Instrument Selection Flashcards
Why is calculus removal a critical step in any nonsurgical perio therapy
Calculus deposits harbor living bacterial biofilm
To reestablish periodontal health, root surfaces must be free of plaque biofilm and all calculus deposits
What is scaling?
Instrumentation of the crown and root surfaces of the teeth to remove plaque, calculus and stains
What is root planing?
Treatment designed to remove cementum or surface dentin that is rough and contains impregnated calculus
Current views on root planing
Vigorous root planing not universally needed to reestablish periodontal health
Bacterial products can be removed with minimal amount of actual cementum removed
What was the former view/approach to scaling?
Gross Scaling- First appointment spent only removing large deposits. Second spent removing medium deposits.
Circuit scaling meant calculus was whittled away at each appointment
Disadvantages of gross scaling
Incomplete calculus removal is not recommended
Leaves behind deposits that are rough and may still harbor biofilm
Marginal tissue can shrink, closing off pocket and allowing an abscess to form
Tissue shrinkage can also make it difficult to insert instruments at future appointments
Patient frustration- Instrumenting same teeth at every appointment
What is the gold standard for care?
At each appointment, the hygienist should decide how many teeth can be completed
Ex. Complete several teeth, complete one sextant or quadrant, complete two quadrants on same side of mouth
Why do we try to work on just one side of the mouth at a time?
Gives patient one side that they can comfortably chew on
Divides work more evenly
Recommended if local anesthesia is being used
How do we determine instrument selection?
Where are the deposits located? Supra/sub? Anterior/posterior?
Size of deposits? Fine, moderate/gross
Are we doing the whole quad? Just molars? etc.
What instrumentation can we do to help determine instrument selection?
Probe pocket depth
Explorer evaluation
Which deposits do we remove first? What type of scaling should be done? Which instruments will we use?
Heavy, tenacious, supra-gingival deposits.
Gross Scaling. Must be followed by fine scaling and root planing
Strong shank, strong blade:
Sickle scalers
4R/4L, 2R/2L universal curets
Which deposits do we remove last? What type of scaling should we do? Which instruments should we use?
Light deposits
Light scaling. Followed by root planing to remove toxins embedded in cementum
Use scalers with thinner, more flexible shanks:
Graceys
Factors to consider for instrumentation
How many teeth to complete at each appointment
Instrument selection based on deposit size and location
Which instruments would be most effective?
Patients have individualized needs
Which instruments should/can be used supra gingivally?
Sickles, universals
Which instruments should be used sub-gingivally?
Universal Curets
Area specific curets (Gracey’s)
