Hand Instruments

used in operative
dentistry

Anurtha k
Final year part 2
INTRODUCTION
The standardization of the design of cutting instruments by the manufacturer has been helpful to the practitioners.

All instruments are identified by a nomenclature and a number that describe the size, design and common clinical
usages.

The general classification of instruments used in restorative dentistry according to their use includes;

1. instruments used for cutting tooth substance:

a. Hand cutting instruments; chisels, hatchets, excavators, angle formers, marginal trimmers.
b. Rotary tools; burs, different abrasives in the form of stones, discs.

2. Plastic filling instrument( used in manipulating, packing, condensation and carving plastic filling materials).

Mixing spatulas, Carvers, Burnishers, Hand and Mechanical condenser.

3. Finishing and polishing instruments:

(used to refine, smoothen, finish and polish all restorative materials).
a. Hand: polishing points, finishing strips.
b. Rotary: finishing burs, mounted stones and brushes, impregnated strips and rubbercup

4 Instruments used for isolation of the working area:

Rubber dam equipments (punch, holder, clamps) saliva ejectors, cotton roll and roll holders, evacuating tips and
equipmenT

5. Miscellaneous instruments: (used mainly to diagnosis and assess carious lesion together with other variable
purposes)
Mouth mirrors, Probes and Explorers, Tweezers.

Examination Kit or diagnostic kit

Moth mirror
Provide indirect vision .
Retract lips, cheeks and Tongue.
Reflect light into mouth.
Explorer Examine tooth for decay, calculus, furcation and abnormalities .

Cotton forceps (Pliers) Grasp materials and/or transfer it into or out of oral cavity.
Periodontal probe
Measure depth of periodontal pockets .
Hand Instruments
• definition: hand instruments were originally used to differentiate between hand cutting instruments and
motorized hand-pieces used for cavity preparation.
• Hand instruments are used for:
a. Examination and charting.
b. Removal of decay.
c. Refining preparations
d. Placement of filling materials.
e. Carving and finishing materials.
f. Burnishing metals.

iii. Hand instruments are composed of three parts:

a. Hand or shaft: The part grasped in the operator’s hand, usually straight and without variations in size, it smooth
knurled and / or serrated to allow for better instrument control.

b. Shank: It begin with the first twisted portion of the shaft and ends where the blade or nib begins. It may be straight,
single, double or triple angled. It tapers smoothly from the shaft to the blade.

c. Blade or Nib: The working part of the instrument, begin at last angle, which terminates the shank.

GV. Black’s Formula ( instrument formula ):

a. Three number formulas;

b. 1. the first number indicated the width of the cutting of the blade in tenths of a millimeter.

2. the second number is indicated the length of the cutting blade in millimeter.

3. the third number is indicated the angle that the blade makes with the long axis of the handle in degree centigrade or
hundredths of a circle.

b. four number formulas;

1. the first number indicated the width of the cutting of the blade in tenths of a millimeter.
 2. the second number indicated the angle of cutting edge makes with the handle in degree centigrade.

3. the third number is indicated the length of the cutting blade in millimeter.

4. the fourth number is indicated the angle that the blade makes with the long axis of the handle in degree centigrade
or hundredths of a circle.

V. Instrument Sharpening :
For efficient use, hand-cutting instrument must be maintained in a sharpened state.

There are tWO methods for sharpening hand instruments:

• Mechanical sharpening
• Hand sharpening

Mechanical sharpening; such as electric sharpeners are more efficient, but tend to wear the cutting blades through
excessive sharpening. The same is true with mounted sharpening stones designed for dental hand-pieces and
laboratory lathes.

Hand sharpening; is somewhat slower, but offers more control. In addition, hand sharpening can be done chair side as
needed. This required sterilization of the stones after each clinical use. Most sharpening stones required the use of a
lubricant for efficient use and maintenance.

VI. Instruments Nomenclature (Instrument Names):

G V Black classified all instruments by name. In addition, for hand cutting instruments, he developed numeric formula to
characterize the dimensions and angles of working end.
Black's classification systems categorized instruments by :
(1) The purpose of use or Function (e.g., scaler, excavator),
(2) The position or Manner of use (e.g., hand condenser),
(3) The form of or Design of working end (e.g., spoon excavator, sickle scaler)
(4) The angles or Shape of shank (e.g., mon-angle, bin-angle, contra-angle).
These names were combined to form the complete description of instrument
(e.g., bin-angle spoon excavator).

VII. Factors Affecting Working Efficiency of hand instruments:

1. contra-angling:
a. To facilitate access to different areas of teeth.
b. To get out of balance and rotate readily in the operator’s hand on application of force.
c. To prevent instrument imbalance or eccentricity.
d. To determines the inaccessibility cavity.
2. Beveling:
Hand cutting instruments, usually the blade is beveled on the right or left side, so it’s called right or left instruments, if
beveled both side called bi-beveled.
These designs facilitate the development of more conservative preparations and allow use of the edge of the cutting blade
in many situations.
If beveled is placed on the distal or mesial aspect of blade relative to the shaft, the instrument called a contra or reversely
or directly beveled like a Curved (Wedelstaedt

3. Direct and lateral cutting instruments.

4. Right and left cutting instruments.
5. Single ended or double ended.
6. Material and design;
a. stainless steel instruments incorporating carbon and chromium give improved corrosion resistance, brightness and
hardness.(Material)

b. Thinner cross section of the cutting edge  more concentrated the pressure (force)  more efficient the instrument
will be.(Design)

IX. Types of hand cutting instruments;

• Chisels : used primarily for cutting enamel surface.
• Excavators: Used for removal of caries and refinement of internal parts of preparation.

