Final Review Flashcards
1
Q
What is the correct seating postiion to gain access to the anterior towards area?
A
8 to 9 o clock
2
Q
What is the correct working position to gain access to away anterior surfaces?
A
11 to 1 o clock
3
Q
What is the correct seating postion for posterior aspects facing toward the clinician?
A
9 o’clock
4
Q
What is the correct seating postion for posterior aspects facing away from the clinician?
A
10 to 11 o’clock
5
Q
What instrument mesures hand strength?
A
a Dynamometer
6
Q
What are the different types of mouth mirrors?
A
Front surface, concave, plane (flat surface)
7
Q
What are some of the features and uses of a front surfce mirror?
A
- Reflecting surface is on front surface of the glass
- Produces a clear mirror image with no distortion
- Most commonly used type because of good image quality
- Reflecting surface is easily scratched
8
Q
What are some of the charateristics of a concave mouth mirror?
A
- Reflecting surface is on front surface of the mirror lens
- Produces a magnified image
- Not recommended because magnification distorts the image
9
Q
What are some of the characteristics of a plane (flat surface) mouth mirror?
A
- Produces a double image (ghost image)
- Durable, resists scratching because the reflecting surface is on the back of the mirror lens
- Not recommended because double image is distracting
10
Q
What are some of the functions of a dental mouth mirror?
A
- Indirect vision
- Retraction
- Indirect illumination
- Transillumination
11
Q
What is the GREATEST asset for detection and removal of deposits?
A
Touch
12
Q
What is pinch force?
A
The force used to grasp the handle during instrumentation. Larger handle diameters and lightweight handles require less pinch force.
*repetitive forceful pinching of an instrument can be a risk factor for carpal tunnel.
13
Q
When choosing the right instrument handle, what is recommended?
A
- Lightweight handle
- Large diameter
- Tapered handle
- Raised texturing (knurling pattern)
14
Q
When is a periodontal instrument “balanced”?
A
A periodontal instrument is balanced if the working-ends are aligned with the long axis of the handle.
15
Q
What is the significance of using a balanced periodontal instrument?
A
- Ensures that finger pressure applied against the handle is transferred to the working-end for calculus removal
- An instrument that is not balanced is difficult to use and stresses the muscles of the hand and arm
16
Q
A shank that is bent in one plane (front to back) is classified as having what?
A
a simple shank design
17
Q
A shank that is bent in two planes (front-to-back and side-to-side) to facilitate instrumentaion that is for posterior teeth is classified as having what type of design?
A
a complex shank design
18
Q
An instrument with a _____shank will withstand the pressure needed to remove heavy calc deposits.
A
rigid
19
Q
An instrument that will not withstand the pressure needed to remove heavy calc deposits but works well to remove small and medium-sized deposits might have a _______ shank.
A
flexible
20
Q
Which portion of the shank allows the working-end to be adapted to the tooth surface?
A
- the functional shank, it may be short or long
- it begins below the working end and extends to the last bend in theshank nearest the handle
21
Q
Which portion of the functional shank is nearest to the working end?
A
-the terminal shank; it may be standard or extended
22
Q
What identifies the school or individual originally resposible for the design and development of an instrument or group of instruments?
A
the design name
23
Q
What number designation when combined with the design name provides the exact identification of he working-end?
A
design number
24
Q
When the design name and number of an instrument is marked along the long axis of the handle, how would each working end be identified?
A
each working end would be identified by the number closest to it
25
When the design name and number is marked around the handle, how would each working-end be identified?
the first number (the one on the left) identifies the working-end at the top end of the handle and the second number identifies the working-end at the lower end of the handle
26
What type of instrument is this?
A slender instrument used to evaluate the health of the periodontal tissues.
(Blunt, rod-shaped working-end)
periodontal probe
27
**What type of instrument is this?**
- Used to locate calculus deposits, tooth irregularities, and defective restoration margins
- Circular in cross section
explorer
28
**What type of instrument is this?**
## Footnote
- Used to remove supragingival calculus deposits
- Triangular in cross section
- Pointed tip
- Pointed back
sickle scaler
29
**What type of instrument is this?**
## Footnote
- Used to remove calculus deposits
- Semi-circular in cross section
- Rounded toe
- Rounded back
curet
30
**What type of instrument is this?**
- Used to crush large calculus deposits
- Each working-end has several cutting edges
periodontal file
31
Define myelination
this is the process of forming a myelin sheath around a nerve to allow nerve impulses to move more quickly
32
Define automaticity.
this is the ability to perform a skill smoothly, easily, and without frustration
33
The _____ the finger rest is positioned to the tooth being instumented, the greater the level of hand control.
closer
34
What type of instrumentation is typically used whenever physical strengh is not required? It may also be acceptable in areas where movement is very restricted?
digital motion activation
35
The wrist rocking motion of activation employ the use of the \_\_\_\_\_, \_\_\_\_\_, & \_\_\_\_\_\_.
hand, wrist, and arm
36
\_\_\_\_\_\_\_\_ is used principally when moving around the line angle and onto the proximal surface of a tooth? This technique assists the clinician in keeping the working end against the tooth as it moves around the tooth.
