10. Periodontal Instrumentation Flashcards
• Do remove some levels of ____, in addition to supra- and subgingival plaque
cementum
UPPER ARCH
Chair Back ____ to the floor, patient’s chin ____
LOWER ARCH
Chair back ____ angle to floor, patient’s chin ____
parallel
up
45deg
down
Right-Handed Clinician vs. Left-Handed Clinician
Take a look
• When positioning for lower and upper anterior sextant > imaginary line down the teeth; the surfaces toward you (yellow), you position yourself at ____ o’clock; surfaces away, you position yourself from ____ o’clock
9
12
Modified Pen Grasp
* IMPORTANT * Thumb/forefinger, ring finger is \_\_\_\_, and \_\_\_\_ stays together * Working stroke > \_\_\_\_ finger flattens out > generates force to remove calculus, \_\_\_\_ is also pushing * Pad of third finger is on instrument shank > incorrect, want the \_\_\_\_ of the third finger, not the pad; if you work like this, you lose control and hinder maneuverability, and makes it difficult to execute a stroke
fulcrum
pinky
index
side
FULCRUMS
* Fulcrum as \_\_\_\_ to the tooth you're working on as possible * Max > \_\_\_\_ fulcrum, three fingers on chin * Fulcrum = \_\_\_\_ point
closed
extra-oral
pivot
Take a look at the hierarchy!
YAY
Instrument Parts
! Terminal shank
! Working end
! The terminal shank is most important when adapting the ____
• IMPORTANT: terminal shank location; in between \_\_\_\_ and the first \_\_\_\_ begins
working end
working end
curve
Periodontal Instrumentation
Gracey Curets
"Gracey 1/2, 7/8 (\_\_\_\_ teeth) " Gracey 7/8, (\_\_\_\_ teeth) "Gracey 11 /12 , 13/14, 15/16, (\_\_\_\_ teeth) ---" 11/12 and 15/16 used on direct \_\_\_\_ surfaces and \_\_\_\_ only ---" 13/14 used on \_\_\_\_ surfaces only
* \_\_\_\_ - more versatile gracey > use on anteronr and posterior * Know the instruments * They are all \_\_\_\_-specific, only for certain areas in mouth
anterior posterior posterior buccal/lingual mesials distal
7/8
site
Working-end Design
* The one end is \_\_\_\_ > important for Gracey's > the cutting edge > apply to root surface * Offset angle to the terminal shank
lower
GRACEY
Hold terminal shank ____ to the floor and find the ____ as cutting edge to adapt to tooth surface
perpendicular
lower edge
Activating the Gracey
! Close face of blade while inserting ____
! Open angle of face at ____ degrees to tooth surface
! Maintain terminal shank ____ to
the surface you are instrumenting
* IMPORTANT * Line terminal shank with the surface that you're instrumenting > not the \_\_\_\_ of the tooth
subgingivally
70
parallel
long axis
Angulation for Calculus Removal
* Enter sulcus > rounded back of gracey, and along the tissue and not traumatizing; establish terminal shank with the gracey * Inefficiently removing calculus (\_\_\_\_); but with 45 - less > it slips right over the calculus > \_\_\_\_ the calculus * Right > when burnish calculus when angle is too small > difficult to \_\_\_\_, and more difficult to \_\_\_\_
90
polishes
detect
remove
• Always instrumenting only a small ____mm band
1-2
ADAPTATION
• Always want to adapt; thumb and fore fingers, and roll, bc you constantly want to \_\_\_\_ the working end to the tooth surface
adapt
Horizontal Stroke
* Any instrument for a horizontal stroke * Horizontal > directing the toe \_\_\_\_, and coming across the direct \_\_\_\_ or direct \_\_\_\_ of molars, and direct \_\_\_\_ of second molars
apically
buccal
lingual
distals
• Point toe in direction you’re going to be ____; here going to scale distal surface of 9
scaling
GRACEY 11/12 and 15/16
* Both for \_\_\_\_ surfaces of molars * 15/16 - has a bigger curve in the shank than the 11/12, allows you to get to your \_\_\_\_ and access \_\_\_\_ to reach areas
mesials
molars
difficult
GRACEY 11/12 AND 15/16
Activation:
! Insert toe subgingivally at ____ line angle
! Strokes are activated across ____ and completion on ____ surface (proximal)
* Or \_\_\_\_ line angle * Same applies to the lingual
distal-buccal
buccal
mesial
distal-lingual
GRACEY 13/14
• Distals of \_\_\_\_ teeth
posterior
SCALERS
* Unlike gracey's, have two \_\_\_\_ edges > terminal shank > the face is \_\_\_\_ (at a right angle), one side is not lower than the other > two cutting edges * \_\_\_\_, \_\_\_\_-gingival only, \_\_\_\_ tip;
____ toe > indicated for ____ use)
cutting right anterior supra-gingival pointy
rounded
sub-gingival
• Universal curet can be used everywhere in the mouht, unlike the ____
gracey’s
WORKING STROKE
