Peridontics : 3/non-Surgical Periodontal Therapy : Instrumentation/ First Semester

Front 1

what are the objectives and goals of peridontal instumenrtaion ?

Back 1

 The objective removal of calculus and
bacterial plaque biofilm is the physical
removal of microorganisms & their
products to prevent & treat periodontal
infections

 Most subgingival plaque biofilm within
pockets cannot be reached by brushes,
floss, or mouth rinses

Front 2

talk about the rationale for peridontal insturmentation

Back 2

 To arrest progress of periodontal disease

To induce positive changes in the
subgingival bacterial flora(count &
content)

To eliminate inflammation in the
periodontium

To increase the effectiveness of patient
self-care

To prevent recurrence of disease during
periodontal maintenance

Front 3

Scaling and root planing are
measures which can be effective
in:

Back 3

Eliminating Inflammation
Reducing Probing Depths
Improving Clinical Attachment

Front 4

Define peridontal debridemnt

Back 4

Removal or disruption of bacterial plaque
biofilm, its byproducts, & plaque retentive
calculus deposits from coronal tooth
surfaces & tooth root surfaces to the extent
needed to reestablish periodontal health

Front 5

define scalling

Back 5

instrumentation of the crown and
root surfaces of the teeth to remove plaque
biofilm, calculus, and stains (supra &
subgingival)

Front 6

define root planning

Back 6

process by which
embedded calculus & “softened cementum”
are removed from the roots to produce
smooth, hard, clean surface

Front 7

Scaling and root planing are not separable
procedures (performed at the same time) , true or fasle ?

Back 7

True

Front 8

define root debridment

Back 8

removal of plaque
and/or calculus from the root surface
without the intentional removal of tooth
structure (more appropriate term)

Front 9

define gingival currtage

Back 9

scraping of the
gingival lining of a periodontal pocket. This
is performed to remove necrotic tissue
from the pocket wall

Front 10

List the classifcation for peridontal insturements

Back 10

1) Calclaus removal instuerments :
sickle scalers
curtes
peridontal files

2) Assessment insturments :
periodntal probes
explorers

Front 11

list the three insturments parts

Back 11

handle , shak and a working end

Front 12

what are the three insturemtns shank designs avalbile

Back 12

a) stright
b) curved
c) contra-angled

Front 13

what are the uses of exploreres ?

Back 13

 Locate calculus deposits and caries
 Check the smoothness of the root surfaces after root planing

Front 14

talk about probes

Back 14

Periodontal probes are used to measure
the depth of pockets and to determine
their configuration

Front 15

describe the typical probe

Back 15

The typical probe
◦ Tapered, rod like instrument
◦ Calibrated in millimeters
◦ Blunt, rounded tip

Front 16

talk about scalling , root planning and curetteage insturments

Back 16

Used for :
 removal of biofilm and calcified deposits
from the crown and root of a tooth
 removal of altered cementum from the
subgingival root surface
 debridement of the soft tissue lining the
pocket

and inculde :
 Manual instruments (scalers - curettes )
 Mechanical instruments (sonic, hyposonic)
 Rotary instruments (burrs)
 Alternating movement instrument

Front 17

talk about scalers

Back 17

 Used primarily to remove large deposits of
supragingival calculus
 Triangular in cross section
 Have two straight cutting edges and a
pointed tip

Front 18

talk abotu curettes

Back 18

Used to remove subgingival calculus,
smooth rough root surfaces (root planing),
and remove the diseased soft-tissue lining of
the periodontal pocket (soft-tissue
curettage)

 Semicircular in cross section

Converge in a rounded toe

Front 19

Scalers Vs. Curettes

Back 19

I. Diameter
II. Tip
III. Cross sectional
IV. Adaptation
V. Use

Front 20

Talk about the types of currets

Back 20

1) Universal :
Paired instrument adapts
to all four tooth surfaces

◦ Blade :
 Curved in one plane
 Has two straight cutting
edges
 Face angled at 90 degrees
to the terminal shank

