1. Periodontal Instrumentation (I)

2. Classification of Periodontal instruments:
1. 牙周探針 (Periodontal probe)
2. 探針 (Explorer)
3. 潔牙及牙根整平器械 (Scaling and root
planing instruments )
4. 磨亮之器械 (Polishing instruments)
5. 手術器械 (Surgical instruments)

3. 1. Periodontal probe--- to locate, measure the
depth of pockets and to determine their
configuration
* With firm, gentle pressure to the bottom of pocket
* The shank 與 long axis of tooth 平行
Marquis Michigan O WHO

5. *牙根分叉(Furcation area)--- best be evaluated by curved, blunt, Nabers probe

6. * Also to check the smoothness of the root
2. Explorer--- to locate subgingival calculus
deposition and caries area
* Also to check the smoothness of the root
surface after root planing

7. 3. 潔牙及牙根整平器械 b) 鐮刀型結石刮(Sickle scaler) c) 銼(File scaler)
a) 牙刮(Curette)
b) 鐮刀型結石刮(Sickle scaler)
c) 銼(File scaler)
d) 鑿(Chisel scaler)
e) 鋤(Hoe scaler)
f) 超音波潔牙機
(Ultrasonic instruments)

8. 3. Sickle scaler--- primary to remove the
supragingival calculus
*With straight shanks for incisors and canine
*With contra-angled shanks for posterior teeth

9. * Difficult to insert the blade under the gingiva
without damaging the surrounding gingiva
* Insert under the ledges of calculus no more
than 1 mm below the gingiva
Point tip, triangular back surface

10. * Finer than sickle, no sharp points or corners
Curette--- used for subgingival scaling, root planing and removing soft tissue lining the pocket
* Finer than sickle, no sharp points or corners
can be adapted and provide better access to deep pockets with a minimum of soft tissue trauma

11. Two basic type--- universal and Gracey curette
Universal type--- the working ends are in pairs
both ends is used for anterior and posterior

13. * Rigid Gracey has a larger, stronger and less
Gracey curettes--- rigid or finishing type of
shank
* Rigid Gracey has a larger, stronger and less
flexible shank and blade than the standard
finishing Gracey
* Rigid Gracey--- to remove moderate
to heavy calculus
* Diameter: 0.75 mm

14. Extended shank curettes--- Hu-Friedy After-Five
curettes are modification of standard Gracey
curettes design
* The terminal shank is 3 mm longer, allowing extension into deeper periodontal pockets of 5 mm or more
* Thinned blade for smoother subgingival insertion and reduced tissue extension

15. * American Gracey curettes
Mini-bladed curettes--- Hu-Friedy Mini-Five
curettes are modification of After Five curettes
* The blade is half the length of After Five or standard Gracey curettes
* American Gracey curettes
Sub-0, #1-2, #11-12,
# Gracey Curvette

16. * Shorter blade allows easier insertion and adaptation in deep, narrow pockets; furcations; developmental grooves; line angles; and deep, tight, facial, lingual or palatal pockets ---Gracey Curvette

17. Mini-bladed curettes should not be used
routinely
2. Large #4 handle are recommended for any mini-bladed instruments
3. Can be used to scale with toe directed either mesially or distally
4. Generally used with straight vertical stroke

18. Mini-Five curettes for anterior teeth has
proven to be more effective than conventional curette in debriding narrow root surface
Singer et al. J. Clin. Periodontol 1992

19. Plastic instruments for implant
* Avoid scarring and permanent damage to implants
* Plastic probes
* Implacare implant instruments

20. Hoe scalers--- to remove tenacious subgingival
calculus and necrotic cementum
* The blade is bent at a 99 degree angle, the cutting edge is beveled at 45 degrees
The blade is slightly bowed so that it can maintain contact at two points on a convex surface --- stabilize the
instrument

21. Chisels--- the end of blade is beveled at 45
degrees to form the cutting edge
* With a modified pen grasp, push stroke
File --- periodontal surgery

22. 振動潔牙系統(Oscillating scaler system)
* Sonic scaler: rotating can generates vibration with frequencies 6000 to 9000 Hz, vibrations depending on the air pressure input, with an amplitude of up to 1000 m, plaque and calculus are removed by tapping motion (輕敲)
* Ultrasonic scaling instruments

23. * Frequency ranging from 20,000 to million cycles per second
Ultrasonic instruments --- for scaling, curetting,
and removing stain
* Frequency ranging from 20,000 to million cycles per second
* The spray is directed at the end of the tip to
dissipate the heat generated by the ultrasonic
vibration
* Apply by slight tactile force

24. * The cavitating water spray also serves to
flush calculus, plaque, and debris
dislodged by the vibrating tip from the
pocket

25. Ultrasonic scaling instruments
* Magnetostrictive (磁振式)--- are driven by nickel-iron alloy strips or a Ferrite Insert inserted into a hand-piece, vibration frequencies to Hz, vibration of tip is elliptical
all side of tip are active and work when adapted to tooth surface. Hammering (錘敲打) or scraping motion (刮削)

26. Ultrasonic scaling instruments
* Piezoelectric (壓電式)--- vibration is generated by changes in the dimension of a quartz crystal, vibration of tip is linear, or back and forth, only two sides of tip are active
Tapping (輕敲) or scraping motion (刮削)

28. Safety and Efficacy of Oscillating Scalers
* Hand instruments depends on the numbers of scaling stroke and lateral force applied
* Oscillating scalers depends on instrumentation time, lateral force, scaler tip angulation, and instrument power setting
* If scaler tip is angulated parallel to root surface and force applied do not exceed 2 N  50 m/year (critical defect depth), 40 second instrumentation --- acceptable

29. Safety and Efficacy of Oscillating Scalers
* Magnetostrictive type ---tip angulation, lateral forces have identical influence on substance removal.
The critical defect depth 50 m can be maintained
if tip is angulated absolutely parallel to root surface
and forces used do not exceed 1 N

30. * Piezoeletric type --- mostly influenced by scaler
tip angulation. If scaler tip is angulated parallel to
root surface, CDD can be maintained below 50 m
even forces up 2N
* Sonic scaler is comparable to the efficacy of
magnetostrictive scaler at low power setting or to
the efficacy of piezoelectric scaler at medium power
setting

32. How to use ultrasonic scaling instruments * Position
* Light pressure, 15 degree to tooth surface
* Cooling system, cc/min
* Not be used in pt’ with cardiac pacemaker
transmissible disease

33. Ultrasonic scaling instruments * Less tissue trauma
* Useful for initial debridement
* Bulky and blunt--- subgingival insertion
to base of pocket is limited
* Fracture calculus and remove it
* Diminish tactile sensation

34. Ultrasonic debridement vs. hand scaling * Microbial plaque removal
To be significant more effective in
* Microbial plaque removal
* Class II or III furcation involve

35. Ultrasonic devices (with thin tip)
As effective as hand-held curette in
* Maintaining clinical attachment levels
* Significantly reduced time
Copulos et al. JP 1993

36. * Significantly less percentage of residual
Mini-bladed curettes vs. slim ultrasonic tip
* Significantly less percentage of residual
deposits --- fine curettes
* The potential value of small, thin blade curettes in debriding involved furcation during initial therapy
Francisco et al. JP 1997

38. Sonic units do not release heat the way
ultrasonic units do, but still have water for
cooling and flushing away debris

42. Dental Endoscope --- Perioscopy system
For use subgingivally in diagnosis and treatment of
periodontal disease, also evaluate
subgingival caries, root fracture
defect restorations, and resorption
* It consist of a 0.99 mm diameter
reusable fiberoptic endoscope
over which is fitted a disposable,
sterile sheath.

43. Fiberoptic endoscope fit
onto periodontal probes and
ultrasonic instrument
The sheath delivers water
irrigation that flushes the
pocket while the endoscope
is in use and keeps the field
clear

44. Cleaning and polishing instrument
Rubber cup, brushes and dental tape --- for
clean and polish tooth surface

45. Air-powder polishing --- Prophy-Jet
An air-powdered slurry of warm water and
sodium bicarbonate.
The slurry remove stains rapidly and
efficiently by mechanical abrasion and
provides warm water for rinsing and lavage

46. * Damage to gingival tissue is transient and
Study shows that tooth substance (cementum
and dentin) can be lost by Prophy-Jet
* Damage to gingival tissue is transient and
insignificant clinically
* Composite restoration can be roughened

47. * Pt’ with medical history of respiratory disease
Contraindications
* Pt’ with medical history of respiratory disease
* Those with sodium-restricted diets
* Individuals on medications affecting the
electrolyte balance
* Infectious diseases aerosol created

48. Surgical Instruments
* Excisional and incisional instruments
* Surgical curette
* Periosteal elevator
* Hoe, chisel, file and rongeur
* Tissue and thread scissors
* Hemostats and tissue forceps

50. a) Excisional and incisional instruments
* Surgical blade--- No. 15, 12, and 11
* Electrosurgery:

51. Electrosurgery (surgical diathermy)
* Using controlled frequency electrical currents million cycles/second
* Three active electrodes:
1. Single-wire electrodes for incision
2. loop electrodes for planing tissue
3. Heavy, bulkier electrodes for
coagulation procedure

52. * Deep resection close to bone, can produce gingival
Most important basic rule of electrosurgery---
always to keep the tip moving, 5-10 second for cooling
* Deep resection close to bone, can produce gingival
recession, bone necrosis and sequestration, loss of
bone height, furcation exposure and tooth mobility
* Contraindicated for patients who have poorly
shielded cardiac pacemakers

53. Four types electrosurgical technique:
1. Electrosection---performs incision, excision, and tissue planing
2. Electrocoagulation--- can prevent bleeding at
initial entry into tissue, but cannot stop
bleeding after blood is present
3. Electrofulguration--- burning of the tissue
4. Electrodesication--- drying of the tissue

54. * Surgical curette--- for the removal of granulation
tissue, fibrous interdental tissue and tenacious
subgingival deposits
* Periosteal elevator--- to reflect and remove the
flap after the incision has been made for flap
surgery

55. Surgical chisel, rongeur and proximal bone file
For removal of sharp bone and osteoplasty

56. * Pocket marker, Kirkland and interproximal
Surgical instruments for gingivectomy
* Pocket marker, Kirkland and interproximal
gingival knife

57. * Pocket marker, Kirkland and interproximal
Surgical instruments for gingivectomy
* Pocket marker, Kirkland and interproximal
gingival knife

58. Gingival enlargement gingivectomy

59. Gingival enlargement gingivectomy

60. Thanks for Your Attention