Instruments in Operative
Dentistry
Hand Rotary
Instruments Instruments
Hand Instruments
Instrument Design
blade Shank Handle Shank blade
nib (face) - blade
Cutting and non cutting
Single ended - Double ended
Instrument shank angles
Straight
Mon-angle
Bin-angle (contra-angled)
Long Axis
1-2mm
Performance,
anti rotation Triple-angle (contra-angled)
Instrument Nomenclature
Function: e.g. condensers, carvers, cutting inst. ……. etc.
Manner of use: hand condenser, mechanical condenser …
Design of working end: spoon excavator, sickle scaler.
Angulations of the shank: mon-angle, bin-angle, triple….
Cutting Instruments
Formula
• Four number code
Expressed
as a percent
of 360
degrees
• Three number code
Example for measuring the 2nd number (cutting edge angle)
Angle measured
between direction of Cutting
cutting edge and edge
long axis in A
clockwise direction
In this example the angle
between cutting edge and long
axis is about 280 degree. So the
percentage of cutting edge angle
from 360 degree is
A
Long
280 Edge angle
axis
=
360 100
Cutting edge angle = 80.5
Cutting instruments bevel
Blank One bevel Bi-beveled
One bevel = Right or left,
Single ended safer but double ended reduce time for instruments exchange
Cutting instruments applications
Excavators
Ordinary Hatchet excavator: cutting edge with
same plane as that of handle’s long axis, and bi-beveled.
Primarily used on anterior teeth for preparing retentive
areas and sharpen internal line angles for direct gold
restorations.
Hoe excavator: planing walls and forming line angles
in class III and IV for direct gold restorations.
Angle former: sharpen internal line angles and
preparing retentive features for gold restorations.
Primary cutting edge at an angle other than 90 degree to
the blade.
Spoon excavator: removal of caries, usually bin
angled or triple angled to facilitate accessibility.
Chisels
Straight chisel: not angulated with one side bevel and
cutting edge perpendicular to long axis of handle. used for
cutting enamel and no need for right and left since a 180
degree turn of the instrument allows for its use for both
side of the cavity. 2nd cutting edges
Bin-angle and Wedelstaedt chisels: cutting
edge perpendicular to long axis of handle. used for cutting
enamel.
Chisel
Enamel hatchet
Enamel hatchet: similar design to ordinary hatchet in
that the cutting edge in a plane parallel to long axis of the
handle, but the blade is larger and beveled on only one
side, so it has left and right side.
Gingival marginal trimmer: designed to produce
proper bevels at gingival margins. Similar to enamel
hatchet but the blade is curved and the cutting edge may
be at angle other than 90 degree with the blade, so if the
second number of the formula is 90-100 this is used for
distal margins, and if its 85-75 this is used for mesial
margins. 100 and 75 pairs used for beveling inlay/onlay
cavities while 85 and 90 pairs used for amalgam cavities.
This instrument also used for rounding or beveling the
axiopulpal line angles.
Gingival trimmer
Other cutting instruments
Cleoid-discoid: used for caving unset amalgam and
burnishing inlay/onlay margins
Knives: finishing knives, amalgam knives, gold knives. All
used for trimming the excess filling materials at
cavity margins.
Files: different size and shape also used for trimming the
excess of filling material particularly at gingival
margins.
discoid Cleoid
file
knife
Non cutting instruments
Diagnostic: mirror, probe (dental explorer), tweezers.
Filling :
Dycal applicator,
Cement spatula,
Ash 49,
Glass slap,
Retainer,
Dappen dish,
Amalgam carrier,
Condenser,
Hollenback carver,
Burnisher,
Plastic instrument…….
Instruments Techniques (Grasping)
Modified pen grasp:
Pen Grasp Modified Pen Grasp
Modified pen grasp: greatest touch delicacy is
permitted with this grasp. A pad of thumb, index and
middle fingers contacting the instrument. While tip of
ring and/or little fingers is used for rest or support on
the nearby teeth surface of the same arch for better
controlling the action and the magnitude of force
applied. Palm is usually facing away from the operator.
Inverted pen grasp: same as modified pen grasp
except that the hand is rotated so that palm is facing
more toward operator. Usually used with lingual
surfaces of anterior teeth.
Inverted Pen Grasp Palm and Thumb Grasp
Palm and thumb grasp: similar to that used for
holding a knife while paring the skin from an apple.
Rest is provided by supporting the thumb on nearby
teeth. Used for preparing incisal retention in class III
cavities.
Modified palm and thumb grasp: only used when
its feasible to rest the thumb on the tooth to be
prepared or the adjacent tooth.
12:00
11:00
Direct rear
Operating
Right rear
Positions
Operator stool
9:00 Patient's
head
Right
Dental chair
7:00
Right front
6:00
Right front:
• Mandibular anterior.
• Maxillary anterior.
• Mandibular posterior “Occlusal” (right and left).
Right:
• Buccal surface of maxillary and mandibular posterior.
• Occlusal of right mandibular posterior.
Right rear:
• All maxillary teeth (indirectly by mirror)
• Directly without mirror for labial surface of maxillary anterior
and lingual surface of mandibular anterior specially right side.
Direct rear:
• Directly for lingual surface of mandibular anterior (both sides).
General position considerations
• Miner rotation for patient head to accommodate the demands of accessibility and
vision is acceptable.
• When working on maxillary arch, the occlusal surfaces or maxillary teeth oriented to be
approximately perpendicular to the floor.
• When working on mandibular arch, the occlusal surfaces of mandibular teeth oriented
to be approximately 45 degree with the floor.
• Avoid close face proximity to the patient (the ideal distance is as reading a book).
• Minimize body contact and avoid resting forearm on patient’s shoulders, head or face
as possible.
• Left hand usually free and used for holding mirror for viewing or retracting soft tissues
and tongue and reflecting light onto operating field to view the cavity
indirectly.
• For long operations, operator must change the position even for a short period to
reduce muscle strain and fatigue.
• Proper distribution of balance on both feet in standing position.
• In sitting position, the stool must be adjustable up and down and well padded with
smooth cushion, backrest adjustable all directions as well.
• Operator stool without foot ring to permit resting the feet on floor. Thighs parallel to
the floor.
• Spinal column straight or slightly forward bended with minimal tension.
• Assistant’s stool 4-6 inches higher than operator for better vision, so assistant stool is
provided by foot ring for feet rest.
Back-rest
Operator Assistant
Foot ring
