Considerations for Selection of Instruments

The following are questions that the dental hygienist might ask herself/himself when determining the types of instruments needed in the practice.

1. Type of patients in your practice: The following questions will help to determine the extent and type of instruments that might be needed on a recurring basis.

   • Do you treat periodontally involved patients?

   • Do you provide initial therapy for the periodontal patient?

   • Do you utilize power instrumentation?

   • Do you have patients that have dental implants?

2. Anatomy of each of the teeth:

   • What is the anatomy of the teeth involved for any given patient? The anatomy complexities of each tooth must be known in order to address challenges that may arise with instrumentation. In addition, understanding how to adapt the instruments to these complex root structures utilizing the instruments’ unique designs is essential for effective and efficient debridement. Also, selection of the instruments should be predicated on patient’s individual tooth structure and their immediate oral health.

   Some questions that you might ask in order to determine what instrument to select would be:

   • What type of blade (shape, thickness, length) do I need to access the surface that needs to be debrided?

   • What type of shank flexibility do I need in order to adapt the cutting edge to the surface?

   • What type of strokes will I be using and can the blade accommodate me with those types of strokes (heavy, light, etc.)?

   • Does the arch create challenges that can be addressed by a particular instrument (such as maxillary 3rd molar in a patient that cannot open widely)?

   • Do you, as a clinician, have any special comfort needs (such as use of extra-oral fulcrums, comfort grip on the instrument handles, etc.)?

   In addition, efficient and effective initial therapy or maintenance procedures cannot be provided unless the debridement instruments are sharp. The sharpness of the cutting edge of the instruments must also be maintained throughout the procedure. This often requires re-sharpening instruments during the therapy session. Instruments can be purchased that also provide blades that maintain sharpness for an extended period of time during use.

3. Oral health of your patient:

    

   After assessing the patient’s oral health, it can be determined the type of instruments that might be needed beyond what normal set-up might contain. Hand instruments can be grouped by whether they are for supragingival scaling or subgingival scaling and debridement in < 4mm areas or subgingival scaling and debridement in > 4mm areas.

4. Instrument modifications: Instruments can also be grouped by the modifications that were outlined in the previous section on Basic Instrument Design. These included things such as:⁹

   • Blade design

   • Blade angulation

   • Blade thickness

   • Blade length

   • Shank length

   • Shank flexibility

   • Location of the blade on the shank