! Apply cutting edge (____ of working end) so that face of blade is angled at ____ degrees to tooth surface
! Begin at ____ of buccal/or lingual surface and move into the ____ surface
! Supragingival scaling stroke activated from gingival margin in a ____ direction
• If at \_\_\_\_ degree > the other side will traumatize
1/3 75-80 midline proximal coronal 90
UNIVERSAL CURETS Columbia \_\_\_\_ and \_\_\_\_ ! A universal curet may be used in any \_\_\_\_ of the mouth ! \_\_\_\_ cutting edges on each opposite working end ! Terminal shank is used to \_\_\_\_ the placement on proximal surface and direction of \_\_\_\_ ! \_\_\_\_ toe = curet (safe subgingivally) ! May be used to remove supra and subgingival deposits effectively
• Columbia have \_\_\_\_ shanks > a lot of calculus, go first with the Columbia, and then follow up with the Gracey's
13/14 4R/4L area 2 guide activation rounded heavier
- Angle is tilted > want ____ back against the tissue and not as a ____ degree angle (75-80 degrees)
- Vertical stroke up the distal, at the DB line angle, take it out and use the left side, and do it until you do your stroke up the mesial
rounded
90
ODU 11/12 - ____
Nabers - ____ Detection
* Difference in design * Feather-like grasp for the \_\_\_\_ * Use the same way as you use \_\_\_\_ * Toe end of right side, vertical stroke, at line angle > take out, and put left side on root surface > sweep with overlapping srokes over the direct buccal until complete stroke until come up mesial all while keeping terminal shank parallel
calculus detection
furcation
ODU 11/12
universal curets
Polishing
• \_\_\_\_ prophy paste > not damaging anything; light touch, control speed
fine
AIR DRIVEN HANDPIECE:
Reduce RPM’s to ____ with Reductor
* IMPORTANT * Using slow handpiece > RPM at \_\_\_\_ * Using air turbine > use a \_\_\_\_ > get it separately from the window, and ask for it!
5000
5000
reductor
Implant Maintenance
* Do not adapt well bc they're too \_\_\_\_ * metal probe does not scratch implant, but start using a plastic in order to protect implant • Get \_\_\_\_, pass through mesial to distal and crisscross > pull the floss so you're hugging the implant > \_\_\_\_ the abutment * IMPORTANT * Metal against metal scratches are important! * Damages with \_\_\_\_, want to keep the implant smooth
bulky
metal
floss
debriding
ultrasonic
Power scalers
• Sonic > \_\_\_\_, not used much anymore
Ultrasonic >
• ____ > cavetron, not used much anymore
- ____
air-driven
magnetostrictive
piezoelectric
Mechanisms of Action
- ____
- Irrigation
- ____
- Mechanical > high energy ____ break up the calculus, etc > important: don’t need to push hard, let it work
- Irrigiation > heats up, a lot of bleeding, ____ field
mechanical
acoustic micro streaming
vibrations
clears
Acoustic Micro Streaming
Forceful flow of ____ fluid
Enhances effectiveness beyond ____ actually touched by tip
* Power washing the tooth surface * Flow of water > water extends beyond the \_\_\_\_ where the tip if touching the tooth (\_\_\_\_-fold increase in \_\_\_\_ environment
cavitating surface point 6 subgingival
Ultrasonic Variables
____
____ Level
____ Level
frequency
power
fluid
Ultrasonic Variables Tuning = Frequency
Definition: Number of cycles per second Cycle: One complete \_\_\_\_ or \_\_\_\_ stroke path Measured in \_\_\_\_: i.e., 30kHz = \_\_\_\_ cycles/second
linear
elliptical
kilohertz
30,000
Power Stroke = Amplitude
! Shorter stroke: less ____ stroke, ____ deposits
! Longer stroke: more ____ stroke , ____ to ____ calculus removal
* Shorter stroke > 22yo, not a lot of \_\_\_\_, and to irrigate and debride, use on low power * Longer stroke > high power, use on \_\_\_\_ patietns to break up calculus deposits
powerful
light
powerful
moderate
heavy
calculus
SRP
Water Flow
Tip tuned for Calculus Removal : Med -High Power Setting
Tip tuned for Deplaquing : Low - Med Power Setting
SKIPPED
Read over just in case
Magnetostrictive
Cavitron
• Insert > stacked \_\_\_\_ > vibrations go through insert and converts electrical energy into \_\_\_\_ energy > causes the vibrations (like a \_\_\_\_, stretches out and goes back in)
metal strips
mechanical
rubber-band
- Energy is dispersed in different ways
- ____ of tip > most powerful, do not want to apply point of tip on tooth surface > will damage
- Magneto > ____ and ____ surfaces are active parts
point
back
lateral
Piezo Electric
