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Periodontal Instrumentation (I). Classification of Periodontal instruments: 1. 牙周探針 ( Periodontal probe ) 2. 探針 ( Explorer) 3. 潔牙及牙根整平器械 ( Scaling and root planing instruments ) 4. 磨亮之器械 ( Polishing instruments) 5. 手術器械 ( Surgical instruments) .

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slide2
Classification of Periodontal instruments:

1. 牙周探針 (Periodontal probe)

2. 探針 (Explorer)

3. 潔牙及牙根整平器械 (Scaling and root

planing instruments )

4. 磨亮之器械 (Polishing instruments)

5. 手術器械 (Surgical instruments)

slide3
1. Periodontal probe--- to locate, measure the

depth of pockets and to determine their

configuration

* With firm, gentle pressure to the bottom of pocket

* The shank 與long axis of tooth 平行

Marquis Michigan O WHO

slide6
2. Explorer--- to locate subgingival calculus

deposition and caries area

* Also to check the smoothness of the root

surface after root planing

slide7
3. 潔牙及牙根整平器械

a) 牙刮(Curette)

b) 鐮刀型結石刮(Sickle scaler)

c) 銼(File scaler)

d) 鑿(Chisel scaler)

e) 鋤(Hoe scaler)

f) 超音波潔牙機

(Ultrasonic instruments)

slide8
3. Sickle scaler--- primary to remove the

supragingival calculus

*With straight shanks for incisors and canine

*With contra-angled shanks for posterior teeth

slide9
* Difficult to insert the blade under the gingiva

without damaging the surrounding gingiva

* Insert under the ledges of calculus no more

than 1 mm below the gingiva

  • Point tip, triangular back surface
slide10
Curette--- used for subgingival scaling, root planing and removing soft tissue lining the pocket

* Finer than sickle, no sharp points or corners

can be adapted and provide better access to deep pockets with a minimum of soft tissue trauma

slide11
Two basic type--- universal and Gracey curette

Universal type--- the working ends are in pairs

both ends is used for anterior and posterior

slide13
Gracey curettes--- rigid or finishing type of

shank

*Rigid Gracey has a larger, stronger and less

flexible shank and blade than the standard

finishing Gracey

*Rigid Gracey--- to remove moderate

to heavy calculus

* Diameter: 0.75 mm

slide14
Extended shank curettes---Hu-Friedy After-Five

curettes are modification of standard Gracey

curettes design

*Theterminal shank is 3 mm longer, allowing extension into deeper periodontal pockets of 5 mm or more

*Thinned bladefor smoother subgingival insertion and reduced tissue extension

slide15
Mini-bladed curettes--- Hu-Friedy Mini-Five

curettes are modification of After Five curettes

* Theblade is half the length of After Five or standard Gracey curettes

* American Gracey curettes

Sub-0, #1-2, #11-12,

#13-14 ---Gracey Curvette

slide16
*Shorter blade allows easier insertion and adaptation in deep, narrow pockets; furcations; developmental grooves; line angles; and deep, tight, facial, lingual or palatal pockets ---Gracey Curvette
slide17

Mini-bladed curettes should not be used

  • routinely
  • 2. Large #4 handle are recommended for any mini-bladed instruments
  • 3. Can be used to scale with toe directed either mesially or distally
  • 4. Generally used with straight vertical stroke
slide18

Mini-Five curettes for anterior teeth has

proven to be more effective than conventional curette in debriding narrow root surface

Singer et al. J. Clin. Periodontol 1992

slide19
Plastic instruments for implant

*Avoid scarring and permanent damage to implants

* Plastic probes

*Implacare implant instruments

slide20
Hoe scalers--- to remove tenacious subgingival

calculus and necrotic cementum

*Theblade is bent at a 99 degree angle, the cutting edge is beveled at 45 degrees

  • The blade is slightly bowed so that it can maintain contact at two points on a convex surface --- stabilize the

instrument

slide21
Chisels---the end of blade is beveled at 45

degrees to form the cutting edge

*With a modified pen grasp, push stroke

File---periodontal surgery

slide22
振動潔牙系統(Oscillating scaler system)

* Sonic scaler: rotating can generates vibration with frequencies 6000 to 9000 Hz, vibrations depending on theair pressure input, with an amplitude of up to 1000 m, plaque and calculus are removed bytapping motion (輕敲)

* Ultrasonic scaling instruments

slide23
Ultrasonic instruments --- for scaling, curetting,

and removing stain

* Frequency ranging from 20,000 to million cycles per second

*The spray is directed at the end of the tip to

dissipate the heat generated by the ultrasonic

vibration

* Apply by slight tactile force

slide24
*The cavitating water spray also serves to

flush calculus, plaque, and debris

dislodged by the vibrating tip from the

pocket

slide25
Ultrasonic scaling instruments

*Magnetostrictive (磁振式)--- are driven by nickel-iron alloy strips or a Ferrite Insert inserted into a hand-piece, vibration frequencies 20000 to 45000 Hz, vibration of tip iselliptical

all side of tip are active and work when adapted to tooth surface. Hammering (錘敲打)or scraping motion(刮削)

slide26
Ultrasonic scaling instruments

*Piezoelectric (壓電式)--- vibration is generated by changes in the dimension of a quartz crystal, vibration of tip is linear, or back and forth, only two sides of tip are active

Tapping (輕敲)or scraping motion (刮削)

slide28
Safety and Efficacy of Oscillating Scalers

*Hand instruments depends on the numbers of scaling stroke and lateral force applied

*Oscillating scalers depends on instrumentation time, lateral force, scaler tip angulation, and instrument power setting

*If scaler tip is angulated parallel to root surface and force applied do not exceed 2 N  50 m/year (critical defect depth), 40 second instrumentation --- acceptable

slide29
Safety and Efficacy of Oscillating Scalers

* Magnetostrictive type---tip angulation, lateral forces have identical influence on substance removal.

