24/10/2013

1









BY Dr
Mohamed H. Ghazy
Professor of Fixed Prosthodontics
October 10, 2013
24/10/2013
2
Classification
4According to their uses

4Diagnostic
4Cutting
4Restoring
4Accessory
24/10/2013
3
Diagnostic instrument
A. Traditional diagnostic instruments:

Mirror
Indirect vision
Light reflection
Retraction
Tissue protection

Explorer (Probe)
Distinguish areas of calculus.
Distinguish decay.
Distinguish areas of discrepancies on teeth.

Cotton Pliers (Tweezers)
Carry, retrieve and place small objects.
Locking
Non-locking

4. Periodontal probe
Measure the depth of salcus

5. Articulating paper and holder
B. New diagnostic instruments:
1. Digital radiograph.
2. Diagnodent Laser
3. Operating Microscope
24/10/2013
4
4. Intra-oral camera.
5. Loupes.
6. DIFOTI (Digital Imaging Fiberoptic Trans-
Illumination


Cutting instruments
Depending on whether mere hand or mechanical force,
are utilized to work out these instruments:
Hand cutting

Powered rotary cutting


Laser equipments


Other equipments
24/10/2013
5
Hand cutting instruments
Manufactured from
Carbon steel
Stainless steel
Carbide steel
Other alloys of nickel, cobalt, chromium
Instrument design
Blade(Working End)
- Portion of the instrument designed for a
specific function



Shank
- Part of the instrument that attaches the
working end to the handle



Handle

- Portion of the instrument where the
operator grasps

24/10/2013
6

Examples of Hand cutting instruments:
Chisels Hatchets Hoes


Marginal Trimmers Angle Formers




Examples of hand cutting
instruments.
24/10/2013
7
G.V. Black describe a way to name dental
instruments:





1. The purpose of its use e.g. excavator, condenser,
scaler.
2. The position or manner of their use e.g. push, pull.
excavator condenser scaler.
G.V. Black describe a way to name dental
instruments:.


3-The form of its working part, hoe, hatchet, chisel etc.
4-The number of angles in the shank, straight- no angle
mon-angle (one angle), bin-angle (two angles), triple-
angle (three angles), quarternary-angle (four angles).
hoe hatchet
chisel
s
t
r
a
i
g
h
t

m
o
n
-
a
n
g
l
e

b
i
n
-
a
n
g
l
e

24/10/2013
8
Powered (rotary) cutting
Instrument
Power sources for dental units
Electric motor
driven


Compressed air

What does the term rotary mean?
(Rotary is a part or device that rotates around an axis.)
In dentistry, rotary instruments are attached to a handpiece.
Handpiece
is a device for holding rotary instruments, transmitting power to them and for
positioning them intra orally
According to shape
Straight handpiece





Contra angle handpiece
24/10/2013
9
Rotary speed ranges
Low speed (below 12000 rpm)
Medium speed (12000-200 000 rpm)
High speed (above 200 000 rpm)
24/10/2013
10
Disadvantages of low speed
1- Ineffective
2- Time consuming
3- Require a relatively heavy force
application


Initial preparation of grooves and pinholes

Cleaning of teeth

Caries excavation

Finishing and polishing procedures
Uses of low speed
Advantages of high speed
Faster removal of tooth
structure with less vibration
and heat production
Better control and greater
ease of operation
Patient is less apprehensive
because annoying vibration
and operating time
decreased
Instruments last longer

24/10/2013
11
Cutting tools

Dental rotary burs
Dental rotary abrasives
The rotary tools used in removing tooth structures may be
classified into burs and abrasives depending on whether
they work by an actual cutting or an abrading process.
24/10/2013
12
Design features
Shank
Neck
Head
Shank design
Definition It is the part that
fit into the handpiece, and
accepts the rotary motion from
it
Long shank
Used with straight handpiece
Short latch shanks
Used with latch type contra angle
handpiece
Friction grip shanks
Used with ultra high speed handpiece
24/10/2013
13
Neck design
It is the intermediate portion of an instrument that
connects the head to the shank

