Hand Cutting Instruments
Hand Cutting Instruments
Hand Cutting Instruments
CONTENTS
INTRODUCTION HISTORY CLASSIFICATION MATERIALS USED HEAT TREATMENT OF STEEL DENTAL INSTRUMENT GAUGE INSTRUMENT DESIGN IDENTIFICATION OF INSTRUMENT BEVELS OF INSTRUMENT
CONTENTS cont.
CUTTING INSTRUMENT METHODS OF CLEANING STERLISATION OF HAND INSTRUMENTS HAND INSTRUMENTATION TCHNIQUES SHARPENING OF HAND INSTRUMENT CONCLUSION REFERENCES
INTRODUCTION
Term instrument refers to a tool, device or implement used for a specific purpose or type of work. They can be used to examine,clean,cut,& restore teeth. The two main types area.Hand instruments-which include a large group of instruments that are hand held when used. b.Rotary instruments- are operated in a handpiece which in turn is hand held. Cutting instrument generally implies, unless otherwise specified ,a hand held instrument used to cut, plane, or cleave tooth structure during the prepration of a cavity to receive a restoration or other treatment.
Access to some interproximal lesions was gained by seperation of the teeth with an assortment of wedges or mechanical seperators. They were made of stainless steel and were difficult to keep sharp , the problem was partly solved at the end of nineteenth century by the use use of carborandum discs and stones. With their large heavy handles and inferior metal alloys in their blades they were cumbersome, awkward to use and ineffective in many situations. There was no uniformity of manufacturing or nomenclature.Many dentists made there own hand instruments for specific needs.
With the subsequent development of the dental handpiece in 1871 there has been a drastic decline in the use of hand instruments. The present trend is to use replaceable bladed or abrasive instruments held in rotary hand pieces.
classification
Operative dental instruments as classified by CHARBENEAU-
-Hatchets -Chisels -Hoes -Excavators -others b) Rotary -Burs -Stones -Disks Others
2. Condensing instruments
a) Pluggers -Hand -Mechanical
3. Plastic instruments a) Spatulas b) Carvers c) Burnishers d) Packing instruments 4. Finishing and polishing instruments a Hand -Orangewood sticks -Polishing points -Finishing sticks b.Rotary -Finishing burs -Mounted brushes -Mounted stones -Rubber cups -Impregnated disks
5.Isolation instruments
a. Rubber dam b. Saliva ejector c. Cotton roll holder d Evacuating tips
6. Miscellaneous instruments
a. Mouth mirrors b Explorers c Probes d Scissors e Pliers f others
By Marzouk
1)Excavators
a. Hatchet b .Hoe c. Spoon d .Discoid e. Cleoid
2)Chisels
a .Straight chisel b .Monoangle chisel c. Binangle chisel d. Triple angle chisel
Classification by Sturdevant
Cutting instruments
a. Excavators
-Hoe -Angle former -Ordinary hatchet -Spoon excavator
:-
b. Chisels
-Straight chisel -Curved chisel -Enamel hatchet -Gingival margin trimmer
c. Others
-Knives -Files -Discoid -Cleiod
-Stainless steel
2) Nichrome-An alloy of nickel-60-80% chromium12-20% iron-0-26% ADV - can be subjected to high degree of temperature.
COLOUR
USE
Parts of instrument
1) Handle/ Shaft-for grasping the instrument. factors to be considered while handle selection-
a.weight-
hollow-increase tactile transfer. -solid-increase hand fatigue. b.diameter- small-decrease control, increase fatigue. - large-restrict movement in inaccessible areas
c.serrations- knurled-maximize control. smooth-increase muscle fatigue.
SHANK
The shank serves to connect the handle to the working end of the instrument They are normally smooth, round and tapered. Any angulation in the instrument is placed at the shaft.
