Join RDH Kathleen Bokrossy for an insightful lecture series on care and maintenance of dental hygiene instruments!

01 Sharp Judgement – When and Why Resharpening Your Dental Hygiene Instrument is Essential

Precision, efficiency, and patient care – these are the hallmarks of effective dental practice, and maintaining sharp instruments plays a crucial role in achieving them. Every well-honed edge enhances tactile sensitivity, reduces practitioner fatigue, and ensures optimal clinical performance.

This session will explore the essential techniques for assessing sharpness, identifying when resharpening is required, and implementing best practices to extend instrument longevity. By mastering these skills, dental professionals can uphold the highest standards of care, safeguarding both their practice and their patients’ well-being. With the right approach, sharp instruments become more than just tools – they are the key to precision and excellence in dentistry.

Take Home Document

Download the documents on the essence of sharpening, signs of instrument wear, and best practices for maintaining the instruments, as presented in the video.

Download PDF

Clinician

Kathleen Bokrossy

Content by RDH, BSc Kathleen Bokrossy

About:

Kathleen Bokrossy, RDH, BSc, has been bringing engaging energy to the dental profession for over 30 years.

Kathleen is the founder and president of rdhu Inc., publisher for the Dental Hygiene Quarterly and the producer and cast member of The RDH View.  An interactive and popular presenter, Kathleen is a Key Opinion Leader for Curion, LM-Dental, Crest+Oral-B, and Ivoclar Vivadent.

She is passionate about making change happen and ensures that every program she presents will ignite a spark in the dental hygienist to implement change in their practice! 

The post 01 Sharp Judgement: The Essence of Sharpening appeared first on LM-Dental.

Join RDH Kathleen Bokrossy for an insightful lecture series on care and maintenance of dental hygiene instruments!

02 Beyond Repair: Knowing When to Retire Dental Instruments

Every tool has a lifespan, and in dental hygiene, recognizing when instruments are beyond repair is essential for maintaining clinical excellence and ensuring patient safety. Worn-out tools not only compromise efficiency but can also lead to increased clinician fatigue and suboptimal care.

This session explores the key indicators of irreparable instrument wear, highlights the risks of using compromised tools, and provides strategies for making informed decisions about instrument retirement and replacement. By maintaining high-quality instruments, dental professionals can uphold the integrity of their practice and safeguard both patient outcomes and their own well-being.

Knowing when to let go of outdated tools is a vital part of delivering precise, effective care – ensuring every patient benefits from well-maintained, high-performing instruments.

Take Home Document

Download the document on when to retire instruments, as presented in the video.

Download PDF

Clinician

Kathleen Bokrossy

Video content by RDH, BSc Kathleen Bokrossy

About:

Kathleen Bokrossy, RDH, BSc, has been bringing engaging energy to the dental profession for over 30 years.

Kathleen is the founder and president of rdhu Inc., publisher for the Dental Hygiene Quarterly and the producer and cast member of The RDH View.  An interactive and popular presenter, Kathleen is a Key Opinion Leader for Curion, LM-Dental, Crest+Oral-B, and Ivoclar Vivadent.

She is passionate about making change happen and ensures that every program she presents will ignite a spark in the dental hygienist to implement change in their practice! 

The post 02 Beyond Repair: When to Retire Instruments appeared first on LM-Dental.

Join RDH Kathleen Bokrossy for an insightful lecture series on care and maintenance of dental hygiene instruments!

03 The Sharpening Debate: Sharpen-Free vs. Traditional Instruments

Maintaining dental hygiene instruments is more than routine upkeep – it directly impacts clinical efficiency, patient care, and practitioner well-being. Choosing between sharpen-free and traditional sharpenable instruments requires a thoughtful evaluation of effectiveness, ergonomics, and financial investment.

This session provides a comprehensive look at the benefits and challenges of each instrument type, offering insights into time management, cost-effectiveness, and overall clinical efficiency. Whether optimizing sharpening techniques or exploring sharpen-free alternatives, understanding these factors is essential for sustaining long-term performance and ensuring high-quality patient care.

By making informed decisions about instrument selection and maintenance, practitioners can enhance their workflow, reduce fatigue, and uphold professional excellence in every aspect of their practice.

Take Home Document

Download the reference guide comparing sharpen-free and traditional instruments, as presented in the video.

Download PDF

Clinician

Kathleen Bokrossy

Video content by RDH, BSc Kathleen Bokrossy

About:

Kathleen Bokrossy, RDH, BSc, has been bringing engaging energy to the dental profession for over 30 years.

Kathleen is the founder and president of rdhu Inc., publisher for the Dental Hygiene Quarterly and the producer and cast member of The RDH View.  An interactive and popular presenter, Kathleen is a Key Opinion Leader for Curion, LM-Dental, Crest+Oral-B, and Ivoclar Vivadent.

She is passionate about making change happen and ensures that every program she presents will ignite a spark in the dental hygienist to implement change in their practice! 

The post 03 The Sharpening Debate: Sharpen-free vs Traditional Instruments appeared first on LM-Dental.

Join RDH Kathleen Bokrossy for an insightful lecture series on care and maintenance of dental hygiene instruments!

04 Investing in Excellence:  Planning Your Annual Instrumentation Investment

A well-structured instrumentation budget is key to maintaining clinical efficiency, patient care, and practitioner well-being. Yet, many practices overlook its impact on operational success. Strategic investment in quality instruments not only ensures high standards of care but also reduces clinician fatigue and supports long-term cost savings.

This session explores how to assess instrumentation needs, establish an annual budget, and implement a proactive replacement plan aligned with clinical demands. We’ll also examine the role of instrument quality in practice efficiency and patient experience, as well as effective strategies for securing investment.

Optimizing instrumentation systems is more than financial planning – it’s about ensuring lasting success and sustainability in dental practice.

Take Home Document

Download the document on cost-effective instrumentation system examples, as presented in the video.

Download PDF

Clinician

Kathleen Bokrossy

Video content by RDH, BSc Kathleen Bokrossy

About:

Kathleen Bokrossy, RDH, BSc, has been bringing engaging energy to the dental profession for over 30 years.

