10. Periodontal Instrumentation Flashcards
(60 cards)
1
Q
• Do remove some levels of ____, in addition to supra- and subgingival plaque
A
cementum
2
Q
UPPER ARCH
Chair Back ____ to the floor, patient’s chin ____
LOWER ARCH
Chair back ____ angle to floor, patient’s chin ____
A
parallel
up
45deg
down
3
Q
Right-Handed Clinician vs. Left-Handed Clinician
A
Take a look
4
Q
• When positioning for lower and upper anterior sextant > imaginary line down the teeth; the surfaces toward you (yellow), you position yourself at ____ o’clock; surfaces away, you position yourself from ____ o’clock
A
9
12
5
Q
Modified Pen Grasp
* IMPORTANT * Thumb/forefinger, ring finger is \_\_\_\_, and \_\_\_\_ stays together * Working stroke > \_\_\_\_ finger flattens out > generates force to remove calculus, \_\_\_\_ is also pushing * Pad of third finger is on instrument shank > incorrect, want the \_\_\_\_ of the third finger, not the pad; if you work like this, you lose control and hinder maneuverability, and makes it difficult to execute a stroke
A
fulcrum
pinky
index
side
6
Q
FULCRUMS
* Fulcrum as \_\_\_\_ to the tooth you're working on as possible * Max > \_\_\_\_ fulcrum, three fingers on chin * Fulcrum = \_\_\_\_ point
A
closed
extra-oral
pivot
7
Q
Take a look at the hierarchy!
A
YAY
8
Q
Instrument Parts
! Terminal shank
! Working end
! The terminal shank is most important when adapting the ____
• IMPORTANT: terminal shank location; in between \_\_\_\_ and the first \_\_\_\_ begins
A
working end
working end
curve
9
Q
Periodontal Instrumentation
Gracey Curets
"Gracey 1/2, 7/8 (\_\_\_\_ teeth) " Gracey 7/8, (\_\_\_\_ teeth) "Gracey 11 /12 , 13/14, 15/16, (\_\_\_\_ teeth) ---" 11/12 and 15/16 used on direct \_\_\_\_ surfaces and \_\_\_\_ only ---" 13/14 used on \_\_\_\_ surfaces only
* \_\_\_\_ - more versatile gracey > use on anteronr and posterior * Know the instruments * They are all \_\_\_\_-specific, only for certain areas in mouth
A
anterior posterior posterior buccal/lingual mesials distal
7/8
site
10
Q
Working-end Design
* The one end is \_\_\_\_ > important for Gracey's > the cutting edge > apply to root surface * Offset angle to the terminal shank
A
lower
11
Q
GRACEY
Hold terminal shank ____ to the floor and find the ____ as cutting edge to adapt to tooth surface
A
perpendicular
lower edge
12
Q
Activating the Gracey
! Close face of blade while inserting ____
! Open angle of face at ____ degrees to tooth surface
! Maintain terminal shank ____ to
the surface you are instrumenting
* IMPORTANT * Line terminal shank with the surface that you're instrumenting > not the \_\_\_\_ of the tooth
A
subgingivally
70
parallel
long axis
13
Q
Angulation for Calculus Removal
* Enter sulcus > rounded back of gracey, and along the tissue and not traumatizing; establish terminal shank with the gracey * Inefficiently removing calculus (\_\_\_\_); but with 45 - less > it slips right over the calculus > \_\_\_\_ the calculus * Right > when burnish calculus when angle is too small > difficult to \_\_\_\_, and more difficult to \_\_\_\_
A
90
polishes
detect
remove
14
Q
• Always instrumenting only a small ____mm band
A
1-2
15
Q
ADAPTATION
• Always want to adapt; thumb and fore fingers, and roll, bc you constantly want to \_\_\_\_ the working end to the tooth surface
A
adapt
16
Q
Horizontal Stroke
* Any instrument for a horizontal stroke * Horizontal > directing the toe \_\_\_\_, and coming across the direct \_\_\_\_ or direct \_\_\_\_ of molars, and direct \_\_\_\_ of second molars
A
apically
buccal
lingual
distals
17
Q
• Point toe in direction you’re going to be ____; here going to scale distal surface of 9
A
scaling
18
Q
GRACEY 11/12 and 15/16
* Both for \_\_\_\_ surfaces of molars * 15/16 - has a bigger curve in the shank than the 11/12, allows you to get to your \_\_\_\_ and access \_\_\_\_ to reach areas
A
mesials
molars
difficult
19
Q
GRACEY 11/12 AND 15/16
Activation:
! Insert toe subgingivally at ____ line angle
! Strokes are activated across ____ and completion on ____ surface (proximal)
* Or \_\_\_\_ line angle * Same applies to the lingual
A
distal-buccal
buccal
mesial
distal-lingual
20
Q
GRACEY 13/14
• Distals of \_\_\_\_ teeth
A
posterior
21
Q
SCALERS
* Unlike gracey's, have two \_\_\_\_ edges > terminal shank > the face is \_\_\_\_ (at a right angle), one side is not lower than the other > two cutting edges * \_\_\_\_, \_\_\_\_-gingival only, \_\_\_\_ tip;
____ toe > indicated for ____ use)
A
cutting right anterior supra-gingival pointy
rounded
sub-gingival
22
Q