Pivoting
37
38
**True or False**
The roots of all maxillary teeth incline inward.
True
39
The roots of the mandibular anterior teeth usually tilt \_\_\_\_\_\_.
The roots of the mandibular premolars are usually positioned more _____ & the roots of the mandibular molars tilt slightly \_\_\_\_\_\_.
inward; vertical; outward
40
What is the act of positioning the first 1 to 2 mm of the working-end’s lateral surface in contact with the tooth?
Adaptation
41
What are the three imaginary sections of the working end?
–Leading-third
–Middle-third
–Heel-third
42
What is the leading-third of the working-end?
the toe or tip third; this end is ALWAYS in contact with the tooth surface.
In some cases, both the leading-third and the middle-third of the working-end can be adapted to the tooth
43
How should you select the correct working-end?
- observe the relation of the **LOWER** (terminal) shank to the **DISTAL** surface of the tooth.
- for posterior teeth, the lower shank is parallel to the distal surface of the tooth and the funtional shank goes "up and over" the tooth
44
What are the two types of instrumentation strokes?
calculus removal strokes and exporatory strokes to detect calculus
45
The _______ \_\_\_\_\_\_\_ is the soft epithelial tissue forming the base of a gingival sulcus. This area could be injured by sharp cutting edges or tips of instruments.
Junctional epithelium
46
What direction are instrumentation strokes made in?
a coronal direction, away from the soft tissue base of the sulcus or pocket
47
When are vertical strokes used?
- On anterior teeth; vertical strokes are used on the facial, lingual, and proximal surfaces.
- On posterior teeth; vertical strokes are used on mesial and distal surfaces.
48
When are oblique stroke used?
-they are used on the facial and lingual surfaces of posterior teeth
49
When are horizonal strokes used?
- At line angles of posterior teeth
- In furcation areas
- In deep, narrow pockets
- On the narrow root surfces or anterior teeth
50
What type of stroke is used to locate calculus deposits or other tooth surface irregularities hidden beneath the gingival margin?
assessment stroke
51
What type of instrumentation stroke is used with sickle scalers and curets to remove calculus deposits from the tooth?
calculus removal stroke
52
What type of instrumentation stroke is used to remove residual calc deposits, plaque biofilm, and byproducts from root surfaces exposed due to gingival recession or within deep periodontal pockets?
root debridement stroke
53
Tiny deposits remaining on the root surface that can be removed using the lighter pressure of a root debridement stroke are termed.
residual calc deposits
54
What is a root debridement stroke characterized by?
a shaving stroke made with moderate pressure with the cutting edge against the tooth cementum. This stroke is slightly longer than a calc removal stroke.
55
Why is conservation of cementum an important goal of instrumentation?
Because it is believed that cementum enhances healing of the soft tissues after instrumentation. In health, an important function of cementum is to attach PDL fibers to the root surface.
56
Why should complete removal of cementum be avoided?
Research studies have shown that complete removal of cementum from the root surface, exposing the dentinal tubules, may allow bacteria to travel from the periodontal pocket to the pulp.
57
What is the purpose of the assessment stroke and what instruments can be used?
to assess tooth anatomy, detect calc, and other plaque retentive factors. A _probe_, _explorer_ or _curet_ may be used to accomplish this.
58
What is the purpose of the calculus removal stroke and what instruments may be used?
to lift calc deposits off of the tooth surface; sickle scalers and curets may be used
59
What is the purpose of the root debridement stroke and what instruments may be used?
to completely remove all residual calc deposits & disrupt plaque biofilm from root surfaces within deep periodontal pockets; area specific curets may be used.
60
What are the differences between the lateral pressure applied between the assessment, calc removal, and root surface debridement strokes?
**_assessment stroke_**- only feather light pressure glides over the tooth surface
**_calc removal stroke_**- firm pressure is applied so that the cutting edge "bites" into the tooth surface
**_root surface debridement stroke_**- moderate pressure is applied so that the cutting edge will "shave" the root surface
61
What is the probe design?