Kathleen is the founder and president of rdhu Inc., publisher for the Dental Hygiene Quarterly and the producer and cast member of The RDH View.  An interactive and popular presenter, Kathleen is a Key Opinion Leader for Curion, LM-Dental, Crest+Oral-B, and Ivoclar Vivadent.

She is passionate about making change happen and ensures that every program she presents will ignite a spark in the dental hygienist to implement change in their practice! 

The post 04 Investing Excellence: Planning Annual Instrument Investment appeared first on LM-Dental.

Systematic Instrument Selection

One of the biggest questions discussed among hygienists is how to fit all the necessary instruments into a tray. How can you anticipate all the anatomical needs of a patient and fit all those instruments into one tray. The system RDH, BSc Beth Parkes presents on the video below will have you fully prepared for the variety of anatomical needs your patients will present throughout the day.

The System Kits

The system consists of a Base Hygiene Tray, which serves as a starting point for any patient profile. The individually wrapped Accessory Kits are kind of building blocks and can be taken out and added as needed for use in addition to base kit, depending on the unique anatomical needs of the patient.

RDH, BSc Beth Parkes presents the systematic approach to choosing instruments and makes every tray count.

Base Hygiene Tray

The Base Tray serves as your essential foundation for clinical care. With a thoughtfully selected set of instruments, this tray is designed to provide versatility and efficiency for a wide range of patient profiles. When anatomical or clinical needs extend beyond the capabilities of the base setup, the additional accessory kits can be seamlessly integrated to enhance instrumentation.

Accessory Kit +01 for advanced perio, complex anatomy, thin tissue phenotype and recession

This accessory kit is designed for more complex clinical scenarios, including advanced periodontal cases, and patients with a thin tissue phenotype or those prone to recession. The instruments included offer enhanced adaptability for deep, narrow pockets, challenging root morphology, and anatomical variations that require more precise, area-specific instrumentation.

Accessory Kit +02 for ledges or tenacious, burnished calculus

This kit is specifically designed to tackle heavy, stubborn deposits. Whether you are dealing with long-standing calculus ledges or burnished deposits that are difficult to detect and remove, the instruments in this set offer the strength, precision, and efficiency needed to effectively manage even the most resilient calculus.

Accessory Kit +03 for furcation involvement

This is a highly specialized kit designed for managing furcation involvement. It is intended to be used in combination with Accessory Kit +01 for advanced periodontal cases.

Accessory Kit +04 for implants

This kit is equipped with titanium implant scalers specifically designed for safe and effective maintenance of implant cases.

Clinician

Beth Parkes

Text, video and clinical pictures by RDH, BSc Beth Parkes

About:

RDH, BSc Beth Parkes is an international speaker who has been a Registered Dental Hygienist for 20 years. She gained her clinical knowledge and skills through general and independent dental hygiene practice, mobile dental hygiene, orthodontics, and periodontics.

Beyond her clinical experience, Beth is the Manager of Clinical Affairs for Curion, a writer, an RDHU speaker, and a valued cast member of the dental hygiene talk show, The RDH View. In recognition of her contributions to the profession, she was awarded the Ontario Dental Hygienists’ Association Distinguished Service Award in 2023.

Her overarching goal is to cultivate future leaders within the dental hygiene profession, equipping them with the necessary knowledge and skills to excel in their careers while helping their patients obtain and maintain optimal oral health.

Related products

The post Systematic Instrument Selection: Making Every Tray Count appeared first on LM-Dental.

Video

Above you find the treatment case presented on this page as full step-by-step demonstrational video.

Treatment case: How to Rebuild Cusps in Large Fillings with Just Three Instruments

The patient attended with a large carious lesion that was buccally cavitated and extended to the occlusal and mesial surfaces of the tooth. It was decided to restore with composite resin, overlaying the mesio buccal cusp. The attached video demonstrates the steps taken in this case, replicated on a typodont model in order to show an alternative use of the LM-Arte™ Solo Anterior and the application of the LM-Arte™ Posterior Misura and LM-Arte™ Solo Posterior.  The LM-Arte™ Solo Anterior is rarely used for posterior teeth however in this case there is the added complication that the rubber dam clamp makes the use of a circumferential matrix difficult.  The use of the LM-Arte™ Solo Anterior helps to rebuild the buccal wall of the lower left seven tooth due to its anatomical curvature.

Once the rubber dam was placed ensuring moisture control, the tooth was prepared, ensuring a clear peripheral seal zone of 1.5-2mm. The tooth was etched, bonded and resin coated.  A fibre composite was placed in deep areas and the tooth was ready to be restored.

Composite was placed on the buccal surface and packed into place using the plugger end of the LM-Arte™ Solo Posterior. The LM-Arte™ Solo Anterior was used to shape and define the buccal wall: creating an anatomical emergence profile while simultaneously rebuilding the necessary structure in order to use a sectional matrix to assist in building the mesial portion of the restoration.

The curved emergence profile was further defined with secondary anatomy in the form of a buccal fissure indicating the space between the mesial and distal cusps.

A sectional matrix and clip were placed, ensuring that the sectional matrix protruded over the ideal mesial marginal ridge height.  This allowed for the use of the LM-Arte™ Posterior Misura instrument, which was placed over the matrix during the process of building the mesial wall.

Composite was placed and packed into the mesial wall using the posterior solo and then the height was determined with the LM-Arte™ Posterior Misura. The sharp end of the LM-Arte™ Solo Posterior. was then used to refine the lingual and buccal edges of the mesial marginal ridge and the composite was cured before the ring and matrix were removed.

The remaining restoration was achieved In a cusp by cusp composite placement protocol, focusing on maintaining morphological contour of cusps and secondary fissure anatomy.  The LM-Arte™ Solo Posterior has a pointed end that is helpful when removing excess and placing secondary anatomy to mimic the natural tooth tissue. The LM-Arte™ Solo Anterior was used again to define the curvature of the mesial cusp tip and the final restoration was cured under glycerine.

Using these LM-Dental™ instruments helps gain predictability in restorations like such as the above example.  This is in part due to the superior grip of the handles, allowing for better clinician comfort and ergonomics and also the innovative design of each instrument, with a focus on clinically representative outcomes for patients.

Choice of instruments

For these type of cases, I recommend to use the following set of LM-Dental™ instruments.

