Periodontal Instrumentation and Probing

Proprioception

The body’s ability to sense its location, movements, and actions.

HINT: like when you touch your finger to your nose while your eyes are closed.

Adaptation

The act of placing the first 1-2mm of the working end’s lateral surface in contact with the tooth.

Neutral joint position, soft c, use of finger tips not finger pads.

Correct ergonomics of the Handle Roll for Adaption includes…

Parallel

For posterior teeth, to select the correct working end of any instrument, we are looking for the lower shank to be _______ to the distal portion of the tooth and the functional shank goes “up and over” the tooth.

Wrapping

For anterior teeth, to select the correct working end of any instrument, we are looking for the lower shank to be _______ the tooth when placed at the midline of a facial surface.

Calculus removal or Exploratory

Instrumentation Stroke is the act of moving the working-end against the tooth surface. These Strokes an be 2 different kinds…

Coronal

Instrumentation strokes are made in a ______ direction, away from the soft tissue base of the sulcus or pocket.

Vertical/oblique, horizontal, and Multidirectional

What are the three stroke directions?

Assessment Stroke

• used to evaluate the tooth surface

• Used with explorers to locate calculus deposits

• AKA exploratory stroke

• Used to reevaluate tooth surface after calculus removal

Characteristics:

• fingers relaxed in MPG

• Flowing, feather-ight stroke of moderate length

• Contacts the tooth, but no pressure is applied against the tooth surface for this stroke

Calculus Removal Stroke

• used to remove calculus deposits off of the tooth surface

• Used with Curets and Sickle scalers

Characteristics:

• Short, controlled, biting stroke used to remove calculus deposit from tooth

• Firm lateral pressure of cutting edge against the tooth during this brief stroke

• At the start of trike, press fulcrum finger down against tooth

Root Debridement Stroke

• used to remove residual calculus deposits, bacterial plaque, and byproducts from…

  • Root surfaces hat are exposed due to recession

  • Root surfaces within deep periodontal pockets

Characteristics:

• Lighter, shaving stroke of moderate pressure

• Used with Curets

• Stroke length slightly longer than calculus removal stroke

• Light pressure is applied against cementum

Pinch pressure of fingers, pressure of fulcrum to stabilize, and lateral pressure against tooth during strokes.

What are the three main pressure forces during instrumentation?

Design of Probe Working-End

• working end is blunt and rod shaped

• Cross section may be circular or rectangular

• Calibrated with mm markings

Uses of Probes

• measure sulcus and pocket depths

• Measure clinical attachment levels

• Determine the width of attached gingiva

• Assess for the presence of bleeding and exudate, measure size of oral lesions

• Measure longitudinal response of Periodontium to treatment

1-3mm

In health, the probing depth of healthy gingival sulcus should be from __to__ mm in depth

Periodontal Pocket

A probing depth deeper than 3mm indicates a ________ _______.

From the gingival margin to the base of the sulcus

What area is measured with the probe?

HINT: what area of the tooth makes up the periodontal pocket

Probing

The act of walking the tip of a probe along the base of a sulcus or pocket for the purpose of assessing the health status of the periodontal tissues.

Parallel

Angulation of the probe working-end is positioned as ________ as possible to the root surface.

HINT: long axis of the tooth

Walking stroke

A series of bobbing strokes that are made within the sulcus or pocket while keeping the probe tip against and in alignment with the root surface.

10 and 20 g

The pressure exerted with the probe tip against the soft tissue base of the sulcus or pocket should be between __and__ g.

The deepest reading would be recorded.

For areas of the where we might get multiple depth reading in a pocket, how do we accurately measure and record?

Affect accuracy of probe measurements

• position of the gingival margin

• Interference from calculus deposits, overhanging restorations

• Amount of pressure applied

• Misread probe calibrations

Are all factors that can…

Distfacial line angle with a distal walk.

Proper probing technique begins in zone 1 which is what area of the tooth?