Principles of Instrumentation
what is another name for the assessment stroke?
"exploratory stroke"
what are the six specific sites that are recorded on each tooth when taking periodontal measurements?
**start at distal line angle** 1. distofacial line angle to the. midline of the distal surface 2. facial surface 3. Mesiofacial line angle to the midline of the mesial 4. Distolingual line angle to the midline of the distal surface 5. Lingual surface 6. Mesiolingual line angle to the midline of the mesial surface
what are the various factors that can affect accuracy of depth measurements?
- position of gingival margin (in health, the position of the GM is slightly coronal to or above the CEJ. if the gingival margin is not in the normal location - probing depths will NOT accurately reflect the health of the periodontium) - interference from calculus deposits, overhanging restorations - amount of pressure applied - misread probe calibrations
what are advantages of the 11/12 explorer?
- smooth back of tip is in contact with soft tissue base of sulcus or pocket - complex shank (an explorer with angles and bends to adapt to the tooth) is excellent for anterior and posterior teeth
what should adaptation look like during an assessment stroke?
1 to 2 mm of side of tip
what is the probe position in healthy tissue?
1 to 3 mm in depth defines a healthy sulcus the probe tip should touch the tooth near the CEJ
outline the steps of producing a walking stroke
1. insert the probe and lightly run the tip along the tooth surface until it encounters the soft tissue base of the sulcus or pocket (the junctional epithelium that forms the base of a sulcus or pocket feels soft and flexible when touched with the probe tip - keep the probe tip against and in alignment with the root surface) 2. create a walking stroke by moving the probe tip up and down in short bobbing strokes 3. move forward in 1 mm increments
what are the three things to remember when recording depth measurements?
1. record six areas per tooth 2. record one reading per area (the deepest) 3. round up measurements to the nearest full mm
describe the steps of probing
1. step 1: insert at the distofacial line 2. step 2: keep the tip in contact with the tooth, pressing down to touch the soft tissue base. initiate a series of short, bobbing strokes toward the distal surface (keeping the working end in contact with the tooth - the strokes should be kept close together and gently touch the JE with each downward stroke of the probe) 3. step 3: walk the probe onto the distal surface until it touches the contact area 4. step 4: tilt the probe so that the tip reaches beneath the contact area. press down against soft tissue and take a reading. the deepest reading encountered for area 1 is recorded 5. step 5: prepare to access zone 2, the facial surface from distofacial line angle to mesiofacial line angle (reposition the probe at the DF line angle) 6. step 6: make a series of tiny walking strokes across zone 2 - the facial surface (starting at DF line angle and making a series of tiny walking strokes moving in a forward direction toward the MF line, record deepest measurement on the periodontal chart) 7. step 7: walk the probe onto the mesial surface until it touches the contact area (probe zone 3 from the MF line angle to the midline of the mesial surface) (probe zone 3 starting at MF line angle and walk the probe across the mesial surface until it touches the contact area) 8. step 8: tilt the probe and press down gently. take a measurement beneath the contact area (assess beneath the contact area)
what is an example of an assessment stroke?
1. the explorer tip quivers as it passes over a calculus deposit on the root of the tooth 2. these vibrations are transmitted from the tip through the instrument shank and handle 3. the clinician feels these vibrations with his or her fingers resting on the instrument shank and handle 4. the clinician recognizes these vibrations as calculus deposits
what are the first step utilized to probe the mesial and distal surfaces?
1. walk the probe between the teeth until it touches the contact area (keep the working end of the probe in contact with the proximal root surface - walk the probe across the proximal surface until it touches the contact area)
how long should strokes be when exploring with 11/12 explorer?
2 to 3 mm in length make many overlapping, multidirectional strokes to assess the entire root surface
what is the second step utilized to probe the mesial and distal surfaces of teeth?
2. tilt the probe slant the probe slightly so that the tip reaches under the contact area. in this position, gently press downward to touch the soft tissue base (the JE)
do you round up when recording measurements?
ALWAYS round up!
should the probe be removed from the sulcus with each walking stroke?
NO! the probe is not removed from the sulcus with each stroke (repeatedly removing the probe can traumatize the tissue)
what is a periodontal probe?
a slender instrument (marked in millimeter increments) used to evaluate the health of the periodontal tissues, utilized for pocket measurements has a blunt, rod-shaped working end
what is the col?
a valley-like depression which connects the gingival papillae situated in the interproximal space between two teeth
what is an assessment stroke?
an assessment stroke is used to detect calculus deposits or other tooth surface irregularities on the tooth surface
why is it important to walk around the entire tooth?
bob along the soft tissue base all around the tooth - walking strokes with the probe should cover the entire circumference of the sulcus or pocket base it is common for the depth of a pocket to be deeper in one place remember each up and down stroke should be approximately 1-2mm in length. the strokes must be very close together, about 1 mm apart
__________ __________ is critical to the successful tx of periodontal disease
calculus removal plaque biofilm is the main cause of periodontal disease but calculus deposits haboring biofilms are directly related to more than 60% of the disease sites in periodontal disease
where do measurements begin being recorded for periodontal measurements?
distal line angle
on proximal surfaces, how should the explorer tip be led?
do NOT "back" into proximal surfaces strokes reach under contact
how should anterior surfaces be explored when you're a right handed clinician?
explore all the surfaces toward you and then do the surfaces away
what is the fifth step when exploring with a 11/12?
explore at least halfway across the mesial surface from the facial aspect
what should lateral pressure look like during an assessment stroke?