BLADE / NIB
The working end of the cutting instrument is called the blade whereas the working end of the non-cutting instrument is called nib. Face is the end of the nib or working surface. It maybe plain or serrated. Cutting edge is the working part of the instrument. It is in the form of a bevel with different shapes. - Blade angle is defined as the angle between the long axis of the blade and the long axis of the shaft. - Cutting edge angle is defined as an angle between the margins of the cutting edge and the long axis of the shaft.
INSTRUMENT FORMULA
1st no. -Indicates the width of the blade or primary cutting edge in tenths of a mm.
-2nd no. -Indicates the primary cutting edge angle. -Measured from a line parallel to the long axis of the instrument handle in clockwise centigrade
-If the edge is located perpendicular to the blade then it is omitted.
-3rd no. - Blade length in mm. -4th no. -Indicates the blade angle, relative to the long axis of the . handle in clockwise centigrade. Example -Binangle hatchet-15-8-12( 3 unit formula) -Distal GMT-12-92-10-8(4 unit formula)
Method:- Place the instrument handle on the principle bar of the gauge, parallel with the lengthwise line and while keeping the blade parallel with one of the gradations of the circular head. This gives the angle of the blade with the shaft in centigrades.
Instrument Design
Direct cutting and lateral cutting instruments
a. Single planed instruments:
- Force is applied in the same plane as that of the blade and handle. - They have curves or angles in the shank but in the same plane as the handle. - Used for direct and lateral cutting. b. Double planed instrument: - In lateral cutting instruments the force is applied at a right angle to the plane of the blade and handle. - They have a curved blade and are called double planed instruments. - Used only for lateral cutting. Example:- GMT and spoon excavator.
Contra-angling:-To gain access many instruments have the shank bent at one or more points. - Accordingly, the working point is moved out of line with the axis of the handle. If this occurs more than 3mm from the handle axis the instrument becomes out of balance in lateral cutting motion and the force will be required to keep it from rotating. - To solve this problem the working end is kept within 3mm from the axis of the handle .This principle of instrument design is called contra-angling. - In addition to balance contra-angling also provides better operating acess and a clearer view in the field.
IDENTIFICATION OF INSTRUMENTS
DIRECT CUTTING INSTRUMENTS
When the instrument is held with the cutting edge down and pointing away from the operator and if the bevel appears on the right side it is a right instruments
LATERAL CUTTING INSTRUMENTS
When the instrument is held with the cutting edge pointing away ,the instrument having the curve of the blade directed to the right it is a right instrument
BEVELS OF INSTRUMENT
1 ) SINGLE BEVELLED INSTRUMENTS- Cutting edge at right angle to the long axis of the shaft. - They can be: a.Distally bevelled -if the angle at the junction of the blade and the shank are observed and if primary bevel is not seen it is distally bevelled . b.Mesial bevelled /Reverse bevel -
2)
Ex
angle former.
ADVANTAGES OF HAND CUTTING INSTRUMENTS Self-limited in cutting enamel, cut only enamel undermined by the loss of enamel. No vibration or heat accompanies the cutting, making it painless and with no adverse effects to tooth tissues. Most efficient means of precise intricate cutting. Create the smoothest surface of all cutting instrument. The longest life span of all cutting instruments.
CUTTING INSTRUMENTS
EXCAVATORSDesigned for excavation and removal of carious dentine and for sharpening of internal parts of cavities.
A) HATCHET EXCAVATOR
It is a chisel-bladed instrument with blade and cutting edge in plane with the long axis of the handle Instrument formula- 3-2-28
USES1. Primarily on anterior teeth for preparing retentive areas. 2. Sharpening internal line angles in class I ,III,V cavities. 3. For delicate cutting within preparation. 4. Removing hard caries.
B) HOE EXCAVATOR
Has a cutting edge that is at right angle to the handle , like that of a chisel but the blade angulation is greater than 12.5 and nearly approaching right angle. Instrument formula -4 -1 -22
3.To remove harder varities of caries. 4.Heavy bladed with contra-angled shanks used for enamel of posterior teeth.