The critical defect depth 50 m can be maintained

if tip is angulated absolutely parallel to root surface

and forces used do not exceed 1 N

slide30
* Piezoeletric type--- mostly influenced by scaler

tip angulation. If scaler tip is angulated parallel to

root surface, CDD can be maintained below 50 m

even forces up 2N

*Sonic scaler is comparable to the efficacy of

magnetostrictive scaler at low power setting or to

the efficacy of piezoelectric scaler at medium power

setting

slide32
How to use ultrasonic scaling instruments

*Position

*Light pressure, 15 degree to tooth surface

*Cooling system, 14-23 cc/min

* Not be used in pt’ with cardiac pacemaker

transmissible disease

slide33
Ultrasonic scaling instruments

*Less tissue trauma

*Useful for initial debridement

*Bulky and blunt--- subgingival insertion

to base of pocket is limited

* Fracture calculus and remove it

* Diminish tactile sensation

slide34
Ultrasonic debridement vs. hand scaling

To be significant more effective in

*Microbial plaque removal

*Class II or III furcation involve

slide35
Ultrasonic devices (with thin tip)

As effective as hand-held curette in

*Maintaining clinical attachment levels

*Significantly reduced time

Copulos et al. JP 1993

slide36
Mini-bladed curettes vs.slim ultrasonic tip

*Significantly less percentage of residual

deposits --- fine curettes

*The potential value of small, thin bladecurettes in debriding involved furcation during initial therapy

Francisco et al. JP 1997

slide38
Sonic units do not release heatthe way

ultrasonic units do, but still have water for

cooling and flushing away debris

slide42
Dental Endoscope--- Perioscopy system

For use subgingivally in diagnosis and treatment of

periodontal disease, also evaluate

subgingival caries, root fracture

defect restorations, and resorption

*It consist of a 0.99 mm diameter

reusable fiberoptic endoscope

over which is fitted a disposable,

sterile sheath.

slide43
Fiberoptic endoscope fit

onto periodontal probes and

ultrasonic instrument

The sheath delivers water

irrigation that flushes the

pocket while the endoscope

is in use and keeps the field

clear

slide44
Cleaning and polishing instrument

Rubber cup, brushes and dental tape --- for

clean and polish tooth surface

slide45
Air-powder polishing --- Prophy-Jet

An air-powdered slurry of warm water and

sodium bicarbonate.

The slurry remove stains rapidly and

efficiently by mechanical abrasion and

provides warm water for rinsing and lavage

slide46
Study shows that tooth substance (cementum

and dentin) can be lostby Prophy-Jet

*Damage to gingival tissue is transient and

insignificant clinically

*Composite restoration can be roughened

slide47
Contraindications

*Pt’ with medical history of respiratory disease

*Those with sodium-restricted diets

*Individuals on medications affecting the

electrolyte balance

*Infectious diseases aerosol created

slide48
Surgical Instruments

*Excisional and incisional instruments

*Surgical curette

* Periosteal elevator

* Hoe, chisel, file and rongeur

*Tissue and thread scissors

* Hemostats and tissue forceps

slide50
a) Excisional and incisional instruments

* Surgical blade--- No. 15, 12, and 11

* Electrosurgery:

slide51
Electrosurgery (surgical diathermy)

* Using controlled frequency electrical currents--- 1.5 -7.5 million cycles/second

*Three active electrodes:

1. Single-wire electrodes for incision

2. loop electrodes for planing tissue

3. Heavy, bulkier electrodes for

coagulation procedure

slide52
Most important basic rule of electrosurgery---

always to keep the tip moving, 5-10 second for cooling

* Deep resection close to bone, can produce gingival

recession, bone necrosis and sequestration, loss of

bone height, furcation exposure and tooth mobility

* Contraindicated for patients who have poorly

shielded cardiac pacemakers

slide53
Four types electrosurgical technique:

1. Electrosection---performs incision, excision, and tissue planing

2. Electrocoagulation--- can prevent bleeding at

initial entry into tissue, but cannot stop

bleeding after blood is present

3. Electrofulguration--- burning of the tissue

4. Electrodesication--- drying of the tissue

slide54
*Surgical curette--- for the removal of granulation

tissue, fibrous interdental tissue and tenacious

subgingival deposits

*Periosteal elevator--- to reflect and remove the

flap after the incision has been made for flap

surgery

slide55
Surgical chisel, rongeur and proximal bone file

For removal of sharp bone and osteoplasty

slide56
Surgical instruments for gingivectomy

*Pocket marker, Kirkland and interproximal

gingival knife

slide57
Surgical instruments for gingivectomy

*Pocket marker, Kirkland and interproximal

gingival knife