Principles of Periodontal Instrumentation 1 & 2 - PDF

Principles of Periodontal Instrumentation – Part 1 Learning Outcomes By the end of this session students should be able to: Be familiar with historic and contemporary periodontal instrumentation terms Explain the anatomical location of instrumentation techniques Explain the basic objectives of...

Principles of Periodontal Instrumentation – Part 1 Learning Outcomes By the end of this session students should be able to: Be familiar with historic and contemporary periodontal instrumentation terms Explain the anatomical location of instrumentation techniques Explain the basic objectives of different periodontal instrumentation techniques Outline the basic framework of ‘principles’ that are associated with periodontal instrumentation 2 Take 15 minutes and research the following  Divide into 4 groups of 4  Share your experiences of ‘terms’ you have heard clinicians use to the patient or each other  Look on dental practice websites and have a look at how periodontal treatment is termed or ‘hygiene’ services 1. Make a list of these terms 2. What do you understand by them? 3. Share them with the entire group on the discussion board 3 Periodontal Instrumentation Terminology Scaling Root Planing  ….removal of dental plaque, calculus and then smoothing of roots surfaces, removing dentine or cementum.’ Grant et al 1988 1. Accessed Nov 2020 3. Accessed Nov 2020 4 Periodontal Terminology Curettage Curettage  ‘………remove the soft tissue lining of the periodontal pocket with a curette, leaving only a gingival connective tissue lining.... Gingival curettage, as originally conceived, was designed to promote new connective tissue attachment to the tooth, by the removal of pocket lining and junctional epithelium’. American Academy report 2002 2. Accessed Nov 2020 5 NON – SURGICAL PERIODONTAL THERAPY / INSTRUMENTATION Sub Gingival Scaling Supra Gingival Scaling 4. Accessed Nov 2020 5. Accessed Nov 2020 6  Prophylaxis  For patients with healthy gum (gingival) tissue.  Removal of plaque, calculus and (extrinsic) stains from the tooth structures  Intended to help the patient maintain a healthy mouth. 7. Accessed Nov 2020 7 Root Surface Debridement / Instrumentation Supportive Periodontal Therapy  … Following completion of treatment and arrest of inflammation, supportive periodontal therapy (SPT) is employed to reduce the probability of re‐infection and progression of the disease; to maintain teeth without pain, excessive mobility or persistent infection in the long term, and to prevent related oral diseases.’ Manresa et al 2018 6. Accessed Nov 2020 8 Other terms…sitting ‘in between’ Gross Scale Fine Scale  Common for patients that have not had  To remove the remaining build-up and their teeth cleaned professionally in a stain removal long time.  More appropriate for patients with  This allows for evaluation heavy deposits but minimal bone  Facilitates home cleaning involvement and probing depths less than 3mm  Can work against you? How so? 9 8. Accessed Nov 2020 Summary – Non-Surgical Periodontal Therapy / Instrumentation Terms Considerations Familiarity of all instrumentation terms Current appropriate instrumentation terms Challenges for clinician undertaking instrumentation Challenges with patients 10 Reading References  The American Academy of Periodontology Statement Regarding Gingival Curettage*  Grant, DS, Stern IB Periodontics, 6th Edition, CV Mosby and Co. St. Louis 1988.  Manresa et al https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009 376.pub2/full  Gehrig, J. (2020). Fundamentals of Periodontal Instrumentation. 7th ed. 11 Principles of Periodontal Instrumentation Part 2 Learning Outcomes By the end of this session students should be able to: Explain keys components involved in delivering non-surgical instrumentation Conceptualise the challenges associated with non-surgical instrumentation Recognise processes to address with identified challenges to support positive treatment outcomes Determine the key objectives of instrumentation 13 Recap Considerations Familiarity of all instrumentation terms Current appropriate instrumentation terms Challenges for clinician undertaking instrumentation Challenges with patients 14 Principles of Instrumentation Patient compliance Accessibility Visibility, Illumination & retraction Condition of instruments Clean field Operator Action – Stabilisation, activation & stroke 15 Patient Compliance 16 1. Accessed Nov 2020 Patient Compliance 2. Accessed Nov 2020 3. Accessed Nov 2020 17 Accessibility during Instrumentation 4. Accessed Nov 2020 19 Accessibility continued – linked to Operator and Patient Positions in Dentistry  Ergonomics – clinician and nurse  Increases visibility  Increases opportunity of using ‘power’ / ‘leverage’ in a safe, effective and efficient manner  Operator fatigue  Reduce risk of trauma to patient  Reduce risk of RSI  Four handed dentistry  Surgery design 5. Accessed Nov 2020 20 Visibility, Illumination & Retraction - linked to Operator and Patient Positions in Dentistry  Can you see?  How wide can the patient open?  Direct vision  Indirect vision – when do you use this?  Retraction – of what? Why?  How? 6. Accessed Nov 2020 21 Condition of Instrument  Sharpness  Working end features  Warping  Bent – trauma from sterilisation  Inappropriate storage 7. Accessed Nov 2020 22 Clean field  Working in an area that is wet  Wet with what?  Pooling of saliva / bleeding  What is the issue?  Resolved how? 8. Accessed Nov 2020 23 Operator Action linked NSPT 1,2 & 3  Stabilisation  Action  Stroke 9. Accessed Nov 2020 24 Automaticity 10. Accessed Nov 2020 11. Accessed Nov 2020 25  Objectives of Non-Surgical Periodontal Instrumentation  To remove and disrupt biofilm  To remove hard deposits – example?  To eliminate or reduce inflammation  To promote soft tissue attachment  Presenting an optimal tooth surface which is as biocompatible with the host as possible 26 Reading References  No turning back: posture in dental practice | BDJ Team (nature.com)  Gehrig, J. (2020). Fundamentals of Periodontal Instrumentation. 7th ed. 27