Rotary and Reciprocating Endodontic Instruments

Dental implantology instruments

At the stage of bone socket preparation and insertion of supporting structures, a highly specialized arsenal of devices is used.

Depth gauges are designed to assess the prepared bone cavity. Cylindrical variants with notches help determine the parallelism of axes when placing multiple screw implants. Modifications with a flattened working end are used for plate-form designs, helping to detect irregularities at the bottom of the socket.

Implant mounts fix the structure in conditions of limited space. These include lever and machine adapters. The main mechanism of action of the machine adapter is transmitting rotational movement to the body of the screw implant for its final fixation. For plate-form analogues, a combination of an implant carrier and a surgical mallet is used: the tip is placed into the recess on the edge of the implant and balanced taps are applied until the endosseous part is fully embedded in the bone.

Additionally, fixation wrenches (standard guiding and reversible ones that do not require removal from the holder to return to the initial position) are used, as well as special screwdrivers (dismantlable or with a shortened handle) for placing superstructures — cover screws and gingival formers. An important surgical element is the mucotome (with a centering pin and perforating cannula), which excises a section of the mucosa strictly in the intervention area, significantly accelerating regeneration.

Periodontal instruments for calculus removal

For closed curettage techniques, removal of infected cementum, and pathological granulations, curettes (semicircular in cross-section) are used. They are divided into:

• Universal (Younger-Good and McCall curettes): have two cutting edges, at a 90° angle to the shank. Designed for polishing with good access.
• Site-specific: have one cutting edge and a 45° angle. Basic movements are strictly vertical and diagonal toward the crown.

The most well-known are Gracey curettes (Gracey), adapted for specific anatomical zones (incisors/canines, premolars/molars from different sides). For deep periodontal pockets, modifications with an elongated working end are used, and for root irregularities, with a curved blade. Langer curettes (different for the maxilla and mandible) and Columbia curettes (one modification for incisors of both jaws, a separate one for molars) are also distinguished.

For superficial crown treatment, scalers (triangular cross-section, two edges) are used. They can be sickle, spear-shaped, as well as special (hoe-shaped, Mitchell and Taylor scalers). For professional implant hygiene, implacers made of Teflon or plastic are used.

For treating root furcation areas, double- and triple-angled periodontal excavators are used. Straight sliding movements in the apical direction are performed with periodontal chisels (scrapers). To remove massive deposits on flattened root areas, files with parallel cutting or diamond coating are used, but they are difficult to sharpen.

Surgical periodontology instruments

For soft tissue fragmentation without pathological compression (during flap operations or excision of hypertrophied gingiva), periodontal knives are used. Their working end is sharply honed and has either a serrated or spear-shaped form.

Gingival incision and contouring are also performed using periodontal nippers, which morphologically resemble surgical scissors. For gentle retraction of gingival flaps during reconstructive operations, small-sized periodontal elevators with a hook-shaped working end are used.

Orthodontic instruments

Fixation of fixed appliances requires precision equipment. Reverse-action tweezers (with a straight arrangement for buccal brackets and a curved one for lingual brackets) are used to grasp and apply brackets, as well as to remove excess adhesive. In conditions of limited access (e.g., hypertonus of the orbicularis oris muscle), universal holders with a spring lock are used.

The exact distance from the horizontal bracket slot to the occlusal surface is determined by positioners (marking cross-type or with a swivel head). They leave a graphite mark at a specified distance (3.5, 4.0, 4.5, or 5.0 mm).

Band adaptation goes through three stages:

1. Initial advancement through the contact point (instrument with a ribbed pad).
2. Seating (biting pad in a plastic holder to protect the antagonists' enamel).
3. Final adaptation (massive press instrument to eliminate micro-voids).

For working with wire arches, multipurpose holding pliers (Weingart, Howe) with smooth or grooved jaws converging along a plane are used. For contouring band rings on teeth with a pronounced equator, pliers with concave and oval jaws are used. Bending straight wire strictly to the dental arch shape is carried out using a forming plier / turret — a cylindrical instrument with circular grooves.

Briefly: answers to topical questions

Class and exam questions

What else to study on this topic

• Biomechanics of movements when using Gracey curettes
• Classification of fixation wrenches for implant systems
• Features of using Langer and Columbia curettes
• Technique of working with periodontal files
• Stages of band fixation and use of biting pads

Other topics in «Chapter 3. Dental Instruments»

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.