- Working-end is **blunt** and rod shaped
- Cross section may be circular or rectangular
- Calibrated with millimeter markings
62
What do findings from a the periodontal probe help determine?
Findings from an examination with a periodontal probe are used to determine the health of the periodontal tissues.
63
What are some of the uses of a periodontal probe?
- Measure sulcus and pocket depths
- Measure clinical attachment levels
- Determine the width of the attached gingiva
- Assess for the presence of bleeding
- Measure the size of oral lesions
- Measure longitudinal response of periodontium to treatment
64
What type of probe is this?
- The UNC 15 probe
- It has millimeter markings at 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, and 15 mm.
65
What type of probe is this?
- Color-Coded Probe
- Marked in bands with each band being several millimeters in width
This example is marked at 3, 6, 9, and 12 mm.
66
In health, the probing depth should be from ________ mm in depth.
1-3
67
What is the "free gingiva"?
this is the unattached portion of the gingiva that surrounds the tooth in the region of the CEJ. It fits closely around the tooth in a turtleneck-like manner, but is not attached to it.
68
What is the gingival sulcus?
Sulcus defined as the distance from the gingival margin to the coronal-most part of the junctional epithelium. It is a shallow, V-shaped *space* between the free gingiva and the tooth surface
69
What is a periodontal pocket?
A gingival sulcus that has been deepened by disease; depth is greater than 3 mm.
It forms from apical migration of the JE and destruction of periodontal fibers and bone.
The JE is now located somewhere on the root of the tooth.
70
What is a gingival pocket?
it is deepening of gingival sulcus caused by detachment of coronal portion of JE and swelling of tissue. In some cases of gingivitis, the gingival tissue swells resulting in an increased probing depth known as a "pseudo-pocket".
71
What is a probing depth?
-The distance in millimeters from the gingival margin to the base of the sulcus or periodontal pocket as measured with a probe
72
**True or False**
In health, the JE is located slightly apical to the CEJ and attaches along its entire length to the enamel of the crown.
True
73
**True or False**
## Footnote
Probing is the act of sliding the tip of a probe along the base of a sulcus or pocket for the purpose of assessing the health status of the periodontal tissues
False.
walking
74
The probe tip is ___ to ____ mm of the side of the probe.
1 to 2
75
**True or False**
## Footnote
The probe working-end is positioned as parallel as possible to the crown.
The probe must be parallel in the mesiodistal dimension and the faciolingual dimension.
The first statment is false; the second statment is true
\*\*The probe working-end is positioned as parallel as possible to the ROOT SURFACE\*\*
76
**True or False**
## Footnote
The JE that forms the base of a sulcus or pocket feels soft and flexible when touched with the probe tip.
When probing, move forward in 2-mm increments
The first statement is true; the second statement is false
\*\*move forward in **1-mm** increments\*\*
77
Is the probe removed from the sulcus with each stroke?
No
78
What is an appropriate stroke pressure?
A pressure exerted with the probe tip against the soft tissue base of the sulcus or pocket should be between **10 and 20 g.**
79
When recording probing depths, how many zones are recorded?
6
80
What are some of the various factors that can affect the accuracy of probing measurements?
–Position of gingival margin
–Interference from calculus deposits, overhanging restorations
–Amount of pressure applied
–Misread probe calibrations
81
What is the 2-step technique used to probe the mesial and distal surfaces of a tooth?
1. Walk the probe between the teeth until it touches the contact area.
2. Slant the probe slightly so that the tip reaches under the contact area. In this position, gently press downward to touch the soft tissue base.
82
When probing, what technique might help when trying to reach the distal surfaces of the maxillary molars?
Reposition the instrument handle to the side of the patient’s face to reach the distal surfaces of the maxillary molars.
83
An _______ is an an assessment instrument with a flexible wire-like working-end. It is used to detect subgingival calculus deposits and anatomic features
explorer
84
What are some of the different functions of an assessment instrument?
**Used to examine tooth surfaces for:**
- Calculus deposits
- Dental anomalies
- Anatomic features of the teeth
- Assess dental restorations and sealants
85
What type of explorer is this? What is it used to detect?
-Pigtail or cowhorn
--Used for calculus detection in normal sulci or shallow pockets extending no deeper than the cervical-third of the root
86
What type of explorer is this?
