Instruments for periodontal treatment Flashcards
ILO 2.2a: be competent at manipulation of scaling instruments
what are the parts of a handheld periodontal instrument?
4
- handle
- shank
- lower shank
- blade
how should you hold instruments?
modified pen grasp
* instrument held between thumb and index finger
* middle finger held further up the shank for stability and strength
* middle finger can be used as a finger rest
what should the ideal finger rest be?
- as close as possible to the tooth being treated
- on a stable tooth rather than soft tissues
- may need to use a finger rest further away in difficult to access areas
how should the wrist be positioned when using periodontal instruments?
neutral wrist
* wrist should be straight
* hand and forearm should be in same horizontal plane
how should you use the instruments when carrying out PMPR?
- ensure the final third of the blade is always closely adapted to the tooth structure
- use lateral upward strokes from base of pocket
- rotate the instrument as you work around the tooth
- lower shank should be parallel to the long axis of tooth
- use overlapping multidirectional strokes upwards from the base of pocket
what position would left and right handed operators sit when working on the labial and lingual surface of 43-33?
- right: 7 o’clock
- left: 5 o’clock
what position would left and right handed operators sit when working on the buccal surface of 44-48?
- right: 9 o’clock
- left: 3 o’clock
what position would left and right handed operators sit when working on the lingual surface of 34-38?
- right: 9 o’clock
- left: 3 o’clock
what position would left and right handed operators sit when working on the buccal surface of 14-18?
- right: 9 o’clock
- left: 3 o’clock
what position would left and right handed operators sit when working on the lingual surface of 44-48?
- right: 11 o’clock
- left: 1 o’clock
what position would left and right handed operators sit when working on the buccal surface of 34-38?
- right: 11 o’clock
- left: 1 o’clock
what position would left and right handed operators sit when working on the labial and palatal surface of 13-23?
- right: 11 o’clock
- left: 1 o’clock
what position would left and right handed operators sit when working on the palatal surface of 14-18?
- right: 11 o’clock
- left: 1 o’clock
what position would left and right handed operators sit when working on the buccal and palatal surface of 24-28?
- right: 11 o’clock
- left: 1 o’clock
what surfaces of which teeth should the operator be scaling at 7 o’clock/5 o’clock?
43-33 lingual and labial
what surfaces of which teeth should the operator be scaling at 9 o’clock/3 o’clock?
- 34-38 lingual
- 44-48 buccal
- 14-18 buccal
what surfaces of which teeth should the operator be scalling at 11 o’clock/1 o’clock?
- 44-48 lingual
- 34-38 buccal
- 13-23 labial and palatal
- 14-18 palatal
- 24-28 buccal and palatal
what are the systemic health condition indications for hand instrumentation?
4
- communicable diseases where aerosols may increase risk of infection e.g. TB or COVID
- difficulty swallowing lots of water e.g. parkinsons, MS, severe gag reflex
- cardiac pacemaker (check make and model)
- access to certain areas of the mouth may be difficult with ultrasonic
what are the oral condition indicators for hand instruments?
5
- demineralised areas can be removed with ultrasonic
- sensitivity e.g. exposed tubules, recession
- children may be less tolerable to ultrasonic scalers due to anxiety
- porcelain or composite restorations can be marked by ultrasonic scalers
- titanium implants need a rubber tip that may not be available
what are the 8 hand instruments used for PMPR?
- mini sickle / point scaler
- universal columbia curette
- hoe scaler red 156-157
- hoe scaler yellow 134-135
- gracey curette grey 1-2
- gracey curette green 7-8
- gracey curette orange 11-12
- gracey curette blue 13-14
describe the mini sickle / point scaler
- double ended with two cutting edges
- curved blade and triangular in cross section
- cutting edges congerve to a sharp point
where can the mini sickle / point scaler be used?
- used supragingivally
- all buccal and lingual embrasure surfaces
- sharp point can damage root surface and pocket walls
how do you use a mini sickle / point scaler?
manipulate so the point always moves towards and into the embrasure
descibe the universal columbia curette
- double ended with two cutting edges
- curved, spoon-shaped blade
- cutting edges form a rounded toe
where can the universal columbia curette be used?
- used throughout the mouth
- supra and subgingivally
- no sharp corner to damage ginigvae
how do you use a universal columbia curette?
- use light lateral force to engage calculus at a 90 degree angle
- short overlapping strokes upwards
describe the yellow and red hoes
- double ended with single cutting edge
- blade is set at a 100 degree angle to the shank and the cutting edge is beveled at 45 degrees
where can the yellow and red hoes be used?