2) Gracey :
Area specific

blade :
 Curved in two planes
 Only one cutting edge
 Offset or tilted at a 60- to
70-degree angle to the
terminal shank

Front 21

Grecy VS . Currete :

Area of use

cutting edge

curvature

Offest blade

Back 21

Grecy currete ---- Universal currete

Area of Use Set of many curette designed for specific
areas & surfaces

one curette designed for all areas &
surfaces

=========================
Cutting edge :

Use One cutting edge used; work with outer edge
only

Both cutting edges used; work with
outer or inner edge

============================

Curvature :
Curved in two planes; blade curves up & to
the side (cutting edge curve from shank to
toe)

Curved in one plane : blade curves up
not to side (cutting edge extend
straight from shank to toe )
Angle with
shank

=================

Offset blade :
face of blade beveled at 70
degrees to shank makes one cutting edge is
lower than the other, & that lower end is
used for instrumentaion

Not offset : face of blade beveled at
90 degree to shank

Front 22

Go to slides 35 , 36 and see where we use the grecy curretes

Back 22

go see it

Front 23

talk about grecey currete modifcations ---> talk first abotu the extended shank curretes which is After five

Back 23

1)) The Gracey #15-16
• modification of the
standard #11-12
• #11-12 blade + #13-
14 shank.


2))) The Gracey #17-18
• modification of the
#13-14.
• terminal shank
elongated by 3 mm
• more accentuated
angulation of the

3)) After Five curettes (Hu-Friedy,
Chicago) :

◦ Terminal shank is 3 mm longer
◦ Thinned blade
◦ Large-diameter, tapered shank.



All standard Gracey numbers except for the #9-10

Front 24

talk about grecey currete modifcations ---> talk about the mini blade curettes

Back 24

Modifications of the After
Five curettes

Blades that are half the
length of the After Five or
standard Gracey curettes
(allows easier insertion
and adaptation in :
◦ Deep, narrow pockets
◦ Furcations
◦ Developmental grooves

Front 25

talk about grecey currete modifcations ---> talk about the micro mini blade curettes

Back 25

Blades that are 20% thinner and smaller than the Mini
Five curettes

Smallest of all curettes

 Provide exceptional access and adaptation to tight,
deep, or narrow pockets; narrow furcations;
developmental depressions; line angles; and deep
pockets on facial, lingual, or palatal surfaces

Front 26

talk about hoe , chiesl and file saclers

Back 26

 Used to remove tenacious
subgingival calculus and
altered cementum

Their use is limited
compared with that of
curettes

Front 27

talk about Plastic and Titanium Instruments
for Implants

Back 27

Used on titanium and other implant
abutment materials to avoid scarring
and permanent damage to the
implants

Front 28

powered insturements

Back 28

Power instrumentation has the
potential to make scaling less
demanding, more time efficient,
and more ergonomically friendly

Front 29

talk about the diffrent types of power insturments

Back 29

1) sonic :
 Work at a frequency of 2000 to 6500
cycles per second
 Use a high or low speed air source from
the dental unit
 Tips are large in diameter and universal
in design
 Tip travels in an elliptical or orbital stroke
pattern

2) Ultrasnoic Scalers :
 works by converting very high frequency sound
waves into mechanical energy in the form of very
rapid vibrations
 A spray of water at the tip prevents the buildup
of heat and provides a continuous flushing of
debris and bacteria from the base of the pocket

3) Magentostrctive ultrasonic :
 Work in a frequency range of 18,000 to
50,000 cycles per second
 Metal stacks that change dimension
when electrical energy is applied
 Vibrations travel from the metal stack to
a connecting body that causes the
vibration of the working tip
 Tips move in an elliptical or orbital stroke
pattern

4) Piezolectraic Ultrasonic :
 Work in a frequency range of
 18,000 to 50,000 cycles per second
 Have ceramic discs that are located in
the hand piece & change in dimension as
electrical energy is applied
 Move in a linear pattern, giving the tip
two active surfaces.

