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.
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
• Gingival curettage.
PERIODONTAL INSTRUMENTS FOR DEBRIDEMENT
The various periodontal instruments are used for debridement process:
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 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 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.
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).
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.
• 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.
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
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.