U2 - Instrumentation and Calculus Removal

What is an instrument stroke?

Movement of a periodontal instrument's working end against a tooth surface.

What are the three types of instrumentation strokes?

Assessment/exploratory, calculus removal/scaling, and root debridement.

What lateral pressure is used for exploratory strokes?

Little to no lateral pressure.

What is the purpose of an exploratory stroke?

Detect calculus and other surface irregularities by tactile assessment.

How are exploratory strokes described?

Light, moving, featherlike strokes.

What lateral pressure is used for calculus removal?

Firm lateral pressure with short, controlled strokes.

What is the purpose of a calculus removal stroke?

Dislodge calculus deposits from the tooth surface.

How does a root debridement stroke differ from a scaling stroke?

It uses moderate pressure and longer strokes against the root surface.

What is the purpose of root debridement?

Remove residual deposits and contaminated root-surface material with controlled strokes.

Which stroke type is described as a shaving stroke on cementum?

Root debridement.

What are the four stroke directions named in the lecture?

Vertical, horizontal, oblique, and multidirectional.

In what direction should scaling strokes generally be activated?

Coronally, away from the junctional epithelium.

Where are vertical strokes commonly used?

Anterior teeth and interproximal surfaces of posterior teeth.

Where are oblique strokes commonly used?

Facial and lingual surfaces of posterior teeth.

Where may horizontal strokes be useful?

Furcations, lingual bars, and deep pockets when instrument design permits.

Which procedure commonly uses multidirectional strokes?

Root planing.

Where is supragingival calculus located?

Coronal to the gingival margin.

Where is subgingival calculus located?

Apical to or below the gingival margin.

How is supragingival calculus commonly detected?

Direct visual inspection, though some deposits may be difficult to see.

How is subgingival calculus commonly detected?

Tactile assessment with an appropriate instrument.

What four calculus features guide instrument selection?

Location, quantity, shape/morphology, and tenacity.

What does calculus tenacity mean?

How firmly a calculus deposit adheres to the tooth.

Why does shank strength matter when removing calculus?

More tenacious deposits require adequate instrument strength and control.

What are the four calculus morphologies in the slideshow?

Sheet/veneer, spicule, ledge, and ring.

What is a calculus sheet or veneer?

A thin, broad layer of calculus that may feel like surface roughness.

What is a calculus spicule?

A small, localized, rock-like bump of calculus.

What is a calculus ledge?

A raised shelf-like deposit that may feel like a stick or ridge.

What is a calculus ring?

A band of calculus extending around the tooth.

Why might a veneer of calculus be missed visually?

It can be thin and subtle, even when supragingival.

Which salivary duct region is a common calculus site on maxillary posteriors?

Near the parotid duct opening.

Which salivary gland region is associated with mandibular anterior calculus?

The submandibular gland duct region.

Which two main groups of hand instruments remove calculus?

Sickle scalers and curettes.

What two types of curettes are named?

Universal curettes and Gracey curettes.

What is the primary use of a sickle scaler?

Removing calculus from the crowns of teeth, especially enamel surfaces.

Why should a sickle scaler generally not be used on exposed cementum?

Its pointed design can damage cementum.

Does the lecture say a sickle scaler is never used subgingivally?

No; it notes limited situations in which it may be used subgingivally.

What shape is the tip of a sickle scaler?

Pointed.

What is the cross-sectional shape of a sickle scaler?

Triangular.

How many cutting edges does each sickle scaler working end have?

Two.

How is a sickle scaler's face oriented relative to its lower shank?

Perpendicular, at approximately 90 degrees.

What grasp is used for instrumentation in this lecture?

Modified pen grasp.

Which finger forms the fulcrum?

Ring finger.

What is the preferred location for an intraoral fulcrum?

On an incisal or occlusal surface in the same arch.

How far from the working tooth is the typical intraoral fulcrum?

About 1-4 teeth away.

What other intraoral location may sometimes be used for a fulcrum?

An embrasure area.

Which part of the fulcrum finger contacts the support surface?

The fingertip.

Why should the fulcrum be near the tooth being instrumented?

A closer, stable finger rest improves control.

Which direction should the palm face for maxillary instrumentation?

Upward.

Which direction should the palm face for mandibular instrumentation?

Downward.

What is an extraoral fulcrum?

A finger rest supported outside the mouth rather than on an intraoral tooth surface.

What is instrument adaptation?

Placing the lateral surface of the terminal 1-2 mm of the working end against the tooth.

How many millimeters of the working end should be adapted?

The terminal 1-2 mm.

