting instruments is also in use.
❖ Design
Most hand instruments, regardless of use, are composed of three parts: handle, shank, and blade. For many
non-cutting instruments, the part corresponding to the blade is termed nib. The end of the nib, or working
surface, is known as face. The blade or nib is the working end of the instrument and is connected to the handle
by the shank. Some instruments have a blade on both ends of the handle and are known as double-ended
instruments. The blades are of many designs and sizes, depending on their functions.

Double-ended instrument illustrating three component parts of hand instruments: blade (​a​), shank (​b​), and handle (​c)​ . ​(Modified from Boyd LRB: ​Dental instruments: A pocket guide​,
ed 4, St. Louis, 2012, Saunders.)

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Handles​ are available in various sizes and shapes. Early hand instruments had handles of quite large
diameter and were grasped in the palm of the hand. A large, heavy handle is not always conducive to
delicate manipulation. In North America, most instrument handles are small in diameter (5.5 mm) and
light. They are commonly eight-sided and knurled to facilitate control. In Europe, the handles are often
larger in diameter and tapered.
Shanks,​ which serve to connect the handles to the working ends of the instruments, are normally
smooth, round, and tapered. They often have one or more bends to overcome the tendency of the
instrument to twist while in use when force is applied.
Enamel and dentin are difficult substances to cut and require the generation of substantial forces at the
tip of the instrument. Hand instruments must be balanced and sharp. Balance allows for the
concentration of force onto the blade without causing rotation of the instrument in the operator’s grasp.
Sharpness concentrates the force onto a small area of the edge, producing a high stress.
Balance is accomplished by designing the angles of the shank so that the cutting edge of the blade lies
within the projected diameter of the handle and nearly coincides with the projected axis of the handle.
For optimal anti-rotational design, the blade edge must not be off-axis by more than 1 to 2 mm. All
dental instruments and equipment need to satisfy this principle of balance.
❖ Shank Angles
The functional orientation and length of the blade determine the number of angles in the shank
necessary to balance the instrument. Black classified instruments on the basis of the number of shank
angles as mon-angle (one), bin-angle (two), or triple-angle (three). Instruments with small, short blades
may be easily designed in mon-angle form while confining the cutting edge within the required limit.
Instruments with longer blades or more complex orientations may require two or three angles in the
shank to bring the cutting edge close to the long axis of the handle. Such shanks are termed
contra-angled.
❖ Names
Black classified all of the instruments by name.In addition, for hand-cutting instruments, he developed a
numeric formula to characterize the dimensions and angles of the working end. Black’s classification
system by instrument name categorized instruments by (1) function (e.g., scaler, excavator), (2)
manner of use (e.g., hand condenser), (3) design of the working end (e.g., spoon excavator, sickle
scaler), or (4) shape of the shank (e.g., mon-angle, bin-angle, contra-angle).2 These names were
combined to form the complete description of the instrument (e.g., bin-angle spoon excavator).
❖ Formulas
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). The instrument is positioned so that this number always exceeds 50. 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

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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). For these measurements,
the instrument is positioned such that this number is always 50 or less. In some instances, an additional
number on the handle is the manufacturer’s identification number. It should not be confused with the
formula number. This identification number is included simply to assist the specific manufacturer in
cataloging and ordering.
❖ Bevels
Most hand cutting instruments have on the end of the blade a single bevel that forms the primary
cutting edge. Two additional edges, called secondary cutting edges, extend from the primary edge for
the length of the blade Bi-beveled instruments such as ordinary hatchets have two bevels that form the
cutting edge.

​ ​Chisel blade design showing primary and secondary cutting edges.

​Examples of hand instruments called excavators (with corresponding instrument formulas). ​A,

Bi-beveled ordinary hatchet (3–2–28). ​B,​ Hoe ( ). ​C,​ Angle former (12–85–5–8).
Certain single-beveled instruments such as spoon excavators and gingival margin trimmers are used with a
scraping or lateral cutting motion. Others such as enamel hatchets may be used with a planing or direct cutting
motion and a lateral cutting motion. For such single-beveled designs, the instruments must be made in pairs,
with the bevels on opposite sides of the blade. Such instruments are designated as right beveled or left
beveled and are indicated by appending the letter R or L to the instrument formula. To determine whether the
instrument has a right or left bevel, the primary cutting edge is held down and pointing away, and if the bevel
appears on the right side of the blade, it is the right instrument of the pair. This instrument, when used in a

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scraping motion, is moved from right to left. The opposite holds true for the left instrument of the pair. One
instrument is suited for work on one side of the preparation, and the other is suited for the opposite side of the
preparation.

Examples of hand instruments called spoon excavators (with corresponding instrument formulas). ​A,​ Bin-angle spoon (13–7–14). ​B,​ Triple-angle spoon (13–7–14). ​C,​ Spoon
(15–7–14).

Examples of hand instruments called chisels (with corresponding instrument formulas). ​A,​ Enamel hatchet (10–7–14). ​B,​ Gingival margin trimmer (

). ​C,​Gingival margin trimmer ( ).

Most instruments are available with blades and shanks on both ends of the handle. Such instruments are
termed double-ended. In many cases, the right instrument of the pair is on one end of the handle, and the left
instrument is on the other end. Sometimes, similar blades of different widths are placed on double-ended
instruments. Single-ended instruments may be safer to use, but double-ended instruments are more efficient

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because they reduce instrument exchange.

Instruments having the cutting edge perpendicular to the axis of the handle, such as bin-angle chisels
instruments with a slight blade curvature (Wedelstaedt chisels), and hoes, are single-beveled and not
designated as rights or lefts but as having a mesial bevel or a distal bevel. If when one observes the inside of
the blade curvature (or the inside of the angle at the junction of the blade and shank) the primary bevel is not
visible, the instrument has a distal bevel. Conversely, if the primary bevel can be seen (from the same
viewpoint), the instrument has a mesial or reverse bevel.

Examples of hand instruments called chisels (with corresponding instrument formulas). ​A,​ Straight (12–7–0). ​B,​ Wedelstaedt ( ). ​C,​ Bin-angle (10–7–8).
As previously described, instruments such as chisels and hatchets have three cutting edges, one primary and two secondary. These allow cutting in three directions, as
the need presents. The secondary edges permit more effective cutting than the primary edge in several instances. They are particularly effective in work on the facial
and lingual walls of the proximal portion of a proximo-occlusal tooth preparation. The operator should not forget the usefulness of these secondary cutting edges
because they enhance the use of the instrument.

❖ Applications

The cutting instruments are used to cut the hard or soft tissues of the mouth. Excavators are used for removal
of caries and refinement of the internal parts of the preparation. Chisels are used primarily for cutting enamel.
Excavators
The four subdivisions of excavators are (1) ordinary hatchets, (2) hoes, (3) angle-formers, and (4) spoons. An
ordinary hatchet excavator has the cutting edge of the blade directed in the same plane as that of the long axis
of the handle and is bi-beveled.These instruments are used primarily on anterior teeth for preparing retentive
areas and sharpening internal line angles, particularly in preparations for direct gold restorations.
The hoe excavator has the primary cutting edge of the blade perpendicular to the axis of the handle. This
type of instrument is used for planing tooth preparation walls and for forming line angles. It is commonly used
in Class III and V preparations for direct gold restorations. 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.

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A special type of excavator is the angle-former.. 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. It is mono-angled 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).
Spoon excavators are used for removing caries and carving amalgam or direct wax patterns. The blades are
slightly curved, and the cutting edges are either circular or claw-like. The circular edge is known as a discoid,
whereas the claw-like blade is termed cleoid. The shanks may be bin-angled or triple-angled to facilitate
accessibility.

Examples of other hand instruments for cutting. ​A. ​Finishing knife. ​B, Alternative finishing knife design emphasizing secondary cutting edges. ​C, Dental file. ​D,
Cleoid blade. ​E,​ Discoid blade carving amalgam.

