A DVANCED I NSTRUMENTATION N EVI & B ARNHART Lisa Mayo, RDH, BSDH Clinical Sciences DH102 Concorde Career College

ADVANCED INSTRUMENTATIONNEVI & BARNHART

Lisa Mayo, RDH, BSDH

Clinical Sciences DH102

Concorde Career College

TOPICS FOR TODAY

Root Planing Furcation & Root Planing Techniques Specialized & Modified Instruments Removing Overhangs on Restorations

SELECTION & SEQUENCE OF ADVANCED INSTRUMENTATION

1. Ultrasonic first to remove moderate to heavy deposits

2. Scalers and/or universal curets second

3. Gracey curets third

4. Specialized instruments Mini & Micro-Mini’s Diamond files File scaler Hoe scaler Chisel scaler

SPECIAL CONSIDERATIONS

Accessibility and visibilityPocket is a confined area Instrumentation is necessary in areas where

access is difficult Instrumentation is dependent almost entirely on

tactile sensitivitySoft tissue pocket wall limits freedom of

movementCareful adaptation to tooth surface configurations

is essential Control bleeding


Subgingival calculus Location

Subgingival calculus may be located on the enamel, the root, or both

AttachmentCalculus attaches to the cementum in small irregularities and in areas of cemental resorption

More tenacious on cementum than Requires a different technique for removal

Enamel: attached by means of an acquired pellicleMakes calculus removal much easier


Subgingival calculus Morphology of calculus

Subgingival calculus is irregularly depositedLedge, smooth veneer, spicules, ringPreviously scaled or burnished calculus

Subgingival calculus that has been partially scaled and left after incomplete instrumentation

Smooth, may be hard to detect and removeHorizontal strokes: good for line angles

Useful when other strokes impossible to remove deposits

REVIEW FROM PRECLINIC

ROOT PLANING

PLANE THE ROOT SURFACE

Finishing techniques Smoothing the tooth surfaces to lessen

immediate recolonization of bacteriaInstrumentation is basically the same

as for scalingOnly where deemed necessary after

exploration


Touch and pressureLighter the grasp = increase tactile

sensitivityLight lateral pressure is applied for

maximum sensitivity to minute irregularities of the surface

Lighter stroke = used for final smoothing of the root surface

Sharp instruments essential


StrokesSmooth that overlapMultidirectional strokes: vert, horz,

obliqueHave to change instrument

adaptation for concavities, convexities

ROOT PLANING

In health: root filled in completely with alveolar bone

Disease: bone support lost = have to scale deeper under the gums to access base of pockets

To effectively remove root deposits = clinician needs precise knowledge of root morphology

ROOT PLANING

Root concavityLinear developmental depression in the

root surfacesCommonly occur on:

Proximal surfaces of ant and post teethFacial and lingual surfaces of molar teeth

Health – concavities are covered w/ alveolar bone and help to secure the tooth in the bone

Instrumentation extremely difficultHave to have correct adaptation and technique

ROOT PLANING CONCAVITIES

REVIEW OF ROOT MORPHOLOGY








ROOT PLANING

Root Concavity in X-Section

Max 1st Premolar

ROOT PLANING

Incorrect Technique Causes Working End to Glide Over the Root Concavity

ROOT PLANING

Correct Technique Causes Working End to Adapt Correctly to Concavity

ROOT PLANING

Anatomic features that complicate root planing

Root concavities: need to know all teeth and areas with concavities for test and to be successful in clinic

DepressionsRoot fissures

ROOT PLANING

Palatal groove on max lateral incisor that extends onto the cervical-3rd of the root surface

ROOT PLANING

Deep linear root concavities on the proximal surfaces of mand canines

ROOT PLANING

Wide shallow root concavity on the mesial surface of mand molars

ROOT PLANING

Deep linear proximal root concavities and furcations on max 1st premolar

ROOT PLANING

Deep depression on root trunk and furcation on mand molars

ROOT PLANING

Proximal concavities extending from the furcation to CEJ on maxillary molar

FURCATION SCALING

Complex morphology and difficult to access

Keys for successSharp InstrumentsCorrect instrument sequence and fundamentals

Close adaptation of blade/tip to root surface

Precise movement of the bladeExcellent ability to explorer accurately

FURCATION SCALING

A. Widely separatedB. Separated but close togetherC. Fused roots separated only in the apical portionD. Presence of an enamel projection that may

be conductive to an early furcation involvement

FURCATION SCALING

FURCATION SCALING

Steps for scaling1. Begin by debriding root trunk w/ mesial/distal

curet2. Instrument each root branch as if it were a

separate tooth. Distal curet for distal portion.3. Mesial curet for mesial portion4. Treat furcation separately5. Turn toe into root furcation

ADAPTING INTO FURCATIONHTTPS://WWW.YOUTUBE.COM/WATCH?

