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Electric toothbrushes and small interproximal brushes have contributed to the increase in patient oral health and this general improvement in oral hygiene means that the epithelial collar can often be very tight and it is therefore difficult to access subgingival plaque and calculus. These areas can be difficult to access with the old style of instrument, as the blades can be too large and can either traumatise or be inclined to leave a small amount of stain around the edge of the elongated clinical crown. Furthermore, a marked increase in the elderly dentate population presents exposed dentine which easily stains, can be sensitive and is often surrounded by delicate friable tissue.
DENTSPLY Ash Instruments decided to address this problem with their new Refinement range. The objective would be to develop a small range of instruments, which by their logical design would result in less trauma to soft tissues. In turn, this would promote and accelerate healing and thereby hasten the formation of long junctional epithelium. It would also be more comfortable for the patient.
A longer clinical crown will naturally necessitate a longer shank on the instrument, if a safe clinical scenario is to be retained. The instrument therefore needed to be slimmer in order to access smaller recesses and the toes of the working ends not only needed to be slimmer, but also shorter by up to 60%. These extensions and reductions have contributed to the general philosophy of the Refinement range by helping to reduce the causes of trauma and increase the level of access.
Choosing instruments to be refined was done with relative ease. By looking at those instruments we use most frequently, it was obvious which ones to select. To ensure that correct selection would take place, Ash Instruments put in place a focus group that gave clinicians the opportunity to both comment upon and select the new instruments. The result is a complete range that caters for all clinicians who have been looking for extra finesse from their instruments, in order to achieve a better result.
In a market where the consumer (ie patient) is frequently paying privately for their dental care, it is essential that clinicians can provide exactly what the patient wants. Increasingly, patients expect to have a greater say in the modality of the scaling operation and to have a clear sense of the result which they expect – ie squeaky-clean teeth and a painless, atraumatic experience in the dental chair.
Moreover, the majority of hand instruments that we use have been around for a long time. The replacement of Jaquettes with H pattern instruments was about 40 years ago and the difference between the styles of instrument was most welcome. So DENTSPLY Ash Instruments thought it was time to update our instrument range and improve upon those that have been around for 50 years or more.
Ash instruments have improved the handles from the eternal Octagonal grip to the Ceramicolor of the 20th Century (1980's) and currently with the 21st Century Flexichange grip. Having addressed the aspect of the ergonomics, with the target of helping the 'health of our hands', it was now time to focus on the working end of the instruments and the health of our patients.
The obvious way to proceed with this requirement was to design a refined range of instruments that would be compatible with today's high levels of skill and the need to stay at the 'cutting edge' of design. With this, the Refinement range was created.
Refinement H6/H7
The H6/H7 was developed in the 1960's to replace 'dirty Druries', which were instruments of a broadly similar design but which were not made of stainless steel. They therefore had to be kept in oil and be continually sharpened to avoid both rust and bluntness! Since that time they have not really been altered until now.
This is a very popular instrument and probably the most used for a general scale and polish. During the development stage, it was important to maintain the basic design whilst still creating a 'refined' adaptation. The actual tip is now 30% finer than the original and as a result, is more appropriate to remove inter-proximal stain and is less likely to traumatise. Furthermore, the total slimline effect will improve shallow access below the epithelial collar.
Refinement Langer 1/2, 3/4 and 5/6
Langers are commonly used throughout the world of periodontology as the 'instruments of choice' for subgingival debridement, following the use of periodontal Hoes. The new Refinement Langers have been refined to enable easier subgingival access and have been elongated on the shank by approx. 10% to allow reach to a greater depth, whilst still maintaining a safe finger rest. The toe has been refined by 60% on the Langer 1/2; by 35% on the Langer 3/4 and by 44% on the Langer 5/6; these refinements will help to reduce the possibility of trauma.
Refinement WonderHoe and Refinement WonderHoe CA
These innovative scalers are designed for light subgingival plaque removal and supra gingival stain and light calculus removal. Because it needs light pressure, it is suitable for patients with sensitive exposed cementum. When used for this purpose, it is easier to achieve a clean surface than by using other more conventional scalers. These instruments have long shanks, softer angles, are quite 'springy' and are great to use. When access is difficult, these new scalers will be extremely useful.
Brewin Straight
This is a totally new addition to the range and was designed with the specific purpose of gaining better access to anterior teeth, hence why it is straight. One end of this double-ended instrument is original in concept (ie. standard thickness) but conventional in its overall dimensions. The other end of this original instrument has been 'refined' by 15% to gain more access interproximally.
van Blerk Scaler
The new Refinement range is not just about accessing areas for root debridement, but also about making life easier for clinicians. An amalgamation of two styles (the existing S204 and M23), this new addition can be used throughout the mouth, up to 2mm subgingivally.
Refinement Columbia 2L/2R and 4L/4R
These universal curettes have been modified in keeping with the Refinement range. The shank has been extended by approximately 10% and the length of the toe reduced and made finer. This will enable the user to have better access subgingivally and result with less trauma and less discomfort for the patient. This is a winner for those clinicians who regularly use Columbia scalers.
Waite Furcation
This useful instrument has been streamlined to allow better access to very narrow furcations. Not only has the shank been made slimmer by 16%, but the diameter of the tip has been reduced by approximately 21%. The slight modifications should enable clinicians greater ease of access.
Cross Calculus Probe
This completes the set. It would have been remiss to exclude this probe, as it is an essential instrument to check that all subgingival deposits have been removed.
Concluding Remarks
Compared to existing hand scalers, it will be instantly obvious that the need to introduce a whole new concept was due. New techniques mean less intervention and the Refinement range will help with this conservation. The results should speak for themselves - faster healing, less trauma and happier patients. There is no other complete range of Refinement instruments currently available and it is reassuring to know that a truly British manufacturer is the first.
Upon examination of the completed Refinement range, it will become obvious that a new standard has been set. The range has been designed to satisfy a specific need in periodontology. They will enable clinicians to fulfil their objectives, compatible with the high standards which patients expect and deserve.
I have absolutely no hesitation in recommending the new Refinement range. It is a totally new range, modified to accommodate today's standards and needs. Remember that clinically 'access is all' and with these instruments, access will certainly be much easier.
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