• LM-Arte™ Solo Anterior

• LM-Arte™ Solo Posterior

• LM-Arte™ Posterior Misura

Step-by-Step Explanation of the case

Figure 1. Patient presented to the clinic with a large buccal cavity on the lower left second molar with caries extending to the occlusal and mesial surfaces.

Figure 2. Tooth was prepared to ensure a clear PSZ and sandblasted , it was decided to overlay the mesio-buccal cusp as it was thin.

Figure 3. Tooth was resin coated with flowable composite and fibre composite placed on deep areas.

Figure 4. As the tooth was the last in arch it was supporting the rubber dam clamp and so placing a circumferential matrix was not an option, the buccal wall was rebuilt using composite and the anterior solo.  The curved surface of the anterior solo provides a buccal contour the mimics the natural dentition.

Figure 5. Aesthetic fissure details are achieved using the fine edge of the LM-Arte™ Anterior Solo.

Figure 6. Final buccal wall form.

Figure 7. Occlusal view of buccal wall form.

Figure 8. Sectional matrix and ring placed and LM-Arte™ Posterior Misura used to determine mesial wall height.

Figure 9 Final mesial wall height created and cusp by cusp placement of composite commences.

Figure 10. LM-Arte™ Fissura used to for incremental placement of cusps.

Figure 11. Final restoration.

Clinician

Cat Edney

Text, video and clinical pictures by Cat Edney, Dip DH Dip DT pgDip Dist

About:

Multi award winning Dental Therapist Cat Edney has over fifteen years’ experience working in specialist and private practice in the UK. In this time she has developed a passion for multidisciplinary team working in the Dental Setting – with a focus on maximizing the use of the full dental team to ensure profitability alongside patient care and engagement.

Cat lectures internationally as a clinical educator and speaker and has developed hands on dental courses under her training brand ‘The Modern Therapist’ which aims to educate the dental profession about the role and integration of Dental Therapy, alongside focusing on providing gold standard hands on training and ongoing support to dental teams.  

Cat is on the faculty of the largest dental academy in the UK – The Smile Dental Academy, lectures for top dental manufactures such as LM, NSK, Oral B and Align Technology and also pens a regular column for Dentistry.co.uk.  She is now an awards Judge for the Private Dentistry awards and was also named in the UK’s Dentistry’s Top 50 most influential dental professionals.

Related products

The post From complexity to simplicity: Practical application of a large direct filling appeared first on LM-Dental.

Introduction

Case for rational approach to sufficient depuration with a minimal set of periodontal instruments

Efficacy of nonsurgical periodontal instrumentation depends on many factors, including gingival inflammation, root anatomy and pain management. However, clinicians’ experience, skills and understanding of periodontal pocket anatomy and defect morphology play a crucial role in the success of subgingival instrumentation. Detailed knowledge of instrument design might also affect technique.

The choice of periodontal instruments for debridement and scaling depends on the location, hardness and composition of tartar, the consistency of adjacent soft tissues, and the topography of the periodontal pocket. Still, it is possible to increase instrument efficiency by selecting appropriate instruments and scaling techniques or better adaptation and movement of instruments.

My choice of hand instrument set will illustrate a professional approach to a time-effective and rational use of only a few periodontal instruments. The suggestion of instrument set aims to meet individual clinicians’ needs and preferences, and in addition to this, is designed to adjust the choice of instruments to reflect the extent and severity of patients’ diseases.

Working with step-by-step illustration of specific set of instruments will help clinicians to systematize the approach to periodontal instrumentation, give suggestions on how to be more creative in instrument choice and application, make instrument use more beneficial for root sites with concavities, grooves and depressions, and be less time-consuming. Besides, novice clinicians often find it helpful to review a simple instrumentation guide. It is advisable to perform sub-gingival periodontal hand instrumentation in combination with powered ultrasonic instrumentation, considering that instrument condition and sharpness are critical in providing successful periodontal treatment.

My desire is to show, through step-by-step clinical cases, how various instruments are used in practice to produce outstanding treatment results. This periodontal set illustrates treatment case with short explanatory texts alongside the images. I have selected the periodontal set based on size and location of tartar deposits, root topography, and an individual clinician’s preferences together with an idea of a rational approach, without compromising quality.

The choice is still the clinician’s choice. There are many excellent options and other plans for tartar removal that can be developed by experienced dental professionals.

Treatment case

Rational approach to sufficient depuration with minimal set of periodontal instruments: Effective instrumentation with Gracey curettes

Text and clinical pictures by RDH Tatiana Brandt, clinical lecturer at School of Oral Health Care, University of Copenhagen

Effective periodontal instrumentation may be achieved by using just a few instruments, provided that the correct
instrumentation technique is applied. There are many combinations of technical depuration solutions with a minimal number of hand instruments, but the clinician’s preferences are the most important factors in choosing the optimal set of instruments. The set presented in this approach is for dental professionals who are familiar with using Gracey curettes. The most valuable features of the instruments can be realized by combining delicate Mini versions and longer Macro versions, but at the same time the number of instruments used on one patient will be reduced as far as possible.

Video

Above you find the treatment case presented on this page as full step-by-step demonstrational video.

PDF document

You can also download the full illustrated case as PDF document.

Download PDF

Clinical characteristics

When planning to remove tartar, some questions need to be answered: What anatomical characteristics present a challenge for this patient? What type and thickness of tartar has been detected? What type of gingival phenotype does the patient have: thin or thick? Which of the periodontal instruments should you select for removing tartar from the back and front teeth?

The present case demonstrates an instrumental approach to patients with the following clinical characteristics:  

• need for more comprehensive periodontal treatment
• probing depth predominantly ≥ 5 mm
• medium tartar deposits above and below the gingival margin
• small deposits on middle or apical third of root
• different topography of pockets with combination of wide and narrow periodontal pockets
• possible thin gingival phenotype

This case does not take account of periodontal diagnostics.
The gingiva has been removed from the typodont in this case images, to provide a view of the working-end of the instruments.

Choice of instruments

My choice for this severity level is a set of Gracey finishing curettes and a sickle.

