Instructional Videos Demonstrating Periodontal Instrumentation on a Typodont with Simulated Calculus

Summary

This manuscript reports on the development of a series of high-resolution instructional videos on periodontal instrumentation techniques using a typodont with plastic teeth coated with simulated supra- and subgingival calculus deposits. Dental students found the recorded videos useful and suggested directions for further development.

Abstract

Video‑assisted instruction can enhance the teaching and learning of periodontal instrumentation when visualization and content quality support clear demonstration of technique. This study aimed to describe the development of high‑resolution instructional videos demonstrating armamentarium and techniques on a typodont with simulated calculus, and to evaluate perceived usefulness among predoctoral dental students. The institutional review board determined that the study was exempt. Instructional videos were recorded in 8K resolution and demonstrated instrument selection, ergonomics, adaptation, angulation, and activation of strokes on a typodont with transparent gingiva and simulated supra‑ and subgingival calculus deposits. Perceived usefulness was evaluated through a brief anonymous survey with optional open-ended feedback. The same cohort was invited to evaluate both video sets, but anonymous responses could not be linked across surveys. Proportions were summarized with 95% Wilson score confidence intervals (CIs). Due to the study's descriptive design, no formal hypothesis testing was performed. Sixteen students completed the survey evaluating the previously used instructional videos; 37.5% rated them "Extremely useful" (95% CI [18.5, 61.4%]), and 50% rated them "Very useful." Fourteen students completed the survey evaluating the new videos; 64.3% rated them "Extremely useful" (9/14; 95% CI [38.8, 83.7%]), 28.6% "Very useful" (4/14), 7.1% "Slightly useful" (1/14), and no participant chose "Moderately useful" or "Not at all useful." All participants indicated they would refer to the new videos in the future. Descriptive categorization of 27 comments identified five recurring themes: clarity, zoom, technique, realism, and accessibility. Students valued improved resolution and close‑up views, while suggestions emphasized captions/written explanations and demonstrations on natural teeth. The findings further support the role of high-resolution instructional videos as useful adjuncts to preclinical periodontal instruction. Future studies should evaluate objective performance outcomes and explore additional content and accessibility features.

Introduction

High-quality periodontal instrumentation is essential for delivering excellent patient care, supporting skill development, and enhancing the patient experience. Various studies have shown that video-assisted clinical instruction in dentistry can effectively complement clinical teaching, enhance understanding in a non-threatening environment, and foster self-directed, active learning¹. At the University of Sydney (Westmead, NSW, Australia), the use of narrated instructional videos to teach dental local anesthesia improved psychomotor skills that required accuracy in 90% of students, which correlated positively with the number of video views². At the University of Alberta (Edmonton, AB, Canada), 79–84% of dental hygiene (DH) students found instructional videos demonstrating clinical instrumentation very or extremely useful in understanding the principles of instrumentation³. At the University of Western Ontario (London, ON, Canada), a 30-min instructional video that demonstrated a step-by-step protocol for performing a tooth preparation for an all-ceramic restoration and fabricating a provisional restoration using a manikin significantly improved students' performance during practical exams and received positive student feedback⁴. Similarly, video instructions demonstrating behavior management techniques for children receiving local anesthetic at the University of Leeds (Woodhouse, Leeds, UK) significantly enhanced dental students' confidence in the subject compared with the standard teaching approach (lectures and seminars) alone⁵.

At the University of Colorado Anschutz School of Dental Medicine (CU Anschutz SDM, Aurora, CO, USA) and many other U.S. dental schools following the four-year curriculum, periodontal instrumentation training starts during second-year preclinical classes. In previous years, the school's faculty members recorded instructional videos demonstrating periodontal instrumentation (including instrument sharpening) and made them readily available on the institutional online platform. Despite the useful content, these videos had several limitations, including: (1) a narrow scope of the demonstrated manual instruments; (2) no powered instruments; (3) no teeth coated with deposits mimicking dental calculus; (4) limited instrument sharpening content; and (5) limited audiovisual quality due to portable media devices used to record these files. Compared with conventional chairside demonstration, previously used (legacy) school-recorded videos, and non-curated online videos, the present approach was designed to provide standardized, repeatable, close-up visualization of adaptation, angulation, and stroke activation using simulated supra- and subgingival calculus.