Which surface of the instrument tip is adapted to the tooth?

The lateral surface, or side of the tip.

What is a common result of incorrect adaptation?

The tip may gouge or poke gingival tissue, including the papilla.

Why is adapting the middle of a cutting edge rather than the tip incorrect?

The terminal 1-2 mm may project away from the tooth and traumatize tissue.

What must you do to maintain adaptation around a curved tooth surface?

Roll the instrument handle as you move around the line angle.

Which fingers are used to roll the instrument?

Thumb or index finger.

Should you roll an instrument using fingertips or finger pads?

Fingertips for precise control.

What is angulation?

The relationship between the instrument face and the tooth surface.

What is the ideal calculus-removal angulation range in the lecture?

60-80 degrees.

What angle is illustrated as a typical ideal value?

About 70 degrees.

What narrower range is emphasized during anterior scaling step 5?

70-80 degrees.

What happens when angulation exceeds 90 degrees?

Overangulation can cause soft-tissue trauma.

What can happen when angulation is less than 45 degrees?

Underangulation may slide over calculus and burnish it.

What is burnished calculus?

Calculus smoothed or flattened against the tooth instead of fully removed.

Why is burnished calculus a clinical problem?

It becomes difficult to detect and remove.

What is the problem with scaling at a very closed angle?

The cutting edge may glide over the deposit instead of engaging it.

How can the lower shank be moved to open the angle for calculus removal?

Tilt the lower shank toward the tooth surface, as shown in the lecture.

What is stabilization during a scaling stroke?

Using a secure fulcrum and controlled grasp to support applied force.

What provides a pivot point during instrumentation?

The firmly supported fulcrum finger.

What hand forces are emphasized for calculus removal?

Adequate grasp or pinch pressure and stable fulcrum pressure.

What is motion activation?

The muscle action used to move an instrument's working end across a tooth.

What is the most common activation for periodontal instrumentation in this lecture?

Wrist-rocking motion.

What moves as a unit in wrist-rocking activation?

The hand, wrist, and arm.

What familiar action is used to describe wrist rocking?

Turning a doorknob.

What does the fulcrum finger do during wrist rocking?

Stays pressed against the support surface as a pivot.

Why is finger-only activation insufficient for tenacious calculus?

It does not generate the controlled power of wrist-rocking activation.

How should the hand be held between strokes?

Relaxed rather than continuously tense.

Should large calculus deposits be removed layer by layer?

No; the lecture warns this can burnish calculus.

How should large calculus deposits be removed?

In sections using short, firm instrumentation strokes.

When should you move to the next calculus section?

After the current section has been completely removed.

Where does anterior sickle scaling begin?

At the midline of the tooth.

In which direction does anterior scaling progress from the midline?

Toward a proximal surface.

What is anterior calculus removal step 1?

Begin at the tooth midline and work toward the proximal surface.

What is anterior calculus removal step 2?

Adapt the terminal 1-2 mm near the midline and tilt the lower shank to establish angulation.

When may you not need to manually tilt the lower shank for angulation?

When the working end is self-angulated.

What is anterior calculus removal step 3?

Make strokes across the facial surface toward the mesial surface.

What is anterior calculus removal step 4?

Roll the handle at the line angle to keep the terminal 1-2 mm adapted.

What is anterior calculus removal step 5?

Continue mesially while maintaining approximately 70-80 degrees of angulation.

What is anterior calculus removal step 6?

Make strokes at least halfway across the mesial surface.

What are the two cutting edges labeled on the anterior sickle illustration?

Cutting edge 1 and cutting edge 2.

In the annotated anterior diagram, which cutting edge is purple?

Cutting edge 1, labeled the far edge.

In the annotated anterior diagram, which cutting edge is yellow?

Cutting edge 2, labeled the near edge.

Why does the clinician roll the handle at a line angle?

To keep the working end adapted as tooth curvature changes.

What must be checked when selecting a posterior sickle scaler working end?

That the chosen end adapts correctly to the tooth and supports correct angulation.

What two directions of posterior application are illustrated near the end?

Distal direction and mesial direction.

What does the posterior tooth-coverage illustration emphasize?

Systematic coverage of the tooth surface rather than missing areas.

Clinical: You feel a small rock-like bump below the margin. What calculus morphology is suggested?

A spicule; subgingival location requires tactile detection.

Clinical: You feel a continuous hard band around a tooth. What morphology is suggested?

Ring calculus.

Clinical: Your scaler is sliding over a deposit at 30 degrees. What is the concern?

Underangulation and burnishing of calculus.