Instrumentation Flashcards
What are the 4 areas of control for periodontal disease?
- Plaque control (skill, routine & motivation)
- Non-surgical debridement (using periodontal instruments to break up biofilm)
- Surgical procedures (same as non surgical but below gum & remove granulation tissue)
- Chemo-theraputic agents (topical and systematic)
What is periodontal instrumentation used for?
Supragingival scaling and root surface debridement (subgingival = open/closed))
Where should your finger rest be?
As close to the target as possible
What does active periodontal treatment involve (3)?
- Breakdown of the plaque biofilm by instrumentation
- Removal of calculus & other plaque retentive factors e.g. rough restoration margins that can harbour biofilm
- Ensure patients plaque control is good enough to prevent re-maturation of biofilm (more problems)
What is the rationale for supragingical scaling?
It alters supragingival biofilm = affects subgingival biofilm (synergistic effect) -> wont completelt improve but will have favourable effect!
Which average turesky score must be achieved before we will do root surface debridement?
<1
Can be achieved just by brushing and adapting good oral health techniques (we also help by doing supragingial scale)
What is calculus?
Minerlalised plaque (non-living) convered on its external surface by a living biofilm = irregular surface
What is the rationale for periodontal debridement?
- Arrest progress of periodontal disease = remove biofilms & plaque retentive calculus
- Create environment permitting healing of gingival tissue (assists maintanance of tissue health = eliminates inflammation)
- Increase effectiveness of patient self care (eliminates areas of plaque retention that are difficult or impossible for patient to clean)
Why is root planing no longer done?
Thought to be too invasice and no better than debridement
(removes calculus & cementum from root surface = glassy root surface)
What is debridement?
Removal of biofilm and calculus from tooth surface
- Aim to conserve cementum (bacterial products removed with ultrasonic instruments or light instrumentation strokes)
- Use combination of hand instruments followed by ultrasonics
What is the minimum amount of time following a root surface debridement that should be left before probing?
6 weeks
What are the 3 main healing responses?
- Complete recession = pocket shrinks completely = stabilised and maintainable
- Long junctional epithelium = maintainable
- Little or no shrinkage of pocket = clean but difficult for patient to maintain (fibrous tissue) = more likely outcome in smokers and those with more courses of treatment
What are the two different types of curretes?
- Gracey
- Universal
Which instrument is this?
Sickle Scaler
What is the sickle scaler used for?
Supragingival scaling
(should NOT be used subgingivally)
How many cutting edges does the sickle scaler have?
2
(why it should not be used subgingivally!)
Which instrument is this?
Jaquettes
How many cutting edges does the jaquette have?
Two
How many sizes of jaquettes are there?
Two
Small = finer deposits
Large = gross deposits
How many shapes of Jacquettes are there?
Two
Straight = anterior teeth
Angled = posterior teeth
What instrument is this?
Curette
Whats the difference between the universal and gracey curette?
Universal = two cutting edges per working end = 90 degree angle
e.g. Columbia, Buntin and Langer
Gracey = one cutting edge per working end (area specific) = 70 degree angle = less trauma to gingive & so can be used subgingivally
e.g. Gracey & mini-gracey
Which is the instrument of choice for manual root surface debridement?
Gracey Curette
Which number of gracey cuvette is better for the anterior teeth?
Lower
Which number of the gracey cuvette is better for the posterior distal surfaces?
The larger numbers
How many different sizes of gracey cuvette is there?
18
Whats the difference with the larger numbers?
Thicker and more bends and kinks in shaft
What instrument is this?
Hoes
How many cutting edges does the hoe have?
1 (45 degree bevel)
What is the main use of hoes?
Subgingival scaling
(can be very aggressive and useful for areas of stubborn calculus)
How many different hoes are there?
4
This is the movement of which ultrasonic instrument?
Sonic
This is the movement of which ultrasonic instrument?
Piezo-electric ultrasonic
This is the movement of which ultrasonic instrument?
Magneto-strictive ultrasonic
Which is the least effective ultrasonic instrument?
The sonic
What are the Hz of sonic scalers?
2500 - 16000
How are vibrations produced in the sonic scaler?
Entry of air through tube is forced through angled holes = tube tilts
(needs water cooling to minimise frictional heat generated at the tip)
How are the vibrations produced in the piezo-electric ultrasonic?
Alternating electric current causes contraction and elongation of crystal disks inside the instrument
(needs water coolant to avoid heat generated by friction of tip on tooth surface)
What are the Hz of piezo electric ultrasonic scalers?
25000 - 50000 Hz
How are the vibrations produce in the magneto-strictive ultrasonic scaler?
Tip connected to ferromagnetic bar or nickel cobalt strips soldered at ends toc reate insert = slides into handle which generates a magnetic field when current starts to flow = contraction of the bar or soldered strips
n.b. all sides of the tip are effective
Which ultrasonic scaler do we use on clinic?
