10. Periodontal Instrumentation Flashcards

1
Q

• Do remove some levels of ____, in addition to supra- and subgingival plaque

A

cementum

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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

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3
Q

Right-Handed Clinician vs. Left-Handed Clinician

A

Take a look

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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

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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

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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

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7
Q

Take a look at the hierarchy!

A

YAY

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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

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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

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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

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11
Q

GRACEY

Hold terminal shank ____ to the floor and find the ____ as cutting edge to adapt to tooth surface

A

perpendicular

lower edge

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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

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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

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14
Q

• Always instrumenting only a small ____mm band

A

1-2

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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

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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

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17
Q

• Point toe in direction you’re going to be ____; here going to scale distal surface of 9

A

scaling

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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

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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

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20
Q

GRACEY 13/14

• Distals of \_\_\_\_ teeth
A

posterior

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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

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22
Q

• Universal curet can be used everywhere in the mouht, unlike the ____

A

gracey’s

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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
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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
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25
Q
  • 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
A

rounded

90

26
Q

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
A

calculus detection
furcation
ODU 11/12

universal curets

27
Q

Polishing

• \_\_\_\_ prophy paste > not damaging anything; light touch, control speed
A

fine

28
Q

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!
A

5000
5000
reductor

29
Q

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
A

bulky
metal

floss
debriding

ultrasonic

30
Q

Power scalers

• Sonic > \_\_\_\_, not used much anymore

Ultrasonic >
• ____ > cavetron, not used much anymore
- ____

A

air-driven
magnetostrictive
piezoelectric

31
Q

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
A

mechanical
acoustic micro streaming
vibrations
clears

32
Q

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
A
cavitating
surface
point
6
subgingival
33
Q

Ultrasonic Variables
____
____ Level
____ Level

A

frequency
power
fluid

34
Q

Ultrasonic Variables Tuning = Frequency

Definition: Number of
cycles per second
Cycle: One complete \_\_\_\_ or \_\_\_\_ stroke path
Measured in \_\_\_\_:
i.e., 30kHz = \_\_\_\_ cycles/second
A

linear
elliptical
kilohertz
30,000

35
Q

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
A

powerful
light

powerful
moderate
heavy

calculus
SRP

36
Q

Water Flow

Tip tuned for Calculus Removal : Med -High Power Setting

Tip tuned for Deplaquing : Low - Med Power Setting

SKIPPED

A

Read over just in case

37
Q

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)
A

metal strips
mechanical
rubber-band

38
Q
  • 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
A

point
back
lateral

39
Q

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 \_\_\_\_
A
elliptical
linear
lateral
ceramic discs
hot
heavy
40
Q

• Green = ____, cannot use green in blue zone, will break in high power

A

low power

41
Q
  • 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)
A
heavy
deeper
depth
markings
green
42
Q
  • 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 = ____
A

one
2
30
fine

endo
surgery

43
Q

• ____ green; ____ blue

A

1-5

10-15

44
Q

Piezo

* \_\_\_\_ grasp
* Fulcrum, \_\_\_\_ wrist > not as critical with ultrasonics as hands
* \_\_\_\_ fulcrums
A

feather-like
neutral
extraoral

45
Q

Modified Ultrasonic Adaptation
• Position insert like a ____
• “____”

• Most > adapt insert like you would use a probe
A

probe

vertical adaptation

46
Q

Traditional Ultrasonic Adaptation
• Position insert like a ____
• “____”

• Good for \_\_\_\_ surfaces using the lateral surface
A

sickle
oblique
proximal

47
Q

• 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)

A

third
L
R
back

pitch

48
Q

Curet Insertion
Cutting edge must be below ____

• Start at \_\_\_\_ and stroke is \_\_\_\_, start apically and go \_\_\_\_
A

deposit
base
coronally
coronally

49
Q

Ultrasonic Insertion

As the tip is inserted ____, deposits are removed as they are encountered

• Ultrasoinc, start \_\_\_\_ and end up \_\_\_\_
A

apically
coronally
apically

50
Q
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
A

sweeping
coloring
horizontal
oblique

long axis
huge

51
Q
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 \_\_\_\_
A

shielded
medical

evacuation
pre-procedural
COPD

choke

margins

52
Q

Instrument Sharpening

* \_\_\_\_ back > subging safe
* \_\_\_\_ > two cutting edges > ends in point
A

rounded

sickle

53
Q
  • Red lines, cutting edges

* ____ and ____ > sharpen both sides

A

universal

scaler

54
Q

Rotating Stone Technique

• Hold stone in right hand, and hold instrument in \_\_\_\_ hand
A

non-dominant

55
Q

Principle for positioning the instrument

Position the working end of a universal, site specific curet or sickle scaler with the face ____ to the floor

A

parallel

56
Q

Establishing Correct Stone Angulation

____ or
____ o’clock

A

100-110

one

57
Q

Positioning the Stone

Goal:
preserve instrument ____

A

design

58
Q

Sharpen in ____

Rotate the Stone: ____, ____,
____

• Divide working into thirds > heel, middle, toe
A

sections
heel
middle
toe

59
Q

Sharpening Universal Curets

Right and Left!

A

Ya!

60
Q

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 ____
A

gauze
curet
x-ray
faculty