instrumentation module 15

instrumentation stroke

act of moving the working-end against the tooth surface

exploratory stroke

detects calculus; assessment stroke

calculus removal stroke

working stroke

movement of working-end

as it moves across tooth surface consider location of JE; sharp cutting edges or tips of instruments could injure the JE

junctional epithelium (JE)

soft epithelial tissue forming the base of gingival sulcus

instrumentation strokes

made in coronal direction, away from the soft tissue base of sulcus or pockets

stroke direction

varies depending on the tooth surface being instrumented

3 stroke directions

-vertical

-horizontal

-oblique

all equal multidirectional

vertical stroke

upward or downward movement of instrument

oblique stroke

slanted movement of instrument

horizontal direction

left to right or right to left movement of instrument

multidirectional

combo of vertical, oblique, and horizontal strokes

vertical strokes on anterior teeth

used on facial, lingual, and proximal surfaces

vertical strokes on posterior teeth

mesial and distal surfaces

oblique strokes on posterior teeth

used on facial and lingual surfaces

horizontal strokes used on:

-line angles of posterior teeth

-furcation areas

-deep, narrow pockets

-narrow root surfaces of anterior teeth

3 types of instrumentation strokes

-assessment stroke

-calculus removal stroke

-root debridement stroke

assessment stroke uses

-evaluate tooth surface

-paired with explorer to locate calculus deposits

-reevaluate tooth surface after calculus removal

-AKA exploratory stroke

characteristics of assessment stroke

-fingers relaxed in modified pen grasp

-flowing, feather light, gliding stroke, short in length (1 to 2mm)

-contacts tooth with very light pressure applied against the tooth surface

calculus removal stroke uses:

-to remove calculus deposits off tooth

-with curets and scalers

characteristics of calculus removal stroke

-short, controlled, biting stroke

-firm lateral pressure of cutting edge against the tooth during brief stroke

-at start of stroke, press fulcrum finger down against the tooth

root debridement stroke uses

to remove residual calculus deposits, bacterial plaque, and byproducts from

1- root surfaces that are exposed in mouth bc of gingival recesssion

2- root surfaces with deep periodontal pockets

characteristics of root debridement stroke

-lighter, shaving stroke

-used with curet

-shorter stroke length than calculus removal stroke

-light pressure applied against cementum

root surfaces

-conservation of cementum facilitates tissue healing

-function of cementum is to attach PDL fibers to root surface

-root debridement stroke with light pressure

-should not be confused with failure to remove calculus deposits

use of pressure during instrumentation

different tasks require different applications of pressure

3 pressure forces of instrumentation stroke

-pinch pressure of fingers in grasp

-pressure of fulcrum finger to stabilize hand

-lateral pressure against tooth

assessment stroke pressures

-light pinch pressure with grasp

-light pressure on fulcrum

-feather light pressure as working end moves over tooth surface

calculus removal stroke pressures

-moderate pinch pressure with grasp

-firm pressure against fulcrum

-firm lateral pressure applied as cutting edge “bites” into tooth surface

-brief strokes to allow hand to rest between strokes

root debridement stroke pressures

-moderate pinch pressure with grasp

-moderate pressure applied on fulcrum

-moderate lateral pressure applied as cutting edge performs “shaving” stroke

ergonomics of stroke pressure

-the 3 pressures should be balanced during strokes

-unnecessary or constant firm pressure becomes a bad habit

-gauge amount of pressure

assessment stroke step 1

get ready by placing working-end of explorer in middle-third of crown

assessment stroke step 2

slide explorer tip beneath the gingival margin, keeping tip against tooth. insert until explorer touches the soft tissue at base of the pocket

assessment stroke step 3

make a light stroke away from soft tissue base of pocket. keep fingers very relaxed in grasp

assessment stroke step 4

stop each stroke just beneath the gingival margin

assessment stroke step 5

make a series of feather light strokes across the facial surface

characteristics of assessment strokes

-flowing, feather light strokes short in length

-contacts the tooth with very light pressure applied against tooth surface