• Mini Gracey 11/12 with miniature working ends for scaling of mesial sides, mesial root segment of furcation areas and root concavities
• Macro Gracey 13/14 where a more rigid working end is used for scaling of moderate and tenacious deposits on distal sides with wider defects and horizontal stroke technique palatally and lingually
• Mini Gracey 1/2 for front teeth and distal root segment of furcations
• Mini Sickle for fracturing, finishing and detecting strokes

Figure 1 Instruments made with LM-DuraGradeMAX™ super steel: Mini Gracey 11/12 211-212MES, Macro Gracey 13/14 213-214AFES, Mini Gracey 1/2 201-202MES and Mini Sickle 311-312ES.

Related products

.

Effective instrumentation with Gracey curettes

It is preferable to start removing medium-size tartar deposits above and below the gingival margin with powered
ultrasonic instruments, choosing a tip designed to be more active at moderate power settings, followed by manual hand instrumentation. It is easier and more time-saving to remove medium-sized tartar deposits located above the gingival margin using an ultrasonic device.

Figure 2 illustrates how Mini Sickle is being used for tartar fracturing as an initial coarse scaling process. It is important to complete instrumentation once coarse scaling starts. Clinicians must decide how many quadrants need to be completed at one appointment and avoid coarse scaling alone because of risk of difficult instrumentation caused by tight gingiva at the next appointment and reduced patient motivation.

Figures 3a, 3b Scaling posterior distal surfaces with the Macro Gracey 13/14 Sickle scalers with fine, slightly angled blades are very good and time-saving for scaling medium size deposits just under the gingival margin. Note that only the extreme third of this sickle scaler needs to be adapted to the tooth surface to be effective and help with debridement. Correct adaptation and angulation at 80 degrees are especially important under the gingival margin and in tight proximal spaces.

If the tartar is not tenacious, the clinician can choose to skip a Mini Sickle and start instrumentation by performing a series of vertical overlapping strokes across the distal surfaces, using Macro Gracey 13/14 with a lower shank adopted parallel to the distal surfaces. Start the periodontal instrumentation from the distofacial line angle to the midline of the distal surface. Continue making a series of short, precise strokes across the distal surface. Extended shank instruments, such as Macro Gracey 13/14, are indicated for deep and wide periodontal pocket depths greater than 5 mm. The lower shank of a Macro Gracey is 3 mm longer than that of a standard Gracey, and the long working blade easily accesses the middle parts of wide distal surfaces with vertical strokes. It is advisable to use an extraoral fulcrum for better angulation and access to the bottom of periodontal pockets as shown (Figures 3a, 3b).

Figures 3a, 3b Scaling posterior distal surfaces with the Macro Gracey 13/14

The clinician can flip the instrument over and move on with the same instrument on the same surface, but by using very tiny, short overlapping horizontal and oblique strokes. Use a series of precise overlapping horizontal and oblique strokes for the distal and facial surface of the posterior teeth, beginning at the distofacial line angle. The extreme third adaptation of the working end is the same as for the standard Gracey, really parallel to the tooth.

Horizontal overlapping strokes are very effective in removing deposits from the distal line angle of posterior teeth and the middle back part of distal surfaces. Additionally, short precise horizontal and oblique strokes work better in narrow distal pockets, preventing damage to the tissue while using a standard working blade. (Figures 4a, 4b, 4c).

Figure 4a, 4b, 4c Overlapping horizontal and oblique strokes with the Macro Gracey 13/14

It is very important for the combination of working end size and long shank in the Macro Gracey to allow the clinician to achieve appropriate lateral pressure on a distal surface without over-stretching the fingers.

An alternative choice of instrument choice would be a Mini Gracey 13/14 for tiny deposits in narrow pockets, or a Gracey 17/18 as shown in the pictures below (Figures 5a, 5b).

Figure 5a, 5b Scaling with standard Gracey 17/18 247-248ES on wide distal surface of lower-jaw third molar.

The lower shank of the standard Gracey 17/18 is as long as that of the Macro Gracey, but the angulation is perfect for the posterior adaptation. We recommend establishing a ring finger fulcrum on the occlusal surfaces of molar or premolar. Closeness to working area fulcrum is recommended for removing tenacious distal tartar.

Usually, it is advisable to use Gracey 7/8 for the buccal and palatal surfaces. However, Gracey 13/14 is much easier to adapt to curved palatal and lingual surfaces scaling palatal anatomical depressions. You can start doing a series of vertical strokes using a Macro Gracey 13/14, but the palatal root has a root depression that is difficult to clean using only vertical strokes. That is why you need to scale palatal surfaces using a Macro Gracey 13/14 with tiny horizontal and oblique strokes, forwarding the tip-up and moving the instrument in a mesial direction. If the 13/14 is still difficult to adapt, you can also use the Mini Gracey 11/12 for the same purpose and with the same technique, but it is more suitable for buccal surfaces. Note that it is the lower cutting edge that is adopted to the tooth surface (Figures 6a, 6b).

The same movement can be used supra- and sub-gingivally on a lower jaw’s buccal surfaces. Selecting a longer shank with a wider and longer blade, such as Macro Gracey, may generally be more efficient in deep and wide periodontal pockets (Figures 7a, 7b).

You must re-establish your finger position before continuing the mesial sides with some vertical strokes, scaling all
posterior teeth in upper and lower jaw with the Mini Gracey 11-12. (Figure 8a, 8b)

It is appropriate to use some tiny horizontal strokes with a tip-up or tip-down technical scaling concavity on the mesials of posterior teeth. You must use a working end opposite from the one you used to make vertical strokes on the mesial surface (Figure 9).

Figure 8a Scaling posterior mesial surfaces with Mini Gracey 11/12 (vertical strokes), upper jaw

Figure 8b Scaling posterior mesial surfaces with Mini Gracey 11/12 (vertical strokes), upper jaw

Figure 9 Scaling posterior mesial surfaces with Mini Gracey 11/12 (vertical strokes) lower jaw

Mini blades are easy to adapt scaling a furcation. You can take all the mesial sides of distal, mesial and palatal roots with the Mini Gracey 11/12 as shown here. You must approach the mesial furcation on upper molars from a buccal position. The rather straight distal surfaces of mesial roots can be treated by the Mini Gracey 1/2. The tooth anatomy is a determining factor in the choice of instrument for the ceiling or bottom of the furcation. See Figures 10c and 10d for use of Mini Gracey 11/12 on furcation, applying very light tiny strokes considering the short distance to the pulp. Additionally, a diamond file may be chosen for extra polishing.

The Gracey 13/14 or Gracey 11/12 can be used on front teeth that are inclined backward (retroclinated), when the angulation of Gracey 1/2 is challenging. It is still preferable to use Mini Graceys in narrow pockets and Macro Graceys for the wider pockets.

It is a common scaling mistake for scaling strokes with Mini Graceys not to extend past the midline of the proximal surfaces. It is therefore advisable to finish instrumentation by doing some vertical proximal detecting evaluating strokes on proximal root surfaces and some scaling strokes under the contact points with a sickle scaler. A sickle is very good for removing tenacious tartar because of a strong working end and pointed tip, which provides good access to proximal surfaces. A sickle is not however recommended for use on root surfaces, but it is excellent for finishing detective strokes and removing small pearls of tartar on the middle part of distals and mesials (Figures 13a, 13b).

You can complete your periodontal instrumentation by adopting the first third of the Mini Sickle tip against the tooth surface pointing down in the apical direction and doing tiny 1-2 mm, nearly detecting horizontal strokes in very shallow pockets and just below the CEJ (cement-enamel junction). The Mini Sickle is also excellent for finishing evaluation strokes in anterior and posterior proximal spaces, where the working end of the Gracey curette is too wide. Particular attention must be paid to soft root surfaces when using Mini Sickle sub-gingivally or under the CEJ. It is only indicated for applying very light strokes. It is not good to apply too much lateral pressure, especially if your instrument is sharp. For this reason, the author prefers working with the LM Sharp Diamond™ coated sharpen-free Mini Sickle SD. Patients generally appreciate this type of finishing.

For better spooling effect, and to remove the tiniest deposits at the bottom of a pocket, a slim periodontal ultrasonic tip can be additionally used following evaluation with an Explorer 11-12 or Periodontal WHO probe.

Clinician

Tatiana Brandt

Text and clinical pictures by RDH Tatiana Brandt, clinical lecturer at School of Oral Health Care, University of Copenhagen

About Me:

• Tatiana Brandt, RDH Med (Master Degree in Health Education and Health Promotion)
• I have been practicing clinical dental hygiene for 17 years, and worked for the Department of Odontology and Periodontology at the Copenhagen School of Dentistry.
• Board member of Danish Society of Periodontology.
• For the last 10 years, I have been clinical lecturer at the School of Oral Health Care, Faculty of Health and Medical Science, University of Copenhagen.
• Speaker and course provider for LM-Dental™ and Plandent.
• My main interest is advanced periodontal instrumentation, ergonomics and prevention of MSD in hands and wrists.

Related products

The post Effective instrumentation with Gracey Curettes appeared first on LM-Dental.

Introduction

Case for rational approach to sufficient depuration with a minimal set of periodontal instruments

Efficacy of nonsurgical periodontal instrumentation depends on many factors, including gingival inflammation, root anatomy and pain management. However, clinicians’ experience, skills and understanding of periodontal pocket anatomy and defect morphology play a crucial role in the success of subgingival instrumentation. Detailed knowledge of instrument design might also affect technique.

The choice of periodontal instruments for debridement and scaling depends on the location, hardness and composition of tartar, the consistency of adjacent soft tissues, and the topography of the periodontal pocket. Still, it is possible to increase instrument efficiency by selecting appropriate instruments and scaling techniques or better adaptation and movement of instruments.

My choice of hand instrument set will illustrate a professional approach to a timeeffective and rational use of only a few periodontal instruments. The suggestion of instrument set aims to meet individual clinicians’ needs and preferences, and in addition to this, is designed to adjust the choice of instruments to reflect the extent and severity of patients’ diseases.

Working with step-by-step illustration of specific set of instruments will help clinicians to systematize the approach to periodontal instrumentation, give suggestions on how to be more creative in instrument choice and application, make instrument use more beneficial for root sites with concavities, grooves and depressions, and be less time-consuming. Besides, novice clinicians often find it helpful to review a simple instrumentation guide.

It is advisable to perform sub-gingival periodontal hand instrumentation in combination with powered ultrasonic instrumentation, considering that instrument condition and sharpness are critical in providing successful periodontal treatment. My desire is to show, through step-by-step clinical cases, how various instruments are used in practice to produce outstanding treatment results. This periodontal set illustrates treatment case with short explanatory texts alongside the images. I have selected the periodontal set based on size and location of tartar deposits, root topography, and an individual clinician’s preferences together with an idea of a rational approach, without compromising quality.

The choice is still the clinician’s choice. There are many excellent options and other plans for tartar removal that can be developed by experienced dental professionals

Treatment case

Rational approach to sufficient depuration with minimal set of periodontal instruments: Effective instrumentation with LM™ Langer curettes

Text and clinical pictures by RDH Tatiana Brandt, clinical lecturer at School of Oral Health Care, University of Copenhagen

Effective periodontal instrumentation may be achieved by using just a few instruments, provided that the correct
instrumentation technique is performed. There are many combinations of technical depuration solutions with a minimal number of hand instruments, but the clinician’s preferences are the most important factors when choosing the optimal set of instruments. This presented set meets the needs of dental professionals who prefer working with a few instruments on all tooth surfaces and feel comfortable using universal curettes but need better posterior angulation and improved access to root surfaces.

Video

Above you find the treatment case presented on this page as full step-by-step demonstrational video.

PDF document

You can also download the full illustrated case as PDF document.

Download PDF

Clinical characteristics

When planning to remove tartar, some questions need to be answered: What anatomical characteristics present a challenge for this patient? What type and size of tartar is detected? What type of gingival phenotype does the patient have: thin or thick? Which of the periodontal instruments should you select for removing tartar from the front and back teeth?

The present case demonstrates an instrumental approach to patients with the following clinical characteristics:  

• need for more comprehensive periodontal treatment
• medium-large deposits, where a powerful stroke might be needed (occasionally burnished calculus)
• first-time appointment or a maintenance patient
• probing depth greater than 5 mm can occur, some furcation involvement
• different topography of pockets with combination of wide and narrow periodontal pockets
• rather thick gingival phenotype.

This case does not take account of periodontal diagnostics.

