4/16/2018. Today s Goals. Sharpening Objectives: Sharpening Learning Objectives. Burnished Calculus Directly Impacts Periodontal Health

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1 Today s Goals Precision Instrument Sharpening Never a Dull Moment Learn better techniques Preserve instruments Save time Improve hand instrumentation Make scaling easier and more effective Nancy Dewhirst RDH,BS Sharpening Objectives: Accuracy, consistency, speed, simplicity, comfort Maintain original shape Remove minimal metal Precision sharpness Sharpening Learning Objectives Identify goals of instrument sharpening Explain instrument design and landmarks needed for sharpening Demonstrate hand sharpening techniques Explain how to use guided and mechanical sharpening devices Benefits of Working with Properly Sharpened Instruments Greater Tactile Sensitivity Better Control Reduce Procedure Time Improve Patient Comfort Reduce Strain and Fatigue Properly Sharpened Instruments Last Longer Reduce Burnished Calculus Burnished Calculus Directly Impacts Periodontal Health When I see thin, flat, burnished calculus at the CEJ with the endoscope, there is always inflammation and ulceration of the pocket wall opposite the calculus, as well as bleeding on probing. Anna Pattison, RDH, MS. Burnished Calculus at the CEJ. Dimensions of Dental Hygiene, August 2011, page 74 1

2 A Dull Story New (big & fat) inst Use it, wear off metal edges (deform) Blunt edges harder to control, slip & slide Grip & press harder Less tactile sensitivity More strokes (repetitive motion) Burnish calculus, work harder Fatigue, possible trauma & risk Sharpen: deform it more? Dull Instruments Fail to detect & remove deposits Require more pressure Produce hand fatigue Increase tissue trauma Increase treatment time You never know how dull your instruments are until you use a really sharp one. Sharp Instruments Accurately detect deposits Effectively remove deposits Require less pressure Reduce operator fatigue Increase patient comfort Reduce treatment time (Time is money) How Often do We REALLY Need to Sharpen? Every dental hygiene school, every dental hygiene textbook, every thought leader all agree Before each patient, and at the first sign of dullness! But what do we really do? RDH Magazine On line Survey: July 2011 How often do you REALLY sharpen each of your instruments? 4.1% 6.4% 15.2% 15.4% 19.3% 22.1% 17.5% Every day Once per week Once every 2 weeks Once per month Once every 1-3 months Once every 4-6 months Once per year 2

3 Time Sound Supplies Hate it Not confident in technique Why? How Do You Know When Your Instrument Needs to be Sharpened? 15.1% 7.4% 59.0% 18.5% The pressure you apply Not removing calculus cleanly Test stick Appearance of the blade Test Your Test Stick Sharp Blade vs. Dull Blade Test cutting edge Test entire blade Sharp edge bites, grabs Metallic sound when removed Dull edge slides Instrument slides if T shank = off Shaving the stick dulls blades Dull Blade Reflects Light When to Sharpen. Before Appointments??? Before: Mechanical Sharpeners: Sharpen sterile instruments Autoclave first, may be unwrapped Autoclave after, wrap! When to Sharpen.. Consider: During appointment: Risk of injury, exposure (hand stone) Contamination of stones, devices Noise: quiet diamond cards Use back up pre sharpened scalers Ergonomics & scaling effectiveness 3

4 How much are you seeing? Sharpening Essentials Hygiene Instruments Light Thank You! Magnification Hu-Friedy Sterilized instruments Nordent Plastic test stick Orascoptic Stones / Sharpeners Lubricant / cleaner Table (elbow on table, inst eye level) Sickle scalers Supra gingival Pointed tip Sharp back Double edged Universal curettes Supra & sub Round tip Round back Double edged Graceys Sub gingival Rounded tip Rounded back Single edged* *Except double bladed Graceys Different Metals High carbon rust Saturated vapor sterilizers Stainless steel Variable qualities Amount of nickel = important Tempering, cryogenics in higher quality EverEdge: honed to higher luster Density affects: Durability Length of time inst stay sharp Retipping????? 4

5 Lesser quality steel: Wears Corrodes easily Retipping: Metal Quality Compromises structural integrity Pealing metal breakage Irregular Angles Retipped or deformed blade angles vary from original design Affects scaling angulation Affects ergonomics Need to recontour Unbalanced instruments are harder to use Increases hand fatigue Reduces precision Instrument Balance Key Instrument Landmarks 1. Terminal shank 2. Working end: Blade face Blade heel Blade toe / tip Lateral surfaces Back Instrument Tip Anatomy Curved Sickle Scaler Terminal Shank Blade Heel Lateral Surface Blade Face Blade Tip 5

