Perio Instru.ppt
-
Upload
sirdebordes -
Category
Documents
-
view
236 -
download
5
Transcript of Perio Instru.ppt
-
8/13/2019 Perio Instru.ppt
1/70
Periodontal Instrumentation
Grasp, Fulcrum, Wrist Motion,
Using the Periodontal Probe
-
8/13/2019 Perio Instru.ppt
2/70
Handle, Shank, Working End
Shank
Shank
Shank
HANDLE
HANDLE
HANDLE
Shank
Head
-
8/13/2019 Perio Instru.ppt
3/70
Use of the Dental Mirror
Indirect vision
Illumination
Reflection of light
Transillumination
Reflection of light through the tooth surface
Especially for calculus
Retraction
-
8/13/2019 Perio Instru.ppt
4/70
Modified Pen Grasp
Most efficient grasp
ControlStability
Pivot Point
-
8/13/2019 Perio Instru.ppt
5/70
Modified Pen Grasp
Left hand
grasp
Right hand
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
-
8/13/2019 Perio Instru.ppt
6/70
Establishing a Finger Fulcrum
Stability
Activate instrument - stroke
pivot
Control - prevents injury
Always on a stable oral structure
Occlusal plane, mandible, zygoma
Ring finger
-
8/13/2019 Perio Instru.ppt
7/70
Intraoral Fulcrum
Intraoral
As close to working
areas as possible Approximately two
teeth away
Do not fulcrum on the
same tooth Mandibular arch
Maxillary anterior
teeth
-
8/13/2019 Perio Instru.ppt
8/70
Extra-Oral Fulcrum
Extraoral
Maxillary arch
Posterior teeth
-
8/13/2019 Perio Instru.ppt
9/70
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
-
8/13/2019 Perio Instru.ppt
10/70
Instrument Identification
Name, design number, manufacturer
Determined by use
Probes
Explorers
Curets
SicklesHoes
Files
Chisels
-
8/13/2019 Perio Instru.ppt
11/70
Probe
Primary instrument in the periodontal exam
Assess gingival health
Periodontal status
Exploratory
Requires skill development
-
8/13/2019 Perio Instru.ppt
12/70
Probe Design
Vary in cross-sectional design
Rectangular in shape (flat)
Oval
Round
Millimeter markings
Calibrated at varying intervals
-
8/13/2019 Perio Instru.ppt
13/70
Marquis Probe
Color coded
3, 6, 9, 12 mm
markings
Thin working end
Key is to know
the increments
Type of probe
being used
-
8/13/2019 Perio Instru.ppt
14/70
Use of the Probe
Inserted to the
Junctional epithelium
Measures sulcus Periodontal pockets
Gingival recession
Attachment loss
-
8/13/2019 Perio Instru.ppt
15/70
Angulation
Probe is parallel to
long axis of tooth
-
8/13/2019 Perio Instru.ppt
16/70
Interproximal Angulation
Slightly tilted
Apical to the
contact point
Not enough
angulation
Correct
angulation
Too much
angulation
-
8/13/2019 Perio Instru.ppt
17/70
Adaptation
Working end is
well-adapted totooth surface
-
8/13/2019 Perio Instru.ppt
18/70
Technique
Gently walk the
probe
-
8/13/2019 Perio Instru.ppt
19/70
Readings
Six readings
Distal (DB & DL)
Buccal (B) or Lingual (L) Mesial (MB & ML)
Deepest reading within
the designated areas
-
8/13/2019 Perio Instru.ppt
20/70
GRACEY SERIES Anterior Teeth
5/6 all surfaces of anteriors/premolars
Posterior Teeth7/8 Buccal & Lingual Surfaces
11/12 Mesial Surfaces
13/14 Distal Surfaces15/16 Mesial Surfaces
17/18 Distal Surfaces
Gracey Curets
-
8/13/2019 Perio Instru.ppt
21/70
Design Characteristics
Standard or Finishing (non-rigids)
Rigid
Extra Rigid
Extended Shanks
Different Blade sizes
Regular
Mini
-
8/13/2019 Perio Instru.ppt
22/70
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
Lateralsurface
Face
Back
Cutting
edge
Lateralsurface
Cutting
edge
-
8/13/2019 Perio Instru.ppt
23/70
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 theone that is used for
instrumentation
-
