Periodontal Instrumentation

1. Periodontal Instrumentation Grasp, Fulcrum, Wrist Motion, Using the Periodontal Probe

2. Handle, Shank, Working End HANDLE Shank Head HANDLE Shank Shank HANDLE Shank

3. Use of the Dental Mirror • Indirect vision • Illumination • Reflection of light • Transillumination • Reflection of light “through” the tooth surface • Especially for calculus • Retraction

4. Modified Pen Grasp • Most efficient grasp • Control – Stability • Pivot Point

5. Modified Pen Grasp Thumb & Index finger opposite at junction of handle & shank Handle is between junction of the first and second joint of the index finger Pad of middle finger against the shank (side of pad) Fingers are a “unit” Left hand grasp Right hand grasp

6. Establishing a Finger Fulcrum • Stability • Activate instrument - stroke • pivot • Control - prevents injury • Always on a stable oral structure • Occlusal plane, mandible, zygoma • Ring finger

7. Intraoral As close to working areas as possible Approximately two teeth away Do not fulcrum on the same tooth Mandibular arch Maxillary anterior teeth FulcrumsIntraoral

8. Extra-Oral Fulcrum • Extraoral • Maxillary arch • Posterior teeth

9. Wrist Motion • Side to side • Up and down • Activated by pivoting fulcrum finger • Wrist must be straight to activate stroke - movement of instrument • Will be demonstrated on the presenter

10. Instrument Identification • Name, design number, manufacturer • Determined by use • Probes • Explorers • Curets • Sickles • Hoes • Files • Chisels

11. The Probe • Primary instrument in the periodontal exam • Assess gingival health • Periodontal status • Exploratory • Requires skill development

12. Probe Design • Vary in cross-sectional design • Rectangular in shape (flat) • Oval • Round • Millimeter markings • Calibrated at varying intervals

13. Marquis Probe • Color coded • 3, 6, 9, 12 mm markings • Thin working end • Key is to know the increments • Type of probe being used

14. Use of the Probe • Inserted to the Junctional epithelium • Measures sulcus • Periodontal pockets • Gingival recession • Attachment loss

15. Angulation • Probe is parallel to long axis of tooth

16. Interproximal Angulation • Slightly tilted • Apical to the contact point Not enough angulation Too much angulation Correct angulation

17. Adaptation • Working end is well-adapted to tooth surface

18. Technique • Gently “walk” the probe

19. Readings • Six readings • Distal (DB & DL) • Buccal (B) or Lingual (L) • Mesial (MB & ML) • Deepest reading within the designated areas

20. Gracey Curets

21. Gracey Series • Anterior Teeth • 5/6 all surfaces of anteriors/premolars • Posterior Teeth (next week) • 7/8 Buccal & Lingual Surfaces • 11/12 Mesial Surfaces • 13/14 Distal Surfaces • 15/16 Mesial Surfaces • 17/18 Distal Surfaces

22. Design Characteristics • Standard or Finishing (non-rigids) • Rigid • Extra Rigid • Extended Shanks • Different Blade sizes • Regular • Mini

23. Face Cutting edge Cutting edge Lateral surface Lateral surface Back Design Characteristics • Area specific • Adapt to a specific area or tooth surface • Two curved edges with a blade • Only one cutting edge is used for calculus removal

24. Design Characteristics • Working end is tilted in relationship to the terminal shank (offset by 70°) • Makes one cutting edge lower than the other • This lower end is the one that is used for instrumentation

25. Identification of the Cutting Edge • Place shank perpendicular to floor • Lower blade is the cutting edge • Lower shank will be parallel to surface being scaled

26. Advantages of Design Characteristics • Allows insertion into deep pockets • Prevents tissue trauma • Correct cutting edge to tooth surface angulation • Easier adaptation • Around convex tooth crowns to access root surfaces

27. Adapting the Curet Blade

28. Blade Adaptation to Tooth Surface 0° <45° 45-90° > 90° Ideal Calculus Removal insertion Healthy tissue Plaque removal Tissue Trauma

29. Adaptation of lower third of blade to tooth surface Incorrect Toe 1/3 Correct Lower 1/3 Incorrect Middle 1/3

30. Relationship of Lower Shank to Blade Angulation Lower shank Too far Toe is coronal Lower shank parallel Lower shank To far forward

31. Calculus Removal“Channeling”

32. Review of Fundamentals of Instrumentation

33. Working Stroke oblique vertical horizontal circumferential

34. Face Cutting edge Cutting edge Lateral surface Lateral surface Back Basic Design Characteristics of the Working end of Instruments Lateral surface Cross section

35. HEEL TIP TOE Curet Toe vs Sickle Tip

36. Comparison of Curets & Sickle Blades

37. Sickle Scaler

38. Uses • Supragingival calculus • Stain • Slightly subgingival (1-2mm)

39. Different Designs • Anterior teeth • Posterior teeth • Modified shank • Blade can vary in size & design

40. Design Characteristics • Straight rigid shank • Two cutting edges • Straight or slightly curved • Back of the instrument • Pointed or rounded

41. Adaptation

42. INCORRECT CORRECT Adaptation

43. ANGULATION

44. Technique • Divide tooth structure in 3rds • Distal line angle towards interproximal • Mesial line angle towards interproximal • Labial or Lingual Surface • Graceys or Universals • Mesial & Distal • Vertical stroke

45. Visual Guide to InstrumentationAnterior Teeth • Handle extends upward/parallel to long axis of teeth when interproximal • Does not apply to Facial or Lingual surfaces • Oblique stroke is best • Alternative instruments are better than sickle • Prevent tissue trauma

46. Visual Guide to Instrumentation • Lower shank is parallel to surface being scaled • Vertical stroke

47. CLINIC DEMONSTRATION • H6/7Sickle Scaler • Shank slightly curved • Review on clinic floor 15 H6/7 33

48. Universal Curets

49. TYPES OF UNIVERSAL CURETTES • Columbia • Barnhart • Bunting • Goldman • Younger-Good • Langer (gracey shank)

50. Design Features • Can adapt to all tooth surfaces • 90 degree blade angulation • shank curvature allows adaptation • both cutting edges are used • blade curved on only one plane