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Questions and Answers
What is an anatomic feature that frequently limits the effectiveness of calculus removal?
What is an anatomic feature that frequently limits the effectiveness of calculus removal?
What is the primary indication for curettage in periodontal therapy?
What is the primary indication for curettage in periodontal therapy?
What does bleeding on probing indicate?
What does bleeding on probing indicate?
What is removed during root planing?
What is removed during root planing?
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What is the term used to describe the ability to distinguish degrees of roughness and smoothness on the tooth surface?
What is the term used to describe the ability to distinguish degrees of roughness and smoothness on the tooth surface?
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What is most likely to be found on the proximal surfaces of mandibular incisors?
What is most likely to be found on the proximal surfaces of mandibular incisors?
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What can be assumed if, after scaling and root planing, the patient returns with hard, black deposits of calculus around the gingival margin?
What can be assumed if, after scaling and root planing, the patient returns with hard, black deposits of calculus around the gingival margin?
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What is the best criterion to evaluate the success of scaling and root planing?
What is the best criterion to evaluate the success of scaling and root planing?
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What is the correct sequence of treatments for periodontal inflammation?
What is the correct sequence of treatments for periodontal inflammation?
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What is the primary objective of scaling and root planing?
What is the primary objective of scaling and root planing?
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What type of local anesthesia is required for gingival curettage?
What type of local anesthesia is required for gingival curettage?
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What is the function of a curette in periodontal treatment?
What is the function of a curette in periodontal treatment?
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What is the advantage of using a sharp curette for subgingival scaling and root planing?
What is the advantage of using a sharp curette for subgingival scaling and root planing?
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What is the benefit of smooth root surfaces after scaling and root planing?
What is the benefit of smooth root surfaces after scaling and root planing?
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When is curettage indicated as a treatment for periodontal inflammation?
When is curettage indicated as a treatment for periodontal inflammation?
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What type of curette is best suited for anterior teeth and premolars?
What type of curette is best suited for anterior teeth and premolars?
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What is a contraindication for gingival curettage as a definitive procedure?
What is a contraindication for gingival curettage as a definitive procedure?
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Which type of inflammation responds better to curettage?
Which type of inflammation responds better to curettage?
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What is the range of ultrasonic vibrations at the tip of instruments in magnetostrictive units?
What is the range of ultrasonic vibrations at the tip of instruments in magnetostrictive units?
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What is the pattern of vibration of the tip in piezoelectric units?
What is the pattern of vibration of the tip in piezoelectric units?
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What is the purpose of the water spray used with ultrasonic and sonic tips?
What is the purpose of the water spray used with ultrasonic and sonic tips?
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What is the device that allows clear visualization deeply into subgingival pockets and furcations?
What is the device that allows clear visualization deeply into subgingival pockets and furcations?
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What is the name of the system that uses motor-driven diamond files to correct overhanging or contoured proximal alloy or resin restorations?
What is the name of the system that uses motor-driven diamond files to correct overhanging or contoured proximal alloy or resin restorations?
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What is the contraindication to the use of air-powered polishing devices?
What is the contraindication to the use of air-powered polishing devices?
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What is the best way to handle sensitivity encountered during the use of air-powered polishing devices?
What is the best way to handle sensitivity encountered during the use of air-powered polishing devices?
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What is the purpose of the air from the air/water syringe in calculus detection?
What is the purpose of the air from the air/water syringe in calculus detection?
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What is the instrument used to remove supragingival calculus?
What is the instrument used to remove supragingival calculus?
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What is the characteristic of curettes?
What is the characteristic of curettes?
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What is the primary use of sickle scalers?
What is the primary use of sickle scalers?
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What type of stroke is recommended when using sickle scalers?
What type of stroke is recommended when using sickle scalers?
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What is the purpose of hoe instruments?
What is the purpose of hoe instruments?
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What type of angle is recommended when sharpening an instrument?
What type of angle is recommended when sharpening an instrument?
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What is the result of using a dull instrument?
What is the result of using a dull instrument?