Chisels
Chisels are intended primarily for cutting enamel and may be grouped as (1) straight, slightly curved, or
bin-angle; (2) enamel hatchets; and (3) gingival margin trimmers. 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. It is similar in
design to a carpenter’s chisel.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. A right or left
type is not needed 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.
The enamel hatchet is a chisel similar in design to the ordinary hatchet except that the blade is larger,
heavier, and beveled on only one side. It has its cutting edges in a plane that is parallel with the axis of the
handle. It is used for cutting enamel and comes as right or left types for use on opposite sides of the
preparation.
The gingival margin trimmer is designed to produce a proper bevel on gingival enamel margins of

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proximo-occlusal preparations. It is similar in design to the enamel hatchet except the blade is curved (similar
to a spoon excavator), 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. The 100 and 75 pairs are for
inlay–onlay preparations with steep gingival bevels. The 90 and 85 pairs are for amalgam preparations with
gingival enamel bevels that decline gingivally only slightly. Among other uses for these instruments is the
rounding or beveling of the axiopulpal line angle of two-surface preparations.
Other Cutting Instruments
Other hand cutting instruments such as the knife, file, and discoid–cleoid instrument are used for trimming
restorative material rather than for cutting tooth structure. Knives, known as finishing knives, amalgam knives,
or gold knives, are designed with a thin, knife-like 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. Sharp secondary edges on the heel aspect of
the blade are useful in a scrape–pull mode.
Files also can be used to trim excess restorative material. They are particularly useful at gingival margins.
The blades of the file are extremely thin, and the teeth of the instrument on the cutting surfaces are short and
designed to make the file a push instrument or a pull instrument. Files are manufactured in various shapes and
angles to allow access to restorations.
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.

❖ Hand Instrument Techniques

Four grasps are used with hand instruments: (1) modified pen, (2) inverted pen, (3) palm-and-thumb, and (4)
modified palm-and-thumb. The conventional pen grasp is not an acceptable instrument grasp.

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​Pen grasps. A
​ , Conventional pen grasp. Side of the middle finger is on the writing instrument. ​B,
Modified pen grasp. Correct position of the middle finger is near the “topside” of the instrument for good control and cutting pressure. The rest is the tip (or tips) of the ring
finger (or ring and little fingers) on the tooth (or teeth) of the same arch.

Modified Pen Grasp

The grasp that permits the greatest delicacy of touch is the modified pen grasp. As the name implies, 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. The instrument should not be
allowed to rest on or near the first joint of the middle finger as in the conventional pen grasp. Although this
latter position may appear to be more comfortable, it limits the application of pressure. A balanced instrument
design allows the application of suitable force without the instrument tending to rotate in the fingers.
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.

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​Inverted pen grasp. Palm faces more toward the operator. The rest is similar to that shown for modified pen grasp.

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.

Palm-and-thumb grasp. This grasp has limited use, such as preparing incisal retention in a Class III preparation on a maxillary incisor. The rest is a tip of the thumb on the
tooth in the same arch.

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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.

Modified palm-and-thumb grasp. This modification allows greater ease of instrument movement and more control against slippage during thrust stroke compared with
palm-and-thumb grasp. The rest is the tip of the thumb on the tooth being prepared or adjacent to the tooth. Note how the instrument is braced against the pad and end joint of
the thumb.

The modified pen grasp and the inverted pen grasp are used practically universally. The modified
palm-and-thumb grasp usually is employed in the area of the maxillary arch and is best adopted when the
dentist is operating from a rear-chair position.
Rests
A proper instrument grasp must include a firm rest to steady the hand during operating procedures. When the
modified pen grasp and the inverted pen grasp are used, rests are established by placing the ring finger (or
both ring and little fingers) on a tooth (or teeth) of the same arch and as close to the operating site as possible.
The closer the rest areas are to the operating area, the more reliable they are. When the palm-and-thumb
grasps are used, rests are created by placing the tip of the thumb on the tooth being operated on, on an
adjacent tooth, or on a convenient area of the same arch. In some instances, it is impossible to establish a rest
on tooth structure, and soft tissue must be used. Neither soft tissue rests nor distant hard tissue rests afford
reliable control, and they reduce the force or power that can be used safely.
Occasionally, it is impossible to establish normal finger rests with the hand holding the instrument. Under these
circumstances, instrument control may be gained using the forefinger of the opposite hand on the shank of the

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instrument or using an indirect rest (i.e., the operating hand rests on the opposite hand, which rests on a stable
oral structure).
Guards
Guards are hand instruments or other items, such as interproximal wedges, used to protect soft tissue from
contact with sharp cutting or abrasive instruments.

