Advanced Instrumentation & Cetacaine

Vocabulary flashcards covering NSPT, root planing, instruments, techniques, furcation assessment, and Cetacaine usage.

Nonsurgical periodontal therapy (NSPT)

Also called Professional Mechanical Plaque Removal (PMPR); goal is to remove dental biofilm, endotoxins, bacterial products, and calculus; may include antimicrobial agents; followed by re-evaluation to determine need for surgical periodontal treatment or maintenance; includes patient education on biofilm management.

Professional Mechanical Plaque Removal (PMPR)

Alternative name for NSPT.

Scaling and Root Planing (SRP)

Common term for NSPT; combines removal of calculus with root surface debridement; historically aimed to remove cementum, but modern healing does not require cementum removal.

Root planing

Removal of subgingival deposits and debris (plaque biofilm, calculus, altered cementum, softened dentin) to create a smooth surface biologically acceptable to surrounding tissue while preserving cementum.

Cementum preservation during root planing

Maintaining cementum integrity to support new attachment of periodontal tissues.

Plaque biofilm

Microbial film on tooth roots that NSPT aims to remove to improve periodontal health.

Endotoxins

Bacterial products removed during NSPT to reduce inflammation and promote healing.

Microbial shift after NSPT

Post-treatment flora tends to become aerobic, Gram-positive, non-motile coccoid forms with a lower bacterial load.

Furcation involvement

Loss of alveolar bone and periodontal ligament fibers in the space between roots of multi-rooted teeth; mandibular molars are typically bifurcated, maxillary molars are typically trifurcated.

Naber's probe

A furcation probe used to measure furcation involvement; has four class grades; markings do not alone indicate furcation involvement.

Furcation Class I

Concavity on the root trunk felt with the probe but penetration does not exceed 1 mm.

Furcation Class II

Probe penetrates into the furcation greater than 1 mm but does not pass completely through.

Furcation Class III

Probe passes completely through the furcation between roots (mandibular molars between mesial and distal roots; maxillary molars between mesiobuccal and distobuccal and touches the palatal root).

Furcation Class IV

Same as Class III with entrance to the furcation visible clinically due to gingival recession.

Root surface concavities

Indentations or grooves on root surfaces that affect access and instrumentation; awareness is essential for effective debridement.

Gracey curets

Area-specific curets with a single cutting edge per working end; designed to adapt to root curvature and anatomy; features include a rounded back, rounded toe, semicircular cross section, and a relatively rigid shank.

After Five

A Gracey variant with a 3 mm elongated terminal shank and a blade about 10% thinner to allow deeper insertion.

Mini Five

Gracey variant with a 3 mm elongated shank and a blade roughly 50% shorter; blade is about 10% thinner to facilitate access in tight spaces.

Micro Mini

Gracey variant with a 3 mm elongated terminal shank and thicker shank; blade about 50% shorter and about 20% thinner for even closer access in restricted areas.

Periodontal file (Traditional file)

Crushes heavy calculus into fragments; removes burnished calculus; smooths overhangs; useful when ultrasonic instrumentation is contraindicated; multiple cutting edges; blades set at 90 degrees to shank; reduced tactile sensitivity.

Diamond file

Diamond-coated instrument with no blades; used for finishing root surfaces and accessing furcation areas; working surface placed flat against root surface with light, multi-directional push-pull activation.

Supra- and subgingival instrumentation with files

Filesadapted to treat both supra- and subgingival deposits; contact: working surface flat against area; activation is a pull stroke with lateral pressure; follow with a curet to smooth the surface.

Two-point contact

Concept where the working end is flat against the deposit and the lower shank is against the tooth surface to maximize contact and control.

File activation and lateral pressure

Pull stroke with lateral pressure; maintains contact and enhances effectiveness of marginal root surface debridement.

Assessing stroke

Light, feather-like strokes used to assess tooth anatomy and locate calculus; many overlapping strokes across the root surface.

Calculus removal stroke

Firm pressure with short, precise strokes to lift calculus deposits off the tooth surface.

Root debridement stroke

Moderate pressure with multidirectional strokes to remove residual calculus and disrupt biofilm from within deep pockets.

Finishing stroke

Longer, shaving strokes that refine the root surface and smooth irregularities after debridement.

Gingival curettage

Removal of pocket epithelium and infiltrated subepithelial connective tissue; borders on surgical therapy; causes tissue shrinkage; not permissible without dentist presence.

Gingival curettage technique

Anesthesia; direct curet blade toward soft tissue; vertical and circumferential sweeping strokes; remove granulomatous tissue.

Cetacaine (topical anesthetic)

Topical anesthetic formulation containing benzocaine 14%, butamben 2%, and tetracaine HCl 2%; available as liquid, gel, or spray; banana scent.

Cetacaine uses

Used for sensitivity or pain control; can be used alone or with local anesthesia; spray helps reduce gagging during X-rays.

Cetacaine dosage

Typical single dose is 0.2 mL (200 mg); maximum dose is 0.4 mL (400 mg); higher doses are contraindicated.

Cetacaine application

Administer with syringe tip or cotton-tipped applicator placed in the pocket to target gingival tissues.

Extraoral fulcrums (Cross Arch and Opposite Arch)

Fulcrums established outside the same arch to stabilize the hand; cross-arch is especially useful for horizontal strokes in proximal root concavities; opposite arch improves access to deep pockets and parallelism.

Cross Arch fulcrum

Finger rest on the opposite side of the same arch to stabilize the hand during instrumentation.

Opposite Arch fulcrum

Finger rest on the opposing arch to improve access and align shank parallel to proximal root surfaces.

Substitute finger rests

Alternatives when a traditional fulcrum is not possible: cotton rolls, gauze, or mobile teeth; use with caution to avoid tissue trauma.

Finger on finger technique

Nondominant hand finger rests on adjacent teeth surfaces to stabilize; not ideal for distal surfaces when access is limited.

Reinforced finger rest

Nondominant index finger rests on an adjacent tooth with the thumb on the instrument shank for additional force.

Edentulous or missing teeth fulcrums

Substitute rests used when teeth are missing; require minimal pressure and short duration to avoid periodontal ligament damage.