2. General principles of instrumentation
* Accessibility (position of operator & patient)
* Visibility, illumination and retraction
* Condition of instruments
* Maintaining a clean field
* Instrument stability
* Instrument activation
3. * Position:
Operator--- feet are flat on the floor and
thighs parallel to floor, keeping back straight
and back erect
6. • Supine Patient position
Patient’s heels should be slightly higher than
tip of his nose, good blood flow to the head
• Mouth is close to resting elbow of operator
7. * Patient:
Instrumentation of maxi. arch, raise the chin
slightly to provide optimal visibility and
accessibility
Instrumentation of mand. arch, lower the
chin until mandible is parallel to floor
9. * Optimum Visibility
The following methods are effective for retraction
1) Use of mirror to deflect the cheek while the finger
of non-operating hands retract the lip and protect
the angle of mouth from
irritation by the mirror
handle
10. 2) Use the mirror alone to retract lip and cheek
3) Use the mirror to retract tongue
4) Use the fingers of non-operating hand to retract
the lip
5) Combination of the preceding
13. General principles of instrumentation
* Accessibility (position of operator & patient)
* Visibility, illumination and retraction
* Condition of instruments
* Maintaining a clean field
* Instrument stability
* Instrument activation
14. * Condition of instruments (sharpness)
Sharp instruments enhance tactile sensation and
allow the clinician to work more precisely and
efficiently
* Maintaining a clean field
Saliva and gingival bleeding interfere visibility
and impede (妨礙)control
15. General principles of instrumentation
* Accessibility (position of operator & patient)
* Visibility, illumination and retraction
* Condition of instruments
* Maintaining a clean field
* Instrument stability
* Instrument activation
16. * Instrument stability
Two factors of major importance in providing
stability are the instrument grasp and finger rest
a. Instrument grasp
A proper grasp is essential for precise control
of movements made during periodontal
instrumentation
18. Modified pen grasp
The middle finger is positioned so that the side the
pad next to the fingernail is resting on the
instrument shank. The index finger is bent at second
joint from the finger tip and is positioned well above
the middle finger on the same
side of the handle
20. b. Finger rest
Serves to stabilize the hand and instrument by
providing a firm fulcrum as movement are made
to activate the instrument. Generally be classified
as intraoral finger or extraoral fulcrum
* Intraoral finger rests
(1) Conventional
(2) Cross arch
(3) Opposite arch
(4) Finger on finger
22. b. Finger rest
May be generally be classified as intraoral finger
or extraoral fulcrum
* Extraoral fulcrum
(1) Palm up
(2) Palm down
23. General principles of instrumentation
* Accessibility (position of operator & patient)
* Visibility, illumination and retraction
* Condition of instruments
* Maintaining a clean field
* Instrument stability
* Instrument activation
24. * Instrument activation
1. Adaptation
2. Angulation ---Different angulation position
will cause different effective
3. Lateral pressure
4. Strokes
25. * Adaptation: the manner in which the working
end of a periodontal instrument is placed against
the surface of a tooth
To make the working end of instrument
conform to the contour of tooth surface
To avoid trauma to soft tissues and root
surface, to ensure maximum effectiveness
of instrumentation
26. * Adaptation
The lower third of the
working end must be kept
in constant contact with the
tooth while it is moving
over varying tooth contours
27. * Adaptation
If only the toe or tip is in adapted, the soft
tissue can be distended or compressed by
the back of the working end, also causing
trauma and discomfort, the toe can gouge
or groove the root surface
28. *Angulation: the angle between the face
of a bladed instrument and tooth surface,
also called “tooth-blade relationship”
29. *The working-end is inserted at an angle
between 0- and 40-degrees.
The 0-to40o angle is referred
to as a closed angle
30. *During S/RP, optimal angulation is between
45 to 90 degrees.