2.) Activity 3: Skill-building Activities (with answer key) (18 minutes + 2 minutes checking)
● Using your study model and any hand instruments practice the four grasps of hand instrument
technique. On the off chance that you have a gadget(smart telephones, I pad, tab, PC) and web
network, it would be ideal if you snap a photo and transfer. If not, please make sure to compile for
submission. On the off chance that you feel you're good with the four grasp of hand instrument
technique pick 1 of your relative to do it with, again in the event that you have a gadget (cell phones,
Ipad, tab, PC) and web availability, kindly snap a photo of you doing the procedures as appeared in the
photos above. If not, it would be ideal if you compile for submission.
● Stop and check your answers against the Key to Corrections found at the end of this Activity Sheet.
Write your score/s on your paper.

3) Activity 4: What I Know Chart (Part 2) (5 min)

● To reflect on what you have learned in this lesson, go back to the “What I Know Chart” in Activity 1 and
write your answers to the questions based on what you now know in the third column of the chart.

4) Activity 5: Check for Understanding (5 min)

● Please answer the short quiz as honestly as you can. Lets go! SCORE: ____________
1. What instrument used to place amalgam inside a prepared cavity?
a. amalgam condenser b. applicator c. carrier d. all of the above
2. One of the following is not included in the set for basic instruments:
a. enamel hatchet b. mouth mirror c. explorer d. cotton plier
3. A dental instrument that uses tactile sense and detects dental caries on non-coalesce enamel.
a. probe b. enamel hatchet c. explorer d. rotary instrument
4. What term is given to tooth cutting instruments which turn on an axis to perform the work?
a. rotary b. manual c. mechanical d. mobile
5. It is a part of hand cutting instrument that connects the handle and its working end:
a. neck b. shank c. straight shank d. latch-type shank
● Stop and check your answers against the Key to Corrections found at the end of this Activity Sheet.
Write your score/s on your paper.

C. LESSON WRAP-UP
1) Activity 6: Thinking About Learning (5 min)
A. Work Tracker
You are done with this session! Let’s track your progress. Shade the session number you just
completed.

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P1 P2 P3

O M1 M2 M3 M4 M5 M6 M7 E M8 M9 M1 M1 M1 M1 M1 E M1 M1 M1 M1 M1 M2 M2 M2 E
0 1 2 3 4 5 6 7 8 9 0 1 2

1 2 3 4 5 6 7 8 9 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2
0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6

☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐

Legend:​ P=period, O=orientation, M=module, E=exam

B. Think about your Learning

Now that you’ve completed the lesson, take a few minutes to reflect on the quality of your work and
the quality of your effort.
● On a scale of 1 - 5, 1 being low and 5 being high, how successful were you in meeting today’s lesson
objectives? Why do you say so ? What factors contributed to this? What changes, if any, should you do
for your next lesson?
__________________________________________________________________________________
__________________________________________________________________________________
____________________________________________________________________________
● What factors lead to low work effort? Describe how it affects you.
__________________________________________________________________________________
__________________________________________________________________________________
____________________________________________________________________________

FAQs
● What are the Types of Hand Instruments used for Operative Procedures.
Restorative instruments can be assigned to one of four categories.
1. Examination instruments - allow the dentist to examine the health status of the teeth and oral cavity
e.g. mouth mirror, explorer, cotton plier, periodontal probe
2. Tooth preparation instruments - allow the dentist to manually remove decay and to smooth, finish,
and prepare the tooth structure to be restored back to its normal function e.g. spoon excavator, chisels,
hoe, hatchet, gingival margin trimmer.
3. Restorative instruments - allow the dentist to place, condense, and carve the dental material to the
original anatomy of the tooth structure e.g. amalgam carrier, amalgam condenser, discoid - cleoid
carver, hollenback carver, burnisher, composite instrument.
4. Accessory instruments - are the multipurpose instruments added to the setup of many procedures.
These types of instruments are used in preparing the setup, carrying things to the mouth, or in the
application or placement of the dental material easier e.g. matrix retainer, articulating paper holder
● What is the instrument set up during operative procedures.
A tray is set up in sequential order from left to right, starting with examination instruments and followed
by hand cutting instruments, restorative instruments, and finally, accessory items. The rationale for this

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sequencing is based on how instruments are transferred and used throughout a dental procedure. The
most frequently used instruments will be closer to the dentist for ready availability

KEY TO CORRECTIONS
Activity 5:
Short Quiz:
1. C. 2. A. 3. C. 4. A. 5. B.

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