1.Chisels
Intended for cutting enamel.
Grouped as:
(a) Straight, Slightly curved, or Bin-angle the bevel on only one side.
primary edge is perpendicular to axis of the handle.may be slightly curved (Wedelstaedt design) or bin-angled .

(b) Enamel hatchets

Is a chisel similar in design to ordinary hatchet except blade is larger, heavier and beveled on one side.
Cutting edges in a plane that is parallel with the axis of the handle.
1.Chisels
1.chisels
1. Chisels
(c) Gingival margin trimmers
 Designed to produce proper bevel on gingival enamel margins of proximo-occlusal preparations and rounding or
beveling axiopulpal line angle of two-surface preparations.

 Similar in design to the enamel hatchet, except the blade is curved.

 Primary cutting edge is at an angle to axis of blade .

2.Excavators
Ordinary hatchet excavator :

Cutting edge of blade directed in the same plane as long axis of handle and is bi-beveled .
Used on anterior teeth for preparing retentive areas and sharpening internal line angles.

Hoe excavator :

Has the primary cutting edge of blade perpendicular to axis of handle .

Used for planning tooth preparation walls and forming line angles.
Commonly used in classes III and V preparations for restorations.

Spoons excavators
Used for removing caries and carving amalgam or direct wax patterns.
Blades are slightly curved and cutting edges are either circular or clawlike. Circular edge is known a discoid, whereas the
clawlike blade is termed cleoid . Shanks may be bin-angled or triple-angled to facilitate accessibility.
Discoid-cleoid
used for carving occlusal anatomy in unset amalgam restorations.
It also may be used to trim or burnish inlay - onlay margins.

NON CUTTING INSTRUMENTS

Amalgam condenser
It is a dental instrument used for compacting silver amalgam while in a plastic state, used for restoring teeth to a natural
contour.

Condensers come in single- and double-ended designs. They have various shaped and sized working ends, which may be
smooth or serrated.

Mouth mirror
mouth mirror or dentist's mirror is an instrument used in dentistry.
The head of the mirror is usually round, and the most common sizes used are the No. 4 and No. 5. A No. 2 is sometimes
used when a smaller mirror is needed, such as when working on back teeth with a dental dam in place.
its most important functions are:
allowing indirect vision by the dentist .
 reflecting light onto desired surfaces
 retraction of soft tissue

A. Carvers.
After the amalgam is condensed, it must then be carved to approximately the same original tooth structure.
Carvers have sharp cutting edges that are used to shape, form, or cut tooth anatomy into amalgam restorations.

B. Burnishers.
When the carving is complete, the dentist may use burnishers.
used to
smooth and polish the restoration.
remove scratches left on the amalgam surface by a carving instrument.

X. instruments grasps:
• For instrument to be used efficiently it must be handled properly.
• In patient mouth hands or fingers of the operator should be firmly braced against hard tissues ( teeth or
jaws not cheek ).
• Instrument movement are more controlled if the bracing point is as close to the actual operating site.
• Maxillary teeth provide better support than mandibular ( no movable joint ).
• To accomplish bracing one can use two hands than one.

Hand instrument techniques

4 Grasps used with hand instruments:

 (1) Pen grasp.

 (2) Inverted pen grasp .
 (3) Palm & Thumb grasp .
 (4) Modified Palm & Thumb grasp .

Pen Grasp

 Pads of thumb, index, and middle fingers contact instrument(shaft), while tip of ring finger and little finger is
placed on a nearby tooth surface of the same arch as rest. Used when direct vision is possible.
 Inverted Pen Grasp

 Hand is rotated so that Palm faces more toward operator .

 Used mostly for tooth preparations utilizing palatal approach on anterior teeth. That facing upwards (indirect
vision) upper teeth.

Palm & Thumb Grasp

 Handle is placed in the palm and grasped by all fingers, while thumb is free of instrument and rest is provided by
supporting tip of thumb on nearby tooth of same arch or on firm, stable structure.(direct vision)
 Used for cutting incisal retention for Class III preparation on incisors in labial, buccal and class I or II in occlusal
surfaces) .
 Used when need more force

Modified Palm & Thumb Grasp

 Handle of instrument is held by all four fingers whose pads press handle against distal area of palm, as well as pad
and first joint of thumb.

 Used in area of maxillary arch and is best adopted when the dentist is operating from near-chair position. (Used
indirect vision)
 Hand is only half closed.
 End of the thumb is used for rest.
  Give greater freedom and ease
 movements.

X. Rest and Guard

Rest ;
1. Finger not used to grasp instrument support and stabilize the working hand.
2. Should always be on firm tissue of teeth.
3. Ideally rest on teeth adjacent to the one being operated.
4. In pen grasp rest is achieved by the 2 small finger.
5. In palm grasp rest is achieved by the thumb.

Sterilization
process by which an article, surface or medium is freed of all living microorganisms.
-Most dental offices have a designated area for instrument reprocessing that is separate from the dental treatment
room. This is ideal, since cleaning, sterilizing and storing instruments in the same room where the delivery of
patient care is provided increases the risk of cross-contamination.
-Some instruments and materials are single use only.
- Single-use items should be segregated in the operatory,
and those that are sharp or otherwise pose a risk of injury must be discarded into a sharps container .
-Items without risk, such as a saliva ejector, can be thrown into the trash.
To prevent accidental injury with the contaminated instruments, special handling should be used to transport the
instruments to the cleaning and sterilization area.

 Steam pressure sterilization: autoclave

 Chemical vapour pressure sterilization
 Dry heat sterilization
 Ethylene oxide sterilization