Front 30

talk about the tip designs for the powered insturments

Back 30

1) Large diameter tips :
Universal design and are indicated for the removal of large,
tenacious deposits

2) :  Thinner diameter tips may be site specific in
design
1) Straight
2) Right and left contra-angled instruments
(allow for greater access and adaptation to root morphology)

Front 31

List the advantages of mechanized (powered ) inturments compared to that of manual insturmetns

Back 31

 Increased efficiency
 Multiple surfaces of tip
are capable of
removing deposits
 No need to sharpen
 Less chance for
repetitive stress injuries (why ? ) ---> (Handpiece size large)
 Reduced lateral
pressure

Front 32

List the disadvantages of mechanized (powered ) inturments compared to that of manual insturmetns

Back 32

 More precautions and
limitations
 Client comfort (water
spraying)
 Aerosol production
 Temporary hearing
shifts, Noise
 Less tactile sensation
 Reduced visibility

Front 33

List the Mechanized instruments precautions

Back 33

 Unshielded pacemakers
 Infectious diseases: human immunodeficiency virus,
hepatitis, tuberculosis (active stages)
 Immunosuppression from disease or chemotherapy
 Demineralized tooth surface & exposed dentin (especially
associated with sensitivity)
 Restorative materials (porcelain, amalgam, gold,
composite)
 Titanium implant abutments unless using special tips
 Children (primary teeth)

Front 34

List the Mechanized instuement CONTRAINDCTIONS

Back 34

 Chronic pulmonary disease: asthma,
emphysema, cystic fibrosis, pneumonia
 Cardiovascular disease with secondary
pulmonary disease
 Swallowing difficulty (dysphagia)

Front 35

talk about the clincal outcomes of power-driven insturments

Back 35

Remove biofilm bacteria, and calculus
through mechanical action

In the furcation area,
the point of a sonic
instrument removes
bacterial plaque
more
efficiently

Front 36

talk about the clincal outcome of power-driven insturements treatment in the case of : chronic peridontits

Back 36

 Tt of chronic periodontitis
◦ single-rooted teeth :
No difference in the efficacy of subgingival
debridement using ultrasonic/sonic scalers vs
hand instruments
◦ multirooted teeth
A benefit for could not be determined because of a
lack of clinical data
 No differences in outcomes between sonic,
magnetostrictive, and piezoelectric scalers.

Front 37

talk about the polishing instruments

Back 37

 Polishing can reduce sonic scaling root surface
roughness
 It also removes any pigmentation left by
smoke, food and drugs (chlorhexidine)
 different procedures
◦1)Rubber cups
◦ 2)Bristle brushes (stiff so should be confined to the
crown to avoid injuring the cementum and the gingiva)

Front 38

talk about "rotary instuements "

Back 38

 use of diamond burrs to remove residues
of calculus and softened root cementum
◦ confined to devitalized teeth transformed into
prosthetic abutments

Also used to remove natural plaque- retentive areas
(odontoplasty of grooves, ridges, irregularities)

Front 39

talk about " alteranting movment insturemtns "

Back 39

 useful in removing calculus and planing
the approximal surfaces of the roots
 also used to remove the excess contours
of iatrogenic interproximal fillings

Front 40

give examples about alternating movment insturments

Back 40

1) strip holders
2)eva system

Front 41

General princples of insturementaion : Accessibility

Back 41

 Clinician :
◦ neutral position with
his/her feet flat on the
floor with the thigh
parallel to the floor
◦ Forearms parallel to the
floor
◦ back straight
◦ head erect

Front 42

General princples of insturementaion : Accessibility

Back 42

 Patient
◦ In a supine position &
placed so that the mouth
is closed to the resting
elbow of the clinician
◦ Upper: chin raised
slightly
◦ Lower: the chair (45
degree) & lower chin
until the mandible is
parallel to the floor

Front 43

look at the slide 86

Back 43

go look at it

Front 44

General princples of insturementaion :Visibility, illumination & retraction

Back 44

 Direct vision with direct illumination is the
most desirable , if not possible use the
mirror for indirect vision or indirect
illumination
 Retraction provides visibility, accessibility
& illumination.
 Fingers &/or the mirror are used for
retraction

