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Periodontal Instruments

Periodontal Instruments – As previously mentioned, plaque with its bacterial by-products plays the key role in initiating the periodontal disease process. Calculus and overhanging restorations provide places for plaque to accumulate on the tooth and in the sulcus.

DEBRIDEMENT PROCESS

The debridement process involves the removal of calculus, plaque, and stain. Depending upon the patient’s periodontal condition, this debridement process may involve the following procedures:

• Gross scaling, or supragingival scaling

• Subgingival scaling

• Root planing

• Oral irrigation

• Polishing

• Gingival curettage.

PERIODONTAL INSTRUMENTS FOR DEBRIDEMENT

The various periodontal instruments are used for debridement process:

Hand Instruments

Hand instruments consist of a handle, a shank, and a blade. An Periodontal Instruments may be double-ended, or it may be single-ended.

Scalers

Scalers come in various shapes and sizes. They are named according to their shape and function:

(i) Sickle scalers have a flat surface and two cutting edges that meet at a sharp, pointed tip. They are used for scaling on enamel.

(ii) Chisel scalers are designed for the proximal surfaces of crowded teeth and for scaling tenacious supragingival calculus.

(iii) Hoe scalers are used with a pull stroke to remove gross deposits.

Curettes

Curettes may be used for some gross scaling procedures, but they are mainly designed for removing subgingival calculus and altered cementum, root planing, and gingival curettage. A curette is a finer instrument than a sickle scaler and has no sharp points. It has a rounded beak, which makes it an ideal instrument for subgingival use.

Portepollsher

A portepolisher is a hand instrument that holds a wooden point. It is used to apply polishing agents manually. The portepolisher is used when an engine-driven polishing system is not available or when it is necessary to reduce aerosols (liquid or solid particles that become airborne and may harbor microorganisms).

Electronic Instruments

Scalers. Ultrasonic scalers and sonic scalers are electronic scalers that remove particles of matter by vibration and liquid spray. A variety of tips are available for these scalers, with different shapes for different functions. The use of the ultrasonic scaler may be contraindicated for patients with a cardiac pacemaker.

Advantages:

• They are capable of subgingival debridement. The liquid spray irrigates the sulcus at the same time.

• They work quickly with minimal hand and wrist fatigue.

Handpieces. Prophylaxis handpieces (and prophy angle) with rubber cups or brushes are used for cleaning and polishing the teeth. Prophy jet A prophy jet removes soft deposits and stain by way of an abrasive spray of sodium bicarbonate and water under pressure.

ORAL IRRIGATION

The role of bacteria and their by-products in the development of periodontal disease has led to the use of antibacterial agents to treat gingivitis and periodontitis. Some of these antibiotics are given systemically. Others are placed locally in gingival sulcus or into the diseased periodontal pocket. Antibacterial substances can also be delivered as mouth rinses. Chlorhexidine gluconate is widely used and believed to be effective in controlling gingivitis. During the debridement process, these antimicrobial rinses are used to irrigate the sulcus.

MAINTENANCE OF INSTRUMENTS

Cleaning and Sterilizing Hand

Instruments

While cleaning and sterilizing the Hand Instruments, the similar procedure and precautions are taken, as with the other surgical Periodontal Instruments .

Cleaning and Sterilizing Electronic Equipment

Ultrasonic scaler. Disinfect the ultrasonic scaler and flush its fluid lines according to the manufacturer’s directions. Its important to sterilize the lips after every use.

Handpiece accessories. Prophy cups and brushes are disposable. Take apart the prophy angle and lubricate it. Package it for sterilization according to the manufacturer’s instructions. Prophy jet. Disinfect the prophy jet and flush the lines. Take apart the handpiece. Follow the manufacturer’s directions for packaging and sterilization. Remove the powder daily.

Oral irrigator. Flush the oral irrigator lines. Dispose of the cannula properly and sterilize the hand pieces, according to manufacturer’s directions.

For the proper and accurate diagnosis of the periodontal condition in a patient, it is important to have a thorough periodontal examination. This examination should include the following:

·HEALTH AND DENTAL HISTORY Health and dental histories.

·Head, neck, and oral exam.

Gingival exam and bleeding index.

Radiographs.

·Deposit evaluation and plaque index.

·Evaluation of personal oral hygiene.

·Charting, complete with probing depths.

·and periodontal notations.

Occlusal analysis.

Screening using advanced diagnostic techniques.

Health History

A complete health history is necessary to identify any factors that will affect the patient’s treatment, as well as those factors that may predispose the patient to various periodontal problems. Patients with some systemic factors (e.g., medication or diseases) may exhibit certain gingival or periodontal problems. It should also be noted that periodontal surgery may be contraindicated for patients with certain conditions. Recently, smoking has been shown to be an important factor in the severity of periodontitis.

Dental History

A dental history is necessary to address a patient’s chief dental complaint. A dental history also gives background irifonnation that may help with the diagnosis and treatment of that patient. Questions relating to bleeding gums, loose teeth, tooth migration (movement), foul taste, pain, sensitivity and his/her habits, may give helpful diagnostic information.

HEAD, NECK AND ORAL EXAMINATION

A complete head, neck, and oral exam should include an examination of all areas of the face and neck region. The tongue, insides of the cheeks, floor of the mouth, palate, and pharynx are observed and palpated. Saliva is checked for consistency, quality and quantity. The patient’s breath is also noted. This exam may reveal conditions that may indicate systemic or anatomical factors affecting periodontal health as well as other factors that may be signs of periodontal problems.

GINGIVAL EXAM AND BLEEDING INDEX

Gingival Exam

It is necessary to observe and palpate the gingiva because any changes in the size, shape, or consistency of the gingival tissue or any notation of bleeding or suppuration may indicate a periodontal problem. Palpation of the gingiva may help to locate infected tissues or a periodontal abscess, which is a localized area of swelling that contains purulent exudate.

During the gingival exam, the dentist should also note the presence of any recession, amount of attached gingiva, and position of the frena.

Bleeding Index

A bleeding index is taken by observing areas of the gingiva that bleed when a blunted instrument is gently inserted beneath the free gingival margin in the sulcular area. Because normal, healthy gingiva should not bleed, this index gives important diagnostic information.

RADIOGRAPHS

Radiographs are needed to observe any bone loss or changes in the normal radiographic appearance of the periodontium.

OCCLUSAL ANALYSIS

Occlusal analysis is the observation of how the teeth on opposing arches occlude. As the opposing teeth occlude together, a great amount of force is exerted. As the periodontal tissues absorb most of this force, they adapt or change to accommodate to the force. When the tissues can not change to handle this force, some injury to the tissues begins to occur. Signs of occlusal trauma that can be observed during an occlusal examination include:

• Tooth mobility or migration.

• Sensitivity when biting down.

• Wearing away of the biting surfaces.

• Problems with the temporomandibular joint (TMJ).

Occlusal adjustments may be necessary to correct periodontal problems that originated from occlusal factors.

DEPOSIT EVALUATION AND PLAQUE INDEX

Deposit Evaluation

An assessment of the amount of hard and soft deposits present in the patient’s mouth is known as a deposit evaluation. The various categories of deposits on the tooth surface, include the following:

• Stain

• Materia Alba

• Plaque

• Calculus.

The mouth minor and an explorer instrument used for a deposit evaluation and plaque EVALUATION OF PERSONAL ORAL HYGIENE

An evaluation of a patient’s personal oral hygiene techniques may be a starting point in identifying the cause of periodontal condition of the patient It is important to establish a good rapport with the patient concerning his or her personal oral hygiene care because patient motivation and oral hygiene maintenance are critical to the success of any periodontal treatment plan. The best in- office periodontal treatment can fail due to the lack of appropriate personal oral hygiene care by the patient.

CHARTING AND CIRCUMFERENTIAL PROBING

Complete charting and circumferential probing are the keys to thorough periodontal assessment. To gauge the periodontal condition, the probe is gently inserted into the sulcus and circumferentially probed. Six readings are recorded for each tooth for periodontal condition, gingival recession and amount of plaque/deposits. Three readings are taken from the facial aspect of the tooth (distal, facial, and mesial), and three readings are recorded from the lingual aspect of the tooth (distal, lingual, mesial). The chart should also include a notation of any area that exhibits bleeding or suppuration upon probing.

Mobility is also recorded on the chart. Tooth mobility is evaluated by attempting to move the tooth between two blunt instruments. The degree of mobility is determined in the following manner N—No movement

1 degree— Movement in the facial and lingual direction up to 1 mm.

2 degrees— Movement greater than 1 mm in the facial and lingual directions.

3 degrees— Movement greater than 1 mm in the facial and lingual directions, and easy depression.

Furcation Involvement

Furcation involvement means that periodontitis has progressed to the extent that the periodontium in the furcation area of a multirooted tooth has been destroyed. The extent of that destruction is measured by evaluating the furcation area.

There are four classifications of furcation involvements:

• Class I—The instrument can enter the furcation area horizontally 1—2 mm, but the arch of the furcation can not be detected.

• Class 11—The instrument can penetrate more than 2 mm or more than halfway into the furcation area but can not go through it

• Class Ill—The instrument can pass through the furcation to the opposite side. The furcation is occluded by gingival tissue and can not be seen clinically.

• Class P7—The furcation is visible as well as having an instrument pass through it.

ADVANCED DIAGNOSTIC TECHNIQUES

• Measure the effects of the inflammation process.

• Test for the presence of certain bacteria forms of periodontal disease, or for those whose in the patient’s mouth. condition has not improved after receiving standard periodontal treatment.

• Assess the patient’s immune response.

About Dr. Muna

Dr. Muna Taqi is a Dental surgeon from India who has more than 10 years of experience in the field of Oral & Maxillofacial surgery, Endodontics, & Pedodontics. She has worked in multinational medical corporates in Middle East and is also a consultant dental surgeon for many. She has authored many articles for medical journals & websites and is a consultant dental expert for Healthdrip.

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