Periodontal Instrumentation

(Scaling and Root Planing)

Malik Hudieb, BDS, PhD
Department of Preventive Dentistry Faculty of Dentistry Jordan University of Science and Technology
Academic/ Research Clinical

Periodontal Instrumentation
Plaque Control & Oral Hygiene instructions.

Plaque

Periodontal Examination & Periodontal Indices Classification of Diseases and Conditions Affecting the Periodontium

Anatomy, Histology and Physiology of Periodontium

Treatment of Periodontal Diseases

Objectives of Nonsurgical Periodontal Therapy

Eliminate inflammation by physical removal of Plaque and Calculus (supra and sub gingival). Controls plaque-induced gingivitis, slight to moderate chronic periodontitis Precedes periodontal surgery

Non-surgical

Surgical

 Non-surgical periodontal therapy:

Oral hygiene measures Periodontal instrumentation Chemical agents

Emerging Terminology Periodontal debridement: Disruption of bacterial plaque and calculus from the crown and root surfaces Deplaquing: Disruption of subgingival microbial plaque from cemental surfaces and the pocket space Gross debridement: to enable an examination and diagnosis

CLASSIFICATION OF PERIODONTAL INSTRUMENTS (non-surgical)

Periodontal Probes Explorers Scaling & Root planing Instruments Cleansing & Polishing Instruments

Parts of Periodontal Instrument

Handle Shank Working end/ Blade

Parts of Periodontal Instrument

Handle

Parts of Periodontal Instrument

Shank: -- Functional -- Terminal/ Lower

CLASSIFICATION OF PERIODONTAL INSTRUMENTS (non-surgical)

Periodontal Probes
Explorers Scaling & Root planing Instruments Cleansing & Polishing Instruments

Periodontal Probes

Examination and Detection Skills

Use of the Probe

Measures sulcus depth Periodontal pockets Gingival recession Attachment loss

Angulation
Probe is parallel to long axis of tooth

Readings
Six readings
Distal (DB & DL) Buccal (B) or Lingual (L) Mesial (MB & ML)

Periodontal Probes
Nabers probe

Deepest reading within the designated areas

CLASSIFICATION OF PERIODONTAL INSTRUMENTS (non-surgical) Periodontal Probes

Explorers

Explorers
Scaling & Root planing Instruments Cleansing & Polishing Instruments

Insertion & use Explorers

CLASSIFICATION OF PERIODONTAL INSTRUMENTS (non-surgical) Periodontal Probes Explorers

Scaling & Root planing Instruments

Cleansing & Polishing Instruments

Scaling & Root Planing Instruments

Types of Curettes

Types of Curettes

Universal Curette

Gracy or Area Specific Curettes

Differences between Universal Curettes & Gracy Curettesa

General Principles of Instrumentation

Accessibility Visibility, Illumination & Retraction Condition of the Instruments Mainting a Clean Field Instrument Stbilization Instrument Grasping Finger Rest Instrument Activation Adaptation Angulation Lateral Pressure

A. Universal Curette B. Gracy Curette

Gracey Curettes
The original series contained 7 double ended instruments (1/2; 3/4; 5/6; 7/8; 9/10; 11/12; 13/14). In the 1980's, 2 modified instruments were added to the collection (15/16; 17/18).

Curettes for Subginbival SC & RP

Universal Curettes

Technique for SC & RP

Adaptaion Angulation Activation

General principles of Instrumentation(746)

1- Accessibility: facilitate thoroughness of instrumentation. Position of patient & operator should provide maximal accessibility. 2- Visibility: whenever possible direct vision with direct illumination

Principles of Instrumentation
3- Condition and sharpness of Instruments 4- Maintaining clean field 5- instrument stabilization: A- Instrument grasp B-Finger rest C- Instrument Activation

A-Instrument Grasp
Modified pen grasp

Instrument Grasp
Standard pen grasp Palm& thumb

B-Finger Rest
Conventional finger rest

Intra-oral
Cross arch opposite arch Palm up

Extra oral rest

Palm down

C-Instrument Activation
1-Adaptation: manner of which instrument end is placed against surface of the tooth

2-Angulation
1-o degree angle angle 2- 45 degree

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Strokes
Exploratory stroke: light, feeling stroke to detect calculus, roughness or smoothness of root Scaling stroke A-Vertical

Scaling strokes
B-Oblique C-Horizontal

5- Grasp in light modified pen grasp, apply rest 6-Use short, light, vertical, horizontal, or oblique strokes 7-Working end should be kept in constant motion, parallel to the tooth 8-Swich off periodically 9- Finish remaining manually

Blade Adaptation to Tooth Surface

0 insertion

<45 Healthy tissue Plaque removal

45-90 Ideal Calculus Removal

> 90 Tissue Trauma

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Sickle Scaler
Supragingival calculus Stain Slightly subgingival (1-2mm)

Different Designs
Anterior teeth Posterior teeth
Modified shank

Blade can vary in size & design

Design Characteristics
Straight rigid shank Two cutting edges
Straight or slightly curved

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

Back of the instrument

Pointed or rounded

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Universal Curets
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

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