To address these gaps, a new series of high-resolution (8K) instructional videos was recorded. This video series (sections 5–10 of the protocol) included demonstrations of various periodontal instrumentation techniques (including instrument sharpening) using standard periodontal armamentarium and a typodont with transparent gingiva and supra- and subgingival deposits on tooth surfaces mimicking dental calculus. This pilot study aimed to evaluate dental students' perceived usefulness of this updated educational material.

Protocol

For the present study (Figure 1), the Colorado Multiple Institutional Review Board (COMIRB) determined that the study was exempt (protocol #22-2099). Conduct all procedures in accordance with relevant local institutional review board or ethics committee guidelines and regulations and with the principles of the Declaration of Helsinki, as revised in 2013⁶. Sections 5–10 discuss the steps involved in making the demonstration videos.

1. Confirming ethics determination and study design

1. Confirm that the appropriate institutional review board or ethics committee has granted the required ethics determination before beginning the study.
2. For this study, define the survey component as two anonymous, descriptive cross-sectional surveys administered to the same eligible student cohort at different time points at CU Anschutz SDM. Because individual responses could not be linked across surveys, analyze the respondent samples descriptively as unpaired.

2. Developing and recording the instructional videos

1. Assemble the periodontal armamentarium, including manual scalers and curettes as well as powered periodontal instruments.
   NOTE: See the Table of Materials for the detailed description of instruments, devices, and software.
2. Mount the periodontal typodont in a dental manikin head to simulate clinical working conditions and spatial limitations encountered in dental practice.
3. Use a periodontal typodont with transparent gingiva and anatomically contoured plastic teeth coated with dark supra- and subgingival deposits that mimic dental calculus.
4. Use the transparent gingiva to demonstrate subgingival instrumentation techniques, including adaptation, angulation, and stroke activation.
5. Set up the imaging system using a high-resolution digital camera with a macro lens for close-up capture and an appropriate lens for wider views. The camera and lenses used in this study are listed in the Table of Materials.
6. Use an adjustable on-camera light-emitting diode panel to reduce glare and shadows when appropriate.
7. Record raw footage in 12-bit 8K Digital Cinema Initiatives (DCI) format.
8. Edit the footage in a professional non-linear editor using a high-quality mezzanine codec.
9. Photograph static objects directly when possible. When direct still photography is not feasible, export selected figure panels as high-resolution frame grabs from the recorded footage.
10. Process all still photographs in professional image-editing software to adjust color and exposure.
11. Structure each instructional video module around a distinct technique or instrument type.
12. Demonstrate the following elements in each applicable module: proper instrument selection and grasp, fulcrum placement and ergonomics, adaptation and angulation, activation of exploratory and working strokes, and sharpening procedures where applicable.
13. Review all videos with the team to confirm technical accuracy, educational clarity, and consistency with the intended instructional objectives.

3. Recruiting eligible participants and administering the survey

1. Invite eligible third-year Doctor of Dental Surgery (DS) students and first-year students in the Advanced Standing International Student Program (ISP) at CU Anschutz SDM to participate in the survey.
   NOTE: ISP students have already obtained a dental degree from their respective non-U.S.-based dental schools.
2. Include participants who meet all of the following criteria: enrollment as a DS3 or ISP1 student at the time of survey completion, provision of consent to participate, and completion of the study requirements.
3. Exclude participants who are not eligible at the time of survey completion, do not provide consent, or do not complete the study requirements.
4. Administer the questionnaire using ten closed-ended items, including demographic information with branching for DS and ISP respondents, and optional open-ended feedback addressing what participants liked, did not like, and would change in future videos, as applicable to each survey.
5. Use lay-language questions approved by all authors before dissemination.
6. Inform participants that the estimated survey completion time is 5–7 min.
7. Invite the same student cohort to evaluate both the legacy videos and the newly developed videos.
8. Collect responses anonymously.
   NOTE: Because responses are anonymous, do not link individual responses across the legacy-video and new-video surveys.

4. Extracting survey variables and analyzing responses

1. Export survey responses into a spreadsheet for analysis.
2. Extract demographic information, including training program type.
3. Extract quantitative responses concerning perceived usefulness and, as applicable to each survey, video quality sufficient to comprehend periodontal instrumentation concepts, interest in developing new videos, preferred changes to the videos, and intention to reuse the videos.
4. Extract open-ended feedback from the optional responses.
5. Define the primary outcome as perceived usefulness of the instructional videos on a 5-point scale: Extremely useful, Very useful, Moderately useful, Slightly useful, and Not at all useful.
6. Define secondary outcomes, as applicable to each survey, as video quality sufficient to comprehend periodontal instrumentation concepts, interest in developing new videos and preferred changes, intention to reuse the videos, and descriptive categories identified from open-ended feedback.
7. Summarize closed-ended survey responses using counts and percentages.
8. Calculate 95% confidence intervals (CIs) for single-proportion estimates using the Wilson score method.
9. Report categories with zero counts using the same Wilson score method.
10. Group open-ended comments inductively into descriptive categories.
11. Present representative quotations and summarize the themes as described in the Representative Results section.
12. Do not perform formal hypothesis testing when the objective is exploratory and descriptive rather than inferential.
13. Interpret CIs as estimates of sampling variability under binomial assumptions.
    NOTE: These intervals do not account for potential selection bias due to modest response rates.

5. Demonstrating exploratory strokes for calculus detection with an 11/12 periodontal explorer

1. Preparation:
   1. Wear personal protective equipment (PPE), including a mask, protective eyewear, and gloves. Position the patient/manikin for optimal visibility and mirror retraction.
   2. Assemble instruments: 11/12 periodontal explorer (flexible shank, paired ends) and dental mirror. Verify tip integrity and shank alignment.
      NOTE: Ensure adequate illumination and a clear mirror view of line angles and proximal surfaces.
      CAUTION: Handle sharp tips carefully to avoid soft-tissue trauma.
2. End selection and closed insertion:
   1. Select the working end by aligning the terminal shank parallel to the distal surface of the tooth; confirm the lower 1/3 of the tip will contact the surface upon insertion.
   2. Critical step: Perform closed insertion (0–10°) at the distal line angle and slide gently to the base of the sulcus while maintaining continuous tip contact. Maintain light pressure throughout insertion; ensure no tissue blanching or displacement.
      NOTE: A stable fulcrum and controlled grasp will improve tactile sensitivity during insertion and exploration.
3. Exploratory strokes:
   1. Use feather-light lateral pressure and short, overlapping strokes (2–3 mm) to assess deposits; keep the lower 1/3 of the tip adapted at all times (see  Figure 2A–F and Video 1, 14:04–20:00)
   2. Roll the instrument at line angles to maintain continuous adaptation when transitioning across surfaces (see handle roll at the line angle in Figure 2E and Video 1, 20:22–50:15).
      NOTE: A predefined, consistent sequence minimizes missed areas and supports complete coverage.
4. Direction and surface coverage:
   1. For posterior teeth (facial): Explore in the sequence from distal (distal line angle to distal surface) to straight (mid-facial path) to mesial (line angle to mesial surface) (see Figure 2A–C).
   2. For anterior teeth (lingual): Explore in the sequence from straight (mid-lingual path) to mesiolingual line angle (transition around the line angle) to mesial (line angle to mesial surface) (see Figure 2D–F).
   3. Confirm that the explorer does not displace tissue during assessment (no blanching; gentle contact).
5. Findings and tactile cues:
   1. Detect residual granular calculus by assessing for a gritty "catch‑skip."
   2. Identify ledge/ring calculus as a distinct elevation; allow the tip to slip under the ledge.
   3. Recognize burnished calculus as a smooth bump indicating incomplete prior removal.
   4. Record tactile findings immediately to guide instrument selection and subsequent debridement.
6. Mapping and documentation:
   1. Record for each tooth: surface (facial/lingual; distal/mesial), site (cervical, mid-root, proximal), deposit type (granular/ledge/burnished), and intensity (mild/moderate/heavy).
   2. Mark areas requiring debridement and plan the scaling sequence accordingly.
7. Quality control (QC) endpoints:
   1. Ensure no tissue displacement or trauma is observed during insertion and exploration.
   2. Ensure complete surface coverage following the specified sequences shown in Figure 2A–C for posterior facial surfaces and Figure 2D–F for anterior lingual surfaces
   3. Ensure consistent tip adaptation (lower 1/3) and stroke length 2–3 mm maintained throughout.
   4. Ensure stable fulcrum and controlled grasp; ensure that tactile cues remain distinct (no over-gripping or excess pressure).

6. Demonstrating periodontal instrument sharpening using a moving sharpening stone

1. Preparation:
   1. Wear PPE (mask, protective eyewear, gloves). Set up stable lighting (loupes with light-emitting diode [LED] or overhead) to create raking light across the cutting edge.
   2. Gather a flat sharpening stone (Arkansas/Ceramic/India). Use water or oil per stone type as a lubricant.
      NOTE: Maintain sharp, correctly contoured edges on curettes and sickles using a moving stone and visual edge test (see the setup and hand positioning in Figure 3A).
2. Safety:
   1. Stabilize both the stone and the instrument to avoid slips (see hands, grasp, and stabilization in Figure 3A).
   2. Maintain a secure grasp throughout the procedure.
      CAUTION: Avoid excessive pressure since wire edges and beveling may occur.
3. Technique (stationary instrument, moving stone):
   1. Clean and dry the instrument; remove debris/oil that can obscure edge reflections.
   2. Hold the instrument in the non-dominant hand (palm grasp); hold the stone in the dominant hand (see Figure 3A).
   3. Orient the toe toward or away, and ensure the face is parallel to the floor.
4. Curette sharpening (stationary instrument, moving stone):
   1. Critical step: Position the stone so that the stone-to-cutting edge angle is approximately 110°; this places the stone on the lateral surface at the cutting edge (see initial placement/angle in Figure 3C).
   2. Stroke: Use short, controlled downward strokes from heel to toe, maintaining continuous contact with the lateral surface (see stroke direction and contact shown in Figure 3C–G).
   3. Toe finishing: Lighten pressure reaching the toe to preserve its rounded contour (see Figure 3E).
   4. Critical step: Avoid creating a bevel; preserve blade width and toe shape (rounded for curettes) (see pre-sharpening profile in Figure 3B and post-sharpening profile in Figure 3H).
5. Sickle scaler sharpening:
   1. Follow the same moving stone technique and approximately 110° stone-to-cutting edge angle on the lateral surface.
   2. Do not round the tip; maintain a pointed toe without overthinning.
   3. Sharpen both cutting edges equally to preserve symmetry.
6. Visual edge evaluation (light test):
   1. Critical step: Under raking light, a sharp edge does not reflect light; any continuous reflective line along the cutting edge indicates dullness.
   2. Confirm the restored design: curette toe rounded; sickle tip pointed; no wire edges; blade width preserved.
7. Frequency:
   1. Use the light test frequently and touch up edges before and during instrumentation as needed.
   2. Replace instruments when metal loss alters the shank-to-cutting edge relationship or when the design cannot be restored.
8. QC endpoints:
   1. Maintain the correct angle (approximately 110° stone-to-cutting edge) using short, controlled strokes (see Figure 3C–G).
   2. Preserve design integrity: Ensure that the curette toe remains rounded, the sickle tip remains pointed, and the blade width remains unchanged (see Figure 3E). Ensure that no beveling or wire edges are visible under light and that a consistent scratch pattern is preserved along the lateral surface from heel to toe (see Figure 3H).

7. Demonstrating ultrasonic and piezoelectric instrumentation on posterior teeth

1. Materials and setup:
   1. Materials: Gather magnetostrictive inserts and piezoelectric tips for ultrasonic scaling (appropriate shapes for posterior access), typodont with simulated calculus deposits, high-volume evacuation (HVE), dental mirror, and PPE.
   2. Water/coolant: Connect the unit to the water supply; set adequate flow for cooling and lavage.
      CAUTION: Maintain active water/coolant flow during powered instrumentation to prevent heat and to support cavitation and lavage. Do not operate without coolant.
2. Safety and infection control:
   1. Wear PPE (gown, mask/respirator, eyewear/face shield, gloves).
   2. Use HVE to reduce aerosol; instruct the patient to perform a pre-procedural rinse; position the mirror and evacuation to capture spray.
      CAUTION: Continuous water coolant is mandatory to prevent thermal injury and maintain instrument longevity. Follow institutional aerosol‑mitigation guidance for powered scaling.
3. Insert/tip selection, power, and motion:
   1. Magnetostrictive insert: Select a posterior insert appropriate for access and the intended deposit type (see a general setup in Figure 4A–F).
   2. Piezoelectric tip: Select a posterior curette-style or universal tip; set power similarly by deposit type (see the general setup in Figure 4G–L).
      NOTE: Maintain constant movement, light lateral pressure, and short overlapping strokes; never "park" the tip.
4. Magnetostrictive scaling sequence:
   1. Critical step: Insertion (closed angle): With the shank aligned to the surface and angulation approximately 0°–15°, insert at the line angle and slide to the base of the sulcus (see Figure 4A, and Figure 4B for adaptation and insertion and Figure 4D and Figure 4E for the corresponding still images).
   2. Proximal (facial/lingual) access: Use short, sweeping strokes using all active surfaces of the insert tip (1–4 mm) along the cervical/root thirds;  keep light pressure and continuous movement (see Figure 4B and Figure 4C; mirrored in Figure 4F).
   3. Interproximal access: Roll the handle to maintain adaptation at line angles; use overlapping vertical/oblique strokes into proximal areas, maintaining low angulation (see Figure 4C and corresponding Figure 4F).
      NOTE: In the corresponding still images (Figure 4D–F), water/coolant is active (for heat control, cavitation, and lavage). In Figure 4, the top‑row photographs and the bottom‑row still images were selected to minimize visible spray to clearly show tip‑to‑surface adaptation and insertion paths.
      CAUTION: Do not operate clinically without coolant.
5. Piezoelectric scaling sequence:
   1. Critical step: Insertion (closed angle): With linear motion tips, align the lateral face to the surface, angulation approximately 0°–15°, and insert at the line angle to the base (see Figure 4G,H; same paths in Figure 4J,K).
   2. Interproximal access: Adjust the handle minimally, because piezoelectric motion is linear; maintain lateral surface contact through vertical/oblique passes in proximal areas with low angulation (see Figure 4I and corresponding Figure 4L).
   3. Proximal (facial/lingual) access: Use short, sweeping strokes using the lateral surfaces of the tip; maintain light pressure and continuous movement (see Figure 4H and Figure 4I and corresponding still images in  Figure 4K and Figure 4L).
      NOTE: In Figure 4J–L, water/coolant is active; Figure 4G–I shows a dry visualization for adaptation only.
   4. Pause point: Pause after completing one surface (e.g., facial) and resume with lingual/proximal without loss of continuity.
6. Finishing and verification:
   1. Rinse/evacuate; perform light exploratory assessment using the 11/12 periodontal explorer to confirm a rough-to-smooth transition.
   2. Repeat localized passes for residual deposits; keep low angulation and short paths; avoid stationary contact.
7. HVE positioning and power ranges:
   1. HVE positioning: Place the HVE tip 10–20 mm from the active insert/tip, slightly trailing the direction of movement. For posterior access, position the HVE on the opposite side of the arch to capture spray without obscuring the mirror view.
   2. Mirror/HVE coordination: Use the mirror for retraction and visualization; adjust the HVE angle to avoid blocking insertion paths at line angles and interproximal surfaces.
   3. Select the insert/tip and power setting according to deposit type, tooth anatomy, access requirements, and the manufacturer’s instructions.
      1. For biofilm or light calculus, use an insert/tip indicated for light deposits at the lowest effective power within its recommended range.
      2. For moderate calculus, use an insert/tip indicated for moderate deposits and adjust the power within the manufacturer-recommended range while maintaining light pressure and continuous movement.
      3. For tenacious calculus, use a robust insert/tip indicated for heavy deposits at the lowest effective power within its recommended range. After bulk removal, use a thinner site-specific insert/tip for restricted access only at its manufacturer-recommended power setting.
         CAUTION: Maintain active coolant flow at all times and avoid stationary contact. Do not exceed the manufacturer-specified power range for the selected unit, insert, or tip.
8. QC endpoints:
   1. Ensure the coolant is active during powered instrumentation; spray capture with the HVE.
   2. Maintain angulation at approximately 0°–15°; engage active tip length 1–4 mm; ensure light pressure and continuous movement.
   3. Preserve adaptation at line angles and proximal surfaces (effective handle roll with magnetostrictive; steady lateral surface contact with piezoelectric).
   4. Maintain stable spray capture; avoid heat generation.
   5. Ensure surfaces feel uniformly smooth on the light explorer assessment.

8. Demonstrating universal curette instrumentation on posterior teeth

1. Preparation:
   1. Materials/equipment: Gather universal curettes (e.g., Barnhart 5/6, Younger-Good 7/8), typodont/molars with simulated subgingival calculus, a dental mirror, and PPE (mask, protective eyewear, gloves).
   2. Positioning and visibility:
      1. When instrumenting maxillary dentition, ensure a supine position with the chin up.
      2. When instrumenting mandibular dentition, ensure a semi‑supine position with the chin down.
      3. Adjust the overhead light or use loupes‑mounted LED illumination, and use the dental mirror for retraction as needed.
         CAUTION: Maintain clear visibility and a stable fulcrum to prevent soft-tissue trauma.
2. Instrument grasp and fulcrum:
   1. Use a modified pen grasp with a ring finger intraoral fulcrum on a stable tooth close to the working area.
   2. Maintain a light, controlled grasp for adaptation and a firmer grasp during activation.
3. Selecting the correct end and cutting edge:
   1. Posterior adaptation test: Place the terminal shank parallel to the long axis of the tooth to verify the correct end (see Figure 5A).
   2. Working edges: Universal curettes have two cutting edges per end, and both are used (adapt the lower 1/3 of the cutting edge to the surface).
4. Insertion:
   1. Closed angle (0°–45°): insert at the distofacial line angle with the face nearly flat to the tooth.
   2. Slide to the base of the sulcus/pocket without tissue damage.
   3. Critical step: Maintain continuous blade contact during insertion.
5. Distal removal strokes with facial activation beginning at the distal line angle (Figure 5A):
   1. Angulation: Open to 45°–90° by tilting the terminal shank away from the tooth.
   2. Stroke type: Use short, controlled vertical, horizontal, and oblique pull strokes from the pocket base toward the cementoenamel junction (CEJ), with the toe directed apically and the lower 1/3 cutting edge engaged.
   3. Pressure and sequence: Apply moderate to firm lateral pressure to engage deposits; intersperse exploratory strokes to verify removal. After completing facial activation, roll the handle around the facial line angle and transition into the mesial surface while maintaining continuous lower-third adaptation (Figure 5C).
6. Lingual surface activation (Figures 5D–E):
   1. Maintain the lower 1/3 of the cutting edge adapted to the lingual surface beneath the transparent gingiva.
   2. Use short vertical, horizontal, and oblique strokes as needed; keep the terminal shank parallel and the toe 1/3 adapted to the tooth surface.
      NOTE: Reassess instrument position.
7. Mesial removal strokes from the lingual surface (Figure 5F):
   1. Adaptation: Maintain the lower 1/3 cutting edge adapted to the lingual surface beneath the transparent gingiva, roll the handle to maintain the lower 1/3 of the cutting edge transitioning around the line angle into the mesial.
   2. Stroke direction: Use vertical, horizontal, and oblique strokes with the toe directed into the interproximal area; maintain continuous adaptation around line angles.
   3. Stroke count: Repeat overlapping strokes until the surface feels uniformly smooth on a light exploratory assessment.
8. QC endpoints:
   1. Ensure the lower 1/3 cutting edge remains in contact; ensure no soft-tissue trauma is observed.
   2. Confirm deposit removal using the 11/12 periodontal explorer with a rough-to-smooth tactile transition (see Section 5).
   3. Ensure 0°–45° angulation at insertion and 45°–90° angulation during activation.
   4. Ensure continuous adaptation around line angles with an effective handle roll, as shown for facial surfaces in Figure 5A–C and lingual surfaces in Figure 5D–F

9. Demonstrating debridement of subgingival deposits on molars using 11/12 and 13/14 Gracey curettes

1. Materials and setup:
   1. Materials and setup: Gather Gracey curettes, including standard or extended-shank variants appropriate to pocket depth, a typodont with simulated subgingival calculus on molars, and a dental mirror. Wear appropriate PPE, including a mask, protective eyewear, and gloves.
   2. Lighting and visibility: Use overhead light or loupes mounted with LED; retract with the mirror to visualize line angles and proximal surfaces.
      CAUTION: Maintain a stable fulcrum and clear field to prevent soft-tissue trauma.
2. End selection:
   1. Posterior adaptation test: Align the terminal shank parallel to the target surface to confirm the lower cutting edge is in use. Use a Gracey 11/12 for mesial surfaces and for the limited transition around the adjacent facial line angle demonstrated in Figure 6A–C. This use is not intended to designate the 11/12 as the conventional primary curette for all posterior facial/lingual surfaces; a Gracey 7/8 or 9/10 is conventionally selected for those surfaces. Use a Gracey 13/14 for distal surfaces (see Figure 6D–F)⁷.
3. Insertion:
   1. Perform closed-angle insertion (0°–10°) at the distal line angle and slide to the base of the sulcus/pocket while maintaining contact.
      NOTE: Keep light pressure during insertion.
4. Activation (by surface):
   1. Mesial surfaces and adjacent line-angle transition (Gracey 11/12): Roll the handle around the line angle to maintain continuous adaptation while transitioning (see Figure 6A–C). Use short vertical, horizontal, and oblique pull strokes with the lower cutting edge engaged and the lower 1/3 of the cutting edge adapted to the surface.
   2. Distal surfaces (Gracey 13/14): Use short vertical/oblique pull strokes from base coronally; maintain firm lateral pressure as deposits release (see Figure 6D–F). Keep the terminal shank parallel and the lower 1/3 of the cutting edge adapted to the surface.
5. Finishing strokes:
   1. Reduce pressure and use longer, lighter strokes to smooth residual irregularities.
   2. Re-evaluate with the 11/12 periodontal explorer (see Section 5). Repeat localized strokes as needed until a uniformly smooth tactile feel is achieved.
6. QC endpoints:
   1. Ensure no "chatter" or gouging; ensure the root surface feels uniformly smooth on light explorer assessment.
   2. Confirm appropriate Gracey selection by surface: 11/12 for mesial surfaces, 7/8 or 9/10 for facial/lingual surfaces, and 13/14 for distal surfaces⁷. In this demonstration, the 11/12 is carried around the adjacent facial line angle to illustrate continuous adaptation (Figure 6A–C).
   3. Critical step: Ensure the toe 1/3 remains adapted to the tooth surface, and the terminal shank remains parallel to maintain the built-in angulation.
   4. Ensure continuous adaptation across transitions and effective rolling of the handle at line angles (see Figure 6A–F).

10. Demonstrating sickle scaler use on anterior teeth

1. Materials and setup:
   1. Materials and setup: Gather an anterior sickle scaler, a typodont with simulated supragingival calculus, and a dental mirror. Wear appropriate PPE, including a mask, protective eyewear, and gloves.
   2. Positioning (for a right-handed clinician): Position at 8 o'clock for surfaces toward the clinician and at 12 o'clock for surfaces away. Ask the patient/manikin to slightly turn the head left/right to optimize visibility and reduce required lateral pressure.
      CAUTION: The pointed tip is kept supragingival; no subgingival insertion with a sickle.
2. Grasp and fulcrum:
   1. Use a modified pen grasp; place an intraoral fulcrum on incisors or the opposing arch for stability (see Figure 7A for fulcrum placement).
      NOTE: A stable fulcrum allows controlled lateral pressure and precise stroke endpoints at contact.
3. Edge selection and angulation:
   1. Edge selection: Use the lower 1/3 of the cutting edge; keep the pointed tip supragingival.
   2. Critical step: Maintain 45°–90° angulation during deposit removal; do not insert subgingivally with the pointed tip.
4. Lingual surfaces:
   1. Midline start: Begin at the midline of the anterior tooth and move toward the proximal using short vertical/oblique pull strokes (see Figure 7A and Figure 7C).
   2. Line angle transition: Roll the handle at the line angle to maintain continuous adaptation into the proximal (see Figure 7B).
   3. Contact stroke: Use a controlled pull stroke from the contact toward the incisal edge to remove the deposit at the contact point (see Figure 7D).
      NOTE: Repeat the sequence for the opposite proximal on the same tooth, then proceed tooth-by-tooth across the arch.
5. Facial surfaces:
   1. Visibility: Use the mirror and/or brief air drying to visualize facial deposits.
   2. Strokes: Repeat the midline-to-line-angle-to-contact sequence on the facial, maintaining 45°–90° angulation and lower 1/3 cutting edge engagement.
6. Contraindications and precautions:
   1. Do not insert subgingivally with a sickle scaler; the pointed tip increases the risk of soft‑tissue trauma and root gouging.
   2. Use reduced lateral pressure on teeth with cervical abrasion, recession, hypoplasia, or exposed root surfaces to avoid enamel/dentin scratching.
   3. Avoid prolonged contact at the CEJ; use short, controlled pull strokes at contacts to limit iatrogenic damage.
      NOTE: Confirm edge sharpness frequently; dull edges increase required pressure and the risk of surface damage and fatigue.
7. QC endpoints:
   1. Do not insert a sickle scaler subgingivally; the pointed tip increases the risk of soft-tissue trauma and root gouging. Ensure the pointed tip remains supragingival at all times.
   2. Use reduced lateral pressure on teeth with cervical abrasion, recession, hypoplasia, or exposed root surfaces to minimize the risk of enamel or dentin damage.
   3. Ensure angulation is 45°–90° during activation and ensure the strokes are short and controlled. Ensure the contact deposits are removed: Confirm a clean contact and smooth facial/lingual surfaces by visual inspection and by light tactile assessment (see Section 5).

Results

Survey results

The following survey results reflect the perceived educational usefulness of the videos and do not measure the technical performance of periodontal instrumentation.

Legacy videos

A total of 16 students (7 DS3 and 9 ISP1) evaluated the legacy videos and completed the survey. Overall, 37.5% of participants (2 DS3 and 4 ISP1) found the videos "Extremely useful" (95% CI [18.5, 61.4%]); 50% of p...

Discussion

The present protocol provides a detailed, high-resolution framework for teaching periodontal instrumentation with explicit steps, QC endpoints, and troubleshooting. The instructional videos were designed to support self-directed learning and repeated viewing. Each video module focused on a distinct technique or instrument type, could be viewed repeatedly, and was structured to demonstrate (1) Proper instrument selection and grasp, (2) Fulcrum placement and ergonomics, (3) Adaptation and angulation techniques, (4) Activat...

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
11/12 Periodontal Explorer	Hu-Friedy	6008097	Double-ended periodontal explorer (paired ends)
11/12 Rigid Gracey Curette	Hu-Friedy	SG11/12R9E2	Area-specific curette; rigid shank; lower cutting edge used; mesial surfaces of posterior teeth; for moderate to heavy calculus
13/14 Rigid Gracey Curette	Hu-Friedy	SG13/14R9E2	Area-specific curette; rigid shank; lower cutting edge used; distal surfaces of posterior teeth; for moderate to heavy calculus
3/4 Rigid Gracey Curette	Hu-Friedy	SG3/4R4XE2	Area-specific curette; rigid shank; lower cutting edge used; anterior teeth; for moderate to heavy calculus
5/6 Barnhart Curette	Hu-Friedy	2010619	Double-ended universal curette; two cutting edges per end; anterior and posterior use
7/8 Younger-Good Curette	Hu-Friedy	6000687	Double-ended universal curette; two cutting edges per end; anterior and posterior use
Cotton Pliers (DP2)	Hu-Friedy	6002432	College pliers, non-locking, smooth beaks, stainless steel
Dental Manikin Head	N/A	N/A	Mount for typodont; patient-position simulation
H6/H7 Anterior Sickle Scaler (#7 handle)	Hu-Friedy	6000047	Double-ended sickle scaler; two cutting edges; supragingival removal on anterior teeth
Image-editing software	Adobe	Photoshop (with Camera Raw)	RAW processing and still image adjustments
Macro lens (100 mm)	Canon	RF 100mm F2.8 L MACRO IS USM	Close-up capture of instrument–tooth interaction
Mask (Level 3)	Ecoguard	N/A	ASTM Level-3 surgical mask with ear loops
Mezzanine editing codec	Apple	ProRes 4444 XQ	Intermediate high-quality editing codec
Mirror Handle (Cone Socket #7)	Hu-Friedy	6001980	Cone-socket mirror handle (#7), stainless steel
Mirror Head (Size 5, front surface)	Hu-Friedy	5866658	Mouth mirror head, size 5, front-surface, cone-socket, stainless steel
Mirrorless Digital Camera	Canon	EOS R5	Body used for still and 8K video capture
ModuPRO Perio Typodont	Acadental	N/A	Transparent gingiva; simulated supra-/subgingival deposits (ModuPRO Perio)
Nabers Probe	Hu-Friedy	PQ2N7C	Double-ended furcation probe; markings at 3, 6, 9, 12 mm; #7 handle
Nitrile Exam Gloves	Halyard	N/A	Powder-free nitrile; 'lavender' line; exam gloves
Non-linear video editor	Blackmagic Design	DaVinci Resolve Studio v.20.3.1	Editing; picture-in-picture; stabilization; color
On-camera RGB LED Panel	Luxli	10″ (Cello series)	Adjustable illumination; glare reduction
Prime lens (50 mm)	Canon	RF 50mm F1.2 L USM	Wider-angle views for ergonomics/hand position
SCNevi 4/9 Posterior Sickle	Hu-Friedy	N/A	Double-ended sickle scaler; two cutting edges; supragingival removal on posterior teeth
Ultrasonic scaler	N/A	N/A	Tip selection, adaptation, stroke activation (supra/subgingival)
UNC-15 Periodontal Probe	Hu-Friedy	6005726	Single-ended CP-15 UNC probe; color-coded 1–15 mm; #7 metal handle
Web-based survey platform	Qualtrics	N/A	Secure, anonymous survey distribution/collection
Yellow Isolation Gown	Medline	N/A