WILLIAM’S PROBE

Markings: 1,2,3,5,7,8,9 and10mm.

Note: Markings at 4 and 6 mm are missing to avoid confusion in reading the markings.
Uses: To measure the depth of the periodontal pocket.
To measure the width of attached gingiva.
To measure clinical attachment levels.
To assess the presence of bleeding.
To assess the presence of purulent exudate.
UNIVERSITY OF NORTH CAROLINA PROBE
(UNC-15)
Markings: 1,2,3,4,5,6,7,8,9,10,11,12,13,14 and 15.
Color coding: 5th(4-5), 10th (9-10) and 15th (14-15) millimeters.
Uses: To measure the depth of the periodontal pocket.
To measure the width of attached gingiva.
To measure clinical attachment levels.
To assess the presence of bleeding.
To assess the presence of purulent exudate.
COMMUNITY PERIODONTAL INDEX OF TREATMENT
NEEDS (CPITN) PROBE/ WHO (WORLD HEALTH
ORGANIZATION) PROBE
Design: unique ball-end of 0.5 mm in diameter, which is attached to a 16-mm-long
working-end
Markings: 3.5, 5.5, 8.5, and 11.5 mm
Uses: In epidemiology and routine periodontal screening in general dental practice.
The ball-end helps to detect root surface roughness like calculus.
FLORIDA PROBE
• Computer-assisted probe with digital readouts and computer storage of data.
• Consists of a probe handpiece and sleeve; a displacement transducer; a foot switch;
and a computer interface .
• Constant probing pressure of 15 g is provided by coil springs inside the handpiece.
• Measurement of the probe depth is made electronically and transferred
automatically to the computer when the foot switch is pressed.
• Can also record missing teeth, recession, pocket depth, bleeding, suppuration,
furcation involvement, mobility, and plaque assessment.
NABER’S PROBE
Markings: 3, 6, 9 & 12mm
Color coding: Black bands from 3 to 6 mm and 9 to 12 mm.
Uses:
For maxillary first premolars and molars:
The N2 is used for assessment of facial and lingual furcation areas.
The N1 is used for assessment of mesial and distal furcation areas.
For mandibular molars
The N2 is used for assessment of facial and lingual furcation areas.
3 Wall Bone Defect
Type of defect : Vertical bone loss with furcation involvement .

Classification of the defect : 3 wall defect with Grade II furcation involvement.

No. of walls present: 3

Treatment plan : Regenerative surgery with bone graft and membrane .

 TYPE OF INFRABONY DEFECTS

A B C
 TYPE OF BONE DEFECT NO. OF WALLS PRESENT

A THREE WALL DEFECT 3

B TWO WALL DEFECT 2

C ONE WALL DEFECT 1

VERTICAL AND HORIZONTAL BONE LOSS WITH
FURCATION INVOLVEMENT
Type of defect : Vertical and horizontal bone defect with furcation involvement.
Classification of the defect : 1 wall defect and horizontal bone loss with Grade II
furcation involvement irt maxillary first and second molar.
Treatment plan : Regenerative surgery with bone graft and membrane and
osteoplasty.
AGGRESSIVE PERIODONTITIS
Type of defect : Vertical and 2 wall defect
Characteristic feature : Arc shaped bone loss extending from distal of second premolar
to mesial of second molar.
Treatment plan : Regenerative therapy
CRATER
Type of bone loss : Vertical bone loss
Classification of the defect : Intrabony defect , 2 wall defect.
( CRATER )
Treatment plan : Regenerative surgery with bone graft.
RADIOGRAPHIC PRESENTATION OF HORIZONTAL BONE
LOSS
Type of bone loss: Horizontal Bone Loss
Type of defect: Suprabony
Treatment plan: Flap surgery with osteoplasty if probing depth after SRP is >5mm
WALKING PROBE METHOD
PROBING TECHNIQUE :
Walking probe method
Helps in detecting the morphology of underlying bone defect
Also the depth of the pocket
SIX POINT PROBING METHOD :
Helps in knowing the pocket depth at 6 sites in tooth
BUILDING BLOCKS FOR PERIODONTAL INSTRUMENTATION