V=V7AWDUKJQ7W

SCALING STEPS REVIEW

1. Instrument Grasp: modified pen grasp2. Stabilization: Finger Rests/Fulcrum3. Select Correct Cutting Edge4. Insertion: insert at 0° angle/flat against tooth

surface to base of pocket then adapt to 70° (Gracey’s self-adapt)

5. Adaptation: toe & middle 1/3 of a blade• Maintain adaptation of cutting edge to

prevent trauma (70° angulation)6. Angulation: 70°7. Lateral Pressure: light, moderate, heavy8. Stroke: wrist-rock, vert/horz/oblique

INSTRUMENT ANGLES REVIEW

GRACEY’S

MODIFIED GRACEY CURETS FOR ADVANCED ROOT PLANING

Extended shanks Miniature working-ends Micro working-ends



Extended shanks aids clinicians in accessing furcation areas of molars


Micro-Miniature and Standard Working-EndsMiniature has ½ the working length then that of the standard Gracey curette



Longer Lower Shanks3mm longerDeep perio pockets

Thinner Working Ends10% thinnerReduced tissue distension away from root

surface Uses

Debride root surfaces w/ deep perio pockets


MINIATURE GRACEY CURETTES

Extended Shank Length3mm longerDeep perio pockets

Thinner Working-EndWorking-end 10% thinnerReduced tissue distension

Shorter Working-End½ the lengthWorking-end does NOT curve up



UsesNarrow deep pockets over 4mm in depthDebride root branchesMidline ant rootsRoot concavitiesFurcation areas (#12/5-M, mand molars

F/L, etc…)Narrow facial/lingual surfacesNot intended to replace either the

standard or extended shank Gracey curets for routine instrumentation of all tooth surface




Longer shank length3mm longerSlightly increased rigidity compared to

miniature curets Thinner working-ends

20% thinner Reduced distension of tissues

Shorter Working-End½ length

MICRO-MINI GRACEY CURETS FOR ADVANCED ROOT

PLANING

UsesVery tight, deep, narrow pocketsNarrow furcationsDevelopmental depressionsLine anglesNot intended to replace either the

standard or extended shank Gracey curets for routine instrumentation of all tooth surface

MICRO-MINI GRACEY CURETS FOR ADVANCED ROOT

PLANING



Diamond Coated Instruments No cutting edges: fine diamond grit 360 around

instrument Shape is similar to Nabers probe – good for

furcation access

DIAMOND COATED

Diamond Coated Instruments Uses

Small, embedded remnants of calculus that remain on the root surface after instrumentation

Finishing toolsLight pressureGood for Class III & IV furcations

C.FILE SCALERD. CHISEL SCALER

E. HOE SCALER

FILE SCALER: WILKINS P.585

Metal or diamond Multiple cutting edges line up as a series of

miniature hoes on a round, oval or rectangular base

Metal multiple blades at 90◦ angle with shank Always use a PULL stroke with linear motion Uses

Crushes and fractures calculus into fragments Burnished calculus that is impervious to removal

with other bladed instruments Used when ultrasonic contraindicated

HOE SCALER: WILKINS P.585-586

Single straight cutting edge Bladed at a 99◦ angle to shank Cutting edge: bevel at a 45◦ angle to end of

blade Always use a PULL stroke with linear motion Uses:

SUPRAgingival calculus large tenacious piecesToo large to insert subgingivally without tissue

trauma

CHISEL SCALER

Single straight cutting edge Blade continuous with slightly curved shank End of blade with flat & beveled at 45◦ angle Can use a PUSH stroke on lower ant lingual

ridge of calculus to break it apart with ONLY a HORIZONTAL stroke

Uses:Supragingival calculus from exposed

proximal surfaces of ant & pm teeth with NO interdental papillae

OVERHANG RESTORATIONS

OVERHANGING RESTORATIONS

Overhanging marginsMay occur on any tooth surface,

supragingivally or subgingivallyProximal surface overhangs result from (NBQ)

Improper placement of the matrix band and/or wedge

Incorrect manipulation of the dental materialFinishing errors

OVERHANGING RESTORATIONS

Benefits of overhang removal Efficient use of dental floss and other interdental

cleaning devices Improvement in periodontal health when

combined with scaling, root planing, and dental biofilm control

Identification Clinical Radiographic

EFFECTS OF OVERHANGING RESTORATIONS

Relationship to periodontal disease and dental cariesNiche where microorganisms that cause periodontal

infections and dental caries can proliferateCatch and tear dental flossRender the area inaccessible to a toothbrush and

other dental biofilm-removing aidsHinder the patient from disease control procedures Increase the severity of existing inflammation Increase the chance of adjacent bone lossRetain debris and microorganisms contributing to

halitosis and a general lack of oral sanitation

OVERHANG REMOVAL

Procedure Manual instrumentation

Sharp instrumentsControlled strokesKeep in contact with tooth to avoid gingival trauma

Floss to check your workPower-driven instruments

First then try manual(chisel, file, scaler, curet)

Cut down on hand fatigue

UNIVERSAL CURETSBARNHART

BARNHART

Names for University of Southern California where was developed by DH faculty

Universal Curet 2 cutting edges, rounded toe Thin, sharp cutting edge Longer shank & blade than Columbia 13/14

More effective at times on interproximal molars Uses

Slips easily under tight tissues Light to mod calculus both supra and sub-g

UNIVERSAL CURETTES

Curettes come in different sizes and lengths

UNIVERSAL CURETTES

Curettes come in different sizes and lengths

UNIVERSAL CURETTEANGULATION

ESTABLISH 70-80° ANGULATION

SICKLE SCALERS

H6/7 Anterior Teeth 204S Posterior Teeth Nevi Cross between the 2

NEVI SICKLE SCALERHTTPS://WWW.YOUTUBE.COM/WATCH?V=O3C2UBLKOPI

Double-ended post and ant sickle Curved, thin blade and lower shank Remove mod to heavy calculus ledges SUPRA just like other sickles

Documents

A DVANCED I NSTRUMENTATION N EVI & B ARNHART Lisa Mayo, RDH, BSDH Clinical Sciences DH102 Concorde Career College