Professional Documents
Culture Documents
Manual Scaling PDF
Manual Scaling PDF
2 30/10/08
PHASES OF PERIODONTAL THERAPY
y Phase I therapy
y Started after E&D and treatment planning
y Removal bacterial plaque and all irritants (periodontal instrumentation)
y OH Instruction
y Maintenance phase
y All patients that undergo periodontal therapy
y Patients return to clinic for evaluation, periodontal instrumentation, and
reinforcement of OH techniques.
y Phase II therapy
y Surgical (periodontal instrumentation)
3 30/10/08
Periodontal Instrumentation
y Scaling: to remove plaque and calculus
y Root planing: to remove plaque, calculus,
endotoxin
y Stain removal
y Surgery
4 30/10/08
Principles of Instrumentation
1. Accessibility (positioning of patient and operator)
2. Visibility, illumination and retraction
3. Condition of instruments (sharpness)
4. Maintaining a clean field
5. Instrument stabilization
6. Instrument activation
7. Selection of the proper instrument
5 30/10/08
1. Positioning
6 30/10/08
Clinical/Operator position
Neutral position
7 30/10/08
8 30/10/08
9 30/10/08
10 30/10/08
11 30/10/08
12 30/10/08
13 30/10/08
14 30/10/08
Patient Head Position
15 30/10/08
Adjust his/her head to provide
best view: chin up/down,
toward/straight/ away
17 30/10/08
maxilla
mandibular
Dental light position
18 30/10/08
Sharpness
y When the instrument is
sharp, the cutting edge is
a fine line
y Light reflected from the
rounded cutting edge of
a dull instrument appears
as a bright line.
19 30/10/08
Maintaining a clean field
y From saliva, blood, and debris
y Pooling saliva interferes: visibility, firm finger rest
cannot be established
y Blood and debris can be removed by wiping with
gauze
y Operative field should be flushed occasionally with
water
20 30/10/08
Instrument stabilization
y Instrument grasp
y Finger rest
21 30/10/08
Fulcrum (finger rest)
y Stabilizes the clinician’s hand during instrumentation
y Intraoral and extraoral fulcrum
22 30/10/08
Instrument activation
yAdaptation
yAngulation
yLateral pressure
yStrokes
23 30/10/08
Adaptation
y Is placing the first one or two millimeters of the side of
the working end in contact with the tooth surface
Adapted Not-adapted
24 30/10/08
25
Adapted Not-adapted 30/10/08
Angulation
y Is the angle formed between the face of instrument and
the tooth surfaces
26 30/10/08
Incorrect
27 30/10/08
Subgingival scaling procedure.
A, Curette inserted with the face of the blade flush against the tooth.
B, Working angulation (45 to 90 degrees) is established at the base of the pocket.
C, Lateral pressure is applied, and the scaling stroke is activated in the coronal direction.
28 30/10/08
Lateral pressure
y Is the act of using the thumb and index finger to
engage (press) the cutting edge against the tooth
surface or calculus deposit
y The amount of pressure must be varied according to
the nature of the calculus and according to whether the
stroke is intended to remove calculus or to smooth the
root surface.
y Lateral pressure may be firm, moderate, or light
y The careful application of lateral pressure during
instrumentation is important
29 30/10/08
Wrist motion activation
y Is the act of rotating the hand and wrist as a unit
y Similar with turning a doorknob
y Recommended for calculus removal with hand activated
instr.
y More powerful and less fatigue than digital motion
activation
30 30/10/08
Digital motion activation
y Is moving the instrument by flexing the fingers
y It may be used with periodontal probes, explorers, and
ultrasonic instruments or where movement is very
restricted, such as in furcation areas
31 30/10/08
Instrumentation Strokes
y Strokes Direction
32 30/10/08
Instrumentation for calculus
removal
y A, Calculus is removed by engaging the
apical or lateral edge of the deposit with
the cutting edge of a scaler; vertical
movement of the instrument will remove
the fragment of calculus engaged by the
instrument
y B, The instrument is moved laterally and
again engages the edge of the calculus,
overlapping the previous stroke to some
extent
y C, The final portion of the deposit is
engaged and removed. Note how the
procedure is performed in an interdental
space by entering facially and lingually.
33 30/10/08
34 30/10/08
SCALING IN DIFFERENT AREAS
OF THE MOUTH
y MAXILLARY TEETH
35 30/10/08
Maxillary right posterior sextant: facial aspect
40 30/10/08
Maxillary left posterior sextant: facial aspect
42 30/10/08
Mandibular left posterior sextant: facial
aspect
51 30/10/08
Universal Curettes
y A, Columbia #4R-4L
universal curette.
y B, Younger-Good #7-8,
McCall's #17-18, and
Indiana University #17-
18 universal curettes.
52 30/10/08
Gracey’s curettes
53 30/10/08
Chisel Wing-shaped Hygienist
54 30/10/08
y Push Scaler or Chisel.
y A pushing instrument used parallel to the occlusal plane. This
instrument can be used supra-gingivally especially in the
anterior. Great care need to be taken to avoid soft tissue
damage.
y Hygienist Sickle.
y Is a single-ended instrument can be used for mesial, distal,
facial, and lingual surfaces of supra and sub gingival calculus.
Adaptation of Sickle scaler is important to prevent damage to
the tissue
y Wing-shaped scaler
y This instrument has a wing blade shape and a sharply pointed
end. The mode of use is pull coronally for the supra and sub
gingival area of the tooth
55 30/10/08
Conclusion: Principles of scaling and
root planing
y Determine the correct cutting edge
y Finger rest
y Concentrate on using the lower third of the cutting
edge for calculus removal (adaptation)
y Allow the hand-forearm to carry the burden of the
stroke, rather than flexing the fingers (digital
motion activation)
y Modulate lateral pressure
56 30/10/08
Calculus detection
y Supragingival calculus can be detected visually or
by using compressed air and dental mirror
y Dry calculus has contrast visually with enamel
y Subgingival calculus are hidden beneath gingiva
57 30/10/08
technique to identify the presence of
supra and subgingival calculus
58 30/10/08
Furcation involvement
y Occurs when periodontal infection invades
the area between and around the roots of
bifurcated or trifurcated teeth
y Access to furcation area
y Mandibular molars (bifurcated) →
examined from the facial and lingual
surfaces
Thursday
Activities Venue(Supervisor)
8-10am
8-9 am Lecture Periodontal Instrumentation DK 1 (ERRY)
13/11/08 KKKK
60 30/10/08
Activity: Supra and Subgingival scaling of artificial calculus on maxillary teeth,
manually
Supra and Subgingival scaling of artificial calculus on mandibulary teeth,
manually
Preparation:
a. Tray set up and cleanliness
b. Identification of instruments
Ergonomic position:
Appropriate positioning of dummy
Correct working position of operator
Scaling technique:
Use of appropriate instrument
Use appropriate technique
61 30/10/08
Week 5
Activity: Scaling and root planing on 16 real teeth, manually
1.Exploring technique
1.Ergonomic position:
a. Appropriate positioning of dummy
b. Correct working position of operator
1.Scaling technique:
a. Use of appropriate instrument
b. Use appropriate technique
1.Root Planing:
a. Use of appropriate instrument
b. Use appropriate technique
62 30/10/08
63 30/10/08
Positioning for the anterior sextant
Anterior surface toward
Turn slightly
toward the
clinician chin-
down position
Turn slightly
toward the
clinician chin-
up position
64 30/10/08
chin-down
position
chin-up
position
65 30/10/08
Positioning Turned
for the slightly
posterior away
sextant from the
clinician
chin-
Posterior
down
aspects
position
facing
toward
Turned
slightly
away
from the
clinician
chin-up
position
66 30/10/08
Positioning Posterior Turned
for the aspects slightly
posterior facing away from
sextant away the
clinician
chin-down
position
Turned
slightly
away from
the
clinician
chin-up
position
67 30/10/08
68 30/10/08