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What is formed when the direction of the sharpening stroke is away from the cutting edge?
What is formed when the direction of the sharpening stroke is away from the cutting edge?
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What is the purpose of lubricating the sharpening stone during sharpening?
What is the purpose of lubricating the sharpening stone during sharpening?
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What type of instruments are used to remove and crush large deposits of subgingival calculus?
What type of instruments are used to remove and crush large deposits of subgingival calculus?
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What is the consequence of using files improperly?
What is the consequence of using files improperly?
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What type of stones should be used with oil lubrication during sharpening?
What type of stones should be used with oil lubrication during sharpening?
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What is the optimal internal angle between the face of the blade and the lateral surface of a universal curette?
What is the optimal internal angle between the face of the blade and the lateral surface of a universal curette?
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What type of shank is stronger and less flexible?
What type of shank is stronger and less flexible?
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What is the term used to describe the angle between the face of the blade and the tooth surface during scaling and root planing?
What is the term used to describe the angle between the face of the blade and the tooth surface during scaling and root planing?
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What is the purpose of the terminal shank in a dental hand instrument?
What is the purpose of the terminal shank in a dental hand instrument?
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What is the primary advantage of using an instrument with a rigid shank?
What is the primary advantage of using an instrument with a rigid shank?
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What is the term used to describe a Gracey curette?
What is the term used to describe a Gracey curette?
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What stroke direction is used on line angles and deep pockets during scaling and root planing?
What stroke direction is used on line angles and deep pockets during scaling and root planing?
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What is the part of the instrument that is in contact with the tooth surface during instrumentation?
What is the part of the instrument that is in contact with the tooth surface during instrumentation?
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What is the primary disadvantage of using mounted rotary stones?
What is the primary disadvantage of using mounted rotary stones?
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What is the best grasp to use when holding an instrument to be sharpened?
What is the best grasp to use when holding an instrument to be sharpened?
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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?
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?
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In patients with deep pockets, what is the expected outcome of surgical periodontal therapy compared to scaling and root planing?
In patients with deep pockets, what is the expected outcome of surgical periodontal therapy compared to scaling and root planing?
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What is the characteristic of healing following scaling and root planing?
What is the characteristic of healing following scaling and root planing?
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What is a common location for residual deposits after scaling and root planing?
What is a common location for residual deposits after scaling and root planing?
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What is the significance of lack of bleeding on probing in patients with periodontal disease?
What is the significance of lack of bleeding on probing in patients with periodontal disease?
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What is the difference in bleeding on probing between smokers and non-smokers with equal amounts of disease?
What is the difference in bleeding on probing between smokers and non-smokers with equal amounts of disease?
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What is the long-term management requirement for patients after scaling and root planing?
What is the long-term management requirement for patients after scaling and root planing?
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What is the indication for surgery in patients who have undergone non-surgical therapy?
What is the indication for surgery in patients who have undergone non-surgical therapy?
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What is the primary goal of root debridement in periodontal treatment?
What is the primary goal of root debridement in periodontal treatment?
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What is the current stance of the American Dental Association on subgingival curettage?
What is the current stance of the American Dental Association on subgingival curettage?
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What is the primary advantage of ultrasonic instrumentation over hand instrumentation?
What is the primary advantage of ultrasonic instrumentation over hand instrumentation?
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What is the purpose of a periodontal probe?
What is the purpose of a periodontal probe?
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What is the recommended technique for measuring pocket depth with a periodontal probe?
What is the recommended technique for measuring pocket depth with a periodontal probe?
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What is a contraindication for the use of ultrasonic scaling devices?
What is a contraindication for the use of ultrasonic scaling devices?
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What is the purpose of a furcation probe?
What is the purpose of a furcation probe?
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What is the recommended method for detecting an interdental crater?
What is the recommended method for detecting an interdental crater?
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What is the mechanism of action of ultrasonic instrumentation?
What is the mechanism of action of ultrasonic instrumentation?
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What is the significance of subgingival root surface roughness in periodontal treatment?
What is the significance of subgingival root surface roughness in periodontal treatment?
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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.