perio instru.ppt

8/13/2019 Perio Instru.ppt

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Periodontal Instrumentation

Grasp, Fulcrum, Wrist Motion,

Using the Periodontal Probe


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Handle, Shank, Working End

Shank

Shank

Shank

HANDLE

HANDLE

HANDLE

Shank

Head


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Use of the Dental Mirror

Indirect vision

Illumination

Reflection of light

Transillumination

Reflection of light through the tooth surface

Especially for calculus

Retraction


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Modified Pen Grasp

Most efficient grasp

ControlStability

Pivot Point


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Modified Pen Grasp

Left hand

grasp

Right hand

grasp

Thumb & Index finger

opposite at junction of handle

& shank

Handle is between junction of

the first and second joint of the

index finger

Pad of middle finger against

the shank (side of pad)

Fingers are a unit


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Establishing a Finger Fulcrum

Stability

Activate instrument - stroke

pivot

Control - prevents injury

Always on a stable oral structure

Occlusal plane, mandible, zygoma

Ring finger


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Intraoral Fulcrum

Intraoral

As close to working

areas as possible Approximately two

teeth away

Do not fulcrum on the

same tooth Mandibular arch

Maxillary anterior

teeth


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Extra-Oral Fulcrum

Extraoral

Maxillary arch

Posterior teeth


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Wrist Motion

Side to side

Up and down

Activated by pivoting fulcrum finger

Wrist must be straight to activate stroke -

movement of instrument

Will be demonstrated on the presenter


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Instrument Identification

Name, design number, manufacturer

Determined by use

Probes

Explorers

Curets

SicklesHoes

Files

Chisels


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Probe

Primary instrument in the periodontal exam

Assess gingival health

Periodontal status

Exploratory

Requires skill development


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Probe Design

Vary in cross-sectional design

Rectangular in shape (flat)

Oval

Round

Millimeter markings

Calibrated at varying intervals


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Marquis Probe

Color coded

3, 6, 9, 12 mm

markings

Thin working end

Key is to know

the increments

Type of probe

being used


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Use of the Probe

Inserted to the

Junctional epithelium

Measures sulcus Periodontal pockets

Gingival recession

Attachment loss


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Angulation

Probe is parallel to

long axis of tooth


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Interproximal Angulation

Slightly tilted

Apical to the

contact point

Not enough

angulation

Correct

angulation

Too much

angulation


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Adaptation

Working end is

well-adapted totooth surface


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Technique

Gently walk the

probe


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Readings

Six readings

Distal (DB & DL)

Buccal (B) or Lingual (L) Mesial (MB & ML)

Deepest reading within

the designated areas


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GRACEY SERIES Anterior Teeth

5/6 all surfaces of anteriors/premolars

Posterior Teeth7/8 Buccal & Lingual Surfaces

11/12 Mesial Surfaces

13/14 Distal Surfaces15/16 Mesial Surfaces

17/18 Distal Surfaces

Gracey Curets


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Design Characteristics

Standard or Finishing (non-rigids)

Rigid

Extra Rigid

Extended Shanks

Different Blade sizes

Regular

Mini


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Area specific

Adapt to a specific area or tooth surface

Two curved edges with a blade

Only one cutting edge is used for calculus removal

Lateralsurface

Face

Back

Cutting

edge

Lateralsurface

Cutting

edge


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Working end is tilted

in relationship to the

terminal shank (offset

by 70) Makes one cutting

edge lower than the

other

This lower end is theone that is used for

instrumentation


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Identification of the Cutting Edge

Place shank

perpendicular to

floor

Lower blade is

the cutting edge

Lower shank

will be parallelto surface being

scaled


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Advantages of Design

Characteristics Allows insertion into deep pockets

Prevents tissue trauma

Correct cutting edge to tooth surface

angulation

Easier adaptation

Around convex tooth crowns to access root

surfaces


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Adapting the Curet Blade


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Adaptation of lower third of

blade to tooth surface

Correct

Lower 1/3Incorrect

Middle 1/3

Incorrect

Toe 1/3


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Relationship of Lower Shank

to Blade Angulation

Lower shank

parallel

Lower shank

Too far

Toe is coronal

Lower shank

Too far forward


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Calculus Removal

Channeling


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Review of Fundamentals

of Instrumentation


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oblique vertical horizontal circumferential

Working Stroke


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Basic Design Characteristics of the

Working end of Instruments

Lateral

surface

Cross section

Lateral

surface

Face

Back

Cutting

edge

Lateral

surface

Cutting

edge


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Curet Toe vs Sickle Tip

HEEL

TIP

TOE

Comparison of Curets & Sickle


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Comparison of Curets & Sickle

Blades


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Sickle Scaler

USES :

Supragingival calculus

Stain

Slightly subgingival (1-2mm)


