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CSP3 YR5- Restorative RESET > Periodontal instrumentation > Flashcards

Periodontal instrumentation Flashcards

1
Q

Periodontal hand instruments? Types and use?

A

Sickle scaler - supragingival

Curettes - subgingival

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2
Q

Scaling - Definition?

A

Instrumentation to remove deposits from the surface of a tooth apical to the gingival margin accumulated in periodontal pockets or the surface coronal to the gingival margin

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3
Q

Root surface debridement (RSD) - Definition?

A

Instrumentation of the diseased root surface without deliberate removal of the cementum.
The goal is to conserve cementum and help maintain or re-establish a health periodontal environment

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4
Q

Sickle scaler? Type? Purpose? Parts? Technique of use?

A

Universal sickle S204 (adapted to every tooth)

Remove medium and large sized deposits from the supra and sub marginal area of the tooth

Working tip projecting from the shank at roughly a right angle and having a sharp pointed end (2 cutting edges) (triangular)

Keep working shank parallel to the long axis of the tooth, to create the correct angulation:

  • tilt towards tooth
  • tip third to tooth surface
  • explore over the surface and over deposits
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5
Q

Periodontal examination? The 3 main parts?

A

General description of the periodontal condition
Periodontal screening using the BPE
Detailed exam of the periodontal tissues and recording of the periodontal indices

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6
Q

General description of the periodontal condition? Presence of?

A
  • gingival inflammation
  • swelling
  • loss of contour
  • gingival recession
  • suppuration
  • supra and subgingival plaque
  • calculus deposits
  • occlusal problems (drifting)
  • local periodontal risk factors
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7
Q

The BPE probe - Use? Parts? Pressure? Sextants?

A

The WHO BPE:

  • 0.5mm spherical ball tip to aid detection of subgingival calculus deposits and limit penetration at the base of the pocket
  • black band 3.5-5.5mm to delineate normal sulci and periodontal pockets
  • recommended probing force of 20-25g

Use: sextants;

  • sextants are 7-4, 3-3 and 4-7
  • must contain at least 2 teeth
  • if only 1 tooth is present add it to the adjoining sextant
  • probe is ‘walked around’ and the highest score recorded
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8
Q

BPE scoring codes? 0-4*?

A

0: Pocket <3.5mm
- no calculus/overhand, no BOP (black band visible)
1: Pocket <3.5mm
- no calculus/overhand, BOP (black band visible)
2: Pocket <3.5mm
- supra or subgingival calculus/overhand, BOP (black band visible)
3: Probing depth 3.5-5.5mm
- black band partially visible, indicating pocket of 4-5mm
4: Probing depth >5.5mm
- black band disappears, indicating pocket of >6mm or more
* : furcation involvement

Code 3: initial therapy including self-care advice then, post-initial therapy, record a 6-point pocket chart in sextant only

Code 4: record a 6-point pocket chart throughout the entire dentition

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9
Q

Code 0 - Clinical signs? Management?

A

All black band visible
No bleeding on probing
No management needed

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10
Q

Code 1 - Clinical signs? Management?

A

All black band visible
No calculus or defective margins
Bleeding on probing

Management:

  • chart gingival bleeding, disclose and chart plaque
  • individualised OHI and prophylaxis
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11
Q

Code 2 - Clinical signs? Management?

A

All black band visible
Supra or subgingival calculus detect or defective margins of crown/restoration

Management:

  • chart gingival bleeding, disclose and chart plaque giving OHI
  • remove defective margins, plaque retentive factors, including supra and subgingival calculus
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12
Q

Code 3 - Clinical signs? Management?

A

The black band is partially visible

Management:

  • initial therapy including self care, OHI and risk factor control, then post initial therapy by recording a 6 point pocket chart in that sextant only (recording depths above 4mm
  • RSD if required
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13
Q

Code 4 - Clinical signs? Management?

A

The black band disappears
(above 6mm)

Management:

  • chart gingival bleeding, disclose and chart plaque giving OHI
  • remove defective margins, plaque retentive factors, including supra and subgingival calculus
  • full periodontal exam of all teeth (recording pockets 4mm and above)
  • once oral hygiene is achieved, RSD where necessary
  • review after 8-12 weeks
  • assess the need for further treatment (supportive periodontal therapy)
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14
Q

When not to use a BPE?

A

It can’t be used to monitor the response to therapy as it doesn’t give enough detail of individual sites

For patients that have undergone initial therapy for periodontitis and who have gone on to the maintenance phase

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15
Q

BPE overview?

A
  • If BPE = 0, screen again at routine recall visit or within 1 year, whichever the sooner
  • If BPE = 1 or 2, treat and screen again at routine recall or after 6 months, whichever the sooner
  • If BPE = 3, record full probing depths (6 sites per tooth) on the index tooth and check other teeth in the sextant, treat (OHI and root surface debridement (RSD) and review after 3 months
  • If BPE = 4 or *, undertake full periodontal assessment and consider referral
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16
Q

Types of curettes?

A
  • Universal: two cutting blades
  • Gracey curettes: one off set blade
  • Many others
17
Q

Purpose of curettes?

A
  • Subgingival instruments with long shanks and off set blades used to refine root surfaces
  • Difficulty can arise when removing large tenacious deposits (long shank may result in burnishing deposits)
  • Site specific
  • Difficult to identify shank
18
Q

Characteristics of a Gracey curette?

A
  • Single cutting edge

- Double ended instruments

19
Q

Different designs of Gracey curettes?

A
  • Area specificity
  • Offset blade
  • One cutting edge
  • Blade curves in 2 planes
20
Q

Area specificity of Gracey curettes?

A
  • Designed to maximise accessibility and adaptability to root surfaces (treat periodontitis)
  • necessary for the instrument to be specific due to diverse complexity of root surfaces
21
Q

Manipulation of a Gracey curette?

A
  • Modified pen grip
  • Action by combination of wrist and digital movement
  • One long stroke used
  • Instrument cleaned before re-introduction
  • Suction throughout aid visibility (reduce time)
22
Q

1-2 Gracey? Area?

A
  • (3-3) all anterior teeth all surfaces
23
Q

7-8 Gracey? Area?

A
  • (4-7) all posterior teeth
  • buccal, lingual and palatal surfaces
  • not to be used interdentally
24
Q

11-12 Gracey? Area?

A
  • (4-7) Mesial surface of all posterior teeth only
25
Q

13-14 Gracey? Area?

A
  • (4-7) Distal surface of posterior teeth only
26
Q

Root surface debridement (RSD) - limitation? clues? Carrying out a RSD?

A 
Limitations:
- impossible to see root surface
- rely on non-visual clue
Non-visual clue:
- explorer probe to identify the shape, deposits and furcations
- radiographs (shape)
- visualise a mental picture of root
RSD process:
- help of LA
- post-OP sensitivity
- activate stoke efficiently
- strict OHI (reduce bacterial plaque)

CSP3 YR5- Restorative RESET (44 decks)

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