Basic Dental Instruments:

Hey everybody, Ryan here. Welcome to this video that I've prepared on basic dental
instruments.

Classification of dental hand instruments:

So, the two main categories of dental hand instruments are non-cutting and cutting
instruments. This is by no means a comprehensive list, but I've included the instruments that
are most frequently used by myself and what you might find in a typical cassette for routine
exams and operative procedures. Near the end, we can talk briefly about “hand pieces”, which
fall into their own category.
Dental hand instruments
So dental hand instruments have three main regions, and they're important to keep in mind as
we talk through each instrument. So the part labeled C is referring to “the handle” of the
instrument. It's about six millimeters in diameter. It's either eight sided or round. It sometimes
has a ribbed grip like you see here for better handling, or it can be smooth and flat. The B
section refers to “the shank”, which may or may not have one or more bends in it so that “the
blade” of the instrument is aligned with the long axis of the handle. I already talked about this,
“the shank” transitions into “the working end”, which should lie in the long axis of the
instrument for best “balance” and “control”. So, “the working end”, which is labeled A in this
diagram, consists of either “a blade” and “a cutting edge” for a “cutting instrument” or a “nib”
and a “face” for a non-cutting instrument. And because this diagram is showing a “cutting
instrument”, the whole A section would be “the blade” of the working end and the actual sharp
“functional cutting part” would be the cutting edge of that blade. So here is another schematic
showing the parts and pieces of “non-cutting” and “cutting” instruments. So enough about that.

The non-cutting dental hand instruments:

Let's go into specific hand instruments and we'll start with the non-cutting variety. All right, so
first we have the dental mirror. And you may be wondering why do we even need a mirror like
this? Well, some tooth surfaces are really difficult or even impossible to see without it. For
example, the biting surfaces of upper teeth would require you as the operator to have the
patient sitting way back and you craning your neck way up and to the side just to get a decent
look. The cheek surfaces of the molar teeth would require you to stretch the cheeks really, really
far to get just a decent look at them, but the mirror makes all of this a lot easier. We call this
ability to look at oral structures using the mirror indirect vision. And you can try indirect vision
yourself if you have a wall mirror in your bedroom or your bathroom and a separate hand
mirror. You stand with your back to the wall mirror and then hold the hand mirror in front of
you and then try to look at the back of your head, angling and using both mirrors. It can be a
little disorienting to track your movements, like if you were brushing your hair in this fashion,
for instance. But this is the learned skill of using indirect vision. And really all it takes is some
practice. Another really cool thing I did back in dental school to practice was buy a cheap plastic
dental mirror, take a piece of paper, and then while looking only into the mirror, try to write my
name upside down on the paper. So it looks right side up in the mirror, but your hand has to do
just the opposite. So it's a fun little trick you can do at home, and I found it really helpful for just
getting indirect vision to start clicking. All right, next we have the Explorer.

The Explorer instrument:

The Explorer provides tactile sensitivity to detect if edges of fillings have good integrity with the
surrounding tooth structure also margins of crowns fitting well to the tooth and other purposes
like that historically they've been used to probe and poke to structure to detect cavities but
doing so too roughly can actually induce a cavitation into weakened enamel so they should be
used gently if used in this way so here we have the shepherd's hook it's the classic curved end
of the explorer it's also noted number 23 explorer number 17 explorer is the flatter shorter
hook on the other end of this one which is great for interproximal areas between the teeth and
lastly there is the 3CH explorer also called a cow horn or a pigtail explorer which curves under
and around the teeth and can be preferred by some providers for detecting crown margins and
other things that might wrap around and underneath the bottom of the tooth next we have the
periodontal probe and this is used to measure the pocket depth between gum and tooth to
detect the presence of gum disease of course they can also be used to measure other things like
width of teeth amount of overbite and things like that so we have a couple different measuring
designations depending on the type of probe that you use up here is the UNC-15 probe and on
the top you can see here that each mark represents one millimeter and then the first thicker
line goes from four to five millimeters then we have six seven eight nine and ten are the next
two of the darker thicker black line and then so on the next one here is called the williams
probe from the university of michigan and this one goes again in one millimeter increments but
it leaves out or omits four and six millimeters so otherwise it includes one to ten and lastly we
have the marquise probe which has three millimeter increments and the blocks of lines and
alternating no marks marks no marks marks that's 0 to 3 then to 6 9 12 15 and so on so those
are just three of several different configurations for periodontal probes used to measure next
for non-cutting we have the amalgam condenser which is used to squish amalgam material into
the depths of a cavity preparation so that's properly condensed some dentists can actually or
prefer to smush amalgam into a cavity prep with their gloved finger but to really get it properly
pushed into the corners and the edges of a cavity preparation you need an instrument like this it
can also be used for condensing composite material into the base of a prep in a similar fashion
so the nib of this device this instrument is the portion of the condensing instrument that comes
into contact with the restorative material being condensed and the very end of the nib is called
the face and it's usually smoothed but can be serrated and lastly for non-cutting we have the
ball burnisher now this one's one of my personal favorites it can be used for burnishing or even
carving the surface of an amalgam filling before it completely sets to give it some contour and
anatomy it can also be used in a similar way to smooth out the occlusal surface of a composite
restoration before it is cured and you can see it usually has some different ends on it this one
has two spherical ends one bigger than the other and others have one spherical end and then
one more football shaped end all right so that was a little bit on non-cutting instruments now
let's talk about some cutting instruments this is a little bit of an overgeneralization but this is
generally what each of these categories of instruments applies to and works on the scalars
working on calculus excavators being used on dentin chisels being used on enamel and then my
other miscellaneous category being used to modify and edit restorative material so keep this in
mind as we go through the next few instruments