feather-light pressure against tooth AVOID: applying pressure with middle finger agains the shank
what is the functions of periodontal probes?
findings from an examination with a periodontal probe are used to determine the health of the periodontal tissues measure sulcus and pocket depths, measure clinical attachment levels, determine the width of the attached gingiva, assess for the presence of bleeding, measure the size of oral lesions used like a miniature ruler for making intraoral measurements
the 11/12 explorer is made of a _______________ metal that conducts ___________ from the working end to the clinician's fingers
flexible, vibrations explorers are circular in cross section and has paired working ends
what should one's stroke look like when performing an assessment stroke?
fluid and sweeping strokes
if the gingival margin is significantly coronal to the CEJ - how does this effect depth measurements?
frequently the gingival tissue is swollen or overgrown due to gingivitis or drug therapy. In such cases, the extent of periodontal destruction is overestimated since the GM is coronal to (above) its normal position
from what point to what makes up the probing depth
from gingival margin to base of the sulcus
what are the two regions of the shank on an 11/12 explorer?
functional shank and lower shank
what is activation?
how the instrument is moved along the tooth surface
if the gingival margin is apical to the CEJ - how does this effect depth measurements?
in situations where recession of the GM is present, PD readings can substantially underestimate the true extent of periodontal destruction
why is it essential to evaluate the entire circumference of the pocket base?
it is important to go all the way around the entire tooth because the junctional epithelium is not necessarily at a uniform depth from the gingival margin in fact, differences of the depths of two neighboring sites along the pocket base are common
what is the tissue that forms the base of the sulcus?
junctional epithelium
with each down stroke during the walking stroke - the probe returns to touch the __________ _____________
junctional epithelium either wrist or digital (finger) activation may be used with the probe because only light pressure is used when probing
what is a color coded periodontal probe?
marked in bands with each band being several mm in width (ex: this one is marked at 3, 6, 9, and 12 mm)
how are measurements recorded when taking periodontal measurements?
measurements are recorded for 6 specific sites on each tooth
is it possible to probe the base of the sulcus directly under the contact area in between two teeth?
no - the probe cannot fit between two adjacent teeth the proximal surfaces should be probed from both the facial and lingual aspects to assure that the entire circumference of the JE is assessed
should any pressure be applied when performing walking probe stroke?
no! even though the probing involves contact of working-end with the root surface, no pressure should be used with a probing stroke
should the explorer tip be removed from the sulcus or pocket as you make an upward stroke?
no! keep the tip in contact with the root surface as you move across the tooth (do NOT remove the explorer tip from the sulcus or pocket as you make an upward stroke. keep the tip beneath the gingival margin)
should the probe tip be held away from the tooth?
no! the probe tip should never be held away from the tooth - it should be parallel to the long axis of the root surface keep tip adapted to the tooth
what are disadvantages of 11/12 explorer?
none! this explorer works well throughout the mouth and can be used in healthy sulci and deep periodontal pockets
what should you observe when selecting the correct working end of a 11/12 explorer?
observe the relation of the lower shank to the distal surface of the tooth you want the working end to be placed so the lower shank is parallel to the distal surface "up and over" - functional shank should be up and over the tooth
How many readings per zone are recorded?
only ONE reading per zone (if probing depths vary within a zone, the deepest reading obtained in that zone is recorded) probing depths are recorded to the nearest full mm. measurements are rounded up to the next higher number (e.g. reading of 3.5 mm is recorded as 4 mm) (in the photo the reading is the one taken at point C - deepest reading would be recorded for the facial reading)
what are periodontal instruments?
periodontal instruments are designed for specific purposes, such as removing calculus, planing root surfaces, curetting the gingival wall or removing diseased tissue
what is pivoting on the fulcrum?
pivoting is a slight swinging motion of the hand and arm carried out by balancing on the fulcrum finger the pivot is a tiny movement to reposition the hand pivoting assists the clinician in maintaining adaptation as the working-end move around the tooth pivoting is used principally when moving around a line angle onto a proximal surface
what is step 3 when exploring with 11/12?
position the tip in the middle-third of the crown and lower the instrument handle gently insert beneath the gingival margin and make a series of feather light strokes across the facial surface
what is the probe position in unhealthy tissue?
probe tip touched the root somewhere near the CEJ probing teeth is greater than 3 mm
what is probing with a periodontal probe?
probing is the act of walking the tip of the probe along the base of a sulcus or pocket for the purpose of assessing the health status of the periodontal tissues
due to its flexible wire-like working end, the 11/12 explorer will _________ when moved over tooth irregularities such as dental calculus
quivers dental calculus deposits frequently are located subgingivally below the gingival margin where they cannot be detected visually since these sub-G calc deposits cannot be seen, the clinician must rely on his or her sense of touch to find and remove these hidden deposits the explorer is the instrument of choice for the detections of sub-G calc deposits
how should one's grasp be when performing an assessment stroke?
remember assessment strokes should be short in length and involve many overlapping strokes the grasp should be relaxes with the middle finger resting lightly on the shank AVOID: firm and tense "death grip"
what can occur if the explorer tip is repeatedly removed and reinserted?
removing and reinserting the tip repeatedly can injure the gingival tissue
what can incorrect probe placement result in?
results in underestimation of the measurement
what is the fourth step when exploring with a 11/12?
roll the instrument handle as you approach the mesiofacial line angle to maintain adaptation
what is rolling the instrument handle?
rolling the instrument handle is the act of turning the handle between the thumb and index finger this maintains precise contact of the working-end to the tooth surface as it moves around the tooth
where should the middle finger be placed on an 11/12 