Periodontal Instrumentation (I)

1. Periodontal Instrumentation (I)

2. 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)

3. 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

5. *牙根分叉(Furcation area)--- best be evaluated by curved, blunt, Nabers probe

6. 2. Explorer--- to locate subgingival calculus deposition and caries area * Also to check the smoothness of the root surface after root planing

7. 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)

8. 3. Sickle scaler--- primary to remove the supragingival calculus *With straight shanks for incisors and canine *With contra-angled shanks for posterior teeth

9. * 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

10. 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

11. Two basic type--- universal and Gracey curette Universal type--- the working ends are in pairs both ends is used for anterior and posterior

13. 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

14. 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

15. 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

16. *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

17. 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

18. 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

19. Plastic instruments for implant *Avoid scarring and permanent damage to implants * Plastic probes *Implacare implant instruments

20. 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

21. 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

22. 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

23. 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

24. *The cavitating water spray also serves to flush calculus, plaque, and debris dislodged by the vibrating tip from the pocket

25. 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)

26. 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)

28. 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

29. 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

30. * 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

32. 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

33. 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

34. Ultrasonic debridement vs. hand scaling To be significant more effective in *Microbial plaque removal *Class II or III furcation involve

35. Ultrasonic devices (with thin tip) As effective as hand-held curette in *Maintaining clinical attachment levels *Significantly reduced time Copulos et al. JP 1993

36. 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

38. Sonic units do not release heatthe way ultrasonic units do, but still have water for cooling and flushing away debris

42. 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.

43. 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

44. Cleaning and polishing instrument Rubber cup, brushes and dental tape --- for clean and polish tooth surface

45. 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

46. 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

47. Contraindications *Pt’ with medical history of respiratory disease *Those with sodium-restricted diets *Individuals on medications affecting the electrolyte balance *Infectious diseases aerosol created

48. Surgical Instruments *Excisional and incisional instruments *Surgical curette * Periosteal elevator * Hoe, chisel, file and rongeur *Tissue and thread scissors * Hemostats and tissue forceps

50. a) Excisional and incisional instruments * Surgical blade--- No. 15, 12, and 11 * Electrosurgery: