Advanced Instrumentation

Advanced instrumentation

• Consider the deposits that need to be removed

• Aim of subgingival PMPR

• Treatment outcomes

• Subgingival calculus

• Good oral hygiene is essential

Root Morphology

• Essential to know root morphology as you will not be able to see within the periodontal pocket

Root morphology

A. Palatal groove

B. Deep linear root concavities

C. Wide shallow root concavity

D. Deep linear proximal root concavities and furcation

E. Deep depression on root trunk and furcation

F. Proximal concavities

Principles of subgingival PMPR

1. Locate and assess deposits

2. Selection of appropriate instrument

3. Correct instrument grasp

4. Finger rest

5. Adaptation

6. Angulation

7. Activation

• Lateral pressure

• Stroke

8. Check

Instruments

Instrumentation

1. Debride the root trunk using the distal curette, then the mesial curette

2. Treat each root as a separate tooth. Use the distal curette on the distal portion of each root

3. Use the mesial curette on the mesial portion of each root

4. Treat the roof of the furcation and the concavity coronal to the furcation with the mesial curette

a. Use the toe of the curette against the roof of the furcation

b. Position the curette in the toe-down position, and use horizontal strokes in the concavity

Patient homecare

Summary

• Manual dexterity and root morphology are key

• Thorough and effective instrumentation takes time

• Patient engagement is essential