Dental Instruments

and Equipment Compiled by Carin Brent

Dipl OH Stell. Expanded functions UWC

3 Clinical points

Operative or restorative dentistry is the area of dental practice concerned with the prevention and

treatment of defects in tooth enamel and dentin. Defects will refer to carious lesions, fractures,

abrasion, erosion and congenital defects. Although hygienists are less likely to treat and prevent

enamel and dentine defects, it consumes the majority of assistants and therapists’ working day.

The most popular materials used for restorations are amalgam, composite resins, and glass ionomer

cements.

Every operator has his/her own preference of materials and techniques. It is therefore important to

be able to identify the instruments, materials and equipment.[1] These instruments are made of hard

wearing materials such as carbon steel, stainless steel, plastic or specialised metal to ensure it can

withstand the sterilization procedures. The dental tray is set up in a specific order that follows the

pattern of the procedure.

This tray shows the appropriate sequence of instruments.

[4]

The numbers refer to:

1. Examination instruments

2. Hand cutting instruments

3. Restorative instruments

4. Accessory instruments

The tray is always set up from left to right and after use; the instrument should be replaced in its

correct position. Accessory instruments will be placed on the counter top in an organized and

accessible manner.

Most instruments are identified by a universal number assigned by the manufacturer and engraved

on the shaft. G.V Black designed a formula that describes the angulation and dimension of the

working end of an instrument. Hand cutting and scaling instruments have three sets of numbers,

referring to the width, length and angle of the blade.[3]

Hand instruments consist of three parts:

[22]

1. Handle/ Shaft This is the part where the operator holds the instrument. The surfaces differ in shape (e.g

round hexagonal), thickness, colour or texture to fit every operator’s preference.

2. Shank This is the part that connects the working area to the handle. The angle and thickness of the

shank depends on its function. The thicker the shank, the more pressure can be applied to

the instrument when in use.

The angle of the shank is designed to allow the instrument to reach the desired area. E.g an

instrument that needs to reach interproximal spaces, will have a curved shape while a

straight shank give better access to occlusal, facial or buccal surfaces.

3. Working end This is the portion of the instrument that is used for a specific function. The end can have a

point, a blade or a nib-depending on its function. The nib may be smooth or serrated.

Hand instruments can be single or double ended. Double ended instruments are usually

mirror images.

LOOK AT VIDEO CLIP: http://slideplayer.com/slide/5301866/

Examination Instruments

1. Examination instruments consists of :

a. Mirror: used for indirect vision, retraction of tongue and cheeks, reflection of light and

protecting the tongue and cheeks against possible injury from the bur

b. Explorers (probes): available in various shapes like the right angle, sheppard’s hook and pig

tail.

c. Cotton pliers (tweezers )

d. Periodontal probe

Hand Cutting Instruments

Many dental procedures require the use of hand instruments with sharp cutting edges. This cutting

instrument group used in operative dentistry includes excavators, chisels, hatchets, hoes, and

gingival margin trimmers. They are used in the cavity preparation of both amalgam and composite

(resin) restorations. The assistants setup the tray in a precise order of use to transfer it to the

operator as needed.

[24]

Excavators

The most commonly used excavators are the spoon excavator and the black spoon.

The spoon excavator is a double-ended instrument with a spoon, claw, or disk-shaped blade. Spoon

excavators are used primarily to remove debris from tooth cavities. Their tips and sides are designed

for cutting action. The most common sizes are the small and the large spoon excavators.

Although the black spoon has a flat appearance, it serves the same purpose.

[2]

Hatchets

A dental hatchet resembles a camper's hatchet, except much smaller. Like dental chisels, some have

single cutting ends, and others have cutting edges on both ends of the handle. These instruments

have different lengths and widths of blades. Hatchets are used on the wall of the cavity preparation

to cleave enamel and cut dentin so there will be a sharp cavity outline with smooth cavity walls and

floor. The cutting edge is parallel to the long axis of the handle.