Function: transmit rotational force to the head
Head design
Is the working part of the instrument, the
cutting edge or portion of which perform
the desired shaping of tooth structure
24/10/2013
14
Characteristics of the head
1. Type of cutting: Bladed (bur).
Diamond abrasive.
2. Material of Construction:
Carbon steel.
Tungsten carbide.
Diamond ships.
Sand.
3. Head size
4. Head shape


Finishing
End cutting
End and
side cutting
Wheal
Pear
Fissure
Inverted cone
Round
Dental bur
(shape)
24/10/2013
15
Burs flute design
Cross cut Plain
Diamond abrasive instruments
Advantages
Long life
More effective in cutting enamel and dentin
24/10/2013
16
Diamond abrasive instruments
Fine
60-74m
Medium
88-125m
Coarse
125-150
m
Very fine
38-44m
Particle
size
Diamond abrasive instruments
OThe wheel stone
ORound and oval shaped
stone
OCylindrical stone
OTapered stone
OInverted cone stone
OCup shaped stone
OBarrel shaped stone
OPear shaped
OBud shaped
ORoot facer stone
24/10/2013
17






Wheel

Round

Spezial shapes








Pointed

Torpedo

Torpedo tapered

Cylinder

Cylinder round

Cylinder pointed








Pear

Cone

Trapered








Tapered round

Wheel

Round






Cylinder

Cylinder round

24/10/2013
18








Pear

Cerafil

Egg








Flame

Grenade

Cone








Bud

Tapered

Tapered round
24/10/2013
19
Oval or flame Shaped: used to reduce palatal and
lingual surfaces of anterior teeth.
Wheel Stone: used to reduce incisal
edges in anterior teeth and occlusal
planes of cusps of posterior teeth.
Wheel Stone may be with flat end,
round end or tapered ended stone.
Barrel and Pear shaped stone: used
to reduce occlusal surfaces of
premolars and molars.
Tinker Stone: used to perform
shoulder with bevel finishing line for
PFM restorations.
Fisssure Stone as:
a. Tapered with round end used to perform
chamfer finishing line for full metal
restoration.

b. Tapered with flat end used to perform
shoulder finishing line for all ceramic full
coverage restoration.

c. Cylindrical stone. (long/short) used to
do grooves for partial coverage
restorations.
24/10/2013
20
According to function

Reducer

Cutter
24/10/2013
21

Finishing

Guidance Stone
24/10/2013
22

Root Facer

Tissue Trimmer

24/10/2013
23
Discs
Abrasive rotary instruments used for proximal
slicing or reduction.
Supplied either mounted or demounted
Used with conventional or slow speed

Discs classification
According to the
abrasive material
Carborandum
Diamond
Metal
Sand paper
According to size
Small 3/8 inch
Medium 5/8 inch
Large 7/8 inch
24/10/2013
24
Discs classification
According to shape
Flat shaped
Cup shaped
According to the side of
abrasive material
Safe sided
Double sided
24/10/2013
25
Accessory instruments and items.
Ultrasonic Hand piece
Design
- Attached to the dental unit.
- Powered by electricity.
- Primarily used for prophylaxis
appointments.
- Attachments are similar in appearance to
scaling instruments.
- Delivers a pulsating spray of water
24/10/2013
26
Uses of the Ultrasonic
Handpiece
Remove calculus
Remove stain
Remove bonding materials from tooth
surface after orthodontic appliances are
removed
Remove cement after orthodontic bands
are removed

Laser Handpiece
Design
- Uses a laser light beam instead of
rotary instruments.
- Laser is conducted through a fiber-
optic cable.
- Resembles a standard handpiece.
- Maintains a water-coolant system.
- Maintains an air-coolant system.

24/10/2013
27
Uses
- Cauterizes soft tissue.
- Vaporizes decayed tooth structure.
Advantages
- Usually painless.
- Patient usually does not require anesthesia.
- Proceed with procedure faster.
Disadvantage
- Cannot be used on teeth with existing restorations.