The exact angulation depends on the amount
and nature of calculus, the procedure being
performed, and the condition of the tissue
31. * Lateral pressure: the pressure created when
force is applied against the surface of a tooth
with the cutting edge of a blade instrument
The exact amount of pressure applied
must be varied according to the nature
of the calculus and according to the stroke
is intended
32. * Strokes: exploratory, scaling & root planing
Exploratory stroke--- the instrument is grasped
lightly and adapted with light pressure against the
tooth to achieve maximum tactile sensation
33. Scaling stroke is a short, powerful pull stroke
* The scaling motion should be initiated
in the forearm and transmitted from
the wrist to the hand with a slight flexing
of the fingers
34. Wrist and forearm motion, finger flexing both are
necessary for complete instrumentation
*The wrist and forearm motion, pivoting in an
arc on the finger rest, produce a more powerful
stroke --- preferred for scaling
*Finger flexing --- for precise control over stroke
length in areas such as line angles and when
horizontal strokes are used on the lingual or facial
aspects narrow-rooted teeth
35. Root planing stroke: a moderate to light pull
stroke for final smoothing and planing of root
surface
*A continuous series of long, overlapping shaving
stroke is achieved
37. Scaling: instrumentation to remove all
supragingival uncalcified and
calcified accretions and all
gross subgingival accretion
38. Root planing: instrumentation to remove
the microbial flora on the root surface or
lying free in the pocket, all fleck of calculus
and all contaminated cementum and dentin
39. Detection skills
*Visual examination--- good light and a clean
field.
Compressed air supragingival calculus
chalky white; subgingival calculus dark
shadow
* Tactile sensation--- light exploratory strokes
are activated vertically up and down on root
surface
40. Detection skills
* Tactile sensation--- the distance between
apical edge of calculus and bottom of the
pocket is 0.2 – 1.0 mm
* Illumination
41. The rationale for root planing
*Assumption that a smooth root surface will
be less plaque retentive and therefore the
danger of re-infection and recurrence of
disease should be less
*Reattachment of epithelial and connective
tissue would be likely on a smooth root
surface than on a rough one
43. * Principles for Gracey curettes usage
1. Determine the correct cutting edge
2. Make sure the lower shank is parallel to
root surface to be instrumented
3. Using finger rest
4. Concentrate on using lower third of
cutting edge for calculus remove
5. Moderate lateral pressure
44. * Determine cutting edge of Gracey curette
1. Hold face of curette blade parallel with
floor and looking down on the face
2. Notice the blade curve
3. Larger, outer curve is
the correct cutting edge
45. * The face of blade be close against the
tooth so it can only be partially seen
46. * Make sure lower shank is parallel with
root surface
47. The functional shank extends from the first
bend in the shank up to working-end
The lower shank is the bent section of the
shank nearest to the working-end
48. To avoid over-instrumentation, a delicate
transition from short, powerful scaling strokes
to longer, lighter root planing strokes must be
made as soon as calculus and initial roughness
have been eliminated
49. *Hoe, files and ultrasonic instruments are
also used for subgingival scaling of heavy
calculus but not recommended for root
planing
*Curette is preferred for subgingival scaling
and root planing
50. A common error in proximal instrumentation
is failing to reach mid-proximal region apical
to the contact point because this area is
relatively inaccessible and this technique
require more skill
51. * The relationship between location of finger
rest and working area is important
1. The finger rest or fulcrum must be position
to allow lower shank of instrument to be
parallel or nearly parallel with tooth surface
being treated
52. * The relationship between location of
finger rest and working area is important
53. 2. Finger rest must be positioned enable the
operator to use wrist-arm motion to
activate strokes
54. Modes of calculus attachment reported by
Zander in 1953
1. Attachment by means of secondary cuticle
2. Attachment of calculus matrix to irregularities
of cementum surface corresponding
to previous insertion location of
Sharpey’s fibers
55. 3. Penetration of microorganisms of calculus
into cementum
4. Attachment in areas of cementum resorption
via mechanical locking into undercuts
56. Limitation of the effectiveness of scaling and
root planing
1. Anatomy of roots
2. Depth of pockets
3. Areas of mouth being treatment
4. Inadequate instruments for diagnosis
5. Inadequate instruments for treatment
6. Range of mouth opening
7. Dexterity of operator
57. Palato-gingival groove
* Developmental abnormality
* A funnel for the accumulation of plaque
and calculus in the depth of groove
* Prevalence on incisors ranges from 1.9 %
to 4.4 %
58. Cervical enamel projections
*Rapid progression of pocket formation (precluding
an organic connective tissue attachment)
*Hemidesmosome attachment in CEJ less
resistant to breakdown by bacterial plaque rapid
progression of disease
67. Information to pt’ with root sensitivity
1. Sensitivity usually temporary
2. Through plaque control
3. Not discourage if desensitizing agent does
not produce immediate effect
4. Avoid foods that heighten sensitivity