[24]

Hoes

Dental hoes look like a miniature garden hoe. They are used with a pulling motion to smooth and

shape the floor and sides of cavity preparations. Hoe blades are set at a 45- to 90-degree angle from

their handle.

[6]

Chisels

Chisels are used to cleave (split) tooth enamel, to smooth cavity walls, and to sharpen cavity

preparations. The two most common types used in operative dentistry are the Wedelstaedt and bin-

angle chisels . The Wedelstaedts have slightly curved shanks and are used primarily on anterior

teeth. The bin-angle chisels have two distinct angles—one at the shank, and one at the working end.

This design allows access to tooth structures that would not be possible with straight chisels.[1]

Chisels have a single bevelled cutting edge. [3]

[6]

[5]

Gingival Margin Trimmers (GMTs)

The GMT is a type of chisel with a slightly curved blade for better mesial or distal access into the

preparation. GMTs are available in double-ended styles and are used in pairs, such as the #26 and

#27. This is because the working ends of the even-numbered instruments are designed for use on

the distal surfaces, and the odd numbered are used on the mesial surfaces. [1][3]

[6]

4. Amalgam Restoration Instruments

The instruments discussed in this section are used when the dentist elects to use an amalgam or a

temporary dental material to restore a tooth.

Amalgam carrier

It comes in various designs and the operator will choose the instrument that suits his/her needs

best. It is usually a double ended instrument designed to carry the freshly mixed amalgam in larger

or smaller increments of amalgam to the cavity.

[7]

Condenser

Condensers come in single- and double-ended designs. They have various shaped and sized working

ends, which may be smooth or serrated. It is also known as the plugger and is used to pack down

freshly mixed amalgam in the preparation.

[8]

Burnisher

Burnishers are used to smooth the surface of the newly placed amalgam. It has a smooth working

end in different shapes. The most commonly used burnisher is the ball shaped, but is also available

in football, T-ball and beavertail.

[9]

Carvers

After the amalgam is condensed, it must then be carved to approximately the same original tooth

structure. Carvers have sharp cutting edges that are used to shape, form, or cut tooth anatomy into

amalgam restorations. These instruments come in assorted shapes and sizes in double-ended

designs.

Many carvers were designed for carving specific tooth surfaces. The Interproximal and #1/2

Hollenback were designed for carving proximal (in between) tooth surfaces; whereas, the discoid-

cleoid # 89/92 and Tanner #5 are used on occlusal surfaces. Carvers shaped similar to Vignon or

Frahm #2/3 are used to quickly carve the basic anatomy on occlusal surfaces. As with condensers,

dentists also have favourite carvers that they use routinely. You must know the dentist's preference

so that you can have the desired instrument ready when it is needed.[1]

[10]

The amalgam knife is used to remove excess amalgam where the tooth and filling material meet.

Burnishers

When the carving is complete, the dentist may use burnishers to smooth and polish the restoration,

and to remove scratches left on the amalgam surface by a carving instrument. Burnishers have

smooth rounded working ends and come in single- and double-ended types. [1]

Composite Resin Instruments

A variety of double-ended instruments make up this instrument group. They are used to transport

and place dental cements, resins, temporaries, and insulating and pulp-capping materials. The

working ends on composite resin instruments range from varying small cylinders to assorted angled,

paddle-like shapes. Composite resin instruments are made of plastic or anodized aluminium (fig 2)or

Teflon (fig 1) to prevent composite materials from being sctatched or discoloured or sticking to the

instrument. These instruments can be heat sterilized and can also be used on cements. [1], [3]

[11]

The Woodson is a double ended instrument. One end is used to carry the material to the cavity,

while the other end is a nib that resembles a condenser

Another instrument frequently used with etching and bonding procedures associated with

composite resins is a disposable brush to apply the bonding agent. Single-use disposal brushes are

being used more frequently, aiding in good infection control practices.

