1. DH101 Preclinical Sciences Instrumentation (Posterior)
Lisa Mayo, RDH, BSDH
Staci Janous, RDH, BS
Concorde Career College TXSAN

3. Objectives Sickle Scaler 204S Universal Curette 13/14 and Barnhart
Gracey Curette 11/12 & 13/14
Reminder:
Strokes for scaling = short, controlled, overlapping
Strokes for assessing = long, light, overlapping

4. Resources
Wilkins
CH 38
Nield
CH 13, 14, 15, 16, 21

5. Sickle Scaler 204S Nield p.331 Used on enamel surfaces only
Remove calculus deposits from crowns of posterior teeth
Working-End
Pointed back
Pointed tip: face converges w/ 2 lateral surfaces to form the tip, sharp point
Triangular cross section: 70-80° internal angles
Two cutting edges w/ curved blade
Face is perpendicular and flat (between cutting edges)

6. Sickle Scaler 204S (same as Ant Sickle)
Nield p.332
70-80°

7. Sickle Scaler 204S
Nield p.332
Same as Ant Sickle

8. Sickle Scaler 204S
Nield p.344
All 4 cutting edges are used for calculus removal
Paired instrument that are mirror images of one another
One side adapt from the F and the other from the L

9. Sickle Scaler 204S Cutting Edges
Nield p.344

10. Scaler 204S ANGULATION Nield p.343
Angle formed by the working end of an instrument with the surface to which the instrument is applied for treatment
Insertion angulation = 0◦
Angulation needed to remove calculus without causing tissue trauma = 70◦

11. Nield
p.343

12. Sickle Scaler 204S GET YOUR TYPODONT & 204S
Nield p.345
Sickle Scaler 204S GET YOUR TYPODONT & 204S

13. Sickle Scaler 204S Technique
Nield p.345
Sickle Scaler 204S Technique

14. Sickle Scaler 204S Technique
Nield p.346
Sickle Scaler 204S Technique

15. Sickle Scaler 204S Technique
Nield p.346
Sickle Scaler 204S Technique

16. Sickle Scaler 204S Technique
Nield p.346
Sickle Scaler 204S Technique

17. Sickle Scaler 204S Technique
Nield p.346
Sickle Scaler 204S Technique

18. Sickle Scaler 204S Technique
Nield p.347
Sickle Scaler 204S Technique

19. Sickle Scaler 204S Technique
Nield p.347
Sickle Scaler 204S Technique

20. Sickle Scaler 204S Technique
Nield p.347
Sickle Scaler 204S Technique

21. Sickle Scaler 204S
Nield p.334

22. Sickle Scaler Reference: Ant & 204S Summary
Use of Sickle Scalers
Remove med-lg size calculus deposits from the crowns of teeth
Pointed tip provides good access to proximal surfaces apical to the contact areas of teeth
NOT recommended for use on root surfaces
Basic Concepts
Tilt lower shank toward tooth surface to establish correct angulation: operator MUST force the instrument into a angle
Adapt TIP 1/3 of cutting edge of tooth
Activate calculus removal stroke using wrist motion activation
Relax your fingers between each calculus removal stroke
Posterior Teeth
Begin at DF line angle of the post-most tooth in the quadrant and work toward the D surface
Reposition at the DF line angle and complete the F/L and M surfaces of tooth working toward the front of the mouth

23. Assessment in Clinic 204S

25. Universal Curette 13/14 Nield p.357 Uses
Remove small – med size deposits both SUB-G and SUPRA-G
Crown and root surfaces ant and post (for this class, we will only be using on posterior teeth until your skills are more developed and you can safely use on ant)
Design
Double-ended instrument w/paired, mirror-image working-ends
Rounded back
Rounded toe
Semi-circular cross section
2 parallel cutting edges on a curved blade
Face is at 90° angle to lower shank = 2 cutting edges are level with one another and can be used for calculus removal. Flat in cross-section and curved lengthwise
70-80° internal angles where lateral surfaces meet the face

26. Nield p.358
70-80◦

27. Universal Curet 13/14

28. Universal Curette 13/14
Nield p.358

29. Universal Curettes Nield p.359
Curettes come in different sizes and lengths

30. Universal Curettes Nield p.359
Curettes come in different sizes and lengths

31. Universal Curettes Nield p.359
Curettes come in different sizes and lengths

32. Nield
p.360

33. Universal Curette 13/14 WORKING END
Nield p.362
Universal Curette 13/14 WORKING END
Selecting the Correct Working End: LOWER SHANK POSITION

34. Operator MUST force the instrument into a 70-80◦ angulation
Nield p.364
Universal Curette 13/14
Operator MUST force the instrument into a 70-80◦ angulation

35. Universal Curette 13/14 ANGULATION
Nield p.364
Universal Curette 13/14 ANGULATION

36. Universal Curette 13/14 ANGULATION
Nield p.364
Universal Curette 13/14 ANGULATION

37. 4 Cutting edges like sickle’s
Nield p.365
Universal Curette 13/14
4 Cutting edges like sickle’s

38. Universal Curette 13/14 GET YOUR TYPODONT
Nield p.366
Universal Curette 13/14 GET YOUR TYPODONT

39. Nield p.366
Universal Curette 13/14

40. Universal Curette 13/14 Nield p.366
Initial Insertion ALWAYS zero degrees for ALL instruments!

41. Nield p.367
Universal Curette 13/14

42. Nield p.367
Universal Curette 13/14

43. Nield p.367
Universal Curette 13/14

44. Nield p.367
Universal Curette 13/14

45. Nield p.368
Universal Curette 13/14

46. Nield p.368
Universal Curette 13/14

47. Universal Curette 13/14 Nield p.368
After done distal, then scale mesial

48. Nield p.370
Universal Curette 13/14
Scaling the Interprox

49. Universal Curette 13/14
Adaptation to F/L root surfaces of mandibular post teeth is challenging
Clinician’s hand position may block the view of mandibular lingual surfaces
Rounded posterior crowns make it difficult to instrument the root surfaces of these teeth
Height of Contour on Molars
Crown protrudes over & overhangs the root surface

