Module 2 Flashcards
What is the main action of ultrasonic and sonic scalers?
mechanical
what other factors of ultrasonics and sonics play a role in debridement
irrigation and cavitation
What is the mechanical action of ultra and sonics?
-coverts electrical energy or air pressure into high frequency sound waves
What do the sound waves produce?
rapid vibrations
What happens to the calculus when sonic or ultrasonics are used?
calculus shatters
What is required to dissipate heat produced at the vibrating tip
water
what is cavitation
action created by formation and collapse of bubbles in the water by high frequency sound waves surrounding an US tip
what is the effect of cavitation?
cable of destroying bactera and can remove endotoxins from the root surface
What is irrigation
the water spray penetrates base of the pocket and flushes out debris microorganisms and endotoxinx
what is believed to have a disruptive effect on surface bacteria
acoustic turbulence
what is the amplitude?
distance of tip measured in micrometers
what determines the power output of the instrument
the distance of tip/amplitude
what is frequency
speed of movement, cycles per second
What are the 2 types of US scaling devices?
- magnetostrictive US
- piezoelectric US
What is the composition of magnetostrictive US scalers?
- conventional magnetostrictive units- long stack of metal strips
- ferromagnetic units- fragile ferric rod, generates less heat
What is the activation of the magnetostrictive US?
- vibrations occur when electric current is applied
- there is expansion and contraction of metal strips
what is the tip motion of a magnetostrictive US?
- conventional moves in an elliptical pattern
- ferromagnetic rotates 360*
What is the tip shape of a magnetostricive US?
round
What is the compositoin of a Piezoelectric US?
ceramic rod
What is the activation of a piezoelectric US?
dimensional changes in quartz or metal alloy crystal transducers housed in the handpiece
what is the tip motion in piezoelectric US?
linear pattern, only forward and backward
what surfaces are active on the tip of a piezoelectric US?
lateral surfaces
What is the technique for a piezoelectric US?
- lateral surface of tip in contact w tooth
- only the terminal 2-3 mm of tip
- keep lateral surface adapted
what is the tip shape of a piezoelectris US?
varies from trapezoidal with angular edges to round to bladed
What is the tip motion in a sonic scaling device?
- driven by compressed air
- moves in an elliptical
- all surfaces of tip are active
does a sonic have more or less amplitude than an US?
less
Is calculus removal easier or harder with a sonic scaler?
harder
What is the water used for in sonic scaling?
cool the friction, heat is not generated by tip
What are the indications for use of power driven scalers?
- removal of calc and tenacious stains
- subgingival perio debridement
- initial debridement
- debridement of a furcation, deposits before oral surgery
- removal of ortho cement and overhanging margins
What are the contraindications for the use of a power driven scaler in people with systemic health conditions?
- communicable disease
- susceptibility to infection
- respiratory risk
- swallowing difficulty
- cardiac pacemaker
What are the contraindications for the use of a power driven scaler in people with oral conditions?
- avoid demineralized areas
- exposed dentinal surfaces
- children
what can vibrations do to children?
- developing tissues are sensitive
- vibrations and heat may cause damage to pulp
What are precautions for using a power driven scaler with restorations?
- porcelain- fracturing, loss of marginal integrity
- amalgam- surface defects, loss of marginal integrity
- composite- surface alterations
Should an US be used on titanium implants?
yes it can be sued with a specially designed plastic shealth
What are the risk considerations for using a power driven scaler for the clinician?
- cumulative trauma (can help reduce risk of carpal tunnel)
- magnetic fields
What are the risk considerations for using a power driven scaler for the patient?
Heat production- may damage pulp if water and moving arent used
-hearing shifts- extended exposure to noise may be damaging
What is another name ofr a conventional or standard tip?
universal
What are universal tips generally used for?
-moderate to heavy deposit supra or sub
What is periodontal or narrow profile tip used for?
better access to subgingival surfaces, superior coverage of deep pockets and furcations
magnetostrictive thin tips must be used on what power
low to medium
piezoelectric thin tips may be used on what power
high
What kind of narrow profile tips remove calc rapidly
beveled and bladed
what kind of thin tip are effective for fine scaling and root planing
diamond coated tips on low power
What is plastic or carbon composite tip used for?
to protect vulnerable restorative surfaces such as implants or esthetic materials
What is the universal shape of an instrument?
slightly curved, to be used throughout dentition
what is the contra-angle shape of an instrument?