Other instruments commonly found on the restorative tray are:

Spatulas

Spatulas are used for mixing restorative materials. Some of these spatulas can cause discoloration in

the material being mixed. The selection of a mixing spatula is not critical except when preparing a

permanent anterior composite restoration. Some composite restoration material discolours easily,

so use the spatulas provided by the manufacturer when working with it.[1]

Syringes and aspirating syringes.

The syringe is used in dentistry to inject a local anaesthetic. The parts of an aspirating syringe

consist of a threaded tip where the needle attaches, a barrel where the ampule is placed, a piston

rod (plunger) with a harpoon attached that embeds itself into the rubber stopper of the ampule, a

finger grip, and a thumb ring. The harpoon allows the dentist to aspirate (draw back) from the

injection site to see if the needle tip is located in a blood vessel before injecting the anaesthetic

solution. Once the harpoon is engaged into the rubber stopper of the anaesthetic ampule, the

dentist can apply inward or outward pressure.[1]

[13]

The Syringe needles

Syringe needles used in dental treatment arrive sterile and are disposable. They are designed for a

single use, and are available in different gauges and lengths. The gauge of a needle refers to the

diameter of the hollow shaft of the needle.

The larger the gauge, the smaller in diameter the needle. The lengths of the needles vary, and are

classified as long (L) or short (S). Each needle has either a plastic or metal hub designed to screw

onto the threaded end of the syringe. This hub is positioned to permit the needle to extend inward

to penetrate the rubber seal portion of a loaded anaesthetic ampule. The plastic caps covering the

sterile needle are easily removed from both ends. When placing the needle onto the syringe,

remove only the cap that covers the syringe end on the needle. This maintains the sterility of the

needle portion used to inject the patient. Normally, you prepare the anaesthetic syringe with a short

needle for maxillary injections, and a long needle for mandibular injections. The tip of the needle has

a bevelled angle, which is turned toward the alveolus to accurately deposit the solution.[1]

To avoid needle stick injuries, always use safety devices or the One-Hand-Scoop technique to recap

needles after use.

WATCH: https://www.youtube.com/watch?v=AYUbpBLceTg

Articulating paper and holder

It is used to check the height of the restoration after placement.

Rubber /dental dam instruments include:

[15]

A. Punch: to punch holes in the appropriate places

B. Rubber dam forceps: used in the placement of the clamp

C. Frame: to stabilize the stretched material

D. Floss

E. Different sized clamps: a clamp consists of the bow that extends through the material and

the jaws that encircles the tooth.

F. Material: comes in different size, colour and thickness

G. Rubber dam napkin: (optional) to place between the rubber dam material and patient’s skin

for more patient comfort

Lubricants: one to cover patients’ lips for comfort and a water soluble lubricant to smear on

underside of the material to help with smooth placement over teeth.[3

Scissors

Different operators will use different techniques and systems of rubber dam. Always follow

manufacturer’s instructions.

https://www.youtube.com/watch?v=Wki6FkFYO0E

Surgical extraction tray

The setup for this tray will vary amongst operators.

The purpose of these instruments is to separate the tooth from the socket, retract surrounding

tissue, loosen and elevate the tooth within the socket or extract the tooth from the socket.

The most commonly used instruments are:

Elevators:

The purpose of an elevator is to help “loosen” the tooth or root fracture from the socket.

Periosteal elevator is used to separate and retract the periosteum from the bone. Before a surgical

forceps is used, the dentist uses a periosteal elevator to detach he gingiva from the neck of the

tooth.

[26]

The straight elevator is used to loosen the tooth from the periodontal ligament for easier extraction.

It may also be used to remove root fragments from the socket or tooth that have been sectioned

with a surgical handpiece and bur.

[27]

Root tip picks are used to remove root tips or fragments that may break away from the tooth during

extraction.[27]

Forceps

Forceps come in different shapes and sizes to hallow the operator to grasp the crown of the tooth to

be extracted.