- Orban-Type
- Used for subgingival calculus detection on anterior root surfaces and facial and lingual root surfaces of posterior teeth
- Bent tip allows the back of the tip to be directed against the soft tissue base of the sulcus/pocket
87
What type of explorer is this?
11/12
- Smooth back of tip is in contact with soft tissue base of sulcus or pocket
- Complex shank excellent for anterior and posterior teeth & can be used in shallow sulci and deep pockets
88
What is the instrument of choice for calculus detection?
an explorer
89
Define tactile sensitivity
the ability to detect tooth irregularities, such as calculus deposits, by feeling vibrations transferred from the explorer tip to the instrument shank and handle.
90
What type of stroke should be short in length and involve many overlapping strokes?
assessment strokes
91
Exploratory/Assessment strokes should be about ___ to\_\_\_\_ mm in length.
Make many overlapping, multidirectional strokes to assess the entire root surface.
2 to 3 mm in length
92
**True or False**
When exploring proximal surfaces, you should always lead with the point of the explorer tip.
true
93
It is common for clinicians to fail to detect calculus deposits that are located near the line angles of posterior teeth & at the midlines of anterior teeth. What is the solution to this problem?
use horizontal strokes
94
What are the common types of calc formation?
- spicules
- ledge
- ring
- veneer
95
What type of sensation will small deposits yield?
there will be a gritty sensation as the explorer passes over the small calculus deposit. *“Inline skating over a few pieces of gravel"*
96
What type of sensation will large ledges of calculus yield?
You will feel the tip move out and around the raised bumpand return back to the tooth surface.
## Footnote
*“Skating over a speed bump in a parking lot”*
97
What type of sensation will an overhang restoration yield?
Explorer must move away from toothand over the restoration.
## Footnote
*“Skating over a section of a sidewalk that is higher than the adjacent section”*
98
What type of sensation will a deficient margin or restoration yield?
The explorer dips into trace the restoration.
## Footnote
*“Skating onto a section of pavement that is lower than the surrounding pavement”*
99
What type of sensation will carious lesion yield?
The explorer tip dips into a rough depression.
## Footnote
*“Skating into a pot hole”*
100
What is a cavitated lesion versus a noncavitated lesion?
_Cavitated lesion_—loss of the outer surface layer of the crown or root surface, usually needing restoration
_Noncavitated lesion_—result of demineralization of an area of tooth surface, usually is reversible or arrested with treatment
101
Why is early caries detection in a noncavitated stage important?
it will allow for remineralization
102
What are some of the disadvantages of using an explorer for caries detection?
- Unreliable for caries detection
- Firm pressure into pit or fissure may damage tooth surface more
- May interfere with remineralization of carious lesion
- A blunt probe is recommended for caries detection
103
What are the prerequisites for early caries diagnosis?
- Good lighting
- Clean tooth surface free of biofilm and deposits
- Three-way syringe with air/water to view tooth wet and dry
- Sharp eyes
- Blunt explorer or periodontal probe
- Bitewing radiographs
104
For calculus removal the face-to-tooth surface angulation is an angle between __ and __ degrees.
Between __ and __ is ideal.
45 and 90;
60 and 80
105
**True or false**
## Footnote
For calc removal, lateral pressure is created by applying pressure with ring finger and thumb inward against instrument handle
False
\*\*For calc removal, lateral pressure is created by applying pressure with index finger and thumbinward against instrument handle\*\*
106
Calculus removal should be done with ___ biting strokes.
long
107
Lateral pressure should be used on the stroke moving ___ from the gingiva (on the upward stroke
away
108
What are the three forces must be balanced as you prepare for an effective instrumentation stroke?
- Fulcrum finger is straight, supporting the hand
- Fulcrum finger presses down against the tooth surface
- Index finger and thumb press inward against instrument handle for lateral pressure
109
The ____ of a sickle is ________ to the _____ \_\_\_\_\_\_. It is NOT recommended for use on root surfaces.
face; perpendicular; lower shank
110
What is the correct angulation for an anterior and posterior sickle scaler?
Between 70 and 80 degrees
111
What are the steps of calculus removal?
- Stabilization
- Adaptation
- Angulation
- Lateral pressure
- Controlled, short strokes
- Various stroke directions
- Number of strokes
112
What type of scaler is used to remove medium-large size calculus deposits from the crowns of posterior teeth?
sickle scalers
113
What components make up the periodontium?
- the gingiva
- the PDL
- cementum
- alveolar bone
114
During insertion the face-to-tooth surface angulation is an angle between __ and __ degrees.
This angle is called a _____ angle since the face is closed against the tooth.