A B
A: Successful periodontal instrumentation requires the mastery of the skill building
blocks of position, grasp, mirror use, finger rests, and stroke production.
B: Faulty Execution of Building Blocks. Incorrect performance of even one of the
building blocks means that periodontal instrumentation will be inefficient and, most
likely, ineffective and uncomfortable for both the patient and clinician.
MODIFIED PEN GRASP
Digit(s) Placement Function
Index and Thumb On the instrument handle Hold the instrument
Middle Finger Rests lightly on the shank • Helps to guide the
working-end
• Feels vibrations
transmitted from the
working-end to the
shank
Ring Finger • On oral structure; often Stabilizes and supports the
a tooth surface hand for control and
• Advances ahead of the strength
other fingers in the
grasp
Little Finger Near ring finger; Has no function in the
held in a natural, relaxed grasp
manner
SICKLE SCALER
• A sickle scaler is a periodontal instrument used to remove calculus deposits from
the crowns of the teeth.
• The working-end of a sickle scaler has a pointed back and pointed tip and is
triangular in cross section.
THE STANDARD GRACEY CURET SERIES.
 Curette Area of application
Gracey 1 and 2
Anterior teeth: all tooth surfaces
Gracey 3 and 4

Anterior teeth: all tooth surfaces

Gracey 5 and 6
Premolar teeth: all tooth surfaces

Gracey 7and 8
Posterior teeth: facial and lingual surfaces
Gracey 9 and 10
Gracey 11 and 12 Posterior teeth: mesial surfaces
Gracey 13 and 14 Posterior teeth: distal surfaces
KIRKLAND KNIFE
• Flat-bladed gingivectomy knives.
• Kidney-shaped knives.
• Typically used for Gingivectomy and Gingivoplasty.
• Can be obtained as either double-ended or single-ended instruments.
• Have a cutting edge that extends around the entire blade.
ORBAN KNIFE
• The Orban knife can be used for interdental areas.
• These spear-shaped knives have two long, straight cutting edges that come together
at the sharply pointed tip of the instrument.
• They are designed with either double-ended or single-ended blades.
• The entire blade is roughly perpendicular to the lower shank of the instrument.
OCHSENBEIN CHISELS
• The Ochsenbein chisel is with a semicircular indentation on both sides of the shank
that allows the instrument to engage around the tooth and into the interdental
area.
• Ochsenbein chisels are paired, with their cutting edges in opposite directions.
AREA-SPECIFIC CURETTE
Cross section: Semi-circular
Working-end: One working cutting edge per working-end
Face: Tilts at approximately a 70° angle to the lower shank
Cutting edges: Curved cutting edges
Enhance adaptation to rounded root surfaces and root concavities
Application: Limited to use on certain teeth and certain surfaces
Primary functions: Instrumentation of crown and root surfaces
Standard curets are used to remove light calculus deposits and for
deplaquing.
Rigid Gracey curets can remove medium-size deposit.
PERIODONTAL FILE
A periodontal file is a periodontal instrument that is used to prepare calculus deposits
before removal with another instrument.
Cutting Edges: Multiple edges, at a 90° to 105° angulation to the base
Uses: Crush large calculus deposit
Roughen burnished calculus deposit
Smooth overhanging amalgam restoration
Examples: Hirschfeld 3/7, 5/11, and 9/10 files and the Orban 10/11 and 12/13 files.
UNIVERSAL CURETTE
Cross section: Semi-circular
Working-end: Rounded back and toe with two working cutting edges per working-end.
Face: Face is at a 90° angle to the lower shank
Cutting edges: Two parallel cutting edges meet in a rounded toe
Application: One double-ended instrument is used on both anterior and posterior
teeth
Primary functions: Instrumentation of crown and root surfaces
Removal of small- to medium-size calculus deposits
Can be used supragingivally and subgingivally-on crown and root
surfaces.
 LANGER CURETTES