Air-Abrasion Handpiece
Design
- Small version of a sandblaster.
- Produces a high-pressure delivery of aluminum oxide particles
through a small probe.
24/10/2013
28
Uses
Prepares teeth for sealants.
Removes external stains.
Class I through class VI preparations.
Endodontic access.
Prepares a tooth surface for the
cementation of a cast restoration, such as
a crown or veneer.
Any Questions.
24/10/2013
29









BY Dr
Mohamed H. Ghazy
Professor of Fixed Prosthodontics
October 20, 2013
Student question
What is the finish line?
a line indicating the location of the finish of a race
24/10/2013
30
Rotary cutting equipments.
Low-Speed Handpiece.
High-Speed Handpiece.
Ultrasonic Handpiece.
Laser Handpiece.
Air-Abrasion Handpiece.
Laboratory Handpiece.
Ultrasonic Hand piece
Design
- Attached to the dental unit.
- Powered by electricity.
- Primarily used for prophylaxis appointments.
- Attachments are similar in appearance to
scaling instruments.
- Delivers a pulsating spray of water
24/10/2013
31
Uses of the Ultrasonic Handpiece
Remove calculus

Remove stain

Remove bonding materials from tooth surface
after orthodontic appliances are removed

Remove cement after orthodontic bands are
removed

Laser Handpiece
Devices which produce beams of very high
intensity light
Design
- Uses a laser light beam instead of
rotary instruments.

- Laser is conducted through a fiber-
optic cable.

- Resembles a standard handpiece.

- Maintains a water-coolant system.

- Maintains an air-coolant system.
24/10/2013
32
LASER WELDING
The effect of laser depends on the power of the
beam and the extent to which the beam is absorbed
e.g. CO2 and ND:YAG Laser

Uses
- Cauterizes soft tissue.
- Vaporizes decayed tooth structure.
Advantages
- Usually painless.
- Patient usually does not require anesthesia.
- Proceed with procedure faster.
Disadvantage
- Cannot be used on teeth with existing restorations.

24/10/2013
33
Air-Abrasion Handpiece
Design
- Small version of a sandblaster.
- Produces a high-pressure delivery
of aluminum oxide particles
through a small probe.

Uses
Prepares teeth for sealants.
Removes external stains.
Class I through class VI preparations.
Endodontic access.
Prepares a tooth surface for the cementation of
a cast restoration, such as a crown or veneer.
24/10/2013
34
Impression Trays
Quadrant tray
- Covers one half
of the arch.
Section tray
- Covers the anterior portion of the arch.
Full arch tray
- Covers the entire arch.
Perforated tray
- Holes in the tray create a mechanical lock to hold the
material in place.
Smooth tray
- Interior of the tray is painted or sprayed with an adhesive to
hold the impression material.

Types of Stock Trays
Metal perforated tray
Mostly used for preliminary impression


Metal water coolant tray
Mostly used with reversible hydrocolloid
impression



Plastic perforated tray
Mostly used for preliminary and final
impression
24/10/2013
35
Crown remover
Hand instrument.
Crown remover.
Manual crown remover.
Pneumatic crown remover.
Brass ligature wire.
Chisel and hummer.
Sectioning.
Crown slitter.

The manual back action hammer is the
classic method for removing prostheses.
It produces the desired force by means
of a weight that slides along a shaft
Spring-loaded back action hammer
allows forces to be directed in a more
controlled manner.
Manual crown remover
24/10/2013
36
Automatic Crown & Bridge Remover
Non-traumatic way to remove crowns,
bridges and inlays
This water soluble, pliable resin adheres to porcelain, enamel,
gold, acrylic and will not damage restorations. Works quickly
and safely. Ideal for the removal of temporary or permanently
cemented crowns.
24/10/2013
37
Cord Placement Instruments

Crown Collars and Scissors
Used to trim temporary crowns, gingival
cord and matrix bands.
24/10/2013
38
Instrument Sequence on a Tray
Instruments set-up from left to right

- Basic set-up

- Additional examination instruments

- Hand cutting instruments

- Restorative instruments

- Accessory items

Preset restorative tray
24/10/2013
39
Cleaning and Sterilization of dental instruments
All instruments need to be cleaned and thoroughly
dried before they are sterilized.
Cleaning
Hand Scrubbing
Ultrasonic
Cleaning
Automated
Washer
24/10/2013
40
Classification of Patient-Care Items
In order to determine the appropriate
treatment for any item that has been
used in patient care, you will need to
classify them into one of the following
three categories based on the risk of
infection associated with their intended use.
- Critical
- Semicritical
- Noncritical
Critical Items
Are defined as those
used to penetrate soft
tissue or bone