0 and 40 degrees; closed angle
115
Where is the "Get Ready" zone located?
middle-third of the crown
116
Define periodontal instrumentation
the removal or disruption of plaque biofilm, its byproducts, and calculus deposits from coronal and root surfaces.
The goal is to reestablish periodontal health and restore balance between the bacterial flora and the host’s immune response.
117
What is the rationale for subgingival instrumentation?
- Remove completely biofilm and calculus deposits
- Induce positive changes in the bacterial flora
- Create an environment that permits tissue healing
- Increase effectiveness of patient self-care
- Prevent recurrence of disease during periodontal maintenance
118
What is the true method of successful subgingival instrumentation?
the response of the tissue to the insrtumentation procedure, NOT the feeling of smoothness.
119
When should a patient who had inflammation and periodontal pockets prior to subgingival instrumentation return for a re-evaluation?
4-6 weeks after periodontal instrumentation; in some cases, it is not possible to determine the true tissue response for at least one month after the completion of periodontal instrumentation.
120
True or False
After periodontal instrumentaion, normally there is NO new formation of alveolar bone, cementum, or PDL
True
121
What is the correct angulation for root surface debridement?
60-70 degrees
122
A periodontal instrument is used to remove\_\_\_\_\_\_and \_\_\_\_\_sized calculus deposits from the crowns and rootsof the teeth
small and medium
123
What are the unique design characteristics of a universal curet?
- A rounded back
- A rounded toe
- Two cutting edges per working-end
- Semicircular in cross section
124
Universal curets can be used to remove\_\_\_\_\_\_ to \_\_\_\_\_-sized calculus deposits & can be used for supragingival and subgingival deposits without traumatizing tissue.
Universal curets can be used to remove small- to medium-sized (light-to-medium sized) calculus deposits on clinical crown and root surfaces.
125
What areas do beginning clinicians often miss calculus deposits in?
1. Distofacial and distolingual line anglesof posteriorteeth
2. Themidlinesof facial and lingual surfaces of anterior teeth
126
What is the periodontal attachment system?
a group of structures that work together to attachthe teeth to the maxilla and mandible.
127
To remain in the oral cavity, a tooth must be attached by:
1. Junctional epithelium: attaches the gingiva to the tooth
2. Fibers of the gingiva: a network of fibers that brace the free gingiva against the tooth
3. Periodontal ligament fibers: surround the root; one end attaches to the alveolar bone, the other to the cementum of the root
4. Alveolar bone: surrounds the roots of the teeth; forms the bony socket
128
What state of health is this gingiva in?
gingivitis or inflammation
129
What does gingivitis result in?
- Reversible damage to the gingiva
- NO damage to the periodontal ligament or alveolar bone
- Height of bone is the same as in health
130
What state of health is this gingiva in?
periodontitis
131
What does periodontitis result in?
- Permanent damage to the periodontal attachment system
- Damage to gingival connective tissue, periodontal ligament, and alveolar bone
- Creates a deep pocket
132
Note that in the two examples of the position of the gingival margin, the level of the alveolar bone is the SAME.
Do not be fooled into thinking that there is no bone loss by the position of the gingival margin.
133
What is a clinical periodontal assessment?
a fact-gathering process designed to provide a complete picture of a patient’s periodontal health status.
134
What is used to gather information for soft tissue lesions
A probe is used to determine the size of an intraoral lesion or deviation.
The findings should be documented in the patient’s chart or computerized record.
135
What measurements are gathered by a probe?
-an anterior-posterior measurement
a superior-interior measurement
- the raised height or depth of a lesion
- tooth mobility
136
Define tooth mobility
The loosening of a tooth in its socket, this may result from loss of bone support around the tooth.
137
What are the classifications of mobility?
**_Class 1_**
Slight mobility, up to 1 mm of horizontal displacement in a facial–lingual direction
**_Class 2_**
Greater than 1 mm but less than 2 mm of horizontal displacement in a facial–lingual direction
**_Class 3_**
Greater than 2 mm of horizontal displacement in a facial–lingual direction or vertical mobility
138
What does bleeding on probing represent?
- Bleeding on probing represents bleeding from soft tissue wall of pocket
- Sign of gingival inflammation
- Can occur immediately after probing, or be slightly delayed
- Observe each site before moving on to next site
139
When documenting the gingival margin level, how is recession recorded versus inflammation?
**A negative (-)number= margin significantly covers the CEJ**
“How much gingival tissue would be taken away (-)to return margin to normal position?”