8/13/2019 Perio Instru.ppt
24/70
Identification of the Cutting Edge
Place shank
perpendicular to
floor
Lower blade is
the cutting edge
Lower shank
will be parallelto surface being
scaled
-
8/13/2019 Perio Instru.ppt
25/70
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
-
8/13/2019 Perio Instru.ppt
26/70
Adapting the Curet Blade
-
8/13/2019 Perio Instru.ppt
27/70
-
8/13/2019 Perio Instru.ppt
28/70
Adaptation of lower third of
blade to tooth surface
Correct
Lower 1/3Incorrect
Middle 1/3
Incorrect
Toe 1/3
-
8/13/2019 Perio Instru.ppt
29/70
Relationship of Lower Shank
to Blade Angulation
Lower shank
parallel
Lower shank
Too far
Toe is coronal
Lower shank
Too far forward
-
8/13/2019 Perio Instru.ppt
30/70
Calculus Removal
Channeling
-
8/13/2019 Perio Instru.ppt
31/70
Review of Fundamentals
of Instrumentation
-
8/13/2019 Perio Instru.ppt
32/70
oblique vertical horizontal circumferential
Working Stroke
-
8/13/2019 Perio Instru.ppt
33/70
Basic Design Characteristics of the
Working end of Instruments
Lateral
surface
Cross section
Lateral
surface
Face
Back
Cutting
edge
Lateral
surface
Cutting
edge
-
8/13/2019 Perio Instru.ppt
34/70
Curet Toe vs Sickle Tip
HEEL
TIP
TOE
Comparison of Curets & Sickle
-
8/13/2019 Perio Instru.ppt
35/70
Comparison of Curets & Sickle
Blades
-
8/13/2019 Perio Instru.ppt
36/70
Sickle Scaler
USES :
Supragingival calculus
Stain
Slightly subgingival (1-2mm)
-
8/13/2019 Perio Instru.ppt
37/70
Different Designs
Anterior teeth
Posterior teeth
Modified shank
Blade can vary in size & design
-
8/13/2019 Perio Instru.ppt
38/70
Design Characteristics
Straight rigid
shank
Two cuttingedges
Straight or
slightly curved
Back of theinstrument
Pointed or
rounded
-
8/13/2019 Perio Instru.ppt
39/70
Adaptation
INCORRECT CORRECT
-
8/13/2019 Perio Instru.ppt
40/70
ANGULATION
-
8/13/2019 Perio Instru.ppt
41/70
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
-
8/13/2019 Perio Instru.ppt
42/70
Visual Guide to Instrumentation
Anterior 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
-
8/13/2019 Perio Instru.ppt
43/70
Visual Guide to Instrumentation
Lower shank is parallel to
surface being scaled
Vertical stroke
CLINIC
-
8/13/2019 Perio Instru.ppt
44/70
CLINIC
DEMONSTRATION
H6/7
Sickle Scaler
Shank slightlycurved
Review on clinic
floor
15
H6/7
33
-
8/13/2019 Perio Instru.ppt
45/70
TYPES OF UNIVERSAL
CURETTES Columbia
Barnhart
Bunting
Goldman
Younger-Good
Langer (gracey shank)
-
8/13/2019 Perio Instru.ppt
46/70
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
-
8/13/2019 Perio Instru.ppt
47/70
-
8/13/2019 Perio Instru.ppt
48/70
Blade Adaptation
-
8/13/2019 Perio Instru.ppt
49/70
Use of the Universal Curet :
Anterior teeth Both instrument ends will be used
Handle is parallel to long axis of tooth Adapt blade to mesial or distal
Initiate by starting at the tooth midline
Work towards the interproximal Refer to diagram on pages 183-184 in
Pattison
-
8/13/2019 Perio Instru.ppt
50/70
Type of Stroke Used
Oblique on buccal & lingual
Vertical on Mesial & Distal
-
8/13/2019 Perio Instru.ppt
51/70
Use of the Universal Curet :
Posterior Region
Select the working end that adapts to the
interproximal surface Lower Shank is parallel to mesial surface
Select blade that is in contact with the
mesial surface
Use from the distal line angle towards
mesial surface
-
8/13/2019 Perio Instru.ppt
52/70
-
8/13/2019 Perio Instru.ppt
53/70
Vertical Interproximal Stroke
Vertical Stroke on Mesial and Distal Surfaces
-
8/13/2019 Perio Instru.ppt
54/70
Posterior Scaling
with
Gracey Instruments
-
8/13/2019 Perio Instru.ppt
55/70
Gracey Curets
Area specific
Shank design
Blade design
Each working end is a mirror image
Blade identification
Allows for correct working end
Adaptation to surface being scaled
-
8/13/2019 Perio Instru.ppt
56/70
Lower third is
used for
calculus
removal
-
8/13/2019 Perio Instru.ppt
57/70
7/8 Gracey Curet
Buccal & Lingual Surfaces
Posterior teeth
Initiate stroke from the distal line angle
Finish stroke at the mesial line angle
Stroke used
Oblique or horizontal Lower shank is not parallel
stroke is towards midline
-
8/13/2019 Perio Instru.ppt
58/70
11/12 and 15/16
Gracey Curets Used on mesial surfaces of all posterior
Initiate stroke at mesial line angle and
continue towards the mesial-interproximalsurface
Each end is a mirror image
-
8/13/2019 Perio Instru.ppt
59/70
-
8/13/2019 Perio Instru.ppt
60/70
Exploratory vs Working Stroke
Blade is less than 45
Grasp is lighter
Tactile sensitivity is
enhanced
On the down stroke
Objective is to identify
depth of calculus
Blade is 45-90
Calculus removal
Firm grasp
Engage blade by
Adaptation or bite
On the up stroke
Vertical
Oblique
-
8/13/2019 Perio Instru.ppt
61/70
Adaptation
Degree of how open or closed the blade
is upon insertion is dependent on:
Type of tissue Fibrotic vs boggy or hemorrhagic tissue
Severity of disease
Retractable tissue
Interproximal embrasure
Tenacity of calculus
-
8/13/2019 Perio Instru.ppt
62/70
-
8/13/2019 Perio Instru.ppt
63/70
How well have we scaled?
At time of S/RP appointment
Exploring, probing
Smoothness of tooth surface
After appointment
Healthy periodontium
Decreased bleeding, pocket depths, marginalbleeding
-
8/13/2019 Perio Instru.ppt
64/70
Limitations
obscured vision from bleeding
tactile sensitivity
instruments selected
direction & length of strokes
confines of soft tissue - tissue type
tooth anatomy
clinical findings
mental image based on visual, mental, andmanual skills
-
8/13/2019 Perio Instru.ppt
65/70
Limitations
Accurate treatment plan
Anesthesia, number of appointments
Severity of Disease progression
Local factors
Systemic factors
Pockets, furcas, anatomical characteristics,
erosion, recession, mobility
-
8/13/2019 Perio Instru.ppt
66/70
Most common areas missed :
most apical portion of pocket
furcation areas & distal surfaces
primary reason: not overlapping strokes
-
8/13/2019 Perio Instru.ppt
67/70
Effects of scaling & root planing
reduction in inflammation
pocket depth reduction-- avg.. 1.36 mm0.8 mm in recession
0.52 in attachment attachment - maintained or slight gain
decreased mobility - fibers
reduction in gram-negative :spirochetes, bacteroides
conflicting results withA. Actinocytemcomitans
-
8/13/2019 Perio Instru.ppt
68/70
-
8/13/2019 Perio Instru.ppt
69/70
Sequence to Periodontal
Instrumentation Phase I Simple = 1 appointment
Simple case, light calculus, little sensitivity, controlledperiodontal condition, mild inflammation
Phase I Intermediate2 appointments Overdue, early Periodontitis 4-5 mm pockets,
Patient may require mouth anesthesia (Lower &upper quads avoid same arch)
Phase I Complex 4 appointment by quads with anesth, pockets, calculus,
furcations
Re-evaluation appointment
-
8/13/2019 Perio Instru.ppt
70/70
Sequence to Periodontal
Instrumentation Full mouth
Start in tooth sequence for plaque removal
Assess where calculus is presentAreas of inflammation
Two appointment
Anesthesia, upper & lower quad
Complex
Each quadrant with anesthesia