Periodontal curette: Difference between revisions

Universal and Gracey curettes are typically used during nonsurgical periodontal therapy of a patient’spatient's dental hygiene care.<ref name=":1">Gehrig JS, Willmann DE. ''Foundations of Periodontics for the Dental Hygienist.'' 4th ed. Philadelphia: Wolters Kluwer; 2016.</ref> The goal of nonsurgical periodontal therapy is to eliminate [[inflammation]] and return the patient’spatient's [[periodontium]] back to health.<ref name=":2">Newman MG, Takei HH, Klokkevold PR, Carranza FA. ''Carranza’s Clinical Periodontology.'' 12th ed. St. Louis: Saunders/Elsevier; 2015.</ref> One of the ways this can be achieved is by minimizing the bacterial challenge to the patient.<ref name=":1" /> To control the bacterial levels in the mouth, oral health education is provided to the patient to control calculus and [[Dental plaque|plaque]] buildup.<ref name=":1" /> An important component of removal and management of bacterial levels in the mouth is the use of hand instruments, such as Gracey curettes and universal curettes, that remove calculus deposits contaminating the tooth surface supragingivally and subgingivally.<ref name=":1" /> This is vital to nonsurgical periodontal therapy because scaling and root planing reduces bacterial biofilms in the mouth that are associated with inflammation.<ref name=":1" /> A research study suggests that periodontal root debridement is a key factor that influences the success of gaining periodontal attachment on previously infected root surfaces.<ref>Obeid PR, D'Hoore W, Bercy P. Comparative clinical responses related to the use of various periodontal instrumentation. ''J Clin Periodontol''. 2004;31(3):193-9.</ref>

== Universal Curettecurette ==

[[Image:Columbia currettes.JPG|150px|thumb|right|'''Universal curettes''' have sharp cutting edges on both sides of their blades. Therefore, only two instruments are necessary --– anterior (pink ring) and posterior (purple ring).<ref name=":3">Gehrig JS, Sroda R, Saccuzzo D. Fundamentals of Periodontal Instrumentation and Advanced Root Instrumentation. 8th ed. Philadelphia: Wolters Kluwer; 2017.</ref>]]

== Gracey Curettecurette ==

[[Image:Gracy currettes.JPG|150px|thumb|right|'''Gracey curettes''' have sharp cutting edges on only one side of their blades. There are two site-specific Gracey curettes --– posterior mesial (white ring) and posterior distal (blue ring), in addition to the anterior curette (red ring).<ref name=":3" />]]

[[Image:Currettes diagram.jpg|150px|thumb|left|While the blade of the universal curette is situated perpendicular to the edge of the terminal shank, the blade of the Gracey curette is only offset by 70 degrees, giving the blade a lower cutting edge and an upper non-cutting edge.<ref name=":3" />]]

There are many different types of Gracey curettes that are designed to access different surfaces of the teeth in different areas of the mouth. In addition to the traditional Gracey curettes, there are also modified designs with extended shanks or miniature and micro-miniature working ends.<ref name=":3" /> The modified curettes with extended shanks have a 3mm3&nbsp;mm longer terminal shank and are used for root surface debridement in pockets deeper than 4mm4&nbsp;mm.<ref name=":0" /><ref name=":3" /> An example of these are called After-Five curettes.<ref name=":0" /><ref name=":3" /> The curettes with miniature and micro-miniature working ends are used for deep narrow pockets, line angles and furcations and an example of these are Mini-Five and Micro-Mini Five curettes<ref name=":0" /><ref name=":3" /> These instruments also have a 3mm3&nbsp;mm longer terminal shank and a blade half the length of a regular Gracey curette.<ref name=":0" /> The micro-miniature working ends are more rigid and are 20% thinner than that of a miniature curette, allowing them to access tight pockets without tissue trauma.<ref name=":0" /> Gehrig<ref name=":3" /> outlines areas of the mouth and tooth surfaces the standard Gracey curettes are used on. The Gracey curettes and areas of use are shown in Table 1.

==== Table 1. The Series of Gracey Curettes and Their Area of Application<ref name=":3" /> ====

|All tooth surfaces: anterior and premolar

Facial, lingual and mesial surfaces: posterior

|Facial, lingual and mesial surfaces: posterior

Similarly to a universal curette, the Gracey curette is used with a modified-pen grasp and fulcrum finger for support, with the toe third of the instrument being adapted to the crown or root surface.<ref name=":3" /> When using a Gracey curette, the terminal shank should be parallel to the tooth surface that is being worked on. This is to ensure that the cutting edge is at the correct angulation.<ref name=":3" /> In order to select the correct working end of an anterior Gracey curette, the face of the instrument must tilt towards the tooth. It is important to select the right end, as tissue trauma may occur if the wrong end is selected.<ref name=":3" /> To select the correct working end of a posterior Gracey curette, the terminal shank must be parallel to the surface being instrumented, and the functional shank goes up and over the tooth rather than down and around the tooth so the current is the best of all
.<ref name=":3" />

== Advantages and Limitations of Periodontal Curetteslimitations ==