6 Sickle Scaler Universal Curette Gracey Curette Sharpening Sickle Scaler Sharpen both lateral (parallel) surfaces Never round toe Universal Curette Sharpen both lateral (parallel) surfaces and toe Gracey Curette Sharpen cutting edge and toe Stones: Composition Natural / synthetic Density varies Grit For re contouring: coarse, follow with fine For frequent honing: med, fine Lubrication Oil / water / dry Shape Conical & cylindrical: for blade face Flat, wedge: for sides & face, toe India India (brown, orange) Synthetic (aluminum oxide + dense binder) Moderate cutting speed, slow stone wear Come in fine, med grit: maintenance / recontouring Oil required Flat & Wedge shapes 6

7 Arkansas Ceramic Arkansas Natural Cut slower than synthetic (slowest stone choice) Fine: for maintenance Oil (floats filings makes sludge) All shapes or dry Ceramic Synthetic (aluminum oxide + soft binder) Cuts fastest, stone wears faster Fine & med grit: maintenance Coarse: re contouring Water (no sludge) Cylindrical & flat shapes Diamond Stones Diamond Stones Industrial diamonds on metal Rough stones have spaces btw diamonds Smooth stones continuous diamonds Hardest, fastest, stones Remove most metal Also used to re flatten worn, grooved sharpening stones Sterilizable Stones Apply lubricant Clean with lubricant Or: water / dry Scrub, ultrasonic Sterilize stones 1 / set up Sharpen before use. Sharpening contaminated scalers = risky Have back ups Honing vs. Re contouring Honing Remove a small amount of metal Extend instrument life Preserve shape Fine stone Hone / each use Re contouring Major change in shape 7

8 Sharpening Variables Stone to blade face angle Stone to blade heal/toe angle Stone pressure Consistency of angles & pressure through stroke Consistency between strokes Fatigue, lighting, mood, time limits and time of day Visualizing Stone to Blade Face Angle Correct Too vertical Too Open ~1:00 Vertical, 12:00 ~2:00 Universals & sickles: T 12:00 Face horizontal <11:00 / 1:00 Stationery Instrument, move stone Clock Imagery, R L Strategy For A Consistent Stroke Perfect a straight stroke Move the instrument into position to repeat the EXACT SAME stroke every time Estimating Optimal Angle Stabilize stone, or one hand Maintain angle while moving instrument or stone in straight line Many move both instrument and stone in fluid motion Increases variables Free Hand Sharpening Variables Stone instrument Relationship Move stone or inst? Focus on edge, side? Check edge by sight, test? Training differences Stone pressure Time crunch Patience Hand fatigue Clinicians unique arm / hand swing Show your style! 8

9 Stationary Instrument, Movable Stone 1. Blade face is held parallel to the floor. Utilize a Table Edge for Stability Hand and forearm rest on the table top. Instrument handle is braced against the table edge. Angle the instrument toward you for easier access and better visibility. Grasp the stone from along the bottom to utilize both the front and back surfaces of the sharpening stone. Position yourself near a corner for additional access. Stationary Instrument, Movable Stone 2. Approach the instrument blade with the stone at the 12:00 position (90 ). Stationary Instrument, Movable Stone 3. Angle the stone back to the 1:00 position (105 ). Stone Blade Face Angles Instrument Grasp Right handers Left handers Hold in non dominant hand Brace index finger or thumb near top Counterbalance blade pressure 6 o clock 9

10 Instrument Position Sickle Scalers Stone Grasp Terminal 12:00 Right Handed Left Handed Grasp lower half in dominant hand Hold 12:00 Thumb on edge towards you Fingers on edge away Stabilizes stone Move entire arm in fluid up / down motion: minimize arm swing R Sharpening Instrument Position Universal L Stone Position Universal Curette T 12:00 Brace inst palm grasp, index or thumb Elbow on table 6:00, toe towards you T 12:00 Place stone vertically, then: Open angle, smooth stroke heal, work towards toe Long strokes, moderate pressure Sludge, filings along whole blade R Sharpening Opposite Cutting Edge Universal T 12:00 Rotate Inst Point Toe Away Secure Grasp L Free hand Sharpening Position Move Back from the Table Position the Instrument Lower In Your Lap Forearms Parallel to the Floor Look Directly Down on the Instrument Blade Face 10

11 Stone Blade Face Angles Right Handers Left Landers Rounding the toe, Universal Curette Toe pointed to 3:00, 9:00 Align stone with blade face, then tilt up to 2:00, 10:00 Consistent overlapping motion Rotate around toe, maintain shape Avoid Sharpening Face Test Stick T 12:00 Toe toward you Rotate stone from heel to toe Remove wire files Non dominant hand Thumb / index finger ½ from top Hold vertical Test cutting edge Test entire blade Sharp edge bites, grabs Metallic sound when removed Dull edge slides Inst slides if T shank = off Shaving stick dulls blades Test Instrument Position Sickle Scaler R L Testing for Sharpness Modified pen grasp Bring blade around back, tip pointed toward you Do NOT fulcrum on top of stick T 1:00, 11:00 (like scaling) Check full length of blade Look for sludge, filings Look for facet at edge Loupes, light allow visualization of facet along edge Bring inst around behind stick, fulcrum on opposite side Duplicate scaling angulation Sharp edge bites don t shave 11

12 Testing Sickle Scaler Sharp Blade vs. Dull Blade Test Stick Position Sharp blade bites Dull blade reflects light Instrument Position Testing Universal Sharpening Gracey Curettes. Right Handed Left Handed To get the blade face horizontal, tilt the (large model) T shank Clock Imagery Graceys: T <1:00 Face horizontal <11:00 / 1:00 Stationery inst, move stone R Right handers: Blade face to stone angle L 12

13 Left handers: Blade face to stone angle Gracey Stone Blade Face Angle Gracey Angles Sharpening Gracey Instrument Position Right handers Left handers T ~ 11:00 & 1:00 Right Handed Left Handed Stone Positions Gracey Curettes Rounding the toe Gracey Terminal ~11:00, ~1:00 R hand: 4 min after L hand: 4 min before Right Handed Left Handed 13

14 Testing the Gracey Curette Guided Sharpening Test stick & T 12 o clock Right Handed Left Handed Stabilizing devices to assist alignment of inst & stone Guide hand movement Non mechanized: Premier Disc Sharpener PDT Gleason Gleason Guide Stone stationary Move instrument Non mechanized Devices Automated Sharpeners Rx Honing Machine sidekick Hu Friedy 14

15 Mechanized Guided Sharpeners Sidekick Guideplate with guide channels Gracey guide channel Sickle / universal guide channel Toe guide Stone moves in 1 plane Honing for maintenance, not re contouring Sterilizable operating parts Sidekick Guideplates Sidekick Guideplate G for Gracey, S/U for Sickle and Universal 2 channels & toe guide 2 areas of contact: Back of blade rests against vertical backstop T shank rests on shank guides Positioning Sickle Scaler Sharpening Sickle Scaler Grip instrument with one hand, use other hand to hold the sidekick securely. Turn on Place middle of blade back in S/U channel against backstop Align terminal shank w/ guide Sweep blade back + forth gently 2 3 times lightly 15

16 Sharpening Sickle Scaler Sharpening Sickle Scaler Sidekick Gentle pressure only More pressure runs down motor Blade side aligned correctly w/ stone Testing Sickle Scaler Sharpening Universal Scaler Test Stick Position Sharp blade bites Insert the blade in S/U channel guide. Sharpening Universal Scaler Sharpening Universal Scaler Place middle of blade back against backstop Establish fulcrum near top of sidekick, secure Sidekick with other hand Turn on, sweep left right, heal to toe 16

17 To Round the toe of Universal Scaler with Sidekick. Sharpening Gracey Keep blade back against wall of hole Roll & sweep 2 3 times lightly Position Use guideplate labeled G Blade Angle Gracey Curette Gracey Curette sharp test Sharpen down side: (towards stone) Align in G channel (back against backstop, T shank against guide) Stabilize Sidekick, fulcrum, light grasp Turn on Gentle pressure, slow back & forth, 2 3 times Sharp blade will bite into test stick shave Don t Mechanical Sharpeners Control More Variables Every Scaler & Curette has 1 Thing in Common

18 Stone Blade Face Angles are set 2 Unique Features Guarantee the Correct Angle Blade Positioner Sharpening Cone 104 Lock instrument into position: Blade face Horizontal Turn Knob to Raise or Lower Positioner Bar Once secured, instrument is grasped by clamp 18

19 Fit Jaws Around Shank and Tighten Using Back Knob 110 Move to Cone & Sharpen 112 Right-Handers Clock Angles Left-Landers 19

20 Sharpening Sickle Scaler Stone passes over both lateral surfaces Never passes over toe Universal Curette Stone passes over both lateral surfaces and toe Stone Direction Sharpening stone reverses direction from left to right side of the instrument. Gracey Curette Stone passes over cutting edge and toe Some You Can Save... Some You Can t! Good Luck!!! Mechanical Devices: Benefits Delegation of instrument sharpening Consistent precision sharpening by different staff members More efficient use of staff time Recontouring of old hand sharpened instruments Easily shared instruments To Get The Best Results High quality instruments: Shank to blade face to lateral side relationships = true High quality metal Avoid retipping Wide, thick bulky blades Off designs Difficult to position May require heavy recontouring Sharpening: Reduces treatment time, hand fatigue, & improves patient comfort Makes instruments last longer 20