Front 45

General princples of insturementaion : Condition of instruments
(sharpness)

Back 45

Every instrument should be clean,
sterile & in good condition

Working ends of pointed or bladed
instruments must be sharp

Front 46

General princples of insturementaion : mainting a clean field

Back 46

Adequate suction is essential for ejecting
saliva, blood & debris
 Compressed air & gauze square can be
used to facilitate visual inspection

Front 47

General princples of insturementaion : Instrument stabilization

Back 47

 Stability & control are essential for effective
instrumentation & avoidance of injury to the
patient or clinician
 2 major factors are important for providing
stability:
1. instrument grasp
◦ Modified pen grasp is the most effective & stable grasp
that ensures the greatest control.
2. finger rest (fulcrum)

Front 48

General princples of insturementaion : resting the hand

Back 48

 To maintain control of the
instrument
 improving stability and efficiency
while minimizing the risk of
damage to surrounding tissues .

Front 49

look at slide 93

Back 49

go look at it

Front 50

General princples of instuementaion : Instrument Activation

Back 50

1.Adaptation :
Refers to the manner in which working end
of a periodontal instrument is placed against
the surface of a tooth.

2.Angulation :
Refers to angle between the face of a
bladed instrument & the tooth surface

3.Lateral Pressure :
Refers to the pressure created when force
is applied against the surface of a tooth
with the cutting edge of a bladed
instrument

4. Strokes :
Activated by push or pull motion in vertical
or horizontal or oblique

Exploratory stroke: light feeling stroke to
evaluate the dimensions of the pocket & to
detect calculus & irregularities of the tooth
surface with maximum tactile sensation

Scaling stroke: short powerful pull stroke
(vertical or oblique)

Root planning stroke: moderate to light pull
stroke used for final smoothing & planning of the
root surfaces

Front 51

Subgingival scaling & root planing
technique

Back 51

 Step 1
The pocket is
probed and the solid
concretion is
identified

 Step 2
The curette is rested
on the tooth with the
rounded back towards
the gingiva

 Step 3
◦The curette is pushed
under the gingiva,
delicately moving the
gingival tissue
◦If calculus is
encountered on the root,
the curette is moved
away from the tooth,
shifting the soft tissues
until the obstacle is
passed.


 Step 4
When the depth of the
pocket has been
reached, the blade of
the curette is engaged
in the root cementum
and moved with an
apical-coronal
movement

Step 5
The apical-coronal
movement of the
curette is repeated a
number of times to
remove the softened
surface of the root
cementum

Step 6
When the sensation is
of scraping a hard,
smooth surface, root
planing is complete

Front 52

PRINCIPLES OF INSTRUMENTATION
WITH ULTRASONIC

Back 52

 A modified pen grasp is used with an
ultrasonic scaler along with an extra-oral
fulcrum
 Light pressure is needed with a power
instrument.
 Increased clinician pressure on the tip causes
decreased clinical efficacy
 The tip is traveling at a set frequency in a set
stroke pattern with removal from the coronal
to the apical portion of the deposit.

Front 53

Number of Appointment

Back 53

 depend on the
◦ No. of teeth in the mouth
◦ severity of inflammation
◦ amount & location of calculus
◦ depth & severity of pockets
◦ present of furcation invasions
◦ patient comprehension of & compliance with
oral hygiene instructions
◦ for local anesthesia

Front 54

Limitations of Non-Surgical Therapy

Back 54

Pocket depths :
◦ Residual calculus likely in deeper
pockets
◦ Average pocket depth for adequate
removal approx. 3.73 mm
◦ Clinical approach: curettes with longer
shanks

 Furcations
◦ Access difficult – residual calculus likely
◦ Opening to furcation often smaller than
diameter of periodontal instrument
◦ Clinical approach: use of slimline inserts

Root anatomy :
◦ Depressions on proximal surfaces
◦ Clinical approach: knowledge of root
anatomy