**A positive (+)number= gingival recession**
“How much gingival tissue would be added (+) to return margin to normal position?”
140
Why is the width of the attached gingiva an important clinical feature for the dentist to keep in mind when planning restorative procedures?
If there is no attached gingiva, the dentist is limited in the types of restorations that can be placed.
(The attached gingiva extends from the base of the sulcusor pocket to the mucogingival junction.)
141
True or False
## Footnote
Probing depth readings can accurately indicate the level of the bone on the gingival margin even when it is not in its normal position, slightly above the CEJ.
False
## Footnote
Probing depth readings accurately indicate the level of the bone only IF the gingival margin is in its normal position, slightly above the CEJ.
142
Bone support must be calculated using what two measurements:
1. Probing depth
2. Gingival margin level
143
Define CAL
Clinical attachment level (CAL) is the estimated position of the structures that support the tooth as measured with a periodontal probe.
144
Define furcation
A furcation is the place on a multirooted tooth where the root trunk divides into separate roots.
145
Define furcation involvement
a loss of alveolar bone and periodontal ligament fibers in the space between the roots of a multirooted tooth.
Bone loss in the furcation area may be hidden beneath the gingival margin, or may be visible with recession.
146
Studies indicate furcation involvement detected more frequently in maxillary molars by clinical exam than by radiographs
-Conversely, furcation involvement detected more frequently in mandibular molars by clinical exam than by radiographs
the first statement is false, the second statement is true
-Studies indicate furcation involvement detected more frequently in maxillary molars by RADIOGRAPHS than by clinical exam
147
What are the features of Class I furcation involvement?
- Concavity can be felt with probe
- Probe tip cannot enter the furcation area
148
What are the features of Class II furcation involvement?
- Probe tip can partially enter the furcation
- Extends about one-third of the tooth
- NOT able to pass completely through
149
What are the features of Class III furcation involvement?
- Mandibular molars— probe passes completely through the furcation
- Maxillary molars— probe touches the palatal (lingual) root
150
What are the features of Class IV furcation involvement?
-Same as a class III except that the furcation is visible clinically due to tissue recession
151
Which cutting edge of a AS curet is used for calc removal?
the lower cutting edge (it is called the working cutting edge)
152
The tilted face of the AS curet is off-set at a ___ degree angularion.
70
153
True or False
Raise or lower the instrument handle until the lower shank is perpendicular to the floor to determine the correct wotking end of an AS curet.
True
154
155
How many instruments were in the ORIGINAL Gracey series
14
(modifications have been made to standard Gracey designs, including rigid shanks, extended lower shanks (3mm longer), miniature working-ends (50% shorter working end), and microminiature working-end versions (50% shorter and 20% thinner).
156
How many double-ended Gracey curets are needed to complete all FACIAL aspect posterior teeth?
two
157
What is a periodontal used for?
-A periodontal instrument that is used to prepare calculus deposits before removal with another instrument; it crushes or roughens a heavy deposit so that it can be removed with a sickle scaler or curet.
Files are limited in use to enamel surfaces, or on outer surfaces of calculus deposits & have a rigid shank
-must have a two-point contact
158
What are miniature langer curets recommended for?
Langer miniaturecurets are recommended for root surface debridement in deep narrow pockets, and adapts well into root furcations.
159
What are standard langer curets designed for?
Standard Langer curets are designed for instrumenting pockets 4 mm or lessin depth.
160
True or False
## Footnote
Standard area-specific curets are designed for use in periodontal pockets 4 mm or lessin depth.
Modified Gracey curets are designed for use in periodontal pockets greater than 4 mmin depth.
True
161
What are some of the characteristics of a micro-minature modified gracey?
Used in special areas of difficult access
- Ideal for fine deposit removal following instrumentation with other curets
- Longer lower shank (still extended 3mm); shorter working-end; 20% thinner than standard Gracey
162
What is the design of a vision curvette?
- Working-end is half the length of a standard working-end
- Working-end is more curved
The lower shank has two raised bands at 5 and 10 mm.
The bands provide a visual means of estimating the depth of a pocket.
163
How is the working end of a minature curvette identified?
An identification mark (+) on the handle near the junction of the shank, indicates the lower cutting edge.
164
What is a Quetin Furcation Curet?
- Quétin curets remove calculus from recessed areas of furcations where other curets can be too large.
- Working-end is a minature hoe available in 0.9 or 1.3 mm size.
- Cutting edge has rounded corners
165
What is an O'Hehir/DeMacro Debridement Curet?
- O’Hehir and DeMarco debridement curets have a tiny circular disk for a working-end.
