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Periodontal Instrumentation. Handle, Shank, Working End. HANDLE. Shank. Head. HANDLE. Shank. Shank. HANDLE. Shank. Use of the Dental Mirror. Indirect vision Illumination Reflection of light Transillumination Reflection of light “through” the tooth surface Especially for calculus
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Handle, Shank, Working End HANDLE Shank Head HANDLE Shank Shank HANDLE Shank
Use of the Dental Mirror • Indirect vision • Illumination • Reflection of light • Transillumination • Reflection of light “through” the tooth surface • Especially for calculus • Retraction
Modified Pen Grasp • Most efficient grasp • Control – Stability • Pivot Point
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
Establishing a Finger Fulcrum • Stability • Activate instrument - stroke • pivot • Control - prevents injury • Always on a stable oral structure • Occlusal plane, mandible, zygoma • Ring finger
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
Extra-Oral Fulcrum • Extraoral • Maxillary arch • Posterior teeth
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
Instrument Identification • Name, design number, manufacturer • Determined by use • Probes • Explorers • Curets • Sickles • Hoes • Files • Chisels
The Probe • Primary instrument in the periodontal exam • Assess gingival health • Periodontal status • Exploratory • Requires skill development
Probe Design • Vary in cross-sectional design • Rectangular in shape (flat) • Oval • Round • Millimeter markings • Calibrated at varying intervals
Marquis Probe • Color coded • 3, 6, 9, 12 mm markings • Thin working end • Key is to know the increments • Type of probe being used
Use of the Probe • Inserted to the Junctional epithelium • Measures sulcus • Periodontal pockets • Gingival recession • Attachment loss
Angulation • Probe is parallel to long axis of tooth
Interproximal Angulation • Slightly tilted • Apical to the contact point Not enough angulation Too much angulation Correct angulation
Adaptation • Working end is well-adapted to tooth surface
Technique • Gently “walk” the probe
Readings • Six readings • Distal (DB & DL) • Buccal (B) or Lingual (L) • Mesial (MB & ML) • Deepest reading within the designated areas
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
Design Characteristics • Standard or Finishing (non-rigids) • Rigid • Extra Rigid • Extended Shanks • Different Blade sizes • Regular • Mini
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
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
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
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
Blade Adaptation to Tooth Surface 0° <45° 45-90° > 90° Ideal Calculus Removal insertion Healthy tissue Plaque removal Tissue Trauma
Adaptation of lower third of blade to tooth surface Incorrect Toe 1/3 Correct Lower 1/3 Incorrect Middle 1/3
Relationship of Lower Shank to Blade Angulation Lower shank Too far Toe is coronal Lower shank parallel Lower shank To far forward
Working Stroke oblique vertical horizontal circumferential
Face Cutting edge Cutting edge Lateral surface Lateral surface Back Basic Design Characteristics of the Working end of Instruments Lateral surface Cross section
HEEL TIP TOE Curet Toe vs Sickle Tip
Uses • Supragingival calculus • Stain • Slightly subgingival (1-2mm)
Different Designs • Anterior teeth • Posterior teeth • Modified shank • Blade can vary in size & design
Design Characteristics • Straight rigid shank • Two cutting edges • Straight or slightly curved • Back of the instrument • Pointed or rounded
INCORRECT CORRECT Adaptation
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
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
Visual Guide to Instrumentation • Lower shank is parallel to surface being scaled • Vertical stroke
CLINIC DEMONSTRATION • H6/7Sickle Scaler • Shank slightly curved • Review on clinic floor 15 H6/7 33
TYPES OF UNIVERSAL CURETTES • Columbia • Barnhart • Bunting • Goldman • Younger-Good • Langer (gracey shank)
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