Powered Instruments for Periodontal Debridement

Question 1

how do powered instrumentation devices dislodge calculus

Answer 1

use a rapidly vibrating irrigated working end

Question 2

what do powered instruments usually consist of

Answer 2

an ultrasonic generator, a handpiece, interchangeable tips or inserts

Question 3

the three A’s of powered instrumentation

Answer 3

adaptation -2-3mm of insert tip
angulation - 0-15 degrees
activation - short, 2-3mm overlapping strokes

Question 4

primary goal of periodontal debridement

Answer 4

removal of bacterial plaque and by-products

Question 5

secondary goal of periodontal debridement

Answer 5

calculus removal

Question 6

therapeutic endpoint of periodontal debridement

Answer 6

decrease in microbial load

Question 7

clinical endpoint of periodontal debridement

Answer 7

tissue response

Question 8

hand vs powered instrumentation

Answer 8

ultrasonic inserts produce smoother roots with: the least amount of damage, better calculus and biofilm removal, less operator fatigue

Question 9

ultrasonic scalers

Answer 9

piezo and magneto

Question 10

magnetorestrictive ultrasonic scaler

Answer 10

electrical energy is applied to coils in handpiece and magnetically changes dimension of metal stack to produce vibrations
elliptical movement
four active surfaces… can use any side of the instrument

Question 11

piezoelectric ultrasonic scalers

Answer 11

electrical energy is applied to crystals in handpiece which emits vibrations
linear movement
two active surfaces… can only use lateral sides

Question 12

what is ideal for furcation due to easy access

Answer 12

thin ultrasonic inserts

Question 13

frequency

Answer 13

of strokes per second
does not change

Question 14

amplitude

Answer 14

length of stroke
affected by power setting and is adjustable
increase in power increases amplitude
decrease in power decreases amplitude

Question 15

tuning

Answer 15

water knob controls water flow
power knob controls length of the stroke

Question 16

amplitude and deposit removal

Answer 16

lower: shorter strokes, less powerful, light calculus, biofilm, endotoxin removal
higher: longer strokes, more powerful, moderate-heavy calculus, moderate-heavy stain

Question 17

4 mechanisms of action of powered instrumentation

Answer 17

mechanical: longitudinal sweeping action of oscillating tip
irrigation: lavage from the water
cavitation: bubbles collapse inward, releasing energy
acoustic microstreaming: forceful flow of cavitating fluid which enhances effectiveness

Question 18

tip wear reduces

Answer 18

efficiency

Question 19

efficiency lost from worn tips

Answer 19

1mm wear: approx 25%
2mm wear: approx 50%

Question 20

powerline (standard) inserts

Answer 20

beavertail
FSI 10
FSI 100
FSI 1000

Question 21

beavertail - rounded toe

Answer 21

removes heavy cal
used on all power settings
vertical strokes

Question 22

FSI 10 - one bend

Answer 22

all surfaces
curved shank
tapered tip
moderate-heavy deposit
low-high power settings

Question 23

FSI 100 - two bend

Answer 23

straight shank
tapered tip
moderate-heavy deposit removal
low-high power settings

Question 24

FSI 1000 - triple bend

Answer 24

line angles and IP surfaces
square edges to provide more energy
moderate-heavy deposit removal
low-high power settings

Question 25

moderate to heavy calculus use

Answer 25

cavitron powerline ultrasonic inserts

Question 26

slimlines

Answer 26

straight - 30% slimmer right and left - curved shank, allows adaptations area specific light to mod deposit and biofilm removal low-med power

Question 27

light to moderate calculus use

Answer 27

cavitron slimline ultrasonic inserts

Question 28

cavitron thinsert

Answer 28

access to tight tissue, interproximal surfaces, misaligned teeth, increased tactile sensitivity because of thinness, light to mod deposit and biofilm removal, usable at all power levels

Question 29

to remove biofilm/light calculus use

Answer 29

cavitron thinsert ultrasonic insert

Question 30

staged instrumentation

Answer 30

initial debridement: gross removal of mod-heavy calculus or stain, standard insert indicated and higher level of power required debridement: definitive removal of light deposits, biofilm, endotoxins, slim inserts indicated and low level of power required

Question 31

biofilm vs calculus removal

Answer 31

biofilm: small sweeping strokes, methodical, slim/thin inserts with round cross sections, low power level calculus: tapping and sweeping strokes, power/standard inserts, power level as needed

Question 32

blue zone

Answer 32

a low power setting which maximizes patient comfort but may need to turn the power beyond depending on the nature of the deposit

Question 33

standard and beavertails operate on what power settings

Answer 33

all

Question 34

slimlines operate on what power settings

Answer 34

low to medium

Question 35

general contraindications to powered instrumentation

Answer 35

-patients with communicable diseases that can be transmitted by aerosols -immunocompromised patients -susceptibility to infection: diabetes, systemic lupus, chrohn's disease, chemo -hearing aids -avoid with patients likely to overreact to stimuli

Question 36

cardiovascular contraindications

Answer 36

take caution when using on automatic implanted cardioverter defibrillators and pacemakers more than 10 years old

Question 37

respiratory contraindications

Answer 37

-COPD or other respiratory conditions -acute pulmonary infections -impaired swallowing -severe gag reflex -muscular dystrophy -paralysis -MS

Question 38

tooth conditions/anomalies contraindications

Answer 38

-demineralized teeth -restorative materials -dentin hypersensitivity

Question 39

cavitron SPS

Answer 39

offers the blue zone offers power boost offers sleeve with swivel offers balance between efficiency and patient comfort automatically maintains power and frequency settings as it meet the tooth/root

Question 40

piezo technology

Answer 40

has a fibreoptic light works from the base of the pocket up

Question 41

magnetorestrictive technique review

Answer 41

fill handpiece with water keep handpiece vertical lubricate O ring slide insert into handpiece vertically adjust water flow

Question 42

patient preparation for powered instrumentation

Answer 42

explain procedure to patient a preprocedure rinse is recommended to reduce the bacterial load in aerosols personal protective equipment for the patient

Question 43

clinician preparation for powered instrumentation

Answer 43

wear a gown with a high neck and long sleeves, mask and protective eyewear and gloves change mask every 20 minutes