pre-clinic quiz 7: Non-Surgical Periodontal Therapy “Scaling and Root Planing” Review of Calculus Detection

What is nonsurgical periodontal therapy?

Deep scaling that removes calculus and biofilm from root surfaces and periodontal pockets to stop periodontal disease progression.

What pain management may be used during nonsurgical periodontal therapy?

Local anesthetic or other pain management techniques.

What four instruments are used for scaling and root planing?

Universal curets, area-specific curets, periodontal files, and ultrasonic instrumentation.

What are standard area-specific curets 1-8 designed for?

Light to moderate calculus; they have a flexible shank.

In what forms are area-specific curets available?

rigid or modified

How many cutting edges does an area-specific curet have per end?

One cutting edge per end; the lower edge.

How deep are standard area-specific curets designed to work?

4 mm or less.

How deep are modified Gracey curets designed to work?

Greater than 4 mm

How much longer is the lower shank of an extended curet?

3 mm longer.

What are the benefits of modified area-specific curets?

Better access to tight, deep pockets, periodontal defects, and furcation sites.

What are the three types of modified area-specific curets?

After Fives, After Five Minis, and Micro-Minis.

What are After Five curets?

3 mm extended shank and 10% thinner.

What are After Five Mini curets?

3 mm extended, 10% thinner, and 50% shorter working end.

What are Micro-Mini curets?

3 mm extended, 20% thinner, and 50% shorter working end.

What are universal curets designed for?

Light to moderate calculus.

How many cutting edges does a universal curet have per end?

Two cutting edges per end.

What type of shank does a universal curet have?

rigid shank

What variations are available in universal curets?

Different shapes, shank lengths, and contra-angles.

What is the purpose of a periodontal file?

Break up large or burnished calculus deposits.

How is a periodontal file used?

Rubbed back and forth against a calculus deposit

Which instrument is suggested for pockets under 3 mm?

sickle scaler

What part of a curet is used in a furcation concavity?

The toe of the curet.

When are multidirectional strokes indicated?

During SRP, in concavities, and for burnished calculus.

What is an assessment stroke?

A light, exploratory stroke used to detect rough root surfaces.

How can you definitively check a root surface?

Use periodontal explorers.

When should calculus removal strokes be avoided?

On surfaces free of deposits.

What is a root debridement stroke?

A light-pressure, long stroke that facilitates tissue healing.

What is a calculus removal stroke?

A firm, biting stroke used to remove calculus deposits.

Why use very light pressure during root debridement?

To preserve cementum.

What are common challenges of nonsurgical periodontal therapy?

Access to pocket depth, root morphology, concavities, multirooted teeth, furcations, limited visibility and tactile sensitivity, and burnished calculus.

What stroke pattern is used for posterior root planing?

Short, overlapping strokes.

What should happen with each root planing stroke?

Ease to the base of the pocket.

Which part of the curet should remain active during posterior root planing?

The toe third.

What changes after larger calculus is removed?

use final root planing strokes.

What angulation is used for final root planing strokes?

Tilt the lower shank toward the root surface at about 60°.

What is the direction of final root planing strokes?

gingival to occlusal/incisal.

How should final root planing strokes feel and move?

Light, shaving strokes that are longer and lighter.

Where do you insert the instrument for distal pockets?

distal line angle

How do you achieve 0° angulation during insertion?

Lower the instrument handle and hug the face against the tooth.

What angulation is created for activation after insertion?

Approximately 70°.

How should a universal curet be positioned for 70° angulation?

Lean in about 20°.

How should an area-specific curet be positioned for 70° angulation?

Keep the instrument parallel.

How far should strokes extend across the proximal surface?

Halfway across the proximal.

How do you maintain adaptation when scaling buccal or lingual surfaces?

Roll the handle to keep the toe third adapted to root contours.

Which direction should strokes move on posterior buccal and lingual surfaces?

toward the mesial surface using oblique or horizontal strokes.

how should you adapt the curet in buccal and lingual furcation concavities?

Curve the toe into the concavity and focus on the toe and its sides.

Which area-specific curet numbers are used for mesial furcation surfaces?

15/16.

which area-specific curet numbers are used for distal furcation surfaces?

13/14.

How do you scale the mesial surface around a line angle?

Roll the handle to maintain toe-third adaptation; "drive around the curve."

How do you begin anterior root planing?

Place the toe near the midline of the tooth, aiming toward the first proximal.

How should an area-specific curet be positioned on anterior teeth?

Keep it parallel.

How should a universal curet be positioned on anterior teeth?

Lean diagonally across the tooth in a "sash."

What is the correct stroke pattern for anterior root planing?

Short, overlapping strokes from gingival to occlusal.

What are common scaling errors?

Wrong instrument, dull instruments, failing to reach the pocket base, poor toe-third adaptation, incorrect angulation, and strokes that are too long, too light, or too few.

What does "on the calculus, not under it" mean?

The instrument is not reaching beneath the deposit to the base of the pocket.

What does "smoothing, not removing" indicate?

Strokes are insufficient to effectively remove calculus.

Why use an air-water syringe to check for calculus?

Dry calculus is easier to see, and air can reflect loose tissue.

Which part of the ODU explorer tip goes deepest?

The back of the tip; the point never goes deepest.

Where is the ODU explorer inserted?

At the distal line angle.

Why can the back of the ODU explorer tip reach the pocket base safely?

It can contact the base without lacerating the junctional epithelium.

What is the correct handle position for ODU explorer insertion?

Relatively vertical.

What strokes are used to explore the distal surface?

Short, gentle, overlapping vertical strokes similar to probing.

How should the terminal shank be positioned on proximal surfaces for the explorer?

Parallel to the long axis of the tooth.

How far do vertical exploring strokes extend into the proximal?

Halfway into the proximal, then upward to the contacts.

How do you transition from exploring the distal to the mesial?

Use vertical strokes to exit the proximal, pivot the tip toward the mesial, and reposition at the distal line angle.

How do you explore buccal and lingual surfaces?

Use diagonal/oblique up-and-down overlapping strokes while keeping the side of the tip adapted.

How do you explore the mesial surface?

Turn the tip around the line angle, stop and drop into the col, then use vertical strokes parallel to the proximal up to the contact.

What are the two calculus detection methods named in the final slides?

Tactile detection and radiographic detection.