3) SPOON EXCAVATOR
It is a modified hatchet with the cutting edge ground to a semi-circular circumferential bevel sharpened to a thin edge.
Uses
a. Excavation of caries. b . Used for carving amalgam & direct wax patterns.
4) DISCOID SPOON
- They have a blade which is
circular in shape with cutting edge extending around the periphery except where it joins the shank. Disc like in shape.
uses
Round shape for reducing excess material
5) CLEIOD EXCAVATOR
Claw like in shape. Essentially a spoon excavator except that the blade is curved to a point. Uses a. For carving occlusal anatomy of amalgam. b. Excavating decay from area of difficult access.
2)CHISELS
Are primarily used for cutting enamel and dentine. They are grouped as chisel enamel hatchet gingival margin trimmer angle former wedelstaed chisel off-set hatchet triangular chisel hoe chisel jeffery hatchet
CHISEL
-Has a blade that is either aligned with the handle, slightly
angled or curved from the long axis of the handle ,with the working end at right angle to the handle.
They are 4 typesa) straight chisel- (12-7-0) straight blade in line with the handle and the shaft
monoangle
Uses for cleaving and planing the cavit walls and floor.
ENAMEL HATCHET
Enamel hatchet is a chisel similar in design to the ordinary hatchet except the blade is longer, heavier and bevelled only on one side.
Instrument formula- 10-7-14.
b) Smaller sizes used for primarily for anterior teeth and larger for posterior teeth.
It is a modified hatchet but differs from hatchet in that a. cutting is at an angle other than 90 b. has a curved blade. c. is a double planed instrument.
Uses:a. 100 and 75 pairs used to prepare steep gingival bevels for inlays and onlays.
d. 85 to 75 used to bevel the mesial gingival margin. e. For bevelling or roundening axiopulpal line angles. f. Accentuate retentive grooves. g. To give reverse bevels
Identification:Distal GMT:-When the cutting edge makes an acute angle with the edge
of the blade farthest from the handle, it is a distal GMT.
Mesial GMT:- The cutting edge makes an acute angle nearest to the handle.
Distal GMT
ANGLE FORMER
Introduced by Woodbury. Made by grinding the bevel at an 80-85 angle with the shaft thus creating a pointed and linear cutting edge. Uses:a. To accentuate line angles and point angles in internal outline form especially for gold restorations. b. Used for giving bevels and retentive features.
Bayonet angle former:When their working blades are offset from the long axis of the shaft they are termed Bayonet angle former.
WEDELSTAEDT CHISEL
Straight chisel with slight vertical curvature in its shank. It is paired. If the bevel is on the side of the blade towards the curvature of the shank it called as the mesial and vice versa. Mesial beveled:- Push motion Distal beveled:- Pull motion Uses:a. Cleaving undermined enamel. b. Shaping walls. Cutting motions:a. Vertical b. Right
c. Left
OFFSET HATCHET
regular hatchet except the whole blade is rotated a quarter of a turn forward or backward along its long axis. Right and left pairs. The whole blade is rotated either forward or backward. Uses:1. To create and shape specific angulation of cavity walls. 2.Planning buccal & lingual wallof posterior teeth.
TRIANGULAR CHISEL
This chisel has a blade which is triangular in shape and the base of the triangle away from the shaft.
HOE CHISEL
JEFFREY HATCHET
Similar to off angle hatchets but their blades are more nearly at right angles to the shaft. It is of 3 types-(depending on the bevel angulation.) a. Inside cutting b. Outside cutting c. Square ended Uses:To prepare mandibular anterior cavities from the lingual side of the teeth.
FILES
USES
Nibs of the file can be:a. Foot shaped b. Parallelogram shaped c. Hatchet shaped
If serrations on the face of the nib are directed away from the handle it is used as a push file, if it is directed towards the handle it is a pull file.