#5-6 #1-2 #3-4

 Curette Area of Use
Langer 5/6 Anterior teeth
Langer 1/2 Mandibular posterior teeth
Langer 3/4 Maxillary posterior teeth
Langer 17/18 Posterior teeth
PERIODONTAL ABSCESS
• A periodontal abscess is a localized purulent inflammation in the periodontal
tissues.
• It is also known as a lateral abscess or a parietal abscess.
• Can present itself as:
i. Abscess in the supporting periodontal tissues along the lateral aspect of the
root. With this condition, a sinus generally occurs in the bone that extends
laterally from the abscess to the external surface.
ii. Abscess in the soft-tissue wall of a deep periodontal pocket.
GOLDMAN-FOX KNIFE
• Spear shaped knives.
• For cutting interdentally after initial incision.
• Severs buccolingually.
• Angled blade.
• Are designed for specific region.
• #11-Offset blade for Posterior teeth
• #8- Anterior teeth
GOLDMAN–FOX SCISSORS
• Goldman–Fox #16 scissors have a curved, beveled blade with serrations.
• Scissors and nippers are used in periodontal surgery to remove tabs of tissue during
gingivectomy, to trim the margins of flaps, to enlarge incisions in periodontal
abscesses, and to remove muscle attachments in mucogingival surgery.
MAGNIFYING LOUPES
• Dental loupes are the most common system of optical magnification used in
periodontics.
• Dental loupes provide a limited range of magnification (×1.5 to ×6).
• Decreased eyestrain and an improved visual sharpness
• Magnification may reduce the tendency to lean forward in an attempt to obtain a
better view of the treatment area and, therefore, reduce musculoskeletal strain to
the clinician’s neck, back and shoulder muscles.
PIEZOELECTRIC ULTRASONIC SCALERS
• Frequency range :18,000 to 50,000 cycles per second
• Mechanism of action: ceramic disks located in the handpiece power the
piezoelectric technology and change in dimension as electric energy is applied.
• Piezoelectric tips move primarily in a linear pattern
• The tip has two active surfaces.
• Various insert tip designs and shapes are available for use.
SCHLUGER PERIODONTAL FILE
• The Schluger periodontal file is a double ended instrument, used for interproximal
bone reduction.
• Can be used for crown lengthening in areas inaccessible with burs.
• These files have two cutting side with a flat side. Flat side protect the teeth to get
damage form sides.
SUGARMAN PERIODONTAL FILE
• Used interproximally.
• File surfaces on both sides allow for push or pull application.
• For removal of granulomatous tissue in supra-bony and infra-bony pockets.
MAGNETOSTRICTIVE ULTRASONIC DEVICES
Frequency range: 18,000 to 50,000 cycles per second.
Mechanism of Action:
• Vibrations travel from the metal stack to a connecting body that causes the
vibration of the working tip.
• Tips move in an elliptical or orbital stroke pattern.
• Tip has four active working surfaces
PERIODONTAL DRESSING(COE-PAK)
• Composition:
• One tube consists of zinc oxide, an oil (for plasticity), a gum (for
cohesiveness), and lorothidol (a fungicide).
• The other tube contains liquid coconut fatty acids that have been
thickened with colophony resin (or rosin) and chlorothymol (a
bacteriostatic agent)
• Have no curative properties
• The dressing facilitates healing by preventing surface trauma during mastication
• Protects the patient from pain induced by contact of the wound with food or with
the tongue during mastication.
FENESTRATION AND DEHISCENCE
• Fenestrations- Isolated areas in which the root is denuded of bone and the root
surface is covered only by periosteum and overlying gingiva.
• In these areas, the marginal bone is intact.
• Dehiscence- When the denuded areas extend through the marginal bone, it is
called dehiscence.
INTERDENTAL BRUSH
• Interdental brushes, also known as interproximal brushes or proxy brushes, are
small cylindrical or tapered brushes that are used to clean the interdental areas of
teeth where toothbrush cannot reach.
• Mechanical method of plaque control.
• Can be used in large embrasure spaces and furcation areas, as well as the mesial
surface of the maxillary first bicuspid, which presents a concavity on the root
surface near the cementoenamel junction.
PALM AND THUMB GRASP
• The palm and thumb grasp is useful for stabilizing instruments during sharpening
and for manipulating air and water syringes, but it is not recommended for
