Module 11: technique essentials - instrumentation strokes

what is an instrumentation stroke?

the act of moving the working end of a perio instrument against the tooth surface

what is the purpose of instrumentation strokes?

used to assess the character of the tooth surface (such as to locate calculus deposits hidden beneath the gingival tissue) and to remove plaque biofilm and calculus deposits from the tooth surfaces

how does an instrumentation stroke over when the working end of a curet is positioned apical to a calculus deposit in preparation for a calculus removal stroke?

occurs as the working end is moved coronally against the calculus deposit to dislodge it from the tooth surface

How do you detect calculus deposits scattered over the root surface of the tooth?

the working end of an explorer is used to make a series of light, flowing instrumentation strokes over the root surface

What are the 3 directions an instrumentation stroke may be made in?

vertical and oblique, horizontal, multidirectional

How are vertical and oblique strokes made?

always should be made in a coronal direction away from the soft tissue base of the sulcus or perio pocket

When are horizontal strokes most useful?

when working around the line angles of a posterior tooth or at the midline of an anterior tooth

what is a multidirectional stroke?

• combined use of all 3 stroke directions

• assures that biofilm is removed from every square mm of the root surface

when are multidirectional strokes most useful?

very useful when removing plaque biofilm from root surfaces

how are multidirectional strokes made?

cover root surface using one stroke direction, followed by a second different stroke direction, and finally uses a third stroke direction

Where are vortical stories used on anterior teeth?

facial, lingual, and prox surfaces

where are vertical strokes used on posterior teeth?

primarily on the mesial and distal surfaces

where are oblique strokes most commonly used?

on the facial and lingual surfaces of posterior teeth

where are horizontal strokes used on posterior teeth?

around line angles, in furcation areas, and in deep pockets that are too narrow to allow vertical or oblique strokes

where are horizontal strokes used on anterior teeth?

facial and lingual surfaces; narrow M-D width making horizontal strokes the most effective in removing calculus from the narrow root surfaces

how is a horizontal stroke made on an anterior tooth?

working end is in a toe down position; short, controlled horizontal stroke is made on the tooth surface

T'/F: the characteristics of an instrumentation stroke changes depending on the purpose of the stroke

true

what are the 3 types of instrumentation strokes?

assessment stroke, calculus removal stroke, and root debridement stroke

what is an assessment (exploratory) stroke used for?

• to locate calculus deposits or other tooth surface irregularities hidden beneath the gingival margin

• to assess tooth anatomy; detect calculus and other plaque retentive factors

what does the superior tactile conduction of an explorer make it the instrument of choice for?

initially locating subgingival calculus deposits and for reevaluating tooth surfaces following calculus removal

What are assessment strokes made with?

• curets to locate calculus deposits

• probes

• explorers

T/F: when all deposits detectable with a curet have been removed, a definitive evaluation of the root surface should be made using a scaler.

False - should be made using an explorer

T'/F: it is common to detect some remaining calculus deposits with an explorer that could not be detected with a curet

true

what are assessment strokes characterized by?

• fingers relaxed in modified pen grasp and feather light strokes against the tooth surface (longer strokes in comparison with the short length of calculus removal strokes)

• flowing, feather light stroke of moderate length

What is a calculus removal stroke?

type of instrumentation stroke used with sickle scalers, universal and area-specific curets to remove calculus deposits from the tooth

what is a calculus removal stroke characterized by?

• a very short, controlled, biting stroke made with firm pressure of the cutting edge against the tooth surface

• brief, tiny biting stroke

How are calculus removal strokes made?

each stroke is a tiny movement of the working end; the working end only moves a few mms

what does a clinician do after each calculus removal stroke?

pauses and then uses a feather-light assessment stroke to determine if the deposit has been completely removed

where are calculus removal strokes not used?

on tooth surfaces that are free of calculus deposits

what is the root debridement stroke?

• a type of instrumentation stroke used to remove residual calculus deposits, plaque biofilm, and byproducts from root surfaces exposed due to gingival recession or within deep perio pockets

• to completely remove all residual calculus deposits and disrupt plaque biofilm from root surfaces deep within perio pockets

what are residual calculus deposits?

very tiny deposits remaining on the root surface that can be removed using lighter pressure of a root debridement stroke

what is a root debridement stroke characterized by?

• a shaving stroke made with moderate pressure with the cutting edge against the tooth cementum and a stroke that is slightly longer than a calculus removal stroke

• shaving stroke of moderate length

what is an important goal of instrumentation?

conservation of cementum

what is conservation of cementum currently believed to do?

• enhance healing of the soft tissues after instrumentation

• during the healing process after disease, cementum is thought to contribute to repair of the periodontium

what is the number of assessment strokes?

many overlapping strokes to evaluate the entire root surface

what is the lateral pressure of an assessment stroke?

contact with tooth surface, but little pressure

what is the lateral pressure of a calculus removal stroke?

firm pressure against tooth surface

what is the number of calculus removal strokes?

limited to areas with calculus deposits

what is the lateral pressure of root debridement strokes?

moderate pressure against tooth surface

what is the number of root debridement strokes?

many, multidirectional strokes; covering the entire subgingival root surface

what is used with root debridement strokes?

area specific curets

what are the 3 types of forces applied during perio instrumentation?

pinch pressure of the fingers in modified pen grasp, pressure of fulcrum to stabilize the hand, and lateral pressure against the tooth

what is the pinch pressure force of an assessment stroke?

should be as light as possible; vibrations transmitted from the instrument to the nerves of the fingertips are enhanced by a light grasp

what is the pressure of fulcrum against stabilizing tooth for an assessment stroke?

apply only light pressure, upward or downward, with the fulcrum finger against a stable tooth surface

what is the lateral pressure against surface of tooth for assessment stroke?

as the working end moves over the tooth surface, only feather light pressure glides over the tooth surface

what is the pinch pressure for a calculus removal stroke?

instrument is held with moderate pressure

what is the pressure of fulcrum against the stabilizing tooth for a calculus removal stroke?

apply firm pressure, up or down, with the fulcrum finger against a stable tooth surface

what is the lateral pressure against surface of tooth in a calculus removal stroke?

• as the working end is adapted to the tooth surface, the fingers in the grasp apply a firm pressure so that the cutting edge “bites” into the tooth surface

• this pressure is only applied briefly just prior to and during the stroke

what is the pinch pressure for root surface debridement stroke?

held with moderate pressure

what is the pressure of fulcrum against stabilizing tooth for root surface debridement stroke?

apply moderate pressure, up or down, with the fulcrum finger against a stable tooth surface

what is the lateral pressure against surface of tooth for root surface debridement stroke?

• as the working end is adapted to the tooth surface, the fingers in the grasp apply moderate pressure so that the cutting edge will “shave” the root surface

• this pressure is only applied prior to and during the slightly longer debridement stroke

T'/F: the three forces used during an instrumentations stroke should be balanced

true

what is the greatest contributing risk factor in the development of injury among dental hygienists?

use of unnecessary force in a pinch grip

what are the 3 most important concepts regarding the use of pressure during perio instrumentation?

gauge amount of pressure (use as little force as possible to accomplish task), apply only brief pressure (apply pressure only just prior to and during - NEVER between), relax after each stroke