Manual Instruments

Question 1

● Positioning

Answer 1

o Posterior
▪ Direct - 9:00
● Buccal of ride side
● Lingual of left side
▪ Indirect - 11:00
● Lingual right
● Buccal left
● Turn toward me and use mirror
o Anterior
▪ Towards: 8:00
▪ Away: 11-12
● EXCETPION: the facials of the maxillary anteriors, MAY BE scaled from 11-12:00 position

Question 2

● Modified Pen Grasp

Answer 2

o Thumb and index finger hold instrument
o Middle finger stabilizes
o Ring finger acts as fulcrum
o Thumb is used to roll instrument
▪ Fingers must maintain contact and work as a unit.
o Individual fingers not strong enough
▪ Need full strength of entire hand & wrist – not just using your fingers
o Index can move up and down, just don’t lose contact b/t them

Question 3

● Adaptation

Answer 3

Manner in which instrument is brought into contact with tooth and maintained during instrumentation
o Roll between index and thumb
● 2mm tip is all you use (Just the tip ;)
● Scalers (=SUPRA-gingival)
o Posterior Sickle Scaler: just for interproximal
● Universal Curets: two cutting edges, does everything, supra and sub G

Question 4

Pocket Depth

Answer 4

Pocket Depth vs. Attachment

Question 5

● Attachment level

Answer 5

= CEJ to base of pocket
o Healthy – JE is at the CEJ
o Periodontitis –JE migrates apically (and that’s only due to bone loss)
o Recession: CEJ to GM
o So attachment level become a significant thing for us to be aware of while diagnosing a pt

Question 6

● Gingival Margin (GM)=

Answer 6

CEJ to gingival margin

Question 7

● PD +/- GM

Answer 7

● PD +/- GM = attachment loss

Question 8

● Recession is a

Answer 8

● Recession is a positive number (CEJ to GM)
o Need to factor in recession as part of the attachment loss even though it doesn’t contribute to pocket depth

Question 9

● Hyperplasia is a

Answer 9

negative number (gingiva goes coronal to CEJ)
o Inflamed gingiva doesn’t count towards the attachment loss which is why we subtract
it

Question 10

Oral Irrigation

Answer 10

• Can result in disruption of loosely attached or unattached supra/subgingival plaque
• Does NOT completely get rid of subgingival bacteria
• NOT a replacement for interproximal plaque control
• Irrigation not indicated for pts who have effective OH or no inflammation
• Irrigation alone is ineffective in reducing inflammation
  o Best benefit is seen when irrigation is combined with toothbrushing