1. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins INSTRUMENT SHARPENING DH102: Clinic II Lisa Mayo, RDH, BSDH Concorde Career College

2. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Reference Neild CH23 Wilkins CH38

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4. Instrument Sharpening Objectives –Preservation of original shape of the instrument or contour –Restore cutting edges Benefits from use of sharp instruments –Minimize tissue trauma –Less strokes to achieve desired effects –Increased tactile sensitivity during instrumentation –Decrease possibility of burnishing calculus

5. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Instrument Sharpening Can use 3 different methods: 1.Moving instrument technique 2.Moving the stone technique: WE WILL LEARN TODAY!! 3.Powered sharpening devises/PDT Gleason Guide

6. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Instrument Sharpening Consequences of using dull instruments –Stress –Frustration –Wasted time, effort, energy –Increased likelihood of slipping during scaling –Increase risk tissue trauma –Loss of patient confidence in you –Increase risk for work=related disorders from muscle strain

7. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Instrument Sharpening When to sharpen –After instrument use –During Tx –Before Tx: IDEAL!! Less chance of hurting yourself

8. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Sharp Cutting Edge Sharpening requires EXACT knowledge of characteristics and designs of instruments Important to know x-sections of instruments

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10. Working End in X-Section When sharpening, vital to maintain relationship between instrument face and lateral surfaces Internal Angles = 70-80°

11. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Working-End in X-Section

12. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Recontouring the Working-End

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14. Sharp Cutting Edge of Curettes

15. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Dull Cutting Edge As use instrument = metal worn away Results when metal is worn away from the cutting edge until the junction between the face and lateral surfaces becomes a rounded surface instead of a fine line

16. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Dull Edge: edges rounded instead of sharp

17. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Instrument Sharpness Visual or glare test –If sharp: does not reflect light –Dull: rounded, shiny surface which reflects light

18. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Visual Test DULL SHARP

19. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Dull Curette x-section

20. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Sharpening Stones Materials and their sources –Natural abrasive stones: Quarried from mineral deposits Hard Arkansas stone: fine abrasive particle size No need to use water or oil –Artificial materials: Hard, nonmetallic substances impregnated with aluminum oxide, silicon carbide, or diamond particles Ruby stone, carborundum stones, and the diamond hone Ceramic aluminum oxide Steel alloys are metals that are harder than most dental instrument steel and, therefore, are capable of sharpening the instrument. Water or oil needed

21. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Sharpening Angulation –Before sharpening, analyze the cutting edge and establish proper angulation –Don’t turn a Gracey into a Sickle!! –Maintain correct angle throughout the sharpening strokes

22. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Sharpening Maintain control –Secure grasp –Secure hand rest –Moderate pressure (not hard!!!) –Short strokes –Dominant hand holds the stone –Non-dominant hand holds the instrument –Both elbows on a tabletop –Correct lighting so can see cutting edges

23. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Dynamics of Sharpening Stone surface –Abrasive to reshape a dulled blade by grinding the surface until the cutting edge is restored –Made up of masses of minute crystals, which are the abrasive particles –Smaller particle size or a finer grain: abrades or reduces more slowly and produces a finer cutting edge

24. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Tests for Instrument Sharpness Plastic testing stick –Sterile 1/4in rod, 3in long –If instrument is sharp, will grip the plastic –Each portion of the cutting edge will engage as you advance the blade along the plastic

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26. Basic Sharpening Principles Sterilization of sharpening stone Instrument handling: never sharpen dirty instruments!!! Preparation of stone for sharpening –Dry stone –Water on stone –Lubricated stone

27. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Basic Sharpening Principles Dry Stone –Advantage: the problems related to maintaining a sterile stone and preventing contamination when oil, tap water, or a lubricant is applied are avoided –Sharpens the cutting edge without nicks in the blade –Nicks can be created from particles of metal suspended in a lubricant –Allows the stone to be completely sterilized without the problem of interference by the oil left in and on the stone

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29. Basic Sharpening Principles Water on Stone –Ceramic stones may be dry or with water Lubricated Stone –Quarried stones need lubrication to prevent drying out –Instruments are autoclaved before sharpening, and the stone and instruments are sterilized again after non-sterile lubricant is used –The lubricant can facilitate the movement of the instrument blade over the stone and prevent scratching of the stone –Suspend the metallic particles removed during sharpening and so help to prevent clogging of the pores of the stone (glazing).

30. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Review Restoring a sharp cutting edge is one of the two main objectives to instrument sharpening. What is the other objective? a.Maintain the internal angle of the cutting blade at about 90 degrees b.Remove metal equally from the face and lateral surface c.Preserve the original shape of the instrument d.Maintain the angle between the instrument face and stone at 90 degrees

31. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Review Restoring a sharp cutting edge is one of the two main objectives to instrument sharpening. What is the other objective? a.Maintain the internal angle of the cutting blade at about 90 degrees b.Remove metal equally from the face and lateral surface c.Preserve the original shape of the instrument d.Maintain the angle between the instrument face and stone at 90 degrees

32. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Curette angle Sickle angle

33. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins After Sharpening Remove any metal particles from the edge with gauze –Could end up in pt’s mouth and not taste good!!

34. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Instrument Wear & Sharpening Results –Reduction in face and length of instruments –Overall size reduced Point to retire or discard instrument –After sufficient reduction –Blades no longer adapt to tooth surface –Thinner blades prone to breakage!!

35. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Sharpening Curets and Scalers Technique objectives –Preserve the contour of the blade –Sharpen frequently to prevent need for excessive re- contouring of the blade Selection of edges to sharpen –Scalers/sickles: cutting edges both sides –Universal curets: cutting edges both sides, round the toe –Area-specific curets: cutting edge one side, round the toe

36. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Steps 1.Both elbows on table top. Start w/ sharpening the cutting edges. 2.Grip instrument tightly in nondominant hand and NEVER move this hand. Instrument should be facing you directly with the lower shank and the working end parallel to your face 3.Establish a 70-80 degree angle between instrument and stone (be sure to change in ppt – was incorrect) 4.Move stone up-n-down in dominant hand with a constant motion, maintaining contact with instrument entire time 5.Finish with a downward stroke to avoid “wiring” the edges of instrument

37. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Steps 6.Round the toe of Curette’s and Gracey’s by turning your instrument so the cutting edge is now facing to your left or right and not directly face-on. Working end should still be parallel 7.Apply stone at a 90 degree angle with the toe then open the stone to establish a 70-80 degree angle 8.Move stone 180 degrees around the toe, covering the entire surface with a fluid-like motion. Always maintain contact between instrument and stone 9.Test for sharpness

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39. Moving The Stone Technique

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44. Angulation of stone to the instrument face should be 70-80°

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47. Cutting Edge Sections: Divide the cutting edge into 3 imaginary sections for sharpening

48. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Sharpening in Sections Apply stone to only a third of the cutting edge at a time to maintain a curved cutting edge

49. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Individual Instrument Sharpening Selection of edges to sharpen –Scalers/sickles: cutting edges both sides –Universal curets: cutting edges both sides w/a toe –Area-specific curets: cutting edge one side w/a toe

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57. When sharpening a wire edge is produced: a.Only when using a coarse artificial stone b.When using a mounted ruby stone only c.When no oil is used for lubrication of the stone d.When the last stroke of the stone is not a downward stroke When sharpening a wire edge is produced: a.Only when using a coarse artificial stone b.When using a mounted ruby stone only c.When no oil is used for lubrication of the stone d.When the last stroke of the stone is not a downward stroke

58. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins When sharpening a wire edge is produced: a.Only when using a coarse artificial stone b.When using a mounted ruby stone only c.When no oil is used for lubrication of the stone d.When the last stroke of the stone is not a downward stroke When sharpening a wire edge is produced: a.Only when using a coarse artificial stone b.When using a mounted ruby stone only c.When no oil is used for lubrication of the stone d.When the last stroke of the stone is not a downward stroke

59. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Common Sharpening Errors Altering Working-End Design A= straight lateral surfaces and a rounded toe B= Clinician altered design characteristics. Thinner & shorter, tip Common Sharpening Errors Altering Working-End Design A= straight lateral surfaces and a rounded toe B= Clinician altered design characteristics. Thinner & shorter, tip

60. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Common Sharpening Errors Altering Working-End Design A= Sickle scaler B= Clinician altered design characteristics. Excessively shortened in length Common Sharpening Errors Altering Working-End Design A= Sickle scaler B= Clinician altered design characteristics. Excessively shortened in length

61. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Common Sharpening Errors Altering Working-End Design A= Sickle scaler B= Clinician altered design characteristics. Straight cutting edges instead of curved Common Sharpening Errors Altering Working-End Design A= Sickle scaler B= Clinician altered design characteristics. Straight cutting edges instead of curved

62. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Common Sharpening Errors Altering Working-End Design A= Area-Specific Curet B= Clinician altered design characteristics. Straight lateral surface, pointed tip instead of curved Common Sharpening Errors Altering Working-End Design A= Area-Specific Curet B= Clinician altered design characteristics. Straight lateral surface, pointed tip instead of curved

63. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Example under electron microscope of a properly sharpened instrument

64. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Care of Sharpening Equipment Flat sharpening stone –Can submerge stones in ultrasonic and/or scrub with soap/water if needed –Storage: keep in cassette or bagged properly Test stick: can sterilize test sticks as well-will not melt in steam autoclave Manufacturer’s directions: always check if unsure

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66. Gleason Guide https://www.youtube.com/watch?v=rBSRxVfPNLohttps://www.youtube.com/watch?v=rBSRxVfPNLo OVERVIEW https://www.youtube.com/watch?v=hJiTW69OoC8 https://www.youtube.com/watch?v=S4yty0Aysuo https://www.youtube.com/watch?v=w7tiRjsDMCohttps://www.youtube.com/watch?v=w7tiRjsDMCo CURET https://www.youtube.com/watch?v=RJq1KHlyoZAhttps://www.youtube.com/watch?v=RJq1KHlyoZA GRACEY