50. Universal Curette 13/14 Incorrect Technique
Nield p.373
Universal Curette 13/14 Incorrect Technique

51. Universal Curette 13/14 Incorrect Technique
Nield p.373
Universal Curette 13/14 Incorrect Technique

52. Universal Curette 13/14 Correct Technique
Nield p.374
Universal Curette 13/14 Correct Technique

53. Universal Curette 13/14 Correct Technique
Nield p.374
Universal Curette 13/14 Correct Technique

54. Instrument Assessment Curette 13/14

55. Universal Curets Barnhart

56. Barnhart
Names for University of Southern California where was developed by DH faculty
Universal Curet
2 cutting edges, rounded toe
Thin, sharp cutting edge
Longer shank & blade than Columbia 13/14
More effective at times on interproximal molars
Uses
Slips easily under tight tissues
Light to mod calculus both supra and sub-g

57. Universal Curettes
Curettes come in different sizes and lengths

58. Universal Curettes
Curettes come in different sizes and lengths

60. Gracey 11/12 & 13/14 Area-Specific Instruments
Nield p.387
Gracey 11/12 & 13/14 Area-Specific Instruments

61. Gracey 11/12 & 13/14
Nield p.387
All Gracey’s are called “Area-Specific Curets”
Remove light to moderate calculus deposits from the crowns and roots of teeth
To instrument all surfaces of posterior teeth – will need to use both sides of the instrument
Characteristics of all Gracey’s
Face is tilted in relation to lower shank: 70° and one cutting edge lower then the other
Only one cutting edge per working-end
Long, complex functional shank
Rounded back
Rounded toe
Semi-circular cross section

62. Gracey 11/12 & 13/14
Nield p.388
70-80°

63. Gracey 11/12 & 13/14
Nield p.388

64. Gracey 11/12 & 13/14
Tilted face causes one cutting edge – “working cutting edge” – to be lower than the other cutting edge on each working end
Side in contact with tooth to remove deposits
Nonworking edge is too close to the lower shank to be used for calculus removal and is the “higher” edge
Side in contact with tissue

65. Gracey’s

66. Nield p.392

67. Nield p.398
Gracey
13/14
11/12
Distal
Mesial

68. Gracey: Correct Working-End
Nield p.399
Gracey: Correct Working-End

69. GET YOUR TYPODONT & G13/14 1st Mand Molar

70. Gracey 13/14

71. NIELD p.400
Gracey 13/14

72. NIELD p.400
Gracey 13/14

73. NIELD p.401
Gracey 13/14

74. NIELD p.401
Gracey 13/14

75. NIELD p.401
Gracey 13/14

76. Gracey 13/14
NIELD p.401

77. NIELD p.404
Gracey 13/14

78. GET YOUR TYPODONT & G11/12 1st Mand Molar

79. NIELD p.402
Gracey 11/12
Notice how much MORE of the tooth you cover with 11/12 than 13/14!

80. NIELD p.402
Gracey 11/12

81. NIELD p.402
Gracey 11/12

82. NIELD p.402
Gracey 11/12

83. NIELD p.403
Gracey 11/12

84. NIELD p.403
Gracey 11/12

85. NIELD p.403
Gracey 11/12

86. NIELD p.403
Gracey 11/12

87. NIELD p.404
Gracey 11/12

88. NIELD p.404
Gracey 11/12

89. Assessment in Clinic Gracey

90. Gracey Root Debridement Strokes
NIELD p.408

91. Gracey Root Debridement Strokes
NIELD p.408
70◦

92. Gracey Root Debridement Strokes
NIELD p.408

93. Gracey Horz Strokes Sub-G
NIELD p.409

94. Gracey Horz Strokes Sub-G
NIELD p.409

95. Gracey Horz Strokes Sub-G
NIELD p.409

96. Scaling Steps: IN THIS ORDER!
Select Correct Cutting Edge
Instrument Grasp: modified pen grasp
Stabilization: Finger Rests/Fulcrum
Adaptation: toe/tip 1/3 of a blade
Insertion: Insert at 0° angle/flat against tooth surface to base of pocket then adapt to 70°
Angulation: 70° for scaling to avoid Trauma to Tissue
Lateral Pressure: light, moderate, heavy
Stroke: wrist-rock with vert/horz/oblique

97. Instrument Angles
70◦

98. Instrument Selection Nield CH21
Instrument selection based on size & location of deposit
EX: Small-medium sized SUBgingival calculus
Universal curet
Area-specific curet

99. Lighter Deposits Subgingival Heavier Deposits Subgingival
WHICH INSTRUMENT WOULD YOU USE?

100. Instrument Selection Nield CH21

101. Instrument Selection Nield CH21

102. Angulation & Calculus Removal Nield CH13
Nield p.320
Calculus Removal Stroke
Assess & find the calculus deposit
Cup the calculus with the face of the instrument
Stroke: lock toe-third against the tooth surface, open face to 70 degrees & stroke AWAY from the base of the pocket

103. Nield p.321

104. Nield p.321

105. Angulation & Calculus Removal Nield CH13
Errors in Angulation
Will burnish or injure tissue
Angles more than 90◦ = 1 cutting edge will be in contact with tissue

106. Angulation & Calculus Removal Nield CH13
Errors in Angulation
Angles less than 45◦ = cutting edge slides over deposit rather than biting into it (burnish calculus) Nield p.324

108. Nield p.325