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Different Designs

Anterior teeth

Posterior teeth

Modified shank

Blade can vary in size & design


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Straight rigid

shank

Two cuttingedges

Straight or

slightly curved

Back of theinstrument

Pointed or

rounded


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Adaptation

INCORRECT CORRECT


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ANGULATION


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Technique

Divide tooth structure in 3rds

Distal line angle towards

interproximal

Mesial line angle towards

interproximal

Labial or Lingual Surface

Graceys or Universals

Mesial & Distal

Vertical stroke


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Visual Guide to Instrumentation

Anterior Teeth

Handle extends

upward/parallel to long

axis of teeth when

interproximal

Does not apply to Facial or

Lingual surfaces

Oblique stroke is best

Alternative instruments are

better than sickle

Prevent tissue trauma


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Visual Guide to Instrumentation

Lower shank is parallel to

surface being scaled

Vertical stroke

CLINIC


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CLINIC

DEMONSTRATION

H6/7

Sickle Scaler

Shank slightlycurved

Review on clinic

floor

15

H6/7

33


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TYPES OF UNIVERSAL

CURETTES Columbia

Barnhart

Bunting

Goldman

Younger-Good

Langer (gracey shank)


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Design Features

Can adapt to all tooth surfaces

90 degree blade angulation

shank curvature allows adaptation

both cutting edges are used

blade curved on only one plane


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Blade Adaptation


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Use of the Universal Curet :

Anterior teeth Both instrument ends will be used

Handle is parallel to long axis of tooth Adapt blade to mesial or distal

Initiate by starting at the tooth midline

Work towards the interproximal Refer to diagram on pages 183-184 in

Pattison


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Type of Stroke Used

Oblique on buccal & lingual

Vertical on Mesial & Distal


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Use of the Universal Curet :

Posterior Region

Select the working end that adapts to the

interproximal surface Lower Shank is parallel to mesial surface

Select blade that is in contact with the

mesial surface

Use from the distal line angle towards

mesial surface


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Vertical Interproximal Stroke

Vertical Stroke on Mesial and Distal Surfaces


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Posterior Scaling

with

Gracey Instruments


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Gracey Curets

Area specific

Shank design

Blade design

Each working end is a mirror image

Blade identification

Allows for correct working end

Adaptation to surface being scaled


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Lower third is

used for

calculus

removal


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7/8 Gracey Curet

Buccal & Lingual Surfaces

Posterior teeth

Initiate stroke from the distal line angle

Finish stroke at the mesial line angle

Stroke used

Oblique or horizontal Lower shank is not parallel

stroke is towards midline


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11/12 and 15/16

Gracey Curets Used on mesial surfaces of all posterior

Initiate stroke at mesial line angle and

continue towards the mesial-interproximalsurface

Each end is a mirror image


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Exploratory vs Working Stroke

Blade is less than 45

Grasp is lighter

Tactile sensitivity is

enhanced

On the down stroke

Objective is to identify

depth of calculus

Blade is 45-90

Calculus removal

Firm grasp

Engage blade by

Adaptation or bite

On the up stroke

Vertical

Oblique


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Adaptation

Degree of how open or closed the blade

is upon insertion is dependent on:

Type of tissue Fibrotic vs boggy or hemorrhagic tissue

Severity of disease

Retractable tissue

Interproximal embrasure

Tenacity of calculus


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How well have we scaled?

At time of S/RP appointment

Exploring, probing

Smoothness of tooth surface

After appointment

Healthy periodontium

Decreased bleeding, pocket depths, marginalbleeding


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Limitations

obscured vision from bleeding

tactile sensitivity

instruments selected

direction & length of strokes

confines of soft tissue - tissue type

tooth anatomy

clinical findings

mental image based on visual, mental, andmanual skills


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Limitations

Accurate treatment plan

Anesthesia, number of appointments

Severity of Disease progression

Local factors

Systemic factors

Pockets, furcas, anatomical characteristics,

erosion, recession, mobility


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Most common areas missed :

most apical portion of pocket

furcation areas & distal surfaces

primary reason: not overlapping strokes


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Effects of scaling & root planing

reduction in inflammation

pocket depth reduction-- avg.. 1.36 mm0.8 mm in recession

0.52 in attachment attachment - maintained or slight gain

decreased mobility - fibers

reduction in gram-negative :spirochetes, bacteroides

conflicting results withA. Actinocytemcomitans


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Sequence to Periodontal

Instrumentation Phase I Simple = 1 appointment

Simple case, light calculus, little sensitivity, controlledperiodontal condition, mild inflammation

Phase I Intermediate2 appointments Overdue, early Periodontitis 4-5 mm pockets,

Patient may require mouth anesthesia (Lower &upper quads avoid same arch)

Phase I Complex 4 appointment by quads with anesth, pockets, calculus,

furcations

Re-evaluation appointment


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Sequence to Periodontal

Instrumentation Full mouth

Start in tooth sequence for plaque removal

Assess where calculus is presentAreas of inflammation

Two appointment

Anesthesia, upper & lower quad

Complex

Each quadrant with anesthesia

perio instru.ppt

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