Instruments Flashcards
What are the probs in a perio kit
WHO BPE probe (screening)
-ball end 0.5mm
-3.5-5.5mm
-8.5-11.5mm
UNC 15 probe
-Used for 6 point pocket chart, check pockets
-grade at every mm
-starts black 4-5mm
-second 9-10mm
-third 14-15mm
What connects handle to end of blade
Shank
How should a lower shank be positioned in respect to the tooth
Positioned at long axis to the tooth
What are the 8 instruments in a PMPR kit
Mini sickle or point scaler
Universal Columbia Curette
Hoe scaler x 2
a) red 156-157
b) yellow 134-135
Gracey Curettes x 4
a) grey 1-2
b) green 7-8 c) orange 11-12 d) blue 13-14
What does a finger rest do
The finger rest is the support/stability on which a lever (our finger) turns.
Control
Stability
Safety to prevent injury
Patient comfort
What is the positioning of an ideal finger rest
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
What technique prevents injury to the hand
Neutral wrist
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
What should be done prior to instrumentation of a tooth
Brobe the area prior to understand the depth and extant of pockets
What instrument is used only supragingivally
Mini sickle scaler
Where is the mini sickle scaler used
All buccal / lingual embrasures supragingival or just into into gingival margin
Why is the mini sickle scaler not suitable for subgingival use
the sharp point can groove/damage the root surface
The pocket wall could be damaged
What are the properties of a mini sickle scaler
Curved blade triangular in cross section converging to a point
Triangular in cross section
Point of scaler must always be moved towards and into the embrasure
What are the red instruments
Mini sickle scaler
Universal columbia curette
How is the universal columbia curette used
Use light lateral force against the root surface to base of pocket , engage calculus with blade at 90°
Use short overlapping strokes upwards
What are the properties of a Universal columbia curette
Red hoe
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
What is the difference between the red and yellow hoes
Red 156-157 for mesial and distal surfaces
Yellow134-135 for buccal lingual surfaces
What can the red and yellow hoes be used for
supra/subgingival calculus removal
All surfaces especially for gross calculus removal
How many cutting edges do hoes have
Single cutting edge
What does the single cutting edge of the hoes mean for use
Limited access if pocket is narrow
Use a curette to fully smooth surface after using hoes
What are the colours ofthe Gracey curettes
Grey
Green
Orange
Blue
Where can each Gracey be used
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 the properties of the Gracey curettes
The tip of the blade curves in 2 planes
Area specific
One cutting edge
Offset blade
What angle are the gracey curettes preset at
70 degrees
Which edge of the Gracey is the cutting edge
Larger outer curve
How is the Gracey curette used
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 position is used to treat teeth 43-33 labial and ligual
7 oclock
Where should the operator be to treat the right hand buccal posterior teeth aside
9 oclock
At 11 oclock what teeth surfaces can the operator reach
44-48 lingual
34-38 buccal
13-23 labial and palatal
14-18 palatal
24-28 Buccal and palatal
When are hand instruments preferable
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
Access to certain areas of tooth can be difficult , hand scalers may offer better access
Demineralised areas – can be remineralising but removed by powerful ultrasonic
Sensitivity – exposed dentinal tubules, recession, children with large pulp horns
Children may be less able to tolerate ultrasonic scalers due to dental anxiety
Restorations-porcelain / composite can be marked by ultrasonic
Titanium implants – ideally have implant inserts onto ultrasonic tips but may not be available
Why are instruments sharpened
To improve calculus/biofilm removal
Less force and time is required with sharp instruments
How is instrument sharpness tested
An acrylic test stick
How are instruments sharpened
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
A sharpening service will maintain your scalers and advise when to replace
What are the benefits to 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 are the properties of 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
What is used along side an ultrasonic scaler
High volume suction
Where is a scaling tip placed when not in use
FLAT
What can be used to remove gross calculus and stain
10 design
1 bend shank
Tapered tip
Supragingival or
subgingival use
What is the #100 design
Gross removal of mod-heavy calculus & stain
2 bend shank
Tapered tip
Supragingival or
subgingival use
What features does a #1000 design have
Gross removal of mod-heavy tenacious calculus
3 bend shank
Tapered tip
Access line angles &
interproximal surfaces
Supragingival use
How many bends does a 3 design have
1
What are the properties of a #3 design
(best use for supragingival gross calculus which needs broken up)
Gross removal of mod-heavy calculus & stain
1 bend shank
Tapered blunt tip
Supragingival use
What tips are used for subgingival narrow pockets
Used at low power
Focused Spray Slimline 1000
When should a slim #10 and slim #1000 be used
Slim #10
-one bend better for >4mm PD anterior surfaces only
Slim#1000
-triple bend for up to 4mm depth in anterioror posterior
What are the benefits of THINSert ultrasonic inserts
9° backward angle
-Allows for easier adaptation
47% thinner diameter
-Provides access in difficult areas without loss of tactile sensitivity
Enhanced durability
-Designed for light to moderate calculus and deplaquing
-Allows use at a higher power setting
What tyoes of water flow design in ultrasonic instruments are there
External flow ultrasonic insert
Internal water flow insert through base of insert
Internal water flow insert through tip
What flow of water is desirable
Constant flow with fine mist and some droplets showing
What are the diameter tip options
Standard
Slim
Thin
If a tip has lost 2mm of length how much less efficient is it
50%
What is a wear guide
Comparison tool for tips to see how much loss of tip has occured
How line should a tip be above on a wear guide
Atleast above the red line to be effective
What directions are used to remove calculus
Olblique and vertical movements
Where must the active portion of the tip be to remove deposits
In contact with the involved surface
How does working from the molars forward make it easier for the patient
Relieved extent of mouth opening as you work forward
When might an insert break off
Incorrect power setting
Insert did not match application
Improper sterilization & maintenance
When would an insert overheat
Improperly adjusted water
NOT filling handpiece with water prior to insert insertion
Use of an unserviceable insert
Adequate water pressure
What steps should you follow when treating a perio patient
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)