• Magneto - \_\_\_\_ • Piezo - \_\_\_\_, only the \_\_\_\_ surfaces are active, do not use the back of the piezo; used just like a universal curette • Magneto has metal inserts, the piezo has \_\_\_\_ that generate vibs ○ Don't get as \_\_\_\_ - get away with using less water, and not as \_\_\_\_
elliptical linear lateral ceramic discs hot heavy
• Green = ____, cannot use green in blue zone, will break in high power
low power
- Two different blue tips > one is blunter (better for ____ calculus deposits) and the other is like a perio probe > nice in ____ pocket bc you can gauage the ____ by looking at ____
- Can use blue in the ____ zone (can use high in the lower, cannot use low in high)
heavy deeper depth markings green
- When putting tip with wrench and tightening, turn until you hear ____ click and it’s locked
- Next, purge the line (in morning for ____ mins, in bt patients you do for ____ s)
- Want a ____ spray
- Yellow = ____; orange = ____
one
2
30
fine
endo
surgery
• ____ green; ____ blue
1-5
10-15
Piezo
* \_\_\_\_ grasp * Fulcrum, \_\_\_\_ wrist > not as critical with ultrasonics as hands * \_\_\_\_ fulcrums
feather-like
neutral
extraoral
Modified Ultrasonic Adaptation
• Position insert like a ____
• “____”
• Most > adapt insert like you would use a probe
probe
vertical adaptation
Traditional Ultrasonic Adaptation
• Position insert like a ____
• “____”
• Good for \_\_\_\_ surfaces using the lateral surface
sickle
oblique
proximal
• Terminal ____ > most important part of working part on ultrasonic (on both magneto and piezo)
○ Piezo > ____ or ____ terminal third; magneto > can use the ____ terminal third!
• When using piezo > high ____ > not adapted correctly (not a lateral surface, but the vibrations are too high/powerful)
third
L
R
back
pitch
Curet Insertion
Cutting edge must be below ____
• Start at \_\_\_\_ and stroke is \_\_\_\_, start apically and go \_\_\_\_
deposit
base
coronally
coronally
Ultrasonic Insertion
As the tip is inserted ____, deposits are removed as they are encountered
• Ultrasoinc, start \_\_\_\_ and end up \_\_\_\_
apically
coronally
apically
STROKE PATTERNS !\_\_\_\_ or \_\_\_\_ motion !Overlapping ◦\_\_\_\_ ◦Vertical ◦\_\_\_\_ ◦Tapping
* Keep motion sweeping and coloring * Horizontal - regard to \_\_\_\_ of tooth * Tapping > one instance where you can use point when \_\_\_\_ chunks of calculus are present
sweeping
coloring
horizontal
oblique
long axis
huge
MEDICAL CONSIDERATIONS: ! Implanted electronic devices... ! Severe respiratory diseases (COPD,CF) ! Transmissible diseases (HIV,hepatitis) ! Difficulty swallowing (MS, muscular dystrophy, geriatrics)
DENTAL CONSIDERATIONS: Newly erupted teeth/ large pulp chambers Exposed dentin Demineralized enamel Crown and bridge and implants
* IED > no piezo's with pacemakers/defib's > now they make them \_\_\_\_; require \_\_\_\_ clearance * COPD, CF > patient breathing in microbes; CDC > high \_\_\_\_, suction and \_\_\_\_ rinse (30s, listerine, CHX, etc.) * HIV, hep > same as \_\_\_\_ * Geriatrics > all the water (piezo's use less H2O) > they feel like they're gonna \_\_\_\_ * Demineralized enamel > history of ortho and decalc on enamel > can look like calculus > be careful on these areas even when polishing * Crown/bridge/veneer > careful with ultrasonics > be sure that you're placing tip on tooth and not \_\_\_\_
shielded
medical
evacuation
pre-procedural
COPD
choke
margins
Instrument Sharpening
* \_\_\_\_ back > subging safe * \_\_\_\_ > two cutting edges > ends in point
rounded
sickle
- Red lines, cutting edges
* ____ and ____ > sharpen both sides
universal
scaler
Rotating Stone Technique
• Hold stone in right hand, and hold instrument in \_\_\_\_ hand
non-dominant
Principle for positioning the instrument
Position the working end of a universal, site specific curet or sickle scaler with the face ____ to the floor
parallel
Establishing Correct Stone Angulation
____ or
____ o’clock
100-110
one
Positioning the Stone
Goal:
preserve instrument ____
design
Sharpen in ____
Rotate the Stone: ____, ____,
____
• Divide working into thirds > heel, middle, toe
sections
heel
middle
toe
Sharpening Universal Curets
Right and Left!
Ya!
Sharpening Site Specific Curets
- When to sharpen •Instrument replacement •Medium and Fine Grit Stones
- Retrieving broken instrument tip
- Tip breaks > explain to patient, and that you broke it, keep head position and go in with ____ and try to retrieve; if still don’t get it > use ____ and scoop it out; if not > you need an ____
- Still don’t have it > if swallows > consult with ____
gauze
curet
x-ray
faculty
