FundamentalsofPeriodontal

Instrumentation
Grasp,Fulcrum,WristMotion,
UsingthePeriodontalProbe

Handle,Shank,WorkingEnd
HANDLE

Shank

Head

HANDLE

Shank
Shank

HANDLE

Shank

UseoftheDentalMirror
Indirectvision
Illumination
Reflectionoflight

Transillumination
Reflectionoflightthroughthetoothsurface
Especiallyforcalculus

Retraction

ModifiedPenGrasp
Mostefficientgrasp
ControlStability
PivotPoint

ModifiedPenGrasp
Thumb&Indexfinger
oppositeatjunctionofhandle
&shank
Handleisbetweenjunctionof
thefirstandsecondjointof
theindexfinger
Padofmiddlefingeragainst
theshank(sideofpad)
Fingersareaunit

Lefthandgrasp

Righthandgrasp

EstablishingaFingerFulcrum
Stability
Activateinstrumentstroke
pivot

Controlpreventsinjury
Alwaysonastableoralstructure
Occlusalplane,mandible,zygoma

Ringfinger

Fulcrums
Intraoral
Intraoral
Asclosetoworking
areasaspossible
Approximatelytwo
teethaway
Donotfulcrumonthe
sametooth
Mandibulararch
Maxillaryanteriorteeth

ExtraOralFulcrum
Extraoral
Maxillaryarch
Posteriorteeth

WristMotion

Sidetoside
Upanddown
Activatedbypivotingfulcrumfinger
Wristmustbestraighttoactivatestroke
movementofinstrument
Willbedemonstratedonthepresenter

InstrumentIdentification
Name,designnumber,manufacturer
Determinedbyuse

Probes
Explorers
Curets
Sickles
Hoes
Files
Chisels

UseoftheProbe
Insertedtothe
Junctionalepithelium

Measuressulcus
Periodontalpockets
Gingivalrecession
Attachmentloss

Angulation
Probeisparallelto
longaxisoftooth

InterproximalAngulation
Slightlytilted
Apicaltothe
contactpoint

Notenough
angulation

Correct
angulation

Toomuch
angulation

Adaptation
Workingendis
welladaptedto
toothsurface

Technique
Gentlywalkthe
probe

Readings
Sixreadings
Distal(DB&DL)
Buccal(B)orLingual(L)
Mesial(MB&ML)

Deepestreadingwithin
thedesignatedareas

GraceyCurets

GraceySeries
AnteriorTeeth
5/6allsurfacesofanteriors/premolars

PosteriorTeeth(nextweek)

7/8Buccal&LingualSurfaces
11/12MesialSurfaces
13/14DistalSurfaces
15/16MesialSurfaces
17/18DistalSurfaces

DesignCharacteristics

StandardorFinishing(nonrigids)
Rigid
ExtraRigid
ExtendedShanks
DifferentBladesizes
Regular
Mini

Adaptationoflowerthirdof
bladetotoothsurface

Correct
Lower1/3

Incorrect
Middle1/3

Incorrect
Toe1/3

RelationshipofLowerShank
to
BladeAngulation

Lowershank
parallel

Lowershank
Toofar

Lowershank
Tofarforward

CalculusRemoval
Channeling

FundamentalsofInstrumentation

WorkingStroke

oblique

vertical

horizontal

circumferential

BasicDesignCharacteristicsof
theWorkingendofInstruments
Face

Cuttingedge

Lateral
surface

Cuttingedge

Lateral
Lateral
surfacesurface

Back
Crosssection

CuretToevsSickleTip

HEEL
TIP
TOE

ComparisonofCurets&Sickle
Blades

SickleScaler

Uses
Supragingivalcalculus
Stain
Slightlysubgingival(12mm)

DifferentDesigns
Anteriorteeth
Posteriorteeth
Modifiedshank

Bladecanvaryinsize&design

DesignCharacteristics
Straightrigid
shank
Twocutting
edges
Straightor
slightlycurved

Backofthe
instrument
Pointedor
rounded

Adaptation

INCORRECT

CORRECT

Technique
Dividetoothstructurein3rds
Distallineangletowards
interproximal
Mesiallineangletowards
interproximal
LabialorLingualSurface
GraceysorUniversals

Mesial&Distal
Verticalstroke

VisualGuidetoInstrumentation
AnteriorTeeth

Handleextends
upward/paralleltolongaxis
ofteethwheninterproximal
DoesnotapplytoFacialor
Lingualsurfaces
Obliquestrokeisbest
Alternativeinstrumentsare
betterthansickle
Preventtissuetrauma

VisualGuidetoInstrumentation
Lowershankisparallelto
surfacebeingscaled
Verticalstroke

DEMONSTRATION
H6/7
SickleScaler
Shankslightly
curved
Reviewonclinic
floor

33

15
H6/7

UniversalCurets

TYPESOFUNIVERSAL
CURETTES

Columbia
Barnhart
Bunting
Goldman
Younger-Good
Langer (gracey shank)

DesignFeatures

Canadapttoalltoothsurfaces
90degreebladeangulation
shankcurvatureallowsadaptation
bothcuttingedgesareused
bladecurvedononlyoneplane