KNIVES
Nibs carry knife edged faces on one side only. Uses:a) Used for trimming excess restorative materials on the gingival, facial or lingual margins of proximal restoration. b) Manipulation of restorative material inter proximally and gingivally. c) Contouring the surface of class 5 restorations.
Examples:a. Blacks knives :- Nibs are almost at a right angle to the handle, with the cutting edge away from the handle in one set (push cutting) and towards the handle in one set (pull cutting). b. Wilsons knife:- Nib is in a plane at at right angles to the shaft and so can be introduced inter proximally for proximal and gingival manipulation of restorative materials.
c. Steins knife
It has a trapezoid nib and is used for direct filling gold contouring and margination
METHODS OF CLEANING
Instruments that touch mucosa or penetrate tissue should be cleaned and then sterilized before reuse. Two methods have been proposed:a. Hand scrubbing b. Ultrasonic cleaning Adv.1 to 9 times more effective.
DISADVATAGES
1.Enhances chances for operator injury. 2.Enhances spread of contamination through splatter. 3.Labour-intensive. 4.Need proper care of scrub brush
HAND SCRUBBING
ULTRASONIC CLEANING
1.Safer than hand 1.Microorganisms may scrubbing. accumulate in cleaning solution. 2.Effectively cleans all instruments. 3.Reduces chances for spread of contaminants. 4.Allows for more efficient use of staff time.
STERILIZATION OF HAND INSTRUMENT Accepted methods of sterilization are:Steam pressure sterilization (autoclave) Chemical vapour sterilization (chemiclave) Dry heat sterilization (dry clave) Ethylene oxide sterilization
2) CHEMICLAVE
Chemical vapor pressure sterilizer operates at 131C and 20 lb of pressure and has a sterilization time of 30 min.
PRECAUTIONInstruments should be absolutely dry when loaded or else sterilization will not be complete. Chemiclave
Plastic or porous material require areation for 24hours before safe use
ADVANTAGES
PRECAUTIONS
SPORE TESTING
BACILLUS STEAROTHER MOPHILUS, STRIPS,VIALS OR AMPULES.
1.Damages plastic or rubber handles. 2.Corrodes non stainless steel items. 3.Use of hard water may leave deposits.
20 min at 270F
1.May damage rubber & plastic items. 2Predry instruments or dip in special solutions . 3.Provide adequate ventilation.
ADVANTAGES
PRECAUTIONS
SPORE TESTING
60-120min at 1.No corrosion. 320F 2.Large capacity per cost 3.Items are dry after cycle 12min at 375F(for wrapped) 6min at 375 F(for unwrapprd items) 1.No corrosion. 2.Short cycle. 3.Items are dry after cycle.
1.Longer sterlization time. 2.Door shouldnt be open before cycle ends. 3.Predry instruments. 1.Door shouldnt be open before cycle ends 2.Small capacity per cost. 3.Unwrapped instruments become contaminated after cycle.
-most commonly used grasp. - the pads of the thumb, index and middle fingers contact the instrument while the tip of the ring or little finger are placed on the near by tooth surface of the same arch as a rest.
- the pad of the middle finger is placed near the topside of the instrument and by this finger, working with wrist and forearm ,cutting and cleaving pressure is generated on the blade. - useful in mandibular arch
Handle is placed in the palm of the hand and grasped by all the fingers ,while the thumb is free of the instrument and the rest is provided by supporting the tip of the thumb on a nearby tooth
Palm and thumb grasp.This grasp has limited use, such as preparing incisal retention in a class iii preparation on a maxillary incisor .The rest is tip of the thumb on tooth in the same arch.
Provides heavy force over a limited range of movement but with greater control than the pen grip.
b.
c.
Gaurds:They are used to protect soft tissues from contact with sharp cutting or abrasive instruments.
