While more clinicians are embracing ultrasonic scaling as their primary debridement tool, hand instruments still have a place in the treatment room for most of us. There are a number of companies that make hand instruments, and just like any other commodity, there are differences between each company’s product lines that can have a significant impact on hand health.
Decades ago, hand instruments were made with skinny handles that were often smooth. Since slender handles force clinicians to use a tighter pinch-grip to hold on to the instrument, large diameter instruments began to appear in the marketplace three decades ago. Textured handles help clinicians use a light grasp since texture equals traction. Every manufacturer has its own signature texture patterns. The design is not critical, but the presence of texture is key.
Instrument handles are made with either lightweight composite resin materials, or are fabricated using a hollow stainless steel tube, which eliminates unnecessary weight. Some clinicians feel the resin handles reduce the risk of cumulative trauma disorders in the hand and wrist, while others prefer the feel of a metal handle. The length of the actual instrument also makes a difference. Clinicians with small hands often prefer an instrument with a short handle, while those with large hands are able to balance a long instrument more comfortably.
Instrument sharpness is a key element to preventing hand fatigue and excessive instrumentation. There are many ways to sharpen scalers and curettes. Some use an Arkansas stone, others work with ceramic stones, and many use some type of machine or rotating stone to keep the edges sharp. No matter how proficient one may feel with instrument sharpening, it is nearly impossible to maintain, much less restore a sharp edge to these tiny blades. To further compound the problem, every clinician sharpens a bit differently. So in the end, most hand instruments don’t get sharpened often enough, which results in a dull instrument that requires more force and more strokes, and often results in burnished calculus.
OK, I bow down to those who feel proficient in sharpening, but is sharpening the best use of our time? With every sharpening the blade gets thinner and thinner, which increases the risk of breakage. Since most of us are not good at the task, could our precious time be better used seeing another patient, or encouraging a patient to schedule needed treatment?
With the exception of one unique patented metal alloy, curettes and scaler blades are made with cryogenically treated stainless steel alloys. About five years ago, American Eagle Instruments introduced a line of hand instruments with blades made from their XP technology, a metal alloy that is a game changer in the world of hand instruments. XP technology is not a coating applied to the surface of a stainless steel instrument, but rather a specially filtered titanium nitride/stainless steel alloy. The alloy is considerably harder than traditional stainless steel, and results in a blade that remains sharp over a protracted period of time.
When traditional stainless steel instruments are manufactured, the blades are made thicker and wider to account for the reduction in size over time through sharpening. Instruments made with XP technology are thinner and smaller since the instrument will retain the original factory sharpness for a time similar to the life span of a traditional curette or scaler. The cutting edges of an XP instrument should be periodically tested with a traditional test stick. When the blade is no longer sharp, it is important to remove the instrument from service. Attempting to sharpen it will result in a dangerously small blade that is subject to breakage.
There are a few simple tips for using XP instruments. Be mindful of the blade sharpness. Lighten your grasp and lightly plane deposits away. Excessive force or pressure with any sharp instrument is not necessary and has the potential to remove excessive root structure.
The initial cost of XP technology is comparable to other brands of premium stainless steel instruments, but the savings in time, frustration, and wear and tear on the hands make this technology a breakthrough for hand instrumentation and a big contribution to our comfort zone, office efficiency, and productivity.
Anne Nugent Guignon, RDH, MPH, provides popular programs, including topics on biofilms, power driven scaling, ergonomics, hypersensitivity, and remineralization. Recipient of the 2004 Mentor of the Year Award and the 2009 ADHA Irene Newman Award, Anne has practiced clinical dental hygiene in Houston since 1971.