BladeAdaptation

UseoftheUniversalCuret:
Anteriorteeth

Bothinstrumentendswillbeused
Handleisparalleltolongaxisoftooth
Adaptbladetomesialordistal
Initiatebystartingatthetoothmidline
Worktowardstheinterproximal
Refertodiagramonpages183184in
Pattison

TypeofStrokeUsed
Obliqueonbuccal&lingual
VerticalonMesial&Distal

UseoftheUniversalCuret:
PosteriorRegion
Selecttheworkingendthatadaptstothe
interproximalsurface
LowerShankisparalleltomesialsurface

Selectbladethatisincontactwiththemesial
surface
Usefromthedistallineangletowardsmesial
surface

UseoftheUniversalCuret:
PosteriorRegion
Usingthesameworkingend
Noflippingofinstrument

Selecttheoppositeorsecondarybladeto
scalethedistalsurface
Notethatthelowershankisparalleltothe
distalsurface

VerticalInterproximalStroke
VerticalStrokeonMesialandDistalSurfaces

PosteriorScaling
with
GraceyInstruments

GraceyCurets
Areaspecific
Shankdesign
Bladedesign

Eachworkingendisamirrorimage
Bladeidentification
Allowsforcorrectworkingend
Adaptationtosurfacebeingscaled

 Lowerthirdis
usedfor
calculus
removal

7/8GraceyCuret
Buccal&LingualSurfaces
Posteriorteeth

Initiatestrokefromthedistallineangle
Finishstrokeatthemesiallineangle
Strokeused
Obliqueorhorizontal

Lowershankisnotparallel
strokeistowardsmidline

11/12and15/16
GraceyCurets
Usedonmesialsurfacesofallposterior
Initiatestrokeatmesiallineangleand
continuetowardsthemesialinterproximal
surface
Eachendisamirrorimage

13/14GraceyCuret

Distalsurfaces
Initiatestrokeatthedistallineangle
Continuetowardsinterproximal(distal)
Difficulttoseebladeuseshankasvisual
cue
Keeplowershankparalleltotoothsurface

ExploratoryvsWorkingStroke
Bladeislessthan45
Graspislighter
Tactilesensitivityis
enhanced
Onthedownstroke
Objectiveistoidentify
depthofcalculus

Bladeis4590
Calculusremoval

Firmgrasp
Engagebladeby
Adaptationorbite

Ontheupstroke
Vertical
Oblique

Adaptation
Degreeofhowopenorclosedtheblade
isuponinsertionisdependenton:
Typeoftissue
Fibroticvsboggyorhemorrhagictissue

Severityofdisease
Retractabletissue
Interproximalembrasure

Tenacityofcalculus

DifferenceinTechnique
Scaling
short,precise,strokes,channelingcalculusdeposits

Planing

longevenstrokes
Objectiveistosmooththerootsurface
Takesexperienceandtimetoobtainskill

Howwellhavewescaled?
AttimeofS/RPappointment
Exploring,probing
Smoothnessoftoothsurface

Afterappointment
Healthyperiodontium
Decreasedbleeding,pocketdepths,marginal
bleeding

Limitations

obscuredvisionfrombleeding
tactilesensitivity
instrumentsselected
direction&lengthofstrokes
confinesofsofttissuetissuetype
toothanatomy
clinicalfindings
mentalimagebasedonvisual,mental,and
manualskills

Limitations
Accuratetreatmentplan
Anesthesia,numberofappointments

SeverityofDiseaseprogression
Localfactors
Systemicfactors
Pockets,furcas,anatomicalcharacteristics,
erosion,recession,mobility

Mostcommonareasmissed:
mostapicalportionofpocket
furcationareas&distalsurfaces
primaryreason:notoverlappingstrokes

Effectsofscaling&rootplaning
reductionininflammation
pocketdepthreductionavg..1.36mm
.8mminrecession
.52inattachment

attachmentmaintainedorslightgain
decreasedmobilityfibers
reductioningram,spirochetes,bacteroides
conflictingresultswithA.Actinocytemcomitans

SequencetoPeriodontal
Instrumentation
PatientAssessment

Localandsystemicfactorsthatinfluenceperiodontal
condition
Hxofsmoking

PeriodontalEvaluation
Severityofdisease
Periodontaltxplan
Surgery,grafts,

OverallobjectiveofphaseItherapy

CalculusAssessment

Howdifficult,tenacity,depth

SequencetoPeriodontal
Instrumentation
PhaseISimple=1appointment

Simplecase,lightcalculus,littlesensitivity,controlled
periodontalcondition,mildinflammation

PhaseIIntermediate2appointments

Overdue,earlyPeriodontitis45mmpockets,
Patientmayrequiremouthanesthesia(Lower&
upperquadsavoidsamearch)

PhaseIComplex

4appointmentbyquadswithanesth,pockets,calculus,
furcations
Reevaluationappointment

SequencetoPeriodontal
Instrumentation
Fullmouth
Startintoothsequenceforplaqueremoval
Assesswherecalculusispresent
Areasofinflammation

Twoappointment
Anesthesia,upper&lowerquad

Complex
Eachquadrantwithanesthesia