• Universal curet can be used everywhere in the mouht, unlike the ____
A
gracey’s
23
Q
WORKING STROKE
! Apply cutting edge (____ of working end) so that face of blade is angled at ____ degrees to tooth surface
! Begin at ____ of buccal/or lingual surface and move into the ____ surface
! Supragingival scaling stroke activated from gingival margin in a ____ direction
• If at \_\_\_\_ degree > the other side will traumatize
A
1/3 75-80 midline proximal coronal 90
24
Q
UNIVERSAL CURETS Columbia \_\_\_\_ and \_\_\_\_ ! A universal curet may be used in any \_\_\_\_ of the mouth ! \_\_\_\_ cutting edges on each opposite working end ! Terminal shank is used to \_\_\_\_ the placement on proximal surface and direction of \_\_\_\_ ! \_\_\_\_ toe = curet (safe subgingivally) ! May be used to remove supra and subgingival deposits effectively
• Columbia have \_\_\_\_ shanks > a lot of calculus, go first with the Columbia, and then follow up with the Gracey's
A
13/14 4R/4L area 2 guide activation rounded heavier
25
* Angle is tilted > want ____ back against the tissue and not as a ____ degree angle (75-80 degrees)
* Vertical stroke up the distal, at the DB line angle, take it out and use the left side, and do it until you do your stroke up the mesial
rounded
| 90
26
ODU 11/12 - ____
Nabers - ____ Detection
* Difference in design
* Feather-like grasp for the ____
* Use the same way as you use ____
* Toe end of right side, vertical stroke, at line angle > take out, and put left side on root surface > sweep with overlapping srokes over the direct buccal until complete stroke until come up mesial all while keeping terminal shank parallel
calculus detection
furcation
ODU 11/12
universal curets
27
Polishing
• ____ prophy paste > not damaging anything; light touch, control speed
fine
28
AIR DRIVEN HANDPIECE:
Reduce RPM’s to ____ with Reductor
* IMPORTANT
* Using slow handpiece > RPM at ____
* Using air turbine > use a ____ > get it separately from the window, and ask for it!
5000
5000
reductor
29
Implant Maintenance
* Do not adapt well bc they're too ____
* metal probe does not scratch implant, but start using a plastic in order to protect implant
• Get ____, pass through mesial to distal and crisscross > pull the floss so you're hugging the implant > ____ the abutment
* IMPORTANT
* Metal against metal scratches are important!
* Damages with ____, want to keep the implant smooth
bulky
metal
floss
debriding
ultrasonic
30
Power scalers
• Sonic > ____, not used much anymore
Ultrasonic >
• ____ > cavetron, not used much anymore
- ____
air-driven
magnetostrictive
piezoelectric
31
Mechanisms of Action
* ____
* Irrigation
* ____
* Mechanical > high energy ____ break up the calculus, etc > important: don't need to push hard, let it work
* Irrigiation > heats up, a lot of bleeding, ____ field
mechanical
acoustic micro streaming
vibrations
clears
32
Acoustic Micro Streaming
Forceful flow of ____ fluid
Enhances effectiveness beyond ____ actually touched by tip
* Power washing the tooth surface
* Flow of water > water extends beyond the ____ where the tip if touching the tooth (____-fold increase in ____ environment
```
cavitating
surface
point
6
subgingival
```
33
Ultrasonic Variables
____
____ Level
____ Level
frequency
power
fluid
34
Ultrasonic Variables Tuning = Frequency
```
Definition: Number of
cycles per second
Cycle: One complete ____ or ____ stroke path
Measured in ____:
i.e., 30kHz = ____ cycles/second
```
linear
elliptical
kilohertz
30,000
35
Power Stroke = Amplitude
! Shorter stroke: less ____ stroke, ____ deposits
! Longer stroke: more ____ stroke , ____ to ____ calculus removal
* Shorter stroke > 22yo, not a lot of ____, and to irrigate and debride, use on low power
* Longer stroke > high power, use on ____ patietns to break up calculus deposits
powerful
light
powerful
moderate
heavy
calculus
SRP
36
Water Flow
Tip tuned for Calculus Removal : Med -High Power Setting
Tip tuned for Deplaquing : Low - Med Power Setting
SKIPPED
Read over just in case
37
Magnetostrictive
Cavitron
• Insert > stacked ____ > vibrations go through insert and converts electrical energy into ____ energy > causes the vibrations (like a ____, stretches out and goes back in)
metal strips
mechanical
rubber-band
38
* Energy is dispersed in different ways
* ____ of tip > most powerful, do not want to apply point of tip on tooth surface > will damage
* Magneto > ____ and ____ surfaces are active parts
point
back
lateral
39
Piezo Electric
• Magneto - ____
• Piezo - ____, only the ____ surfaces are active, do not use the back of the piezo; used just like a universal curette
• Magneto has metal inserts, the piezo has ____ that generate vibs
○ Don't get as ____ - get away with using less water, and not as ____
```
elliptical
linear
lateral
ceramic discs
hot
heavy
```
40
• Green = ____, cannot use green in blue zone, will break in high power
low power
41
* Two different blue tips > one is blunter (better for ____ calculus deposits) and the other is like a perio probe > nice in ____ pocket bc you can gauage the ____ by looking at ____
* Can use blue in the ____ zone (can use high in the lower, cannot use low in high)
```
heavy
deeper
depth
markings
green
```
42
* When putting tip with wrench and tightening, turn until you hear ____ click and it's locked
* Next, purge the line (in morning for ____ mins, in bt patients you do for ____ s)
* Want a ____ spray
* Yellow = ____; orange = ____
one
2
30
fine
endo
surgery
43
• ____ green; ____ blue
1-5
| 10-15
44
Piezo
* ____ grasp
* Fulcrum, ____ wrist > not as critical with ultrasonics as hands
* ____ fulcrums
feather-like
neutral
extraoral
45
Modified Ultrasonic Adaptation
• Position insert like a ____
• “____”
• Most > adapt insert like you would use a probe
probe
| vertical adaptation
46
Traditional Ultrasonic Adaptation
• Position insert like a ____
• “____”
• Good for ____ surfaces using the lateral surface
sickle
oblique
proximal
47
• Terminal ____ > most important part of working part on ultrasonic (on both magneto and piezo)
○ Piezo > ____ or ____ terminal third; magneto > can use the ____ terminal third!
• When using piezo > high ____ > not adapted correctly (not a lateral surface, but the vibrations are too high/powerful)
third
L
R
back
pitch
48
Curet Insertion
Cutting edge must be below ____
• Start at ____ and stroke is ____, start apically and go ____
deposit
base
coronally
coronally
49
Ultrasonic Insertion
As the tip is inserted ____, deposits are removed as they are encountered
• Ultrasoinc, start ____ and end up ____
apically
coronally
apically
50
```
STROKE PATTERNS
!____ or ____ motion
!Overlapping
◦____
◦Vertical
◦____
◦Tapping
```
* Keep motion sweeping and coloring
* Horizontal - regard to ____ of tooth
* Tapping > one instance where you can use point when ____ chunks of calculus are present
sweeping
coloring
horizontal
oblique
long axis
huge
51
```
MEDICAL CONSIDERATIONS:
! Implanted electronic devices...
! Severe respiratory diseases (COPD,CF)
! Transmissible diseases (HIV,hepatitis)
! Difficulty swallowing (MS, muscular dystrophy, geriatrics)
```
```
DENTAL CONSIDERATIONS:
Newly erupted teeth/ large pulp chambers
Exposed dentin
Demineralized enamel
Crown and bridge and implants
```
* IED > no piezo's with pacemakers/defib's > now they make them ____; require ____ clearance
* COPD, CF > patient breathing in microbes; CDC > high ____, suction and ____ rinse (30s, listerine, CHX, etc.)
* HIV, hep > same as ____
* Geriatrics > all the water (piezo's use less H2O) > they feel like they're gonna ____
* Demineralized enamel > history of ortho and decalc on enamel > can look like calculus > be careful on these areas even when polishing
* Crown/bridge/veneer > careful with ultrasonics > be sure that you're placing tip on tooth and not ____
shielded
medical
evacuation
pre-procedural
COPD
choke
margins
52
Instrument Sharpening
* ____ back > subging safe
* ____ > two cutting edges > ends in point
rounded
| sickle
53
* Red lines, cutting edges
| * ____ and ____ > sharpen both sides
universal
| scaler
54
Rotating Stone Technique
• Hold stone in right hand, and hold instrument in ____ hand
non-dominant
55
Principle for positioning the instrument
Position the working end of a universal, site specific curet or sickle scaler with the face ____ to the floor
parallel
56
Establishing Correct Stone Angulation
____ or
____ o’clock
100-110
| one
57
Positioning the Stone
Goal:
preserve instrument ____
design
58
Sharpen in ____
Rotate the Stone: ____, ____,
____
• Divide working into thirds > heel, middle, toe
sections
heel
middle
toe
59
Sharpening Universal Curets
Right and Left!
Ya!
60
Sharpening Site Specific Curets
* When to sharpen •Instrument replacement •Medium and Fine Grit Stones
* Retrieving broken instrument tip
* Tip breaks > explain to patient, and that you broke it, keep head position and go in with ____ and try to retrieve; if still don’t get it > use ____ and scoop it out; if not > you need an ____
* Still don't have it > if swallows > consult with ____
gauze
curet
x-ray
faculty