PRINCIPLES OF SHARPENING
a Done only after the instrument has been cleaned and sterilized. b. Proper bevel angle and desired angle of the cutting edge to the blade should be maintained. c. Light pressure against the stem should be used to minimize frictional heat.
d. Rest/guide should be used e. Minimal material from the blade should be removed. f. Unleveled side of the blade should be lightly honed. g. After sharpening, the instruments have to be resterilized. h. Sharpening stone should be kept clean and free of metal cutting.
SHARPNESS TEST
A. PLASTIC STICK TEST
Sharpness of an instrument can be tested by lightly resting the cutting edge on a hard plastic surface. If the instrument digs in during an attempt to slide the instrument forward over the surface the instrument is sharp, if it slides it is dull.
B. VISUAL INSPECTION
To test sharpness instrument is held under a magnifying glass in bright light ,& rotated until the edge is facing the light
MECHANICAL TECHNIQUES
a. RECIPROCATING HONING SHARPNER The blade is placed against the steady rest and proper angle of the cutting edge of the blade is established before starting. Trace of metal debris on the face of a flat hem along the length of the cutting edge is indication that the entire cutting edge is contributing the hem.
b. HANDPIECE STONES are used for instruments with curved blades, especially for inside curves of the blade. -They are mounted silicon carbide and aluminium oxide stones with straight and contra-angled handpiece. -
The handpiece should be run at a low speed with the instrument held lightly in a modified pen grasp and the little fingers of each hand touching each other acting as a rest. Overheating is avoided and the use of lubricant or coolant is desireable.
Disadv.:a. It is difficult to produce a flat cutting surface. b. Inconsistent results due to speed variables. c. Lack of rests and guides
SHARPENING OF CHISELS, HATCHETS AND HOES a. The instrument is held in modified pen grasp. b. The blade is placed perpendicular to the stem. c. The correct bevel is established. d. The instrument is moved back and forth with the force from the shoulder coming along the stone or the stone is moved back and forth while maintaining a constant position.
SHARPENING OF DISCOID/CLEOID
Similar to excavator , to hone the flat inside surface of the blade ,a small cylindrical stone is passed back & froth over the surface.
SHARPENING OF GMT
It requires more orientation of the cutting edge, palm and thumb grasp is used for sharpening.
b. The blade is tilted to an acute angle with the stone, and the stroke is straight along the stone and towards the edge of the blade.
b.
c. d.
5. DELIVERY
Place on intended work
surface. Open wrap and retain as sterile work surface cover. Open cassette & place the lid under cassette bottom. Inspect indicator strip & use
2 CLEANING
Place detergent sol.&cassettes in ultrasonic unit Place lid on ultrasonic unit.clean for 16min. Remove cassettes..Rinse thoroughly under warm water. Stand vertically to dry.
4. STERILE STORAGE
3.STERLIZATION
Open cassettes & inspect instruments visually. Wrap instrument in autoclave & seal with monitor tape. Place & process the cassettes
CONCLUSION
REFERENCES
1.PRINCIPLES AND PRACTICES OF OPEERATIVE DENTISTRYGERALD .T.CHARBENAU III EDITION. 2.OPERATIVE DENTISTRY MODERN THEORY& PRACTICES-M.A MARZOUK,A.L SIMONTON,R.D GROSS I EDITION. 3.FUNDAMENTAL OF OPERATIVE DENTISTRY CONTEMPORARY APPROACH-JAMES.B.SUMMIT,J WILLIAM ROBIN,RICHARD SCHWARTZ II EDITION 4.ART & SCIENCE OF OPERATIVE DENTISTRY-STURDEVANT, IV EDITION 5.OPERATIVE DENTISTRY-GILLMORE,LUND BALES,VERNETTI IV EDITION 6.ATLAS OF OPERATIVE DENTISTRY-WILLIAM .W .HOWARD, II EDITION 7.TEXTBOOK OF OPERATIVE DENTISTRY-BAUM ,PHILLIPS,LUND, III EDITION