The gingiva has been removed from the typodont in this case images, to provide a view of the working-end of the instruments.

Choice of instruments

My choice for this severity level is the following set of Mini Langer universal curettes and a sickle.

• Mini Langer 1/2: or mandibular back teeth and furcations
• Mini Langer 3/4: or maxillary back teeth and furcations
• Mini Langer 5/6 or front teeth and furcations
• Mini Sickle for fracturing and finishing strokes in proximal spaces

Figure 1 Instruments with uncoated LM-DuraGradeMAX™ super steel: Mini Langer 1/2 281-282MES, Mini Langer 3/4 283-284MES, Mini Langer 5/6 285-286MES, and Mini Sickle 311-312ES.

Related products

.

Effective instrumentation with Langer curettes

It can be easier to start debridement with Langer curettes in a lower jaw scaling the third and fourth quadrant using a Mini Langer 1/2 for vertical strokes on the distal and mesial surfaces. Note that the inner cutting edge closer to a handle is used to instrument the distal surfaces. Remember, that the correct face-to-tooth surface angulation is 70-80 degrees. (Figures 2a, 2b, 2c)

Note that the outer cutting edge, facing away from the instrument handle, is used to instrument the mesial surfaces, and that the correct face-to-tooth surface angulation is 70-80 degrees. (Figure 2b).

The outer cutting edges are used to instrument the facial and lingual surfaces. Horizontal strokes are used at the line angles and midlines of the facial or lingual surfaces of the back teeth (Figures 3a, 3b, 3c).

Furcation areas can be scaled with a combination of two types of movement: vertical and horizontal. Note the different fulcrum position and application of different lateral pressure using vertical and horizontal strokes. It is advisable to use very light strokes in the bottom and ceiling of the furcation area (Figures 4c, 4d, 6d), occasionally using a diamond file for extra polishing.

Figure 4a Scaling mesial and distal aspects of root in furcation area with Mini Langer 1/2 and bottom of furcation area

Figure 4b Scaling mesial and distal aspects of root in furcation area with Mini Langer 1/2 and bottom of furcation area

Figure 4c Scaling mesial and distal aspects of root in furcation area with Mini Langer 1/2 and bottom of furcation area

Figure 4d Scaling mesial and distal aspects of root in furcation area with Mini Langer 1/2 and bottom of furcation area

Next, we come to the upper jaw scaling the first and second posterior quadrant with a Mini Langer 3/4. This instrument is used for vertical strokes on the distal and mesial surfaces. Note that the inner cutting edge closer to a handle is used to instrument the distal surfaces and the proper angulation of 70-80 degrees. The outer cutting edge is used to instrument the facial, lingual, and mesial surfaces. (Figures 5a, 5b)

Figure 5a Scaling posterior distal and mesial surfaces with Mini Langer 3/4 (vertical strokes)

Figure 5b Scaling posterior distal and mesial surfaces with Mini Langer 3/4 (vertical strokes)

The same movement and angulation are used for scaling the distal and mesial aspects of roots in furcation areas (Figures 6a, 6b). Vertical and horizontal strokes are used like in a lower jaw. It is recommended to use very light strokes in the bottom of the furcation area (Figure 6d), occasionally using a diamond file for extra polishing.

Figures 6a, 6b, 6c, 6d Scaling mesial and distal aspects of roots in furcation areas with Mini Langer 3/4 and bottom of furcation area

Horizontal strokes are used at the line angles and the midlines of the facial or palatal surfaces of back teeth (Figures 7a, 7b). Note that the inner edge of Mini Langer 3/4 can be easier to adapt to the palatal side.

Figures 7a Scaling the lingual and facial surfaces of back teeth with Mini Langer 3/4 (horizontal strokes)

Figures 7b Scaling the lingual and facial surfaces of back teeth with Mini Langer 3/4 (horizontal strokes)

Debridement of front teeth in the upper and lower jaws begins from the left canine and ends with the right canine. Note that when using a Mini Langer 5/6 curette on front teeth, scaling of front teeth starts with vertical strokes on mesial and distal surfaces and horizontal strokes on the midlines of the facial or lingual surfaces of the front teeth if necessary. (Figures 8a, 8b)

Figures 8a Facial, palatal, mesial and distal surfaces of front teeth are instrumented with Mini Langer 5/6.

Figures 8b Facial, palatal, mesial and distal surfaces of front teeth are instrumented with Mini Langer 5/6

As the toe of universal curettes is wider than the pointed tip of a scaler, it is more difficult to adapt to proximal surfaces. Additionally, a common scaling mistake occurs when scaling strokes with mini-model instruments do not extend past the midline of the proximal surfaces. It is therefore advisable to finish instrumentation by doing some vertical proximal detecting evaluating strokes on proximal root surfaces and some scaling strokes under the contact points with a sickle scaler. Sickle is very good for removing tenacious tartar because of its strong working end and pointed tip, which provides a good access to proximal surfaces. Although the sickle is not recommended for use on root surfaces, it is excellent for finishing detective strokes and removing small pearls of tartar on the middle part of distals and mesials. (Figures 9a, 9b). In this case I have chosen to use Mini Sickle. Alternatively, the clinician can choose Sickle LM23, which has a shorter blade and longer lower shank than Mini Sickle.

Figures 9a, 9b Finishing and detecting strokes with Mini Sickle

Your periodontal instrumentation can be finished perfectly by adopting Mini Sickle´s tip third against the tooth surface pointing down in an apical direction and doing tiny 1-2 mm, nearly detecting horizontal strokes in very shallow pockets and just below the ECJ (Enamel-Cement Junction). Mini Sickle is also excellent for finishing evaluating strokes in front and back proximal spaces, where the working end of Gracey curettes is too wide. Great care must be taken with soft root surfaces when using Mini Sickle sub-gingivally or under the ECJ. Only very light strokes may be applied. It is not appropriate to apply too much lateral pressure, especially if your instrument is sharp. For this reason, the author prefers working with LM Sharp Diamond™ coated sharpen-free Mini Sickle. Patients generally appreciate this type of finishing.

To provide a better spooling effect and to remove the tiniest deposits at the bottom of a pocket, a slim periodontal ultrasonic tip, preferably the tip 40H, can be additionally used following evaluating with an Explorer 11-12.