- all surfaces of all teeth
- supra and subgingival for gross calculus
- yellow 134-135 - buccal/labial and lingual/palatal surfaces
- red 156-157 - mesial and distal surfaces
how do you use the yellow and red hoes?
- use in overlapping strokes
- cutting edge should be angulated at 90 degrees to the tooth surface
- use a curette to fully smooth the surface after
describe the gracey curettes
- double ended with one cutting edge
- offset blade at an angle to the lower shank
- angle of 110 degrees between the lower shank and face of blade
- toe of the blade curves upwards and to the side
- longer, outer convex edge is the cutting edge
where can the gracey curettes be used?
- supra and subgingival for fine or deep calculus
- grey 1-2 - anterior sextant
- green 7-8 - buccal / lingual in posterior sextants
- orange 11-12 - mesial in posterior sextants
- blue 13-14 - distal in posterior sextants
how do you use the gracey curettes?
- use vertical and diagonal strokes
- lower third is in contact with the tooth
with what systemic health conditions should you use hand instruments oover ultrasonic?
- communuicable diseases where aerosol may increase risk of infection
- difficulty swallowing lots of water
- cardiac pacemaker - check make and model
with what oral conditions should you use hand instruments over ultrasonic?
- demineralised areas
- sensitivity
- children may be less tolerable to ultrasonic scalers due to dental anxiety
- porcelain / composite restorations may be marked by scalers
- titanium implants - use an implant insert if available on ultrasonic tip
why do you need to sharpen hand instruments?
- to improve calculus / biofilm removal
- less force and time required
what methods are there to sharpen hand instruments?
- Arkansas hand stone
- sharpening machines
- hoes require a diamond abrasive without oil
what components make up an ultrasonic?
- electric power generator
- handpiece
- insert with working tips
- water
how would you use an ultrasonic?
- turn the instrument on and fill water reservoir
- connect the barrel and turn the water supply up
- use the pedal to fill the barrel with water until it almost overflows
- place the insert into the barrel
- press the foot pedal to get a fine mist spray out the end of the tip - adjust the power if needed
descibe the #10 design tip
- 1 bend shank
- tapered tip
where and what is the #10 design tip used for?
- supra or subgingival
- gross removal of moderate-heavy calculus and stain
describe the #100 design tip
- 2 bend shank
- tapered tip
where and what is the #100 design tip used for?
- supra and subgingival
- gross removal of moderate-heavy calculus and stain
describe the #1000 design tip
- 3 bend shank
- tapered tip
where and what is the #1000 design tip used for?
- supragingival
- gross removal of moderate-heavy tenacious calculus
- can access line angles and interproximal surfaces
describe the #3 design tip (beaver tail)
- 1 bend shank
- tapered blunt tip (wide)
where and what is the #3 design tip used for?
- supragingival
- gross removal of moderate-heavy calculus and stain
describe the slim #10 and #1000 design tip and where are they used?
- # 10 - 1 bend shank
- # 1000 - 3 bend shank
- more defined bend angle
- indicated for use on surfaces with minimal contour after heavy calculus is removed
- supragingival - >4mm anterior surfaces only
- subgingival - <=4mm posterior or anterior
describe the slim curved design tips and where are they used?
- left and right curved shank
- area specific
- enahnces adaption - posterior root surfaces, concavities and furcations
describe the THINsert ultrasonic inserts
- 9 degrees backward angle for easier adaption
- 47% thinner diameter for access in difficult areas
- enhanced durability for light-moderate calculus
how much active area do ultasonic tips have and how does bluntness affect work?
- new tips have 4.2mm of active area
- tips become less effective with use
what can be used to test the wear of an ultrasonic tip? what would it tell you?
wear guides
* if the tip measures to the blue line, 1mm of active area is worn and results in a 25% efficiency loss
* if the tip measures to the red line, 2mm of active area is worn and results in a 50% efficiency loss
how would you adapt ultrasonic instruments?
- oblique adaption
- vertical adaption
- the active portion must contact the surface
- adapt the lateral surface in a vertical position at the midline of the tooth and stroke horizontally between mesial and distal line angles
- at the line angle, transition to oblique adaption and stroke vertically
what surfaces in the mouth would the left curved insert adapt to?
- UR buccal
- UL palatal
- LR lingual
- LL buccal
what surfaces in the mouth would the right curved insert adapt to?
- UR palatal
- UL buccal
- LR buccal
- LL lingual
why would an insert break or not work?
- incorrect power setting (too high)
- insert not matching application
- improper sterilisation and maintenance
why would an insert overheat?
- improperly adjusted water
- not filling handpiece with water prior to insert insertion
- use of unserviceable insert
- adequate water pressure