The beaks of the forceps are shaped to grasp the crown of the tooth at the cervical line- taking in

consideration of the shape of the crown. For maximum effectiveness, the beaks of the pliers can be

smooth or serrated. The location of the tooth dictates which forceps to use.[27]

Types:

A. Maxillary molar extraction forceps

B. Maxillary anterior extraction forceps

C. Mandibular molar extraction forceps

D. Mandibular anterior extraction forceps

E. Root tip extraction forceps

[28]

Rongeurs

The Rongeurs is used to trim alveolar bone after multiple extractions to shape the edentulous ridge.

It resembles nail clippers. The beaks of the instrument must be kept clean during use, and the

assistant can remove debris with a sterile gauze.

Other items on the surgical extraction tray include a scalpel handle and blade, needle and sutures

and suture scissors.

Dental Handpieces

Dental handpieces are the most frequently used devices in the surgery with the low-speed (slow)

and high-speed (fast) handpieces best known. Others are the Endodontic, Ultrasonic, Air abrasion,

the Laboratory and the Laser Handpiece. Through compressed air and electricity, the dental unit

provides power to the handpiece that enables the bur to rotate – hence the need for a compressor.

The low-speed handpiece

This handpiece consists of a motor and either a straight or contra-angle handpiece and runs at 10

000-30 000 rotations per minute (rpm). The bur can move in a clockwise (forward) and anti-

clockwise (reverse) direction. Straight handpieces are usually used to do laboratory or surgical

work, while contra angle handpieces are used for clinical work.

Clinical uses are:

Removal of decay and fine finishing of cavity preparation

Finishing and polishing of restorations

Supra-gingival polishing and removal of stains

Root canal treatments

Adjustment to porcelain

To remove bone during surgical extractions

To split a tooth during surgical extractions

Laboratory uses are:

Trimming and contouring of temporary crowns

Trimming and relining of removable partial and full dentures

Adjusting and trimming of orthodontic appliances[3]

[17]

High-speed handpieces

This is the workhorse that removes decay, faulty restorations and unwanted tooth structure in

crown preparations, prepare the outline and retention grooves for a new restoration, polish

restorations and section teeth during surgical extractions. It has no different attachments and

operates at 450 000 rotations per minute.

At this speed the bur can generate heat that may damage the pulp. To prevent pulp damage, high-

speed handpieces are equipped with a water coolant system that sprays cold water on the tooth and

bur. The spray also helps to clear debris away from the operating site and give better visibility.

High-speed handpieces have a different locking system from the low-speed handpiece and operates

with a friction-gip device to keep burs, stones or polishing devices in place.

It is also equipped with fibre optic lighting. Light ports are situated near the bur and deliver light

directly on the operating sight.[3]

[18]

Ultrasonic handpiece

The ultrasonic handpiece uses mechanical radiant energy of water and sound vibrations to create a

pulsating effect on the tooth. (Radiant energy is energy contained in electromagnetic waves)[19]

This handpiece is used mainly for prophilaxes (scale and polish) and to remove orthodontic cement

from teeth, but can also be used for endodontic procedures. Different tips perform different

functions and are selected according to the surface and function.[3]

Some handpieces have a fibreoptic light.

Laser Handpiece

All lasers work by delivering energy in the form of light. When used for surgical and dental

procedures, the laser acts as a cutting instrument or a vaporizer of tissue that it comes in contact

with.

Advantages of using laser:

May cause less pain in some instances, so reduces the need for anaesthesia

May reduce anxiety in patients uncomfortable with the use of the dental drill

Minimize bleeding and swelling during soft tissue treatments

May preserve more healthy tooth during cavity removal[21]

Disadvantages of using laser:

Lasers can't be used on teeth with fillings already in place.

Lasers can't be used in many commonly performed dental procedures. For example, lasers

can't be used interproximally, around old fillings, and large cavities that need to be prepared

for a crown. In addition, lasers cannot be used to remove defective crowns or silver fillings,

or prepare teeth for bridges.