- These curets are designed to smooth root surfaces and remove small residual deposits.
- The workingend is a tiny, circular disk
- The entire circumference of the working-end is a cutting edge
166
What is the purpose of a diamond coated instrument?
Diamond-coated instruments are finishing instruments for use after deposit removal
- Used with very light pressure and with multidirectional strokes
- Ideal for use in class III and class IV furcations
- Have no cutting edges
- Coated with very fine diamond grit
- Working-end design similar to Nabers furcation probe
- Used like an emery board to remove small remnants of calculus
167
What is a dental endoscope?
- An endoscope is an illuminated optic instrument used to view the interior of a body cavity or organ.
- Endoscopes have been used for many years in medicine.
- Recently, a dental endoscopehas been introduced
- Consists of a fiber optic camera covered with a disposable sterile sheath
- Subging visualization of root surface is magnified at 20x to 40x on a screen
168
What speed do sonic powered devices operate at?
Sonic powered devices—operate at lower frequency of 3,000 to 8,000 cycles per second
169
Ultrasonic powered devices, piezoelectric and magnetostrictive, devices operate at how many cycles per second?
‐Ultrasonic powered devices—operate at 18,000 to 45,000 cycles per second
170
\_\_\_\_\_\_ ______ use electrical energy to activate crystals within the handpiece to vibrate the instrument tip
‐
‐
Piezo devices
171
\_\_\_\_\_\_ ______ transfer electrical energy to metal stacksof nickel–iron alloy or to a ferrous rod to vibrate the insert
Magneto devices
172
What are some of the strengths of powered instrumentation?
‐Effectively removes supra- and subgingival calculus deposits
‐Effectively removes subgingival plaque biofilms
‐Slim tips reach deeper into periodontal pockets than hand instruments
‐Slim tips provide access to furcation areas
‐Waterirrigation flushes bacterial products from pockets
‐Instrumentationtime reduced
173
What is the mode of action for powered instrumentation?
‐Very rapid vibrations of powered working-end that create _microfractures in calculus deposits_ (gradual removal).
‐Constant stream of water exits near point of the working-end and is called _fluid lavage_ this is the water flowing through to the pocket and removing everything.
‐Water _dissipates heat_ caused by rapid vibrations
‐Water _flushes toxic products_ and bacteria from pocket
174
What is cavitation?
The formation of tiny bubbles. When the tiny bubbles collapse, they produce shock waves that may alter or destroy bacteria by tearing the bacterial cell walls.
175
What are the benefits of acoustic microstreaming?
- forceful flow if cavitational fluid
- enhances effectiveness beyond surface actually touched by the tip
176
When using a powered instrument, cleaning efficency is measured by _______ plus \_\_\_\_\_.
frequency + amplitude
177
What does the frequency of powered instrumentation measure?
Frequency—measure of how many times a powered working-end vibrates per second.
Compare the working-end frequency to car windshield wipers:
- _low frequenc_y-wipers only go back and forth a few times in a minute
- _high frequency_-wipers go back and forth many times in a minute
178
What does amplitude of powered instrumentation measure?
Amplitude—measure of how far (how long the strokes are) the powered working-end moves back and forth.
_Lower amplitude_—delivers a shorter, less powerfulstroke
_Higher amplitude_—delivers a stronger, more powerful stroke
179
Research finds no difference between efficiency of high-powered or medium-powered instrumentation;
To maximize patient comfort and minimize potential damage to tooth surface, the power setting should always be placed above the medium power setting
The first statement is true, the second statement is false
\*Research finds no difference between efficiency of high-powered or medium-powered instrumentation; to maximize patient comfort and minimize potential damage to tooth surface, the power setting should rarely be placed above the medium power setting\*
180
\_\_\_\_\_ vibrations and _______ strokes are ideal for removal of plaque biofilm.
Fewer, shorter
(Low Frequency, Low Amplitude)
181
\_\_\_\_ vibrations and ____ strokes; ideal for removal of tenacious calculus deposits
many; longer
(High frequency, high amplitude)
182
What is the stroke pattern for the magneto?
elliptical
183
What is the stroke pattern for a piezo?
linear
184
How should piezo devices be irrigated?
only the working-end needs to be cooled by water
185
How should magneto devices be irrigated?
handpiece and working-end shold be irrigated with water
186
True of False
The use of chemotherapeutic agent with ultrasonic instruments has been shown to enhance pocket depth reduction beyond that of instrumentation with water.
