s6 - area specific curets (gracey)

area specific curets

• for specif areas of mouth

• ant vs. post

• mesial vs. distal

• light-mod calc deposits

• crows & roots

design

• long complex fxnal shank (good for root surfs & concavities)

• (like univ) round back, round toe, semicirc cross-sect

• 2 lateral sides come together for round toe

• BUT only has one designated cutting edge (univ has 2)

• face is tilted in relation to lower shank (offset by 70 deg)

• LOWER edge is only side used

• NONWORKING edge not for perio debriding (not sharp)

• nonworking edge angled away from soft tissue wall (good bc no trauma)

self-angulated

• lower cutting edge already 70 when lower shank parallel

gracey series

• dr. clayton gracey

• worked with hugo friedman to dev 14 area specific graceys

• used to be more rigid (limits tactile info) but now more flex

• used to have larger, stronger working end & shank

• moreso medium deposits

• easier control & less energy for stroke

variations in shank length

Standard

• slight flexion with moderate to heavy

  instrumentation pressure

• application: healthy or maintenance clients

• area specificity allows for deep scaling, root

  planing, and periodontal debridement

• blade = offset relative to the lower shank,

  curved upward with a curved blade producing

  an elongated cutting edge

Rigid - Extra rigid

• Larger and stronger, less flexible shank

• applic: Moderate to heavy tenacious calculus

  removal

longer shank by 3mm = deep perio pockets

blade = length shorter by ½ of standard for deep narrow perio pockets and furcations

Gracey 1/2

fxn = ant teeth, all surfs

loc = limits for shallower pocket depths

shank = straight but shorter

Gracey 5/6

fxn = ant + premolar teeth all surfs

• also all surfs EXCEPT DISTAL for molars

shank = straight but longer

Gracey 3/4

fxn = ant teeth all surfs

loc = limits to shallower pocket depths

shank = bent but shorter

Gracey 7/8

fxn = ant + premolar teeth all surfs

• also post teeth facial + lingual

shank = similar shank bend but longer

Gracey 9/10

• ant + premolar all surfs

• post’s facial + lingual surfs

• shank = bend more than 7/8

Gracey 11/12 (like 15/16)

• ant teeth (mesial + distal)

• post teeth all except distal

• shank = slightly angulated at two points

Gracey 13/14 (like 17/18)

• ant teeth (mes + dist)

• post teeth (distal)

• shank = angulated for adaptation to distal

Gracey 15/16 (not part of orig series)

• mimics 11/12 but more complex shank (fulc will be farther and shank parallel

• post teeth all except distal

Gracey 17/18 (not part of orig series)

• mimics 13/14 but more complex shank (fulc will be farther and shank parallel)

• post teeth distals

ant teeth sequence

face tilt toward tooth (hidden from view bc adapted)

RH = 8-9

LH = 3-4 (towards)

1. GRZ = midline

2. adapt tip 1/3 (hug tooth)

3. terminal shank parallel to scale

4. work across facial

5. as approach mesiofacial line angle, pivot & roll

6. when in interprox, terminal shank slightly overlap tooth

posterior sequence

lower shank parallel to prox surface & fxnal shank up and over

• typically paired (need 2 double ended instrums for post teeth debride)

11/12 + 13/14 (traditional pairing)

14 for distal, 11 for facial/lingual to mesial

Modified pairing (only 1 double ended gracey)

• one end is 11 one end is 14

• advantage = no need change instrument

RH = 9

LH = 3

Distal (13/14 or 17/18)

1. GRZ = distofacial line angle

2. lower handle (toward tooth working on)

3. hug face, insert

• if right, face-tooth angulation is 70

Facial/Mesial (11/12 or 15/16)

1. start at distofacial line angle toward mesial

2. tip 1/3 adapt

3. oblique/hor strokes on facial/lingual

4. lower angle, enter 0-40

5. roll and pivot

6. vertical strokes for interprox

gracey overall

good for

• root debriding

• light calc

• (if rigid) medium-tenacious calc

root debriding (RDS)

• remove subg plaque biofilm

• remove residual calc deposits or surf irregularities

1. insert at 0 degree

2. slide into ging margin

3. tilt lower shank 60-70

4. light shaving stroke (lighter and longer than CRS)

modes of calc attachment

1. to pellicle

pellicle = thin coating of salivary proteins attaching to tooth surf minutes after cleaning

• act like double sided tape for tooth & calc

• tooth surf = enamel

• attach strength = weak

2. to surf irregularities

• tiny openings in root surf where PDL fibs are detached

• grooves in cemental surfs (over-instrumentation)

• tooth surf = root surf

• attach strength = strong

3. interlocked with organic crystals of tooth

• matrix of the calc deposit firmly interlocked with org crystals of root surfs

• tooth surf = root surf

• attach strength = extremely strong

planning for calc removal: 2 approaches

1. full mouth debridement

2. sext/quad debridement

1. full mouth debride

• ppl might not want long appts

• 1-2 longs appts vs, 2-6 1hr appts

• minimize appts bc can also be issue for the practice for that many appt

2. sext/quad debride (mult appt.)

• complete calc removal on teeth treated at each appt

• only does as many as one can thoroughly debride in that appt

several teeth = more difficult cases

a sext/quad = more typical, adjacent teeth if time

• can complete 2 quads on same side of mouth (max+mand)

• ^give patient untreated side to chew comfortably with

• when local anaesthetic need

gross calc removal

• gross scaling - removing large calc at first appt

• not good bc proliferation of microorgs

• leave behind rough irreg deposits covered with bact plawque

• as marginal tissue shrink, closes off entrance to pocket wher orgs mult

• can lead abscess formation (localized collection of puss in perio tissue)

• occur on teeth w deep probing depth, while gross scale only remove deposits above & slight beneath margin

root concavity - difficult for plaque remove

• linear dev depression in root surf

• when healthy, covered in alveolar bone & help secure tooth to mouth

• in periodontitis, bone loss expose these

• commonly found mesial/dist surfaces of teeth

• facial & lingual surfs of molars

• best explorer = 11/12 w extended shank

• important to adapt

when exploring

• vert & hor

• should be explored for facial/ling

root furcation

treat each root as separate root

• D curet for distals of each root

• M curet for mesial portions of each root

• for furcation roof & concavities = M curet (toe against roof, then for concavity curet is toe-down with hor stroke)

root trunk

1. distal curet from distofacial line angle to distal surf

2. mesial curet from distofacial line angle to mesial surf

root branches

1. treat each branch as if its each a tooth

2. distal curet for its distal

3. mesial curet for its mesial

standard area specif vs modified curet

standard = perio pockets 4mm or less in depth

modified = perio pockets more than 4mm in depth

• an extended one is 3mm longer lower shank + thinner working end by 10%

miniature working end

• shorter + thinner

• good for tiny roots of mand anteriors

modified gracey w mini work ends

• longer lower shank

• thinner working end

• shorter by 50%