Clinician

Tatiana Brandt

Text and clinical pictures by RDH Tatiana Brandt, clinical lecturer at School of Oral Health Care, University of Copenhagen

About Me:

• Tatiana Brandt, RDH Med (Master Degree in Health Education and Health Promotion)
• I have been practicing clinical dental hygiene for 17 years, and worked for the Department of Odontology and Periodontology at the Copenhagen School of Dentistry.
• Board member of Danish Society of Periodontology.
• For the last 10 years, I have been clinical lecturer at the School of Oral Health Care, Faculty of Health and Medical Science, University of Copenhagen.
• Speaker and course provider for LM-Dental™ and Plandent.
• My main interest is advanced periodontal instrumentation, ergonomics and prevention of MSD in hands and wrists.

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The post Effective instrumentation with LM™ Langer curettes appeared first on LM-Dental.

Introduction

Case for rational approach to sufficient depuration with a minimal set of periodontal instruments

Efficacy of nonsurgical periodontal instrumentation depends on many factors, including gingival inflammation, root anatomy and pain management. However, clinicians’ experience, skills and understanding of periodontal pocket anatomy and defect morphology play a crucial role in the success of subgingival instrumentation. Detailed knowledge of instrument design might also affect technique.

The choice of periodontal instruments for debridement and scaling depends on the location, hardness and composition of tartar, the consistency of adjacent soft tissues, and the topography of the periodontal pocket. Still, it is possible to increase instrument efficiency by selecting appropriate instruments and scaling techniques or better adaptation and movement of instruments.

My choice of hand instrument set will illustrate a professional approach to a time-effective and rational use of only a few periodontal instruments. The suggestion of instrument set aims to meet individual clinicians’ needs and references, and in addition to this, is designed to adjust the choice of instruments to reflect the extent and severity of patients’ diseases.

Working with step-by-step illustration of specific set of instruments will help clinicians to systematize the approach to periodontal instrumentation, give suggestions on how to be more creative in instrument choice and application, make instrument use more beneficial for root sites with concavities, grooves and depressions, and be less time-consuming. Besides, novice clinicians often find it helpful to review a simple instrumentation guide.

It is advisable to perform sub-gingival periodontal hand instrumentation in combination with powered ultrasonic instrumentation, considering that instrument condition and sharpness are critical in providing successful periodontal treatment. My desire is to show, through step-by-step clinical cases, how various instruments are used in practice to produce outstanding treatment results. This periodontal set illustrates treatment case with short explanatory texts alongside the images. I have selected the periodontal set based on size and location of tartar deposits, root topography, and an individual clinician’s preferences together with an idea of a rational approach, without compromising quality.

The choice is still the clinician’s choice. There are many excellent options and other plans for tartar removal that can be developed by experienced dental professionals.

Treatment case

Rational approach to sufficient depuration with minimal set of periodontal instruments: Effective instrumentation with LM™ Dual Gracey curettes

Text and clinical pictures by RDH Tatiana Brandt, clinical lecturer at School of Oral Health Care, University of Copenhagen

Effective periodontal instrumentation may be achieved by using just a few instruments, provided that the correct
instrumentation technique is used. There are many combinations of technical depuration solutions with a minimal number of hand instruments, but the clinician’s preferences are the most important factors in choosing the optimal set of instruments.

This set is for dental professionals who prefer working with universal curettes but also need a subgingival approach. LM Dual Gracey™ instruments, also known as Syntette™, combine traditional universal curettes and Gracey curettes to provide efficient supragingival instrumentation and allow subgingival access in deep pockets.

Video

Above you find the treatment case presented on this page as full step-by-step demonstrational video.

PDF document

You can also download the full illustrated case as PDF document.

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Clinical characteristics

When planning tartar removal, some questions need to be answered: What anatomical characteristics present a challenge for this patient? What type and size of tartar has been detected? What type of gingival phenotype does the patient have: thin or thick? Which of the periodontal instruments should you select for removing tartar from the front and back teeth?

The present case demonstrates an instrumental approach to patients with the following clinical characteristics:  

• Treatment of patient with small to moderate tartar deposits
• Probing depth ≤ 5 mm
• Patient with gingivitis or periodontitis
• Vertical and horizontal bone loss may occur
• Some gingival recession may occur
• There may be furcation involvement

This case does not take account of periodontal diagnostics.

The gingiva has been removed from the typodont in this case images, to provide a view of the working-end of the instruments.

Choice of instruments

My choice for this severity level is a set of LM Dual Gracey™ curettes, a sickle and a universal curette.

• Mini Syntette™ Anterior SD: a combination of universal curette and Mini Gracey 1/2 and Mini Gracey 7/8 curettes
• Mini Syntette™ (posterior) SD: a combination of universal curette and Mini Gracey 11/12 and Gracey 13/14 curettes
• Sickle LM23 SD (alternative Mini Sickle SD)
• Barnhart 5-6 SD

Figure 1 Instruments with sharpen-free LM Sharp Diamond™ coating: Mini Syntette™ Anterior SD 275-276MSDES, Mini Syntette™ SD 215-216MSDES, Sickle LM23 SD 313-314SDES and Barnhart 5-6 SD 227-228SDES.

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Effective instrumentation with LM Dual Gracey™ curettes

It is always preferable to start removing medium-size calculus deposits above and below the gingival margin with a powerful ultrasonic instrumentation, choosing a tip designed to be more active at moderate power settings followed by hand instruments. If tartar is tenacious, it would be appropriate to use some vertical movements with a first third-part of the scaler tip to fracture the tartar before using Gracey curettes. However, this case describes a recall patient with small tartar deposits. It is advisable to apply periodontal instrumentation from the distofacial line angle to the midline of the distal surface on molars and premolars. I prefer starting from the first quadrant and continuing to make a series of short, precise strokes across the distal surface using Mini Syntette™ (posterior). Watch the bend between the lower and upper shank; it is pointed distal as shown in Figure 2a. Use a series of precise overlapping horizontal and oblique strokes for the distal and facial surface of the back teeth, beginning at the distofacial line angle (Figure 2b).

Horizontal strokes are very effective in removing deposits from the distal line angle of back teeth. The third tip adaptation of the working end is the same as with Gracey, parallel to the tooth. The adjustment of lateral pressure depends on your fulcrum and your stroke technique.

Figure 2a Scaling with Mini Syntette™ (posterior) SD of molar and premolar distal surfaces (vertical strokes).

Figure 2b Scaling with Mini Syntette™ (posterior) SD of molar and premolar distal surfaces (horizontal strokes).

Move on and continue instrumentation at least halfway across the mesial surface from the facial aspect using the same working end of Mini Syntette™ (posterior). Then use some horizontal facial strokes if necessary and if the soft tissue is quite loose. Horizontal strokes are also effective when a neighboring tooth is missing, as depicted (Figure 3b).

Figure 3a Scaling with Mini Syntette™ (posterior) SD of molar and premolar mesial surfaces (vertical strokes)

Figure 3b Scaling with Mini Syntette™(posterior) SD of molar and premolar distal surfaces (horizontal strokes)

Figure 3c Scaling with Mini Syntette™ (posterior) SD of molar and premolar mesial surfaces (horizontal strokes)

Proceed to the palatal or lingual side with the same instrument, using another working end if necessary. Place the Mini Syntette™ (posterior) with the toe pointing toward the mesial surface and gently slide the working end under the gingival margin. Make a series of horizontal overlapping strokes in the mesial direction.

Figure 4a, Scaling with Mini Syntette™ (posterior) SD of molar and premolar palatal and lingual surfaces (horizontal strokes)

Figure 4b Scaling with Mini Syntette™ (posterior) SD of molar and premolar palatal and lingual surfaces (horizontal strokes)

Furcation areas can be scaled with a combination of two instruments: Mini Syntette™ (posterior) and Barnhart 5-6 (Figures 5a, 5b, 5c and Figures 6a, 6b, 6c).

Note the different fulcrum position and application of different lateral pressure using Mini Syntette™ and Barnhart 5-6. It is advisable to use very light strokes in the bottom and ceiling of furcation areas, occasionally using a diamond file for extra polishing.

Completing a maxillary and mandibular quadrant on one side of the mouth before proceeding to anterior teeth is recommended, especially when local anesthesia is indicated for two quadrants, because the maxillary arch can be more difficult to scale.

Figure 5a Scaling with Mini Syntette™ (posterior) SD of distal and mesial root aspects of furcation area (vertical strokes)

Figure 5b Scaling with Mini Syntette™ (posterior) SD of mesial root aspects of furcation area (vertical strokes)

Figure 5c Scaling with Mini Syntette™ (posterior) SD of mesial root aspects of furcation area in lower jaw (vertical strokes)

Figure 6a Scaling of ceiling of furcation area with Barnhart 5-6 SD using very light strokes

Figure 6b Scaling of ceiling of furcation area with Barnhart 5-6 SD using very light strokes

Figures 6c Scaling of ceiling of furcation area with Barnhart 5-6 SD using very light strokes

Instrumentation of the front teeth is possible, starting with scaling all surfaces facing you, then flipping the instrument and scaling all surfaces facing away from you on the facial. Figures 7a and 7b depict application of the cutting edges to the maxillary front teeth, facial aspect.

Figure 7a Scaling of front teeth with Mini Syntette™ Anterior SD (vertical strokes towards clinician, facial and palatal aspect

Figure 7b Scaling of front teeth with Mini Syntette™ Anterior SD (vertical strokes away from clinician, facial and palatal aspect

Figure 8a Scaling of retroclinated front teeth with Mini Syntette™ (posterior) SD

It can be appropriate to use Mini Syntette™ (posterior) on front teeth that are inclined backwards (retroclinated) when the angulation of Mini Syntette™ Anterior is difficult.

A common scaling mistake occurs when scaling strokes with mini model instruments do not extend past the midline of the proximal surfaces. It is therefore advisable to finish instrumentation by doing some vertical evaluating strokes on proximal root surfaces and some scaling strokes under the contact points, using a sickle scaler. A sickle is very good for removing tenacious tartar because of its strong, rigid working end and pointed tip, which provides a good access to proximal surfaces.

Although the sickle is not recommended for use on root surfaces, it is excellent for detective evaluating strokes and removal of small pearls of tartar on the middle part of distals and mesials. In this case, the recommended device is Sickle LM23 (Figures 9a, 9b, 9c) with shorter blades and longer lower shank than in the Mini Sickle for periodontal patient maintenance.

Figure 9a Scaling of back teeth with Sickle LM23 SD vertical detecting strokes)

Figure 9b Scaling of front teeth with Sickle LM23 SD (finishing vertical strokes)

Figure 9c Scaling of front and back teeth with Sickle LM23 SD (finishing detecting horizontal strokes)

As an alternative, the Mini Sickle can be used for the same purpose. When doing short powerful vertical strokes in proximal, the fulcrum in the lower jaw is further behind the working area. Use very short precise fracturing horizontal strokes if the tartar is too tenacious. Only 1-2 mm of a tip is used, to avoid soft tissue trauma (Figures 10a, 10b).

Figure 10a Detective evaluating strokes with Mini Sickle SD as alternative to Sickle LM23 SD (vertical strokes

Figure 10b Detective evaluating strokes with Mini Sickle SD as alternative to Sickle LM23 SD (horizontal strokes)

To provide a better spooling effect, and to remove the tiniest deposits at the bottom of the pocket, a slim periodontal ultrasonic tip, preferably 40H, can be additionally used following evaluation with an Explorer 11-12.

Clinician

Tatiana Brandt

Text and clinical pictures by RDH Tatiana Brandt, clinical lecturer at School of Oral Health Care, University of Copenhagen

About me:

• Tatiana Brandt, RDH Med (Master Degree in Health Education and Health Promotion)
• I have been practicing clinical dental hygiene for 17 years, and worked for the Department of Odontology and Periodontology at the Copenhagen School of Dentistry.
• Board member of Danish Society of Periodontology.
• For the last 10 years, I have been clinical lecturer at the School of Oral Health Care, Faculty of Health and Medical Science, University of Copenhagen.
• Speaker and course provider for LM-Dental™ and Plandent.
• My main interest is advanced periodontal instrumentation, ergonomics and prevention of MSD in hands and wrists.

Related products

The post Effective instrumentation with LM Dual Gracey™ curettes appeared first on LM-Dental.