DD -Perio Page 345 -378

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Questions and Answers

What is an anatomic feature that frequently limits the effectiveness of calculus removal?

Furcations on mandibular molars

Mesial surfaces of maxillary premolars (correct)

Proximal surfaces of mandibular incisors

Root concavities of maxillary canines

What is the primary indication for curettage in periodontal therapy?

Removal of diseased soft tissue from the gingival wall (correct)

Removal of plaque and calculus

Smoothing the root surface

Elimination of bacterial plaque

What does bleeding on probing indicate?

Inflammation in the tissue (correct)

Complete removal of calculus

Tactile sensitivity on the tooth surface

Success of scaling and root planing

What is removed during root planing?

Cementum, dentin, and calculus Signup and view all the answers

What is the term used to describe the ability to distinguish degrees of roughness and smoothness on the tooth surface?

Tactile sensitivity Signup and view all the answers

What is most likely to be found on the proximal surfaces of mandibular incisors?

Flutings Signup and view all the answers

What can be assumed if, after scaling and root planing, the patient returns with hard, black deposits of calculus around the gingival margin?

A reduction in inflammation occurred after the procedure Signup and view all the answers

What is the best criterion to evaluate the success of scaling and root planing?

No evidence of bleeding on probing Signup and view all the answers

What is the correct sequence of treatments for periodontal inflammation?

Scaling, root planing, curettage Signup and view all the answers

What is the primary objective of scaling and root planing?

To remove etiologic agents that promote gingival inflammation Signup and view all the answers

What type of local anesthesia is required for gingival curettage?

Local anesthesia Signup and view all the answers

What is the function of a curette in periodontal treatment?

To perform root planing Signup and view all the answers

What is the advantage of using a sharp curette for subgingival scaling and root planing?

It has greater tactile sensitivity Signup and view all the answers

What is the benefit of smooth root surfaces after scaling and root planing?

Reduced potential for bacterial accumulation Signup and view all the answers

When is curettage indicated as a treatment for periodontal inflammation?

After scaling and root planing for new attachment attempts Signup and view all the answers

What type of curette is best suited for anterior teeth and premolars?

Area-specific curette (Gracey #5-6) Signup and view all the answers

What is a contraindication for gingival curettage as a definitive procedure?

All of the above Signup and view all the answers

Which type of inflammation responds better to curettage?

Edematous and granulomatous inflammation Signup and view all the answers

What is the range of ultrasonic vibrations at the tip of instruments in magnetostrictive units?

20,000 to 45,000 cycles per second Signup and view all the answers

What is the pattern of vibration of the tip in piezoelectric units?

Linear Signup and view all the answers

What is the purpose of the water spray used with ultrasonic and sonic tips?

To flush calculus, plaque, and debris Signup and view all the answers

What is the device that allows clear visualization deeply into subgingival pockets and furcations?

Dental Endoscope Signup and view all the answers

What is the name of the system that uses motor-driven diamond files to correct overhanging or contoured proximal alloy or resin restorations?

EVA system Signup and view all the answers

What is the contraindication to the use of air-powered polishing devices?

Respiratory illnesses Signup and view all the answers

What is the best way to handle sensitivity encountered during the use of air-powered polishing devices?

Adjust the water spray: increase water flow to cool the tip Signup and view all the answers

What is the purpose of the air from the air/water syringe in calculus detection?

To detect calculus present both supra- and subgingivally Signup and view all the answers

What is the instrument used to remove supragingival calculus?

Sickle scalers Signup and view all the answers

What is the characteristic of curettes?

They have a spoon-shaped blade and a rounded tip, and are finer than sickle scalers Signup and view all the answers

What is the primary use of sickle scalers?

To remove supragingival calculus Signup and view all the answers

What type of stroke is recommended when using sickle scalers?

Pul stroke, up and away from the gums Signup and view all the answers

What is the purpose of hoe instruments?

Removing ledges and rings of subgingival calculus Signup and view all the answers

What type of angle is recommended when sharpening an instrument?

The original angle of the instrument Signup and view all the answers

What is the result of using a dull instrument?

Reduced tactile sensitivity and increased possibility of instrument slipping Signup and view all the answers

What is formed when the direction of the sharpening stroke is away from the cutting edge?

A wire edge Signup and view all the answers

What is the purpose of lubricating the sharpening stone during sharpening?

To reduce friction and prevent overheating Signup and view all the answers

What type of instruments are used to remove and crush large deposits of subgingival calculus?

Files Signup and view all the answers

What is the consequence of using files improperly?

The root surface becomes indented and roughened Signup and view all the answers

What type of stones should be used with oil lubrication during sharpening?

Natural stones Signup and view all the answers

What is the optimal internal angle between the face of the blade and the lateral surface of a universal curette?

70° to 80° Signup and view all the answers

What type of shank is stronger and less flexible?

Rigid, thick Signup and view all the answers

What is the term used to describe the angle between the face of the blade and the tooth surface during scaling and root planing?

Angulation Signup and view all the answers

What is the purpose of the terminal shank in a dental hand instrument?

To extend from the working-end to the bend before the handle Signup and view all the answers

What is the primary advantage of using an instrument with a rigid shank?

Is stronger and less flexible Signup and view all the answers

What is the term used to describe a Gracey curette?

Offset blade Signup and view all the answers

What stroke direction is used on line angles and deep pockets during scaling and root planing?

Horizontal Signup and view all the answers

What is the part of the instrument that is in contact with the tooth surface during instrumentation?

Working-end (blade) Signup and view all the answers

What is the primary disadvantage of using mounted rotary stones?

All of the above Signup and view all the answers

What is the best grasp to use when holding an instrument to be sharpened?

Palm grasp Signup and view all the answers

What is the primary objective of removing local deposits such as plaque, calculus, endotoxins, and other plaque-retentive local factors through scaling and root planing?

To remove etiologic agents that promote gingival inflammation Signup and view all the answers

In patients with deep pockets, what is the expected outcome of surgical periodontal therapy compared to scaling and root planing?

Greater reduction in pocket depths and clinical attachment gain Signup and view all the answers

What is the characteristic of healing following scaling and root planing?

Formation of a long, thin junctional epithelium Signup and view all the answers

What is a common location for residual deposits after scaling and root planing?

All of the above Signup and view all the answers

What is the significance of lack of bleeding on probing in patients with periodontal disease?

Stability and lack of inflammation Signup and view all the answers

What is the difference in bleeding on probing between smokers and non-smokers with equal amounts of disease?

Smokers tend to bleed less Signup and view all the answers

What is the long-term management requirement for patients after scaling and root planing?

Ongoing maintenance therapy Signup and view all the answers

What is the indication for surgery in patients who have undergone non-surgical therapy?

Failure to achieve periodontal health Signup and view all the answers

What is the primary goal of root debridement in periodontal treatment?

To remove all calculus and altered cementum Signup and view all the answers

What is the current stance of the American Dental Association on subgingival curettage?

It has no significant therapeutic benefit and is not recommended Signup and view all the answers

What is the primary advantage of ultrasonic instrumentation over hand instrumentation?

It is a more time-efficient method Signup and view all the answers

What is the purpose of a periodontal probe?

To detect, measure, and mark pockets Signup and view all the answers

What is the recommended technique for measuring pocket depth with a periodontal probe?

Insert the probe with gentle pressure and 'walk' it along the circumference of the tooth Signup and view all the answers

What is a contraindication for the use of ultrasonic scaling devices?

All of the above Signup and view all the answers

What is the purpose of a furcation probe?

To detect and evaluate bone loss in the furcation areas of multi-rooted teeth Signup and view all the answers

What is the recommended method for detecting an interdental crater?

Position the probe obliquely from both the facial and lingual surfaces Signup and view all the answers

What is the mechanism of action of ultrasonic instrumentation?

Alternating electrical current generates oscillations in the handpiece Signup and view all the answers

What is the significance of subgingival root surface roughness in periodontal treatment?

It does not interfere with healing after scaling and root planing Signup and view all the answers

Study Notes

Anatomic Features of Teeth

Mesial surfaces of maxillary premolars and proximal surfaces of mandibular incisors are most likely to have flutings.
Root proximity is a problem when performing scaling and root planing on mandibular incisors.
Furcations on maxillary first molars are the most difficult to adequately instrument (root planing).

Limitations of Calculus Removal

Anatomic features of teeth frequently limit the effectiveness and efficiency of calculus removal.

Success of Scaling and Root Planing

The best criterion to evaluate the success of scaling and root planing is no evidence of bleeding on probing.
Bleeding on probing indicates inflammation in the tissue.
The amount of inflammation present is used to determine the effectiveness of periodontal instrumentation and home care by the patient.

Periodontal Instrumentation

Cementum, dentin, and calculus are removed during root planing.
Scaling refers to the removal of deposits from the root surface, whereas planing means smoothing the root to remove infected and necrotic tooth substance.
Curettage refers to the intentional removal of diseased soft tissue from the gingival wall of a periodontal pocket.