Traditional drills may still be needed to shape the filling, adjust the bite, and polish the filling

even when a laser is used.

Lasers do not always eliminate the need for anaesthesia.

Laser treatment tends to be more expensive -- the cost of the laser is much higher than a

dental handpiece.[21]

It is important to follow manufacturer’s instructions carefully when handling or storing the fibre-

optic cable, since damage to the cable can lead to harm for operator and patient. [3]

Air Abrasion Handpiece

This unit is the mini version of a sandblaster. It delivers aluminium oxide under high pressure to

remove enamel, dentine and restorative material without compromising healthy tooth structure.

It is mainly used for the following procedures:

Fissure sealants

External stain removal

Class l to Class V preparation

Endodontic access

Crown margins

Preparation of tooth surface for cementation of cast restorations like crowns and veneers.[3]

Endodontic Handpiece

Endodontic handpieces are attached to an endodontic motor. The handpiece is used to clean root

canals . Rotary endodontic files are inserted into the handpiece in order to mechanically clean and

shape a root canal. The handpiece either rotates the file or uses reciprocating movement .

Reciprocating movement is when the file is turned in one direction (cutting direction), and then the

direction of file movement is reversed. The amount of reverse movement is less than that in the

cutting direction. The amount (degrees of turn) differ with different file systems. (Pro-taper, Wave

one)

The endodontic motor allows the correct torque and speed for the files to be used and reduces the

risk of file breakages. Again, file systems require different settings.

Laboratory Handpiece

It operates at a speed of 20 000 rpm and uses laboratory burs and stones of different shapes and

sizes. It provides more torque than the other handpieces that makes it better for procedures

needed to be done outside the mouth. (Torque is a force that cause rotation)[3]

Operators will develop his or her own work style and techniques and tray set up may vary from

surgery to surgery. It is therefore important that the assistant knows the names and functions of all

the various instruments and equipment.

Remember to wear on your best smile every day!

Question time:

Please note, where more than one answer is correct, all the correct numbers have to be ticked to get

the point.

1. Examination instruments consist of:

a. Mirror

b. Explorer

c. Tweezers

d. Periodontal probe

2. The shank is:

a. the part where the operator holds the instrument.

b. the part that connects the working area to the handle

c. the portion of the instrument that is used for a specific function

3. An instrument with a curved shank is usually used on the posterior occlusal surfaces

a. True

b. False

4. Which instrument is a double-ended instrument and is used primarily to remove debris from

tooth cavities?

a. Spoon excavator

b. Hoe

c. Hatchet

d. Chisel

5.

This forceps will be used for the extraction of:

a. 26

b. 36

c. 41

d. 21

6. Which instrument is not classified as a hand cutting instrument?

a. Spoon excavator

b. Hoe

c. Hatchet

d. Hollenbeck carver

7. What benefit is there in using an aspirating syringe?

a. Allows for a smoother injection.

b. Allows you to refill the ampule

c. The operator can aspirate to see if a blood vessel has been penetrated.

8. Which of the two needles has the smallest diameter (thinnest)?

a. 25 gauge

b. 27 gauge

9. Which area requires a long needle to administer local anaesthetic?

a. Anterior teeth

b. The maxilla

c. The mandible

10. To avoid needle stick injuries, you must:

a. Hold the syringe in one hand and “scoop up” the cap of the needle.

b. Replace the cap carefully with both hands.

c. Ask your employer to invest in a needle recapping device

11. Which of the following are functions of the low-speed handpiece?

a. Removal of decay and fine finishing of cavity preparation

b. Remove leaking restoration material from tooth

c. Trimming and contouring of temporary crowns

d. Removal of stains

12. Which of the following are functions of the high-speed handpiece?

a. Removal of decay and fine finishing of cavity preparation

b. Remove leaking restoration material from tooth

c. Trimming and contouring of temporary crowns

d. Removal of stains

13. How fast does the high-speed handpiece operate?

a. 10 000-30 000 rpm

b. 100 000 rpm

c. 450 000 rpm

14.

