1. Fundamentals of “Universal” Instruments:

2. To date you’ve learned:
*#17 Explorer
To date you’ve learned:
-Gracey 1/2
-204s

3. 2 Types of Universal Instruments:
1. Scalers (in cross-section)
pointed tip
pointed back
supragingival calculus removal
2. Curets (in cross-section)
rounded tip
rounded back
sub/supragingival calculus removal

4. Let’s first talk about the Sickle Scalers

5. Types of Sickle Scalers:
Anterior- ‘straight’ shank instrument
Posterior- ‘curved’ or multiple shank instrument
(actually can be used universally in the mouth)

6. Anterior Sickle

7. Top instrument (Unpaired) is an example of a
curet (on the left) and an anterior sickle on the (right)
Bottom instrument (paired) is an example of a
posterior sickle on both ends.

8. Design Characteristics: Basically there are 2 cutting edges at each end. The Face of the Sickle is at a 90 degree angle to the terminal shank.
Flat “face”
Terminal shank

9. Sickle instrument have two cutting edges on each
end of the instrument:

10. Terminal shank is at
a 90 degree angle to
the Face

11. Face
Face

13. Your instrument casetes do not include the Anterior Sickle.
You will use the Posterior Sickle throughout the mouth including the anterior teeth.

14. Let’s get prepared to Initial scaling with the Sickle Scaler

15. P. 210
p.290
In Nield Book
(mirror, sickle, etc.)
(mirror)
(sickle)

16. (fulcrum)

17. Keep In Mind: Operator and Client Positioning
Instrument Blade Selection
Grasp
Fulcrum
Insertion
Adaptation
Angulation

18. Please remember: The Sickle instrument is used SUPRAGINGIVAL!
(You can go sub about 1-2 mm if necessary, but not more than that!!!)

19. Anterior Scaler The above shows a straight shanked sickle.
Initial point of insertion is always at
the line angle
The above shows a straight shanked
sickle.
Since we will not use this type of
instrument, please focus instead on
the Terminal Shank and its cutting
edges and how it relates to the tooth.
Tip 1/3 of the cutting edge of the instrument stays in contact with the tooth surface

21. Mandibular Anteriors: Buccal Right Handed Clinician5 6 4 3 1 2
#27
#26
#25
#24
#23
#22
From a 12:00 position, insert at the Distal Buccal Line Angle of #22 (tip towards the col)
Initiate walking stroke towards and into the distal col. Remove at end of pull stroke
Reinsert at the Mesial Buccal Line Angle of #22 (tip towards the mesial col)
Initiate walking stroke toward and into the mesial col. Remove at end of pull stroke
Move onto #23 D and then #23 M, then #24D, #24 M, etc.

22. Mandibular Anteriors: Lingual Right Handed Clinician
#22
#23
#24
#25
#26
#27
From a 12:00 position, insert at the Distal Lingual Line Angle of #22 (tip towards the col)
Initiate walking stroke towards and into the distal col. Remove at end of pull stroke
Reinsert at the Mesial Lingual Line Angle of #22 (tip towards the mesial col)
Initiate walking stroke toward and into the mesial col. Remove at end of pull stroke
Move onto #23 D and then #23 M, then #24D, #24 M, etc.

23. Mandibular Anteriors: Buccal Left Handed Clinician5 6 4 3 1 2
#27
#26
#25
#24
#23
#22
From a 12:00 position, insert at the Distal Buccal Line Angle of #27 (tip towards the col)
Initiate walking stroke towards and into the distal col. Remove instrument at upward stroke
Reinsert at the Mesial Buccal Line Angle of #27 (tip towards the mesial col)
Initiate walking stroke toward and into the mesial col. Remove instrument at upward stroke
Move onto #26 D and then #26 M, then #25D, #25 M, etc.

24. Mandibular Anteriors: Lingual Left Handed Clinician
#22
#23
#24
#25
#26
#27
From a 12:00 position, insert at the Distal Lingual Line Angle of #27 (tip towards the col)
Initiate walking stroke towards and into the distal col. Remove at end of pull stroke
Reinsert at the Mesial Lingual Line Angle of #27 (tip towards the mesial col)
Initiate walking stroke toward and into the mesial col. Remove at end of pull stroke
Move onto #26 D and then #26 M, then #25D, #25 M, etc.