periodontal instrumentation.
• Maneuverability and tactile sensitivity are so inhibited by this grasp that it is
unsuitable for the precise, controlled movements necessary for periodontal
procedures.
DISCLOSING AGENTS
• Disclosing agents are solutions or wafers that stain bacterial biofilm on the surfaces
of the teeth, tongue, and gingiva.
• They usually produce staining of plaque biofilm, gingiva, tongue, lips, and fingers.
• They can be used as educational and motivational tools to improve the efficiency of
plaque biofilm control procedures.
PERIOCHIP
Composition: 2.5 mg of the active ingredient chlorhexidine gluconate in a resorbable,
biodegradable matrix of hydrolysed gelatin that is cross-linked with glutaraldehyde
Size: 4.0 × 5.0 × 0.35 mm
Site: into the periodontal pocket
Uses: in local drug delivery as an adjunct to SRP procedures for the reduction of pocket
depth in adults with periodontitis
Can be used as part of a periodontal maintenance program which includes good oral
hygiene and SRP.
DENTAL IMPLANT
A dental implant is a nonbiological (artificial) device surgically inserted into or onto the
jawbone to replace individual teeth or support a fixed bridge or removable denture.
Implant system components.
• Implant body,
• Abutment
• A prosthetic crown or prosthesis
Osseointegration: direct contact of the living bone with the surface of the implant body
(with no intervening periodontal ligament).
Osseointegration is a major requirement for implant success.
HORIZONTAL BONE LOSS
• Horizontal bone loss is the most common pattern of bone loss in periodontal
disease.
• The bone is reduced in height, but the bone margin remains approximately
perpendicular to the tooth surface.
• The interdental septa and the facial and lingual plates are affected but not
necessarily to an equal degree around the same tooth.
RADIOGRAPHIC PRESENTATION OF VERTICAL BONE
LOSS
• Vertical or angular defects are those that occur in an oblique direction, leaving a
hollowed-out trough in the bone alongside the root.
• The base of the defect is located apical to the surrounding bone.
• In most instances, angular defects have accompanying infrabony periodontal
pockets.
• Infrabony pockets must always have an underlying angular defect.
DENTAL FLOSS
• Most widely recommended tool for removing biofilm from proximal tooth surfaces
• Floss is made from nylon filaments or plastic monofilaments, and it comes in waxed,
unwaxed, thick, thin, and flavored varieties.
• The floss is slipped between the contact areas of the teeth and wrapped around the
proximal surface, and removes plaque by using several up-and down strokes. The
process must be repeated.
NEW MINI TITANIUM IMPLANT SCALERS
• Plastic and titanium instruments for use on titanium and other implant abutment
material
• May be used for implant maintenance with careful, light pressured strokes for
biofilm and light calculus removal. Moderate- or heavy-pressured strokes should be
avoided to prevent scratching or roughening of implant surfaces.
• These instruments are not intended for removal of heavy calculus or cement.
HOE SCALER
• Hoe scalers are used for scaling of ledges or rings of calculus.
• The blade is bent at a 99-degree angle
• Cutting edge is formed by the junction of the flattened terminal surface with the
inner aspect of the blade. The cutting edge is beveled at 45 degrees.
• Blade has been reduced to minimal thickness to permit access to the roots without
interference from the adjacent tissues.
• Works by PULL action.
EXTRAORAL PALM-UP FULCRUM
• The backs of the fingers rest on the right lateral aspect of the mandible while the
maxillary right posterior teeth are instrumented.
• The palm-up fulcrum is established by resting the backs of the middle and fourth
fingers on the skin overlying the lateral aspect of the mandible on the right side of
the face.
 ADAPTATION OF GRACEY CURETTES

A b
A: Correct cutting edge of a Gracey curette adapted to the tooth
B: Incorrect cutting edge of a Gracey curette adapted to the tooth
With the toe pointed in the direction to be scaled (e.g., mesially with a #7-8 curette),
only the back of the blade can be seen if the correct cutting edge has been selected.
If the wrong cutting edge has been adopted, the flat, shiny face of the blade will be
seen instead.