Since the risk of
transmission would be
high, they must be heat
sterilized

Examples:
Surgical instruments
Scalers
Forceps
Scalpels
Bone chisels
burs
24/10/2013
41
Clinical Application
What do you use clinically everyday
that is considered a critical item?
How do you treat these items before
they are used again?
Semicritical Items
Touch mucous
membranes or non
intact skin

Have a lower risk of
transmission. However,
if an item can be heat
sterilized, it should be
heat sterilized.
Examples:
Mouth mirrors
Amalgam
condensers
Impression trays
X-ray film holders

24/10/2013
42
Semicritical instruments which cannot
tolerate the high temperatures of
sterilization must be processed by
using a sterilant or high level
disinfectant.

These products achieve sterilization
(kills all forms of life including spores)
after immersion in the solution for 3
to 10 hours. Follow manufacturers
instructions for the product in your
office.
Which items do you use daily which
are considered semi-critical?
Do you routinely sterilize these
items?
If not, what is your method for
assuring that they have remained in
the disinfectant or sterilant for the
necessary length of time?
Clinical Application
24/10/2013
43
Immersion Disinfectants FDA-
Approved for use in dentistry
Sterilants:
-Gluteraldehyde -6 to 10 hour contact time
-Hydrogen peroxide (7.3%) 6 hour contact
time.
-Gluteraldehyde and phen0ol/phenate-12
hour contact time
-Hydrogen peroxide and peracetic acid-3
hour contact time.
High level Disinfectants
- Ortho-phthalaldehyde (12 minute contact time)
- Gluteraldehyde- 20 to 90 minute contact time
- Hydrogen peroxide- 30 minutes contact time
- Gluteraldehyde and phenol/phenate- 20 minute contact
time
- Hydrogen peroxide and peracetic acid-15 minute contact
time.
(You must always use personal protective equipment (PPE),
including utility gloves, mask, eyewear, and protective
clothing, when processing instruments)


24/10/2013
44
Definitions to remember.
Sterilization is the process that kills all
microorganisms and is considered the
highest level that can be achieved. It is
accomplished by the proper use of
immersion chemical sterilants or by heat.

High level disinfection is used when a
semicritical item cannot withstand heat
sterilization. Used correctly, it is
intended to kill disease producing
microorganisms but not spores. These
products are not used for surface
disinfection, but for immersion.

Noncritical Items
Contact intact skin only.
Have a low risk of disease
transmission.
Some of these(*) should be
precleaned and disinfected
or barrier protected.

Examples:
Blood pressure
cuff
*X-ray cone
Stethoscope
*Lead apron


24/10/2013
45
Universal Sterilization
means that all reusable
instruments and handpieces are
sterilized (rather than disinfected)
between use on patients.
This provides the highest level of
patient protection.


Miller & Palenik, p. 196
Steralization
1. Steam autoclave:
Most effective.
Steam, heat (270 F), pressure (27 PSI).
for at least 6 minutes.


2. Unsaturated chemical vapor:
Best for carbon steel instruments.
Heat (270 F), pressure (20-40 PSI).
for at least 20 minutes.

24/10/2013
46
3. Dry heat oven:
Heat (230 F) for 2 hours.
Temperature above 350 F may cause
premature instrument failure.


4. Chemical solution:
Used for materials that can not withstand heat
sterilization process.
Not recommended for metal dental
instruments.
Instrument processing flowchart
Remove
Items from
operatory
Use holding
Solutions if
necessary
Sterilize
Clean by
Automated
Or manual
method
Store
Package
24/10/2013
47
Ultrasonic cleaner
This solution is considered
highly contaminated. Retrieve
instrument cassettes while wearing
utility gloves

Dont forget to close
the lid during
operation to reduce
aerosols!
A commercial all-purpose
ultrasonic cleaner.
(Courtesy of Certol.)

An enzyme ultrasonic cleaner in
tablet form.
(Courtesy of Crosstex.)
Copyright 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
24/10/2013
48
Take care not to overload steam
heat sterilization equipment.

If steam cannot circulate and
penetrate, instruments may not
be sterile.
Packed handpiece
24/10/2013
49
Process Indicators
Do not indicate sterility.
Simply indicate that the
autoclave reached a
certain temperature.
Show at a glance if a load
has been run.
Instrument Processing
Sterilization Monitoring
Do not use instrument packs if chemical or
mechanical monitoring indicate inadequate
processing.

24/10/2013
50
Personal Protective Equipment
(PPE)
Protects the skin &
mucous membranes of
the eyes, nose, and
mouth from exposure
to blood or OPIM
Use of PPE is dictated
by the exposure risk,
not the patient.
Masks and Protective Eyewear
Wear a surgical mask and
protective eyewear with solid
side shields to protect
mucous membranes of the
eyes, nose, & mouth
Change masks between
patients, or during treatment
if it becomes wet
24/10/2013
51
Protective Clothing
Wear long-sleeved reusable or disposable
gowns, clinic jackets, or lab coats to
protect skin of the forearms and clothing
likely to be soiled with blood, saliva.

Change immediately if visibly soiled
Protective coverage
24/10/2013
52
Clinical Contact Surfaces
Housekeeping Surfaces

Environmental IC
Use surface barriers to protect clinical contact
surfaces, especially which are difficult to clean.

Change barriers between patients

24/10/2013
53
Digital Imaging
General Considerations
Equipment difficult, if not impossible, to clean
and disinfect
Barrier-protect clinical contact surfaces

FIXED EQUIPMENT AND PRODUCTS
Microblasters
Porcelain Ovens
Burnout Ovens
Microscopes
Die Pinning System
Casting Machines
Porcelain
24/10/2013
54
Microblasters


Many options available:
Choose from number of tanks
Air pressure adjustment location
See Synopsis of Laboratory Air-
Abrasion Units on the DIS
website
Renfert Basic Master
Vaniman Sandstorm Expert
Porcelain Ovens
Ivoclar Vivadent Programat P100
Electronic vacuum control system
helps prevent firing errors if vacuum
is set incorrectly
$3,876 w/pump

Jelrus VIP Vision 300
User friendly
Keypad let's you "Name That
Program" from A-Z
$2,399
24/10/2013
55
Porcelain Ovens (cont.)
VITA VACUMAT 4000
Two thermocouples within the
chamber provide better
temperature control
Automatic temperature
calibration after 100 hours of
usage
Internal memory for up to 500
programs
Portable, detachable keypad
$5,836.50
Porcelain Ovens (cont.)
Whip Mix Pro Series
Fast-cool feature
Pressing furnace has
advanced cycles for
Inceram, Procera, pressing
and porcelain firing
Pro Press 100 - $3,351
Pro 100 - $2,500
24/10/2013
56
Burnout Ovens
Whip Mix Apollo II
Unique feature is its bottom
loading lift platform that raises
and lowers investment rings
Has an optional foot-control
switch
Reduced heat blast
Microscopes
Meiji BM
Dependable and inexpensive
Easily adjustable
$549

Renfert Mobiloscope
Swivel arm microscope
Space saving
$1,111
$1,438 w/fiber optic light
Meiji BM
Renfert Mobiloscope
24/10/2013
57
Microscopes (cont.)

Nikon SMZ-645
Versatile lab microscope
$2,141 w/fiber optic ring light
and light source

Die Pinning Systems
Renfert TopSpin
Tool-free drill bit replacement
Two working positions via swivel foot
on base
$599

Whaledent Pindex
Foot-controlled or Hand-controlled
Both are laser guided
$599


24/10/2013
58
Casting Machines
KerrLab Centrifico
Reliable broken-arm casting
machine
Easy to use
$479.50
Induction Casting Machines
Dentsply Ceramco Super
Cascom
100 program digital memory
Vacuum/pressure assisted
casting
$15,000 retail price

Bego Fornax T
Compact design
Short heating time due to
infrared controller
$12,473 retail price
24/10/2013
59
Porcelain
Ivoclar IPS d.Sign Porcelain
Produces esthetic restorations
Mixes easily with minimal
slumping
Comparable price to other
porcelain systems used in the
USAF (basic system-$717)
Rated Acceptable by DIS

Porcelain
Vita Omega 900-3D
Low-fusing ceramic
Used for crowns, bridges,
laminates
Reportedly compatible with
wide variety of metals
Wear is reportedly similar to
natural teeth
Standard kit - $1,696.00
24/10/2013
60