Grasp & Fulcrum Flashcards
Handle:
used for holding the instrument
Shank:
rod-shaped length of metal
located between the handle and
working-end of an instrument
Working-End:
the part of the instrument
that does the work of the instrument
Functional shank:
the part of the shank that allows the
working-end to be adapted to the tooth surface;
begins below the working-end and extends to the last
bend in the shank nearest the handle
Terminal shank:
the portion of the functional shank
nearest to the working-end
Shank Design
• Simple
(3)
• A shank that is bent in one plane (front-to-back)
• Simple shank=straight shank
• Used primarily on anterior teeth
Shank Design
• Complex
(3)
• A shank that has been bent in two planes
(front-to-back and side-to-side)
• Complex shank=angled/curved shank
• Used on posterior teeth
How to determine if
your shank is
simple or complex
• Hold the instrument so that the working-end
toe is facing you
• Instrument A, when viewed from the front
appears to be straight, therefore, simple shank
design
• Instrument B, when viewed from the front
appears to be bent from side-to-side, therefore
this instrument has a complex design
The function of an instrument is
determined, primarily, by the
design of the
working-end.
To determine an instrument’s use,
you must be able to recognize the
design characteristics of the (4)
face,
back, lateral surfaces, and cutting
edges of the working-end.
The Modified
Pen Grasp
• Grasp for
• Allows
• Permits
• Facilitates
holding periodontal instruments
precise control of the working-end
a wide range of movement
good tactile conduction
The Modified Pen
Grasp- continued
• Thumb and index finger hold the
instrument
• Middle finger stabilizes
• Ring finer used to fulcrum (hinge/pivot)
• Thumb is used to roll the instrument
• Fingers maintain contact and work
together to adapt the instrument
• Movement is in the wrist
Finger Placement and Function
Digit (s): Index and Thumb
Placement:
Function:
On the instrument handle
Hold the instrument
Finger Placement and Function
Digit (s): Middle Finger
Placement:
Function:
Rests lightly on the shank
Helps to guide the workingend
Feels vibrations transmitted
from the working-end to the
shank
Finger Placement and Function
Digit (s): Ring Finger
Placement:
Function:
On oral structure; often a tooth surface
Stabilizes the hand for control and strength
Finger Placement and Function
Digit (s): Pinky Finger
Placement:
Function:
Near ring finger, held in a natural, relaxed manner
Has no function in the grasp
What is a
Fulcrum?
Stabilizing point for clinician’s
hand during instrumentation
3 types of
fulcruming
techniques
Intraoral fulcrum*
Extraoral fulcrum
Advanced fulcrum
INTRAORAL FULCRUM
• A stabilizing point inside the
patient’s mouth against a
tooth surface
EXTRAORAL FULCRUM
• A stabilizing point outside
the patient’s mouth (e.g.,
against the patient’s chin or
cheek)
What is the full meaning of probe?
• to search into and explore very
thoroughly
Therefore, the — is the
MOST important instrument used for
assessing and diagnosing periodontitis
periodontal probe
probe design
The periodontal probe is a slender, tapered, blunt instrument with
millimeter markings on it
Many different variations and design differences are noted among
different manufacturers
Probing inaccuracy is related to (3)
probe design, pressure applied,
contour of the tooth, etc.
Probing depth usually correlates to attachment loss, but it is
always an objective measure of the distance between the
base of
the pocket and the crest of the gingiva regardless of the degree
of attachment loss. Readings may change over time due to
changes in the position of the gingival margin
Nabers
(furcation)
Probe
Used to evaluate the bone support in
the furcation areas of bifurcated and
trifurcated teeth
How to use a Nabers Probe
• The correct working-end of the
probe is when the lower
(terminal) shank is positioned
parallel to the tooth surface
being examined.
Nabers Probe- continued
• Do not need to read mm
markings when identifying
class
of furcation
Probing=
act of walking the tip of a probe
along the junctional epithelium(JE) within
the sulcus or pocket for the purpose of
assessing the health status of the
periodontal tissues
Walking stroke is the movement of a
calibrated probe around the perimeter of
the base of a sulcus/pocket.
Essential to evaluate the entire “length” of
the pocket base because the
JE is not
necessarily at a uniform level around the
tooth.
skipped
The Basics of
Probing
• Use modified pen grasp technique for holding
the probe
• Fulcrum close to the tooth you are probing
• Working-end of the probe should always
contact the tooth
• Probe should be parallel to the long axis of the
tooth around all proximal surfaces, except when
probing the interproximal spaces (due to the
gingival col)
• Place the probe below the gingival margin to the base
of the sulcus (10-15 grams of pressure)
• In health, the probe will stop at the junctional
epithelium
• In disease, the probe will go into the connective tissue
• Your probing depth will be calculated based on the
line you see at the gingival margin
• Keep the probe subgingival (below the gingiva), as
you move along the tooth
• “hop” along the circumference of the tooth
• Begin at the distal line angle and back into the distal
aspect of the tooth; move forward toward the mesial
• Your probing depth readings should be the deepest
Probing measures
six sites per tooth
- distofacial
- facial
- mesiofacial
- distolingual
- lingual
- mesiolingual
Note: only one reading per site is recorded; if probing depths vary within a sire, the deepest
reading obtained in that site is recorded
PD =
probing depth/ pocket
depth
GM =
gingival margin (measuring
recession or overgrowth)
ATTACH =
clinical attachment loss
(CAL)
BOP =
bleeding on probing
Pocket/Probing Depth (PD):
Base of pocket to gingival margin
Attachment Level:
CEJ to base of pocket
Recession:
CEJ to Gingival Margin (GM)
If the measurement for the
gingival margin is (+),
recession is present
If the measurement for the
gingival margin is (-),
the
gingival margin is coronal to
the CEJ- no recession
