Instrumentation for Periodontal Treatment Flashcards
What are the two probes used and what are they each used for?
WHO used for BP screening
UNC 15 used for detecting pockets (6-point pocket chart)
How should the lower/terminal shank be positioned?
parallel to the long axis of the tooth
What finger is used to rest?
middle finger
What is the modified pen grasp?
Instrument is held between thumb and index finger.
Middle finger is placed further up shank to provide stability and strength during instrumentation
What does the finger rest provide?
Control
Stability
Safety to prevent injury
Patient comfort
What is an ideal finger rest?
- Tooth as close to tooth treating
- Prevents injury if patient moved suddenly or instrument slips
- Stable tooth rather than soft tissues(lips/cheeks) which can move/slide around
- May need to use a rest further away in difficult access e.g. treating upper left posteriors palatally , using upper right palate as a rest
How should the wrist be?
- The wrist should be straight
- Hand and forearm should be in the
same horizontal plane - Reduces risk of pressure of median nerve in wrist
- Helps reduce risk of carpal tunnel syndrome
When and how is a mini sickle scaler used?
- All buccal/lingual embrasures supragingival or just into into gingival margin
- Curved blade triangular in cross section converging to a point
- Double ended and 2 cutting edges
- Point of scaler must always be moved towards and into the embrasure surfaces
When can a mini sickle scaler not be used?
- Not for sub gingival use because
1. the sharp point can groove/damage the root surface
2. The pocket wall could be damaged
When and how is a universal colombia curette used for supra/subgingival PMPR?
- Curved spoon shaped blade with 2 cutting edges to form a rounded toe
- No sharp corners so can be used both supragingival and subgingival in all areas - double ended
- Use light lateral force against the root surface to base of pocket, engage calculus with blade at 90°
- Use short over lapping strokes upward
What are the colours of hoes used?
- Red156-157 for mesial and distal surfaces
- Yellow134-135 for buccal lingual surfaces
- Double ended
- supra/subgingival calculus removal
- All surfaces especially for gross calculus removal
What should be used after a hoe?
Use a curette to fully smooth surface after using hoes
What are the colours of gracey curettes used for?
- Grey 1-2 anterior sextant
- Green 7-8 buccal/lingual posterior
sextant - Orange 11-12 mesial posteriors sextants
- Blue 13-14 distal posterior sextants
What are gracey curettes used for and what do they look like?
Supra/subgingival PMPR
- The tip of the blade curves in 2 planes
- One cutting edge
- Offset blade
Where should the cutting edge of the curette be?
towards tooth surface and non-cutting edge at the periodontal pocket preventing enlargement of pocket
In gracey curettes, how should they be used?
Larger outer curve is cutting edge
* Confirm correct cutting edge by gently adapting it to the tooth with the lower shank parallel to the long axis to the tooth.
* Only the back of the instrument can be seen from above if correct.
* Use finger rest
* Use vertical and diagonal strokes
What should the hour position of the right handed operator be?
7 - 11 o’clock
What are systemic health conditions that may cause issues with ultrasonic scalers?
- Communicable diseases where aerosol may increase risk of infection e.g. Tuberculosis, Coronavirus
- Difficulty in swallowing lots of water from ultrasonic– Parkinson’s disease, Multiple sclerosis or severe gag reflex
- Cardiac pacemaker – check make and model ( patients have details given to them to check online or check with Cardiology) prior to using ultrasonic
What are oral conditions that may cause issues with ultrasonic scalers?
- Demineralised areas – can be remineralising but removed by powerful ultrasonic
- Sensitivity – exposed dentinal tubules, recession, children with large pulp horns
- Restorations-porcelain / composite can be marked by ultrasonic
- Titanium implants – ideally have implant inserts onto ultrasonic tips but may not be available
What are the benefits of sharpening hand instruments?
- To improve calculus/biofilm removal
- Less force and time is required with
sharp instruments - Can check sharpness with a acrylic test stick
What are the methods of sharpening?
- Arkansas hand stone-natural stone from aluminium oxide with oil for steel instruments
- Hoes require a diamond abrasive without oil as they have tungsten carbide
- Sharpening machines will be quicker
What are advantages of ultrasonic scalers?
- Equally as effective as hand instruments
- More time efficient if patient able to tolerate water/suction
- Can be more efficient for stain removal
- Range of tips available for different areas requiring access
- Must monitor wear of scaling tips as wear can reduce effectiveness
What is an ultrasonic scaler?
- Electric power generator
- Handpiece( black barrel)
- Insert with working tips
- Power is converted to about 25 000 microscopically small strokes per second
- Water is needed to cool vibrating tip
When is an ultrasonic scaler avoided?
- Generally avoided in patients with implanted electronic devices,
- Eg pacemakers/spinal cord stimulators
- The risk is assumed to be hypothetical, but piezo instruments or hand instruments can be used with equal efficacy so why take the risk?
How should you place a scaler if stopping to check scaling?
leave scaling tip flat on a bracket table to avoid sharps injury
What is a slim tip often used for?
used for sub-gingival narrow pockets
What is a curved tip used for?
if there are a lot of fissures/ fossas
What is the scaler 10 design?
- Gross removal of mod-heavy calculus & stain
- 1 bend shank
- Tapered tip
- Supragingival or subgingival use
What is the scaler 100 design?
- Gross removal of mod-heavy calculus & stain
- 2 bend shank
- Tapered tip
- Supragingival or subgingival use
What is the scaler 1000 design?
- Gross removal of mod-heavy tenacious calculus
- 3 bend shank
- Tapered tip
- Access line angles & interproximal surfaces
- Supragingival use
What is scaler 3 design?
- Gross removal of mod-heavy calculus & stain
- 1 bend shank
- Tapered blunt tip
- Supragingival use
- Used for breaking up heavy deposits
What are the slim 10 and 1000 used for?
slim 1000 (triple curve) = < 4 mm PD anterior or posterior
slim 10 (singe curve) = >4 mm PD anterior surfaces only
Why is a slim curved design good?
Enhances adaptation around
* posterior root surfaces
* concavities
* furcations
Area specific
Where can internal water flow be through?
TFI - through base of insert
FSI - through tip of insert
What should the flow be like?
a mist with droplets
At what colour line on a wear guide is too worn/ not as effective?
red and below
What are specialty inserts used for?
used to avoid scratching titanium implants
What are the steps of a procedure?
- Choose the correct instrument (s)
- If using USS set it up, set the water spray/power setting
- choose the patient position (both head position chair position
- Choose your seating position
- Choose the light position
- Identify your finger rest
- Remove the plaque/calculus
- Check you’ve done the job properly
- Continue treatment (eg next tooth)