This statement is false
## Footnote
Use of chemotherapeutic agents with ultrasonic instruments **has not** been shown to enhance pocket depth reduction beyond that of instrumentation with water
187
What are the contraindications for powered instrumentation?
‐review patient medical and dental histories
- consider aerosol production
- respiratory problems, communicable disease transmission
- susceptibility to infection, cardiac implantable devices
- sensitive, demineralized teeth
- difficulty in swallowing
- titanium implant surfaces
188
189
What powered tip is best for standard size, moderate to heavy deposits in shallow pockets?
Standard tip
190
What powered tip removes light to moderate calculus deposits on anterior teeth and posterior root surfaces
slim perio tip
191
What type of powered instrument tip removes biofilm and light calculus deposits?
Round tip
192
What powered instrument design removes medium- to large-sized deposits?
flat lateral surfaces
193
A rule of thumb, ___ mm of wear results in approximately ___ less efficiency
‐A tip with ___ mm of wear should be discarded
1; 25%; 2
194
What is the active tip area of the powered instrument?
the last 2-4 mm of the lateral surfaces
195
What does nonsurgical periodontal therapy describe?
nonsurgical steps to eliminate inflammation in the periodontium
196
What are the goals of nonsurgical periodontal therapy?
‐Control the bacterial challenge to the patient
‐Minimize impact of systemic risk factors
‐Control impact of local environmental factors
‐Stabilize the attachment level
197
What is the primary cause of gingivitis and periodontitis?
plaque formation
198
Studies indicate following periodontal instrumentation, subgingival pathogens return to preinstrumentation levels in about __ to \_\_\_weeks
Research evidence shows periodontal maintenance should be performed every __ months or less to remove periodontal pathogens
9 to 11 weeks; 3 months
199
\_\_ _____ uses a combination of a glycine-based powder with water, and compressed air. It is delivered to tooth surface through air polishing tip/nozzle
Air polishing
200
‐A standard metal nozzled elivers a glycine-based powder in pockets up to \_\_\_mm
‐A site-specific plastic perio tip is used in pockets greater than ___ mm
4;4
201
How many millimeters has the Food and Drug Administration approved plastic perio tip for use in periodontal pockets?
up to 5 mm
202
Conventional air polishing is intended for ____ use only. What is the most common spray pweder used with this method? It is NOT recommended for use on exposed surfaces or root surfaces.
supragingival; the most common powder used is sodium bicarbonate
203
What are some of the indications for use of sodium bicarbonate?
‐Removal of supragingival plaque biofilm
‐Removal of extrinsic stain
‐Use on enamel surfaces
‐Cleaning of fissures prior to sealant placement
204
What are some of the advantages of glycine-based powders?
‐they are low-abrasive powders that may be used subgingivally
‐Have fine, round, soft particles
‐Gentle on soft tissues of the oral cavity and on subgingival epithelium
‐Feels gentle to the patient
‐Glycine first trialed in 2003, commonly used in Europe
‐80% less abrasive than sodium bicarbonate
205
What are the indications of use for glycine powder?
‐Removal of plaque biofilm and stain
‐Use on enamel
‐Use on cementum and dentin
‐Use within sulci or periodontal pockets up to 5 mm in depth
‐Use on restorative materials
‐Cleaning of fissures prior to sealant placement
‐Cleaning of implant surface
206
What are the precautions and contraindications for supragingival air polishing?
Contraindications for sodium bicarbonate powder include:
- patients on physician-directed sodium- restricted diet
- respiratory problems (aerosols created)
- immunocompromised patients (consult physician)
- pregnant or breastfeeding patients
- patients undergoing treatments (chemotherapy, radiation)
- patients with communicable infection
- history of allergic reaction to powder
- patients on medications that affect body’s acid–base balance (potassium, antidiuretics)
- presence of some composite, glass ionomer restorations (avoid margins of amalgams, crowns because of cements)
207
What are some of the precautions and contraindications for subgingival air polishing?
Contraindications for glycine powder include:
- respiratory problems
- patients undergoing treatments (chemotherapy, radiation)
- patients with communicable infection
- history of allergic reaction to powder
\*No sodium concern and is safe on all types of restorative materials including implants
208
What is iatrogenic facial emphysema?
‐a rare condition that results from accidental collection of air in the soft tissues of the face from pressurized air in dental procedures
‐Symptoms include:
- facial swelling
- crackling feeling of the face and neck area
- tenderness and pain
209
What are some dental procedures associated with emphysema?
use of high-speed dental handpieces, air/water syringes, taking impressions, and air polishing