Indications and Contraindications for Curettage

Indications for curettage are very limited.
Curettage should always be preceded by scaling and root planing.
Gingival curettage always requires some type of local anesthesia.
Contraindications for gingival curettage as a definitive procedure include:
- Acute periodontal inflammation
- Firm, fibrotic tissue
- Intrabony pockets
- Mucogingival involvement
- When the lateral gingival wall is extremely thin

Periodontal Probes and Furcation Probes

Periodontal probes are instruments used to detect, measure, and mark pockets.
A furcation probe is a blunt-tip curved instrument used to detect and evaluate bone loss in the furcation areas of multi-rooted teeth.

Probing Technique for Pocket Assessment

The probe is inserted into the base of the pocket with a steady and gentle pressure.
The shank of the probe should be positioned parallel to the vertical axis of the tooth and "walked" along the circumference of each tooth to determine the pocket depth.

Ultrasonic and Sonic Instrumentation

Ultrasonic instruments have a light touch and light pressure, keeping the tip parallel to the tooth surface and constantly in motion.
Leaving the tip in one place for too long or using the point of the tip against the tooth can produce gouging and roughening of the root surface or overheating of the tooth.
Contraindications to the use of ultrasonic and sonic scaling devices include:
- Older cardiac pacemakers
- Known communicable diseases that can be transmitted by aerosols
- Patients at risk for respiratory disease, including patients who are immunosuppressed or have chronic pulmonary disorders
- Patients with titanium implants, porcelain or bonded restorations (unless plastic-tipped inserts are used)

Dental Endoscope and EVA System

A dental endoscope allows clear visualization deeply into subgingival pockets and furcations.
The EVA system uses motor-driven diamond files to correct overhanging or overcontoured proximal alloy or resin restorations.

Polishing Devices

The Prophy-Jet air-powder polishing device is very effective for the removal of extrinsic stains and soft deposits.
Contraindications to the use of air-powered polishing devices include:
- Respiratory illnesses
- Hemodialysis
- Hypertension
- Infectious diseases

Power-Driven Instruments

Power-driven instruments work best with quick hand movement - rapid, controlled movements.

Sharpening Instruments

The objective of sharpening is to restore the fine, thin, linear cutting edge of the instrument.
Principles of sharpening include:
- Choose a sharpening stone appropriate for the instrument
- Use a sterilized sharpening stone if the instrument to be sharpened will not be resterilized before it is used on a patient
- Establish the proper angle between the stone and the surface of the instrument
- Maintain a stable, firm grasp of both the instrument and the sharpening stone
- Avoid excessive pressure
- Avoid formation of a "wire edge"
- Lubricate the stone during sharpening### Angulation in Scaling and Root Planing
Optimal angulation is between 45 and 90 degrees for effective calculus removal.
Angulation of less than 45 degrees causes the cutting edge to slide over the calculus, smoothing or burnishing it.
Angulation of more than 90 degrees leads to the lateral surface of the blade being against the tooth, failing to remove calculus and potentially burnishing it.

Stroke Directions and Factors

Three basic stroke directions used in scaling and root planing: vertical, oblique, and horizontal.
Vertical and oblique strokes are most commonly used.
Horizontal strokes are used on line angles and deep pockets.
Factors determining stroke direction, length, pressure, and number include:
Gingival position and tone
Pocket depth and shape
Tooth contour
Amount and nature of calculus or roughness

Dental Hand Instruments

Dental hand instruments have three basic parts: handle, shank, and working-end (blade).
The working-end or blade is divided into three parts: toe/tip, middle, and heel.
The tip-third of a scaler and toe-third of a curette are the surfaces that remain in contact with the tooth surface during instrumentation.

Objectives and Outcomes of Scaling and Root Planing

The objective is to remove etiologic agents that promote gingival inflammation, including plaque, calculus, endotoxins, and other local factors.
Scaling and root planing improve pocket depths and clinical attachment levels in mild to moderate periodontitis cases.
Scaling and root planing can successfully treat chronic periodontal disease if adequate plaque control is maintained.
Factors influencing effectiveness include pocket depth and complex root anatomy.
Residual deposits commonly occur at the cemento-enamel junction, line angles, and infurcations.

Healing and Assessment

Healing following scaling and root planing is largely due to a reduction in edema and is characterized by the formation of a long, thin junctional epithelium.
Bleeding on probing (BOP) is a simple assessment of the inflammatory status of the gingiva.
Lack of BOP is highly correlated with stability and a lack of inflammation.
Tissue healing, as evidenced by a reduction or absence of bleeding on probing, is a stronger predictor of success than calculus removal and smooth root surfaces.

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Description

This quiz covers the anatomic features of teeth that affect the effectiveness and efficiency of calculus removal during scaling and root planing procedures.