Dental Instruments PDF

Introduction to Instrumentation Fundamentals Modified Pen Grasp & Dental Mirror Instrument Grasp Modified Pen Grasp The recommended grasp for holding a periodontal soft soft instrument...

Introduction to Instrumentation Fundamentals Modified Pen Grasp & Dental Mirror Instrument Grasp Modified Pen Grasp The recommended grasp for holding a periodontal soft soft instrument Sensitive, stable and strong grasp because of the tripod effect produced by the position of the thumb, index and middle finger Must be continually reestablished on the instrument Jenna Kuzik RDH Parts of An Instrument To follow the instructions for a modified pen grasp, you must be able to identify the parts of a periodontal instrument Jenna Kuzik RDH  At first glance, it may appear that a periodontal instrument is held in the same manner as the grasp used for writing This is NOT the case; the modified pen grasp is much more precise than the grasp for writing Jenna Kuzik RDH Successful instrumentation technique depends to a great degree on the PRECISE placement of each finger in the modified pen grasp Jenna Kuzik RDH Finger Identification for Grasp BOARD Exam Q Assist with rolling small micro adjustment orroll with each stroke to maintain adaptation of the leading third of the working end Jenna Kuzik RDH  Thumb and Index Finger with “rolling” icro ment or roll with oke to maintain ion of the third of the g end xam Q! Jenna Kuzik RDH Thumb and Index Finger Hold the handle in a relaxed manner Grasp the handle lightly The thumb and index finger are opposite each other at or near the junction of the handle and shank Blanched fingers indicate a grasp that is too tight Jenna Kuzik RDH Incorrect Finger Placement When index finger and thumb are NOT across from each other on handle, the instrument is difficult to control Jenna Kuzik RDH No Overlap Thumb and index finger should NOT overlap Overlapped fingers make it difficult to roll the instrument handle Jenna Kuzik RDH Form a Soft C-Shape Jenna Kuzik RDH Incorrect Grasp: U-Shaped Index finger and thumb should not curve inward toward the handle Jenna Kuzik RDH  Incorrect U-Shaped Grasp Causes the finger pads to lift off of the handle Makes it difficult to control the instrument Makes it difficult to roll the handle between the fingers Jenna Kuzik RDH Handle Rests Against Hand The instrument handle rests against the hand to stabilize the instrument Jenna Kuzik RDH Incorrect: No Handle Rest Holding the handle in a pinch-grip away from the hand creates a weak, unstable grasp Jenna Kuzik RDH Middle Finger One side of the pad of the middle finger rests LIGHTLY on the shank tac Jenna Kuzik RDH Middle Finger With the middle finger on the shank, the clinician is able to feel vibrations transmitted from the working-end TACTILE! Jenna Kuzik RDH Incorrect: Middle Finger on Handle Middle finger should NOT rest on the instrument handle Reduces tactile information to hand Reduces control of the instrument Jenna Kuzik RDH Middle Finger The other side of the finger pad of the middle finger rests against- -or slightly overlaps--the ring finger Jenna Kuzik RDH Middle Finger One side of pad on the shank Other side of pad against ring finger, for stability Jenna Kuzik RDH  Ring Finger 1. Standard intra oral fulcrum The pad of the ring finger - Stable fulcrum with the ring balances firmly on the incisal finger or occlusal surface of a tooth MUST be on an occlusal or incisal Fulcrum finger surface pivot The ring finger acts as a 1-3 teeth away from the area you are support beam for the working As close as possible to the area you are hand in the mouth working but Standard intra-oral fulcrum NEVER directly above (INJURY, visibility) 2. Advanced fulcrums Jenna Kuzik RDH Stands Straight and Tall Ring finger advanced ahead of the other fingers in the grasp Jenna Kuzik RDH Incorrect Ring Finger NOT held in a curved, limp manner Provides no stability for hand Makes it difficult to control instrument stroke Jenna Kuzik RDH “United We Stand” The index, middle, and ring finger should be in contact at least at one point Provides stability and strength in the grasp Jenna Kuzik RDH Incorrect: Split Fulcrum No point of contact between middle and ring fingers in the grasp Creates a weak grasp Stresses the muscles of hand Jenna Kuzik RDH Little Finger Has no function in the grasp Held in a relaxed manner Jenna Kuzik RDH Review: Correct Finger Placement Index and Thumb: opposite each other near junction of handle and shank Middle: one side lightly on shank; one side against ring finger Ring: rests on tooth; acts as support beam for hand Jenna Kuzik RDH  Practical Focus Analyze the Following Grasps  Photo 1 middlefinger be should shank finger is off ank CTILE SENSE or Jenna Kuzik RDH Photo 2 are Fingers punching A I Jenna Kuzik RDH  Photo 3 finger Eping fingers over Jenna Kuzik RDH  Photo 4 c the middle oing? ng” pastein Jenna Kuzik RDH Photo 5 Jenna Kuzik RDH Photo 6 O Jenna Kuzik RDH Photo 7 Connected poping Jenna Kuzik RDH  Photo 8 e fingers Jenna Kuzik RDH  Photo 9 c asp Jenna Kuzik RDH  Photo 10 latexfree only are that Gloves tootight may EE e too tight fatigue tear fear thatar e too loose 105 of Gloves ose tactile loose too instru control of sens tactile Jenna Kuzik RDH lose  Surgical Glove Injury Ill-fitting gloves can contribute to surgical glove injury The glove should fit the hand snugly but be neither too tight not too loose from the fingers to the forearm Symptoms include: tingling in the fingers, cold extremities, loss of muscle control and hand strength, numbness or pain in the fingers Gloves that are too tight, proper circulation to the clinicians fingers is compromised Gloves that are too loose will cause the clinician to grasp the instrument handle tighter to compensate for lack of feeling Jenna Kuzik RDH Dental Mirror Dental Mirror The working-end of a dental mirror has a reflecting mirrored surface Jenna Kuzik RDH  Three Common Types of Mirrors 1. Front Surface 2. Concave 3. Plane (Flat) Surface Jenna Kuzik RDH  Front Surface Produces a clear mirror image with no distortion Most commonly used type because of good image quality This is the mirror that you have in your kits Jenna Kuzik RDH  Concave Produces a magnified image Not recommended because magnification distorts the image Jenna Kuzik RDH  Plane (Flat) Surface Produces a double image (ghost image) Durable, resists scratching because the reflecting surface is on the back of the mirror lens Not recommended because double image is distracting Jenna Kuzik RDH  1st 1* Evaluation in Pre-Clinic 1. Seating positions Uses of Dental Mirror Assigned an area Hosion VouP 1. Indirect Vision clock positions 2. Retraction Position your client (chin up, chin down, 3. Indirect Illumination head turned towards you 4. Transillumination or away from Position the light Mocited den crase testablish a fulcrum 3. Verbally explain the 4 functions of the dental mirror Jenna Kuzik RDH  02104 1. Indirect Vision 102011 position The use of a mirror to view a tooth surface or intraoral structure that cannot be seen directly us towards Jenna Kuzik RDH 2. Retraction Use of the mirror to hold the client’s cheek, lip, or tongue so that the clinician can view tooth surfaces that are otherwise hidden from view by these soft tissue structures Jenna Kuzik RDH Retraction Be careful not to of Tongue cause injury! Oral tissues are very sensitive and vascular Lubrication on pt. lips can enhance comfort Face of mirror should be towards the surfaces you are working BE AWARE OF WHERE YOU ARE RESTING THE MIRROR Jenna Kuzik RDH Retraction of Lip The index finger is used to retract the lip away from the teeth More comfortable for client than using a mirror for retraction of the upper or lower lip “Palm grasp” mirror Jenna Kuzik RDH Retraction of Cheek Jenna Kuzik RDH 3. Indirect Illumination Use of the mirror to reflect light onto a tooth or soft tissue structure in a dark area of the mouth Jenna Kuzik RDH 4. Transillumination The technique of directing light off of the mirror surface and through the anterior teeth Jenna Kuzik RDH Uses of Dental Mirror The dental mirror has four important functions during periodontal instrumentation: 1. Indirect Vision 2. Retraction 3. Indirect Illumination 4. Transillumination Moistening the face of the mirror by gently rubbing it against the buccal mucosa or dipping it in a commercial mouthwash prevents mirror from fogging up Jenna Kuzik RDH Transillumination Definition The technique of directing light off of the mirror and through the anterior teeth Jenna Kuzik RDH  Purpose of Transillumination A carious lesion--that otherwise might be hidden from view--shows up as a shadow when the anterior tooth is transilluminated Jenna Kuzik RDH  Use of Transillumination Only anterior teeth can be transilluminated because these teeth are thin enough to allow light to pass through them Posterior teeth are “bulky teeth” that cannot be transilluminated Jenna Kuzik RDH 1. Light Position Sit in the 12:00 position Position unit light directly over the oral cavity with light beam perpendicular to the facial surfaces of the anterior teeth Jenna Kuzik RDH 2. Position Mirror Hold the mirror behind the anterior teeth with reflecting surface parallel to the lingual surfaces Jenna Kuzik RDH 3. View Tooth Look DIRECTLY at the tooth, not in the mirror Tooth should appear to “glow”; lighted by the reflected light Jenna Kuzik RDH  Note: When practicing transillumination on a student partner, you probably will not see any shadows on the teeth This is because he or she most likely does not have untreated interproximal decay on the anterior teeth Jenna Kuzik RDH Example: Interproximal Decay Detection by Transillumination Jenna Kuzik RDH Example: Indirect Vision As seen here, no decay is visible when the lingual surfaces of these teeth are viewed with indirect vision in a mirror (Courtesy of Dr. Robert P. Langlais) Jenna Kuzik RDH Example: Transilluminated The same teeth as in the previous slide Transillumination reveals interproximal decay—seen as shadows on the teeth (Courtesy of Dr. Robert P. Langlais) Jenna Kuzik RDH  Transillumination is a useful technique for detecting “hidden” decay on anterior teeth. Jenna Kuzik RDH Jenna Kuzik RDH