- curvatures to left and rt to adapt to posterior surfaces of teeth
what is the beavertail shape of an instrument?
supragingival surfaces for removal of heavy stain, calc and ortho cement
What is the thin periodontal shape of an instrument?
straight or contra designed for subgingival instrumentation
What are the 2 ways water is delivered from an instrument?
external, internal
What kind of grasp is used in US scaling?
modified pen, light grasp
What kind of stroke is used in US scaling?
moderate to slow pace with a feather-light though to prevent tooth damage
What should you do following US scaling?
complete the procedure with manual instruments
The US scaler without power can be used as what only?
a probe
With each mm of tip loss there is a corresponding loss of
power
What happens if your stroke is too rapid?
fast movement is ineffective for deposit removal
What renders the vibrations ineffective?
lateral pressure
What do you evaluate in an immediate evaluation?
teeth and gingiva
What is examined of the teeth in an immediate evaluation?
-observation and exploration for a smooth surface
what is examined of the gingiva in an immediate evaluation
-gingival changes are not apparent immediately after instrumentation
When does tissue regeneration and initial healing occur after instrumentation?
a few days
when can the areas instrumented be probed?
2 weeks after
what is the objective of tx?
create an environment in which the gingival tissue can heal and be maintained in health by the patient
What information should be included in printed patient take home instructions?
- possible discomfort to expect
- rinsing
- toothbrushing
- eating
- where to call in case of a problem
What are the solutions suggested for use in rinsing?
Hypertonic salt solution
sodium bicarbonate solution
what directions are given for rinsing?
every 2 hours, after eating, after tb, before retiring
what does rinsing with a warm solution do?
sooths tissues, improves circulation which helps healing
WHen is chlorohexidine indicated following instrumentation?
when a patient has, NUG, necrotizing ulcerative perio, and advanced perio
What are the recommendations for tb after instrumentation?
soft brush is recommended
What should a patient eat after having tx?
- anesthesia- avoid solid until it has worn off
- if tissues are tender avoid strong, spicy seasonings
- soft or liquid diet if needed
What do we hope for after instrumentation?
-no bleeding on probing
-lower probe depths
-inflammation resolved
-normal gingiva
-
What factors effect healing?
- severity of infection
- noncompliance of pt
- tobacco use
- systemic (diabetes, lowered defense)
- incomplete debridement
What do we see in the resolution of imflammation?
edemarecedes, necrotic cells gone, tissue regengeration
what do we see in the clinical attachment in healing?
long epithelial attachment
What are the changes in the subgingival pocket flora?
changed from anaerobing gram negitive motile to aerobic gram positive non motile
what is the effect of the conversion of microorganisms?
they are changed to health producing gram positive flora
Without personal daily biofilm control what can happen?
microorganisms return to pretreatment levels in 42 days
Where do endotoxins occur?
in bacteria covering the cementum and in the cementum
When can a follow up appt be scheduled for patient?
2 weeks
What procedures should be included in the assessment iin a follow up evaluation?
perio probing
tactile evaluation- bleeding points evaluated for residual calc
Why do we reinstrument at a follow up appointment?
remove any remaining calculus
What do you do with a patient who has not responded adequately to non surgical therapy?
refer to a periodontist
What factors are taken into account in determining a maintenance schedule?
soft tissue response, changes/stabilization, demonstrates effective biofilm control, motivation, responsibility, psycho social factors
What sterilization method should be avoided with US tips?
dry heat
What happens with worn out US tips when instrumenting?
incapable of removing deposit, it is only burnished
What is the principle objective in the location of a broken instrument?
to know positively that the tip has been removed
what immediate action takes place in the care of a broken instrument?
- stop procedure
- don’t move pt. head
- isolate
- dont use a/w syringe
- don’t alarm pt
what should you do in the examination of an area in the care of a broken instrument?
- don’t dry with air
- use careful retraction to examine immediate area
- use transilluminating
- examine sulcus, use a spoon like stroke of curet
what do you do in tx of a broken instrument?
- apply magnetized retrieving instrument
- consult with dentist for assistance
- prepare an x-ray
what do you do if you do not find the broken tip in any of the procedures?
arrange for a perio surgical procedure