Magneto-strictive
What are the Hz of the magnetostrictive ultrasonic scaler?
18000 - 45000
What are the 3 purposes of water flush with the magneto-strictive ultrasonic scaler?
- Cools handpiece
- Cools tooth
- Wash away calculus and plaque
What is cavitation?
Little bubbles of air in the water = disperse all over the place & the bubbles break = rip appart bacterial cell walls (kills cell)
Which different tips are availiable for ultrasonic scalers?
- Straight
- Right slim line
- Left slim line
- Ball ended
What is an example of a magnetostrictive ultrasonic scaler?
Cavitron
What is the risk when you increase the power of a magnetostrictive ultrasonic scaler?
Increased risk of damage (little increase in efficacy)
What is the ultrasonic debridement technique?
Used almost parrelel to tooth surface using gentle stroking movements
Why should the ultrasonic scaler not be used at a right angle?
= damage!!!
How far from the point of contact do the effects of ultrasonic debridement spread?
A few mm
Which material should you NOT use ultrasonics on?
Porcelain crowns!
What is the effect of ultrasonics on enamel?
Reduces hardness (negligible for healthy enamel but catastrophic if demineralised = removes it)
What is the effect of ultrasonics on the root surface?
Causes less damage than hand instruments (less likely to remove cementum)
What is the effect if ultrasonics on pulp?
With water coolant temp increases up to 8 degrees
Without water coolant temp increases up to 35 degrees (pulp cannot tolerate)
What is the effect of ultrasonics on periodontal tissues?
minor histologic changes (not significant if used correctly)
What are the differences between manual and ultrasonic instrumentation technique?
Manual = up and down (right hand side)
Ultrasonic = side to side just running across surface (left hand side)
What are the advantages of ultrasonics over manual instrumentation (10)?
- Irrigation of pocket with water
- Cavitation effect (bacteriacidal)
- Water cleans working field (removes blood)
- Increased tactile sense of pocket topography
- Effective with every movement (hand instruments must have certain angulation)
- Better access in furcations
- Size and shape of tip can be chosen appropariately (also true for hand instruments)
- Slight pressure required = less operator fatigue
- Faster and easier to remove calculus
- Shorter learning process
What are the disadvantages of ultrasonics compared to manual instrumentation (6)?
- Contaminated aerosol (aspiration required)
- Expensive (but saves lots of time)
- Noisy
- = burnished root surface & risk of damage to enamel and dentine
- Temporary increase in dentine hyersensitivity (use toothpastes or gels after)
- Reduced tactile feeling of root surface
What are the contraindications of the use of ultrasonics (8)?
- TB
- Compromised immune system
- Respiratory problems
- Swallowing problems
- Primary teeth
- Newly erupted teeth
- Decalcified enamel
- PACEMAKERS
- Metal tips on implants
When used correctly which technique removes least cementum… manual or ultrasonic?
Ultrasonic
What are the pre-requisites for non surgical debridement therapy (5)?
Good plaque control (turesky <1)
6 point pocket depth charts
Appropriate radiographs
Periodontal diagnosis and treatment plan
Explanation given to patient and risks discussed
List 6 plaque retentive factors:
- Calculus & roughened tooth surfaces
- Overcontoured & defective restorations
- Dental caries
- Anatomical grooves and irregularities
- Displaced contact points and wisdom teeth
- Dentures and orthodontic appliances
What are the two debridement approaches?
Full mouth in a single stage (otherwise: colonise in groups, persistance of pathogens and recolonisation with smaller number within 1 week)
Quadrant (more thorough)
What can incomplete debridement of a pocket lead to?
Blockage of exudate & increases risk of lateral periodontal abscess
Partial healing = resists re-entru of instruments and can produce less favourable healing in the future
What is the best approach for debridement?
Total debridement in as few appointments as possible and the closer the appointments the better
What are the symptoms a periodontal patient will understand?
- Blood when brushing
- Blood on pillow
- Bad taste
- Bad breath
- Wobbly teeth
- Drifting teeth
- Sensitivity
- Black triangles between teeth
- Stained teeth
What are the 3 side effects if periodontal therapy?
- Recession (due to reduced inflammation)
- Sensitivity
- Interproximal dark triangles
How can the side effects of periodontal therapy be reduced?
Operative intervention
Prosthetics
What are the risk factors affecting non surgical therapy outcomes (7)?
- poor compliance with plaque control
- poor attendence patterns
- insuficient debridement
- systemic conditions (e.g. diabetes mellitus if poorly controlled)
- Smoking
- persistant deep periodontal pockets
- molars with furcation involvement
Name this instrument:
Periodontal probe
