Expanding Nonsurgical Periodontal Therapies, Langer Currettes

Here we’ll aim to provide dental hygienists with instrument solutions for one of the more challenging aspects of hygiene– nonsurgical periodontal therapies.

We know that periodontal diseases affect nearly half of all adults over thirty years of age¹ and is the most common non-contagious disease affecting mankind, according to the 2001 Guinness Book of World Records! What’s more, its treatment is complicated by the lack of visibility by treating clinicians (since the bulk of scaling is done in deep subgingival pockets). For these reasons, many general practices or individual clinicians still hesitate to treat stage III Periodontitis, which makes up a significant portion of most patient demographics and loses potential revenues. Many practices refer even localized Stage III cases to Periodontists’ care. While there are certainly select patients who may do best with this treatment path, let’s examine some ways general practices can expand their treatment approaches and instrumentation skills and possibly begin offering more comprehensive periodontal therapies in-house. Ultimately, this will contribute to less loss of revenue from referrals, higher patient confidence, better treatment outcomes, and possibly increased new patient referrals.

Let’s focus on the broadest challenge clinicians face during Scaling and Root Planing (SRP) Stage III Patients — efficient adaptation with thorough calculus removal.

While most hygienists learn to scale with Gracey curettes, their adaptation can be a bit tricky. Additionally, the time constraints placed on many SRP appointments and the loss of clinical time while administering local anesthesia can create a rush to scale. Even worse, many practices are shortening the allotted times for SRP, in efforts to increase production or offset low insurance reimbursements. These can create ethical and quality concerns for the care of periodontally involved patients. It can be difficult for clinicians using area-specific scalers to check every Gracey as they pick it up, carefully peer at the face, and accurately identify the single cutting edge with confidence. This is especially true for clinicians who have become accustomed to picking up universal curettes and scalers for routine cleanings, as they are out of practice with area-specific instruments.

Enter solution 1: Langer curettes.

Created in 1985 by Periodontist Dr. Burton Langer, these curettes feature the same shank bends as some of the well-known Gracey curettes, but they are specially equipped for use in our fast-paced practices. There are several benefits to using this unique line of curettes; we’ve outlined them below. We recommend Langers for standard SRPs for time and cost savings to the practice. This will allow clinicians more time to simply detect and remove subgingival deposits. Typically, hygienists are skilled and educated in proper adaptation and likely do not need area-specific curettes for treating Stage 1 or even 2 Periodontitis.

Advantages over Gracey curettes:

  1. Universal working ends– Though they are modeled after Gracey curettes, each Langer boasts two cutting edges on each working end, allowing for the use of both sides of the toe in subgingival scaling! This reduces wasted appointment time switching instruments for specific clinical aspects, then ensuring the proper cutting edge is used to avoid tissue trauma. It also serves as a game-changer in SRP therapy for many clinicians, particularly those who are familiar with Gracey curettes already, but have become accustomed to universal instruments in daily practice.
  1. Better coverage- One advantage is that the toes of Langer curettes are a bit more open compared to the more closed (curved) toes of Graceys. This provides broader root adaptation and coverage, and better furcation extension and access. This provides useful reassurance for clinicians and reduced doubt of deposits left behind between our strokes. This is particularly important in more advanced cases such as Stage III Periodontitis and may help our patients avoid surgical interventions later on.
  1. Smaller setups– This series reduces the number of curettes needed for full-mouth scaling, reducing armamentarium expenses, and simplifying setups. Full -mouth coverage can require up to nine Gracey curettes, but only three or four Langer curettes. We suggest keeping these four instruments bagged separately and simply adding them to prophy setups when needed, reducing the number of mirrors, explorers, and air/water syringes used by each clinician daily. This is so important in practices where hygiene budgets are strictly capped or closely monitored, and where replacement instruments are not provided at the proper intervals.
  1. Guess-free maintenance– Lastly, these instruments are easier to maintain than Graceys, as they are sharpened the same as any other universal instrument, and there is no risk of needlessly sharpening a non-active cutting edge and reducing the toe thickness unnecessarily.

Introduction to each scaler:

Now, we will highlight key features of each Langer curette and those they share with Graceys. We would recommend the full set of Langer curettes, as each one allows ergonomic access with proper fulcrums to specific zones in the mouth. Use our comparison photos to get to know each one below:

Langer 1/2– This universal curette is modeled with similar shank design and lengths as the Gracey 11/12. It is recommended for mandibular posteriors, but its universal cutting edges allow it to be used anywhere with appropriate angulation and fulcrum. Clinicians may find it is best for straighter, upright fulcrums and around premolars, first molars, and second molars, as it does not have many complex shank bends and may not provide the best terminal posterior access.

 

Langer 3/4– This curette is made with similar shank design and lengths to the Gracey 13/14 curette. It is recommended for maxillary posteriors. However, it has multiple contra-angled shank bends, so it can also be useful and extended into any posterior areas which may require instrument extension or advanced fulcruming. In fact, some clinicians keep this particular curette in each prophy pack as well, for a well-rounded universal curette for posterior access at terminal molars.

Langer 5/6– This curette is designed with a similar shank to the Gracey 5/6 and is recommended for the anteriors and premolars. This one curette effectively replaces the Gracey 1/2, Gracey 3/4, and the Gracey 5/6.

Langer 17/18– A later addition to the original series, this curette is made shank bends similar to the Gracey 17/18. It is recommended for posteriors (both maxillary and mandibular). Clinicians may find it is helpful around the most difficult-to-access distal line angles at terminal molars, and even into furcations, as it has the most complex shank design and the most potential reach into difficult spaces (though it may require more advanced cross-arch or opposite arch fulcruming). We recommend it even for severe recession on the upper linguals which extends around to the distals, as these can be some of the trickiest areas to instrument.

Above we see a lineup of the Langers curettes beside their corresponding Gracey designs. Surely, implementing this unique and often-overlooked set of curettes will feel like a natural transition, as most clinicians are fully familiar with these shank designs. Give them a try, enjoy simpler setups, easier sharpening, and lower costs for full-mouth coverage!

Sources Cited

  1. Eke PI, Dye B, Wei L, Thornton-Evans G, Genco R. Prevalence of Periodontitis in Adults in the United States: 2009 and 2010. J Dent Res. Published online 30 August 2012:1–7.