25. Stroke Sequence for Posterior Teeth:2

26. Notice that you will begin your working stroke at the 1 2 1 2 1 2 1 2
Notice that you will begin your working stroke at the
Distal Line Angle (1) and proceed into the distal col.
You will then reinsert tip at the Mesial Line Angle (2)
(tip now pointing towards the Mesial). Remember,
Terminal shank of instrument is parallel to the line angle-
proceed with walking stroke into the mesial col area.

27. Correct:
Auxiliary Shank
Terminal Shank

28. Incorrect:
Auxiliary Shank
Terminal Shank

29. Correct angulation

30. Incorrect angulation

34. Do Not use the
sickle on direct
buccal/lingual
surfaces!!!

35. Walking Sequence (per quadrant):
(limited radius)
Midline 1. 2. 2. 2. 2. 1. 2. 2.
For Right Handed Clinicians: 2. 2. 2. 1. 2. 2. 2.
Area
Patient’s Head
Clock Position
1. UR and LR Buccal
Left
10:00-11:00-
12:00 (Anteriors)
2. UR and LR Lingual
Right
11:00
2. UL Buccal
2. UL Lingual
2. LL Buccal
10:00-11:00
1. LL Lingual
Notice that operator position and the direction of the instrument handle changes at the canine on the dominant side. 1. 2. 1. 2. 1. 2. 1. 2. 1. 2. 1. 2. 2. 1.

36. Walking Sequence (per quadrant): For Left Handed Clinicians: Area
(limited radius)
Midline 1. 2. 2. 2. 1. 2.
For Left Handed Clinicians: 2. 2. 1. 2. 2. 2. 1. 2. 2.
Area
Patient’s Head
Clock Position
1. UL and LL Buccal
Right
2:00-1:00
12:00 (Anteriors)
2. UL and LL Lingual
Left
2. UR Buccal
1:00
2. UL Lingual
2. LR Buccal
1. LR Lingual
Notice that operator position and the direction of the instrument handle changes at the canine on the dominant side. 2. 1. 1. 2. 1. 2. 1. 2. 2. 1. 2. 1. 1. 2.

37. So, what are we saying? You will be using the Posterior Sickle on ALL
proximal surfaces in the mouth.
When you are scaling only the anterior teeth- please follow the sequence in slides (slides #20-23)
When scaling posterior and anterior teeth in a single session- instrumentation sequence is:
quadrant at a time! (slides #35/36)

38. In Review You Should ALWAYS Keep in Mind:
Lateral Pressure
Strokes
Stroke Direction
Stroke Length
Reinforcement

39. Now, Let’s take a look at the
Universal Curet

40. The Universal curet is similar to the Sickle in that it also has two cutting edges per end.
The difference between them is that the tip of the Universal curet is rounded- not pointed like the Sickle.
This allows you to use this instrument
SUBGINGIVAL!!!

41. Universal Curets: Scalers - (in cross-section) pointed tip
pointed back
supragingival calculus removal
Curets (in cross-section)
rounded tip
rounded back
sub & supragingival calculus removal

42. Universal Curets Columbia Barnhardt Younger Good
Blade size, shank length and design will determine preferred area usage.

43. So, Let’s Keep in Mind. . .
Fulcrum rest must be near, but not directly over the surface being scaled (fulcrum on same arch).
Determine correct working end of instrument:
Terminal shank parallel to MESIAL line angle of molar
Foot of instrument curves towards the tooth
Angle for insertion is 0-40 (closed blade)

44. Continued
With closed blade, insert subgingival to JE- lateral pressure should be fairly light.
Open angle to 45-90° (subgingival) and initiate exploratory stroke (pull stroke)
Lateral pressure against tooth should remain fairly light unless a ‘bump’ is felt. Return back to JE and apply firmer pressure during pull stroke to remove ‘bump’  calculus?
Fulcrum pressure increases during pull stroke

45. Continued. . . Relax fingers during exploratory stroke
Apply greater lateral pressure during pull stroke.
Strokes should be short and controlled, with moderate pressure from the base of the pocket, toward the gingival margin.
Stroke direction – vertical, oblique & horizontal (overlapping) remaining primarily in the gingival sulcus.

46. Please remember~ You should ALWAYS scale a tooth to completion!!!
That means: Look at the clock and budget your time!!!
Quesstimate how long it will take you to scale a lingual/buccal surface
Dependant on : How ‘heavy’ the calculus is
How ‘tenacious’ the calculus is
How good is your technique?!?
Then determine how many teeth you can scale thoroughly and completely with the amount of time you have. . .