This forceps will be used for the extraction of:

a. 26

b. 36

c. 41

d. 21

15. Reciprocating movement is when:

a. there is spontaneous resistance against file movement

b. the file moves horizontally and vertically in the canal

c. the file is turned in one direction (cutting direction), and then the direction of file

movement is reversed.

Sources:

1. http://www.sweethaven02.com/PDF_Health/14274les13.pdf 2. https://www.google.co.za/search?hl=en&tbm=isch&source=hp&biw=911&bih=409&q=black+spoon+excavator&oq=black&gs_l

=img.1.0.35i39k1l2j0l8.1162.2140.0.4479.7.7.0.0.0.0.451.815.3-

1j1.2.0....0...1.1.64.img..5.2.811.0...0.jjZ2yz3se9Q#imgrc=hIiTEhskW5lWJM:

3. Modern Dental Assisting. Bird Robinson 9th Edition p 479-516 p 533-534 4. https://www.google.co.za/search?hl=en&tbm=isch&source=hp&biw=911&bih=409&q=dental+tray+setup+for+amalgam&oq=d

ental+tray+setup&gs_l=img.1.5.0l6j0i30k1j0i5i30k1j0i8i30k1l2.100.7897.0.17117.16.16.0.0.0.0.891.3482.3-

3j2j1j1.7.0....0...1.1.64.img..12.1.891....0.b3aiZxCIQfE#imgrc=BlUIk2QVZNEPAM:

5. https://www.google.co.za/search?hl=en&biw=911&bih=409&tbm=isch&sa=1&q=cavity+preparation+hand+instrument+picture

&oq=cavity+preparation+hand+instrument+picture&gs_l=psy-ab.12...15634.19182.0.21249.16.14.0.0.0.0.716.2794.3-

2j1j2j1.6.0....0...1.1.64.psy-ab..14.0.0....0.ZsKziZEkLO4#imgdii=JLwF6fz2CzjXmM:&imgrc=Z6tj0D2lnkSmmM:

6. https://www.google.co.za/search?hl=en&biw=911&bih=409&tbm=isch&sa=1&q=dental+chisel+vs+hatchet&oq=chisel+vs+&gs

_l=psy-ab.1.3.0l2j0i30k1j0i5i30k1l2j0i8i30k1l2j0i24k1l3.1867.12088.0.14665.36.14.0.0.0.0.630.1926.3-

4j0j1.6.0....0...1.1.64.psy-ab..30.4.1619.0..0i67k1.296.NdHlurgPGJs#imgdii=8ZfHXs6uXQCkZM:&imgrc=nXy_ZKYih9EC6M:

7. https://www.google.co.za/search?hl=en&tbm=isch&source=hp&biw=911&bih=409&q=amalgam+carrier&oq=ama&gs_l=img.1.

0.35i39k1l2j0l8.2483.3094.0.4957.5.5.0.0.0.0.512.849.3-

1j0j1.2.0....0...1.1.64.img..3.2.849.0...0.NX5qHkcWxSo#imgrc=RmPgoPByOodtNM:

8. https://www.google.co.za/search?hl=en&tbm=isch&source=hp&biw=911&bih=409&q=amalgam+plugger+dental&oq=amalga

m+plugge&gs_l=img.1.1.0l3.1392.6330.0.8384.16.16.0.0.0.0.610.2505.3-

3j2j1.6.0....0...1.1.64.img..10.6.2501.0..35i39k1j0i24k1.0.5oWBb6ah-GE#imgrc=mfnSWbBhE4PpQM:

9. https://www.google.co.za/search?hl=en&biw=911&bih=409&tbm=isch&q=t+ball+burnisher&sa=X&ved=0ahUKEwiJn7fy0erWA

hVkGsAKHYYKCoUQhyYIJw#imgrc=YyMRzo4H-C8FxM:

10. https://www.google.co.za/search?hl=en&biw=911&bih=409&tbm=isch&sa=1&q=amalgam+carver&oq=amalgam+carver&gs_l=

psy-ab.1.0.0l5j0i5i30k1j0i24k1l2.2974.11618.0.13947.30.18.0.0.0.0.882.2956.3-1j1j2j1.6.0....0...1.1.64.psy-

ab..24.5.2948.0..0i67k1.627.VzrY3isyyyQ#imgdii=scoX_zNTvnUqEM:&imgrc=h4Us261eK24sbM:

11. https://www.google.co.za/search?hl=en&biw=911&bih=409&tbm=isch&sa=1&q=composite+placement+instrument&oq=comp

osite+plac&gs_l=psy-ab.1.0.0l3j0i8i30k1j0i24k1l2.855949.865379.0.867839.35.22.2.0.0.0.967.5391.3-

5j1j4j1.12.0....0...1.1.64.psy-ab..21.13.5419.0..0i67k1j0i5i30k1.295.yrUUnTZUDTg#imgrc=jYQ8FVcyHqj5CM:

12. https://www.google.co.za/search?hl=en&biw=911&bih=409&tbm=isch&q=woodson+dental+instrument&sa=X&ved=0ahUKEwj

njPiB2-rWAhUFKcAKHSP7ALgQhyYIJw#imgrc=rWAXXfm_nDjeuM:

13. https://www.google.co.za/search?hl=en&tbm=isch&source=hp&biw=911&bih=441&q=anatomy+of+dental+syringe&oq=anato

my+of+dental+syringe&gs_l=img.12...73.7732.0.10178.22.17.0.0.0.0.489.2486.2-

1j1j4.6.0....0...1.1.64.img..16.0.0....0.7WaV4ZxmWio#imgdii=js1ZqqXWZ3kUyM:&imgrc=Q0II_qWyOdXW2M:

14. https://www.google.co.za/search?hl=en&biw=911&bih=409&tbm=isch&sa=1&q=anatomy+of+dental+syringe+needle&oq=ana

tomy+of+dental+syringe+needle&gs_l=psy-ab.12...726393.727561.0.730277.7.7.0.0.0.0.665.665.5-1.1.0....0...1.1.64.psy-

ab..6.0.0....0.63KRap6bMyQ#imgrc=39tIdyJAgLw0UM:

15. https://www.google.co.za/search?hl=en&biw=911&bih=409&tbm=isch&sa=1&q=rubber+dam+tray+setup&oq=rubber+dam+tr

ay&gs_l=psy-ab.1.0.0i24k1.1988708.1994253.0.1996503.47.20.0.0.0.0.734.3387.3-6j0j1j1.9.0....0...1.1.64.psy-

ab..38.7.3075.0..0j0i67k1.689._v7l_wZrVCk#imgrc=MYyp8ySPVorreM:

16. http://am-eagle.com/product-information/instrument-care

17. https://www.google.co.za/search?hl=en&tbm=isch&source=hp&biw=911&bih=409&q=high+speed+dental+handpiece&oq=hig

h+speed+denta&gs_l=img.1.1.0l3j0i30k1l2j0i8i30k1l2j0i24k1l2.2143.10621.0.13011.18.18.0.0.0.0.577.3214.3-

6j1j1.8.0....0...1.1.64.img..10.8.3210.0...0.nAxXY9mh4XQ#imgrc=8t44ENtW4bDxKM:

18. https://www.google.co.za/search?hl=en&tbm=isch&source=hp&biw=911&bih=409&q=high+speed+dental+handpiece&oq=hig

h+speed+denta&gs_l=img.1.1.0l3j0i30k1l2j0i8i30k1l2j0i24k1l2.2143.10621.0.13011.18.18.0.0.0.0.577.3214.3-

6j1j1.8.0....0...1.1.64.img..10.8.3210.0...0.nAxXY9mh4XQ#imgrc=ZKfX22oa81ErNM:

19. http://study.com/academy/lesson/forms-of-energy-thermal-radiant-chemical-electric-nuclear-energy.html

20. https://www.google.co.za/search?hl=en&biw=911&bih=409&tbm=isch&sa=1&q=ultrasonic+scaler+handpiece&oq=ultra&gs_l=

psy-ab.1.0.0i67k1j0j0i67k1l2j0l2j0i67k1l4.1308916.1312414.0.1316319.31.12.0.0.0.0.710.1566.3-1j0j1j1.4.0....0...1.1.64.psy-

ab..27.3.1562.0..0i8i30k1j0i24k1.361.ZqDP91p9WeE#imgdii=PGqk2sl7dIIkSM:&imgrc=rV9QT94PS7tppM:

21. https://www.webmd.com/oral-health/guide/laser-use-dentistry#1-2

22. https://www.google.co.za/search?hl=en&biw=911&bih=409&tbm=isch&sa=1&q=main+parts+of+dental+hand+instruments&o

q=main+parts+of+dental+hand+instruments&gs_l=psy-ab.12...118065.139860.0.141836.79.42.0.0.0.0.707.6752.3-

7j4j3j1.16.0....0...1.1.64.psy-ab..63.5.2387.0..0j0i67k1.841.Asp1JfVzUAk#imgrc=GkHEXs9GGsQKnM:

23. https://www.google.co.za/search?hl=en&biw=911&bih=409&tbm=isch&sa=1&q=cutting+instruments+excavators+chisels+othe

rs&oq=cutting+instruments+excavators+chisels+others&gs_l=psy-ab.12...32170.41453.0.43692.26.25.0.0.0.0.666.4574.3-

2j2j5.9.0....0...1.1.64.psy-ab..17.2.775...0j0i30k1j0i5i30k1j0i8i30k1.0.GO4BogcE7uE#imgrc=lcYTE7O82hjucM:

24. https://www.google.co.za/search?q=dental+hoe&hl=en&tbm=isch&tbs=rimg:CXsvZZuin7HZIjgXC4a9nndMTh_11Y4SL7Id4-

s85MjvlfwwqvblEThBT7Muq1lg_1BWOPDLlUGlv1aoXdI73lPs3QsioSCRcLhr2ed0xOEZMx2XtrSiuhKhIJH_1VjhIvsh3gRFoMlsz02Q7

oqEgn6zzkyO-

V_1DBGHr7O3pR9GbSoSCSq9uUROEFPsEfYBlGGrBZuMKhIJy6rWWD8FY48RQ4NZ30Mz4sYqEgkMuVQaW_1VqhREJoBCcaZGNV

SoSCd0jveU-

zdCyEbBLlsM4AMoj&tbo=u&sa=X&ved=0ahUKEwij3aa25_TWAhXDUBQKHTvnAAUQ9C8IHw&biw=911&bih=441&dpr=1.5#img

dii=3SO95T7N0LKPuM:&imgrc=H_VjhIvsh3hx5M:

25. Modern Dental assisting Bird Robinson Ninth Edition p898-902

26. https://www.google.co.za/search?hl=en&tbm=isch&q=periosteal+elevator&chips=q:periosteal+elevator,g_3:dental&sa=X&ved

=0ahUKEwiDyuuMvfrWAhWBAMAKHVkDCNQQ4lYIKygA&biw=911&bih=441&dpr=1.5#imgrc=JfvrhrryL7laNM:

27. https://www.google.co.za/search?hl=en&biw=911&bih=409&tbm=isch&sa=1&q=straight+elevator+dental&oq=straight+elevat

or&gs_l=psy-ab.1.1.0i67k1j0l4j0i7i30k1l3j0i24k1.1314276.1318242.0.1320792.20.12.0.0.0.0.940.1884.3-

1j0j1j1.3.0....0...1.1.64.psy-ab..18.2.942....0.EbxJpHZz-4U#imgrc=pCauanCmL9JUOM: