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Yr 2 - Competency in periodontology > Instrumentation > Flashcards

Instrumentation Flashcards

1
Q

What are the 4 areas of control for periodontal disease?

A
  • 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)
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2
Q

What is periodontal instrumentation used for?

A

Supragingival scaling and root surface debridement (subgingival = open/closed))

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3
Q

Where should your finger rest be?

A

As close to the target as possible

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4
Q

What does active periodontal treatment involve (3)?

A
  • 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)
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5
Q

What is the rationale for supragingical scaling?

A

It alters supragingival biofilm = affects subgingival biofilm (synergistic effect) -> wont completelt improve but will have favourable effect!

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6
Q

Which average turesky score must be achieved before we will do root surface debridement?

A

<1

Can be achieved just by brushing and adapting good oral health techniques (we also help by doing supragingial scale)

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7
Q

What is calculus?

A

Minerlalised plaque (non-living) convered on its external surface by a living biofilm = irregular surface

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8
Q

What is the rationale for periodontal debridement?

A
  • 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)
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9
Q

Why is root planing no longer done?

A

Thought to be too invasice and no better than debridement

(removes calculus & cementum from root surface = glassy root surface)

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10
Q

What is debridement?

A

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
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11
Q

What is the minimum amount of time following a root surface debridement that should be left before probing?

A

6 weeks

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12
Q

What are the 3 main healing responses?

A
  • 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
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13
Q

What are the two different types of curretes?

A
  • Gracey
  • Universal
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14
Q

Which instrument is this?

A

Sickle Scaler

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15
Q

What is the sickle scaler used for?

A

Supragingival scaling

(should NOT be used subgingivally)

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16
Q

How many cutting edges does the sickle scaler have?

A

2

(why it should not be used subgingivally!)

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17
Q

Which instrument is this?

A

Jaquettes

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18
Q

How many cutting edges does the jaquette have?

A

Two

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19
Q

How many sizes of jaquettes are there?

A

Two

Small = finer deposits

Large = gross deposits

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20
Q

How many shapes of Jacquettes are there?

A

Two

Straight = anterior teeth

Angled = posterior teeth

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21
Q

What instrument is this?

A

Curette

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22
Q

Whats the difference between the universal and gracey curette?

A

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

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23
Q

Which is the instrument of choice for manual root surface debridement?

A

Gracey Curette

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24
Q

Which number of gracey cuvette is better for the anterior teeth?

A

Lower

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25
Q

Which number of the gracey cuvette is better for the posterior distal surfaces?

A

The larger numbers

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26
Q

How many different sizes of gracey cuvette is there?

A

18

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27
Q

Whats the difference with the larger numbers?

A

Thicker and more bends and kinks in shaft

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28
Q

What instrument is this?

A

Hoes

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29
Q

How many cutting edges does the hoe have?

A

1 (45 degree bevel)

30
Q

What is the main use of hoes?

A

Subgingival scaling

(can be very aggressive and useful for areas of stubborn calculus)

31
Q

How many different hoes are there?

A

4

32
Q

This is the movement of which ultrasonic instrument?

A

Sonic

33
Q

This is the movement of which ultrasonic instrument?

A

Piezo-electric ultrasonic

34
Q

This is the movement of which ultrasonic instrument?

A

Magneto-strictive ultrasonic

35
Q

Which is the least effective ultrasonic instrument?

A

The sonic

36
Q

What are the Hz of sonic scalers?

A

2500 - 16000

37
Q

How are vibrations produced in the sonic scaler?

A

Entry of air through tube is forced through angled holes = tube tilts

(needs water cooling to minimise frictional heat generated at the tip)

38
Q

How are the vibrations produced in the piezo-electric ultrasonic?

A

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)

39
Q

What are the Hz of piezo electric ultrasonic scalers?

A

25000 - 50000 Hz

40
Q

How are the vibrations produce in the magneto-strictive ultrasonic scaler?

A

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

41
Q

Which ultrasonic scaler do we use on clinic?

A

Magneto-strictive

42
Q

What are the Hz of the magnetostrictive ultrasonic scaler?

A

18000 - 45000

43
Q

What are the 3 purposes of water flush with the magneto-strictive ultrasonic scaler?

A
  • Cools handpiece
  • Cools tooth
  • Wash away calculus and plaque
44
Q

What is cavitation?

A

Little bubbles of air in the water = disperse all over the place & the bubbles break = rip appart bacterial cell walls (kills cell)

45
Q

Which different tips are availiable for ultrasonic scalers?

A
  • Straight
  • Right slim line
  • Left slim line
  • Ball ended
46
Q

What is an example of a magnetostrictive ultrasonic scaler?

A

Cavitron

47
Q

What is the risk when you increase the power of a magnetostrictive ultrasonic scaler?

A

Increased risk of damage (little increase in efficacy)

48
Q

What is the ultrasonic debridement technique?

A

Used almost parrelel to tooth surface using gentle stroking movements

49
Q

Why should the ultrasonic scaler not be used at a right angle?

A

= damage!!!

50
Q

How far from the point of contact do the effects of ultrasonic debridement spread?

A

A few mm

51
Q

Which material should you NOT use ultrasonics on?

A

Porcelain crowns!

52
Q

What is the effect of ultrasonics on enamel?

A

Reduces hardness (negligible for healthy enamel but catastrophic if demineralised = removes it)

53
Q

What is the effect of ultrasonics on the root surface?

A

Causes less damage than hand instruments (less likely to remove cementum)

54
Q

What is the effect if ultrasonics on pulp?

A

With water coolant temp increases up to 8 degrees

Without water coolant temp increases up to 35 degrees (pulp cannot tolerate)

55
Q

What is the effect of ultrasonics on periodontal tissues?

A

minor histologic changes (not significant if used correctly)

56
Q

What are the differences between manual and ultrasonic instrumentation technique?

A

Manual = up and down (right hand side)

Ultrasonic = side to side just running across surface (left hand side)

57
Q

What are the advantages of ultrasonics over manual instrumentation (10)?

A
  • 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
58
Q

What are the disadvantages of ultrasonics compared to manual instrumentation (6)?

A
  • 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
59
Q

What are the contraindications of the use of ultrasonics (8)?

A
  • TB
  • Compromised immune system
  • Respiratory problems
  • Swallowing problems
  • Primary teeth
  • Newly erupted teeth
  • Decalcified enamel
  • PACEMAKERS
  • Metal tips on implants
60
Q

When used correctly which technique removes least cementum… manual or ultrasonic?

A

Ultrasonic

61
Q

What are the pre-requisites for non surgical debridement therapy (5)?

A

Good plaque control (turesky <1)

6 point pocket depth charts

Appropriate radiographs

Periodontal diagnosis and treatment plan

Explanation given to patient and risks discussed

62
Q

List 6 plaque retentive factors:

A
  • Calculus & roughened tooth surfaces
  • Overcontoured & defective restorations
  • Dental caries
  • Anatomical grooves and irregularities
  • Displaced contact points and wisdom teeth
  • Dentures and orthodontic appliances
63
Q

What are the two debridement approaches?

A

Full mouth in a single stage (otherwise: colonise in groups, persistance of pathogens and recolonisation with smaller number within 1 week)

Quadrant (more thorough)

64
Q

What can incomplete debridement of a pocket lead to?

A

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

65
Q

What is the best approach for debridement?

A

Total debridement in as few appointments as possible and the closer the appointments the better

66
Q

What are the symptoms a periodontal patient will understand?

A
  • Blood when brushing
  • Blood on pillow
  • Bad taste
  • Bad breath
  • Wobbly teeth
  • Drifting teeth
  • Sensitivity
  • Black triangles between teeth
  • Stained teeth
67
Q

What are the 3 side effects if periodontal therapy?

A
  • Recession (due to reduced inflammation)
  • Sensitivity
  • Interproximal dark triangles
68
Q

How can the side effects of periodontal therapy be reduced?

A

Operative intervention

Prosthetics

69
Q

What are the risk factors affecting non surgical therapy outcomes (7)?

A
  • 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
70
Q

Name this instrument:

A

Periodontal probe

Yr 2 - Competency in periodontology (8 decks)

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