Formula of the dimensions of the working end of cutting

instruments:
So, in addition to the three sections of an instrument, we can now introduce a formula that
describes the dimensions of the working end of most cutting instruments. Now I won't belabor
this point too much, but it is interesting to know that there is a three or four number formula
that can describe most cutting instruments. The first number refers to the width of the blade. So
in this example, this instrument has a first number of 10. That refers to this dimension of the
blade being just one millimeter. So this number is referring to the width of the blade in tenths of
a millimeter. The second number refers to the angle of the cutting edge relative to the long axis
of the blade so in this scenario the blade's long axis is like this and the cutting edge is like this so
they form a 90 degree angle and the cutting edge is perpendicular to the blade so it's omitted if
that's the case it would be 90 degrees but we actually don't include that number The third
number of the formula refers to the blade length. That's simply the length of the blade right
there. And because the number is seven, this is measured in millimeters. So the blade is seven
millimeters long. And the fourth and final number of the formula is probably the most
complicated. It refers to the angle of the blade this time relative to the long axis of the handle.
So this is the handle here I already basically drew the long axis of the blade so the handle would
go something like this if we were to continue that long axis And the number doesn't refer to the
actual angle this time, like the second number. It refers to the percent of 360 degrees. So 14
would mean 14% of 360 degrees, which is about 50 degrees. So this angle right here that the
blade takes relative to the handle is about 50 degrees. So if you know the three or four numbers
of a formula, you can visualize and even identify what kind of hand instrument it's describing. In
this case, 10-7-14 refers to an enamel hatchet, which we'll talk about in just a little bit. Alright so
our first cutting instrument we'll talk about is the scaler. Now scalers are usually two-sided
instruments, each with its own working end, and each working end has two cutting edges that
adapt closely to the tooth and remove calculus from the crown or root surface. There are
universal types that can be used anywhere in the mouth and then specific types like Gracie's
that are designed for specific teeth and specific areas in the mouth. Sickle scalers with sharp
points are used for calculus above the gum line, and curettes with rounded ends are used for
calculus below the gum line. That's because it's a little bit more gentle when used below the
gums. I have much more in-depth information about hand scalers in my periodontics series, so
go check that out if you're interested. The spoon excavator, with a formula of 11.5714 as an
example, is used for gentle and controlled carries removal. So some operators prefer to use a
round burr and a slow speed handpiece. We'll talk about that a little bit more later. And others
like to use small controlled movements with the spoon excavator to scrape carious dentin with
the paddles of the spoon excavator. There's also the black spoon, which is a larger, more robust
version of the spoon excavator I just showed you. And this one has some other uses. It can also
be used to burnish metal, like a matrix band or the margin of a gold crown, with the rounded
end or the backside of the spoon. Next we have the enamel hatchet. This is a double-ended
cutting instrument used for planing walls of enamel. This is the one we were looking at before
with the formula 10-7-14. The bevel on one end planes the facial wall, the bevel on the other
end planes the lingual wall, and vice versa if you're in another part of the mouth. Here is an
example of an enamel hatchet used to plane unsupported enamel from the facial wall of a prep.
Next we have the bin angle chisel.

Bi-angle Chisel:
This is also a double ended cutting instrument used for planing walls of enamel and it's called
bin angle because there are two angles in the shank of the instrument so if this is the handle,
we transition to the shank there's one more subtle angle and there is the second and you can
also see it in this diagram here and here and then we transition into the working end so this
angling of the shank is to allow for proper orientation of the blade and to provide balance when
using the instrument it's similar to the enamel hatchet in function both are used to plane walls
of enamel but the blade is perpendicular to the blade of the enamel hatchet so you can see the
difference this one is flat to the screen and this one is facing the other way so this enables us to
use this instrument in another part of the mouth where the enamel hatchet couldn't access and
next we have the gingival margin trimmer again similar to the last two except this instrument is
designed for planing enamel at the gingival floor of a prep rather than the facial and lingual
walls the cutting edge is most importantly not perpendicular to the blade of this instrument so
there is a second number in the formula to represent that if that number is less than 90 degrees
then it's used for the mesial side of the tooth if it's greater than 90 degrees it's used for the
distal side of the tooth so this represents a mesial marginal tremor this a distal marginal tremor
and so instead of being used for facial and lingual walls the margin trimmer is used to plane or
trim off this unsupported enamel at the gingival floor all right next now we're moving into our
other category the discoid cleoid is a double-ended round-handled instrument used for carving
and contouring amalgam so the cleoid end is this claw-like end used for carving grooves into the
amalgam the discoid or circular disc-like end is used for carving pits and fossa into the amalgam
the Hollenbach Carver is also a double-ended round handle instrument used for placing carving
and contouring amalgam the two ends are oriented 90 degrees to one another alright so now
we can talk a little bit about how we hold all of these dental instruments that I just talked about
so a normal pen grasp involves directly holding a dental instrument with your index finger and
thumb so the instrument rests on your middle finger and you can try this with a pencil or a pen
or whatever you might have at your disposal with this grasp your ring finger is used as a finger
rest and then we have the modified pen grasp which is my personal favorite and what's taught
in many dental schools and this is where you add the middle finger to grabbing the instrument
directly and so the instrument then rests on your ring finger which provides additional control
now having three fingers instead of just two it provides additional control for fine motor
function and then you can use your ring finger and your pinky finger together as a finger rest
and what do I mean by finger rest well all grasps require firm finger rests which provides a
fulcrum point so that your hand is stable and in case the patient moves you move with them
because your instrument is in your hand and then your hand is resting on some stable structure
so best to use is adjacent teeth and the maxilla and those are the most stable landmarks the
mandible is stable if the patient is biting on a bite block but otherwise they can just open and
close at will so it's not always the best finger rest also use a short working radius don't
overextend the instrument and don't hold the instrument too far back so this means you should
grab the instrument more close more towards the working end so your fulcrum is nearer to the
working end for more control and more accuracy

Rotary Instruments:
Now we can talk about rotary instruments. So, this is the handpiece category. Low speed or
slow speed handpieces operate at less than 12000 RPM. RPM stands for revolutions per
minute. Even though it's the slowest, 12,000 RPM is still fairly fast, that's 200 spins per second.
It can easily injure yourself or your patient if you're not being careful while using the
instrument. Low-speed handpieces are used for “cleaning teeth” with a prophy cup and prophy
paste, “dental caries excavation”, like we talked about before as an alternate to using the spoon
excavator and “finishing and polishing a restoration” with a polishing cup or a polishing brush.
Here is “the slow speed motor” and this is the “latch type contra angle attachment”. Referring
to the fact that it angles away from where you're working. This is the straight attachment and
that's used for the prophy cup for hygiene cleanings.

“The high-speed handpiece” is used for “tooth preparation for fillings or crowns”, “removing old
restorations” and many other procedures that require quote-unquote drilling teeth. They
operate at over 200,000 RPM. They usually have a fiber optic light. They usually operate with
air-water spray.

The medium speed handpiece is between these two and it can be like “an electric handpiece”
where you can actually control the mean RPM of the instrument so medium speed can be used
for the same applications as high speed but depending on the RPM you have it set at it. May
not be quite as efficient the rheostat is the foot pedal type. Foot pedal is used to control all of
these kinds of hand pieces often with variable speed depending on how hard you push down
with your foot. There is also a little switch on foot pedal, which turns the water on and off if
you're using a hand piece with air water spray.

The burs that go into the handpieces. The burr has its own anatomy and it consists of “the
shank” which is the actual part that's inserted into the head of the handpiece. “The neck”
which transitions to the head which is the actual cutting part of the instrument.

So, a high speed burr and a “latch type” slow speed burr that would fit into the contra angle
latch type attachment. So, high-speed burs would fit into high-speed handpiece. There are
different types of materials that burs are made of: (1) diamond burs were historically called
“diamond instruments” and not burs. Carbide burs are made of tungsten carbide. They come
in many different sizes and shapes because of their material and their design. They're better for
end cutting like with punch cuts, to start a preparation. They also create a smooth preparation
wall. They're good for “amalgam removal” and “creating retentive features” and “produce
lower heat” than their counterparts. “Diamond burs" are better at “side cutting” and are
therefore preferable for most preparations. Especially crown preparations bevels enamel-
plasty and this is due to the greater hardness of diamond and overall more effective cutting, but
as a downside it generates more heat and they're also way more expensive so the finer grit of
the diamond the less aggressive the burr will be. For “carbides” the more blades that a carbide
burr has, the less aggressive that burr will be. So, more you would use it for finishing and
polishing rather than cutting and drilling.

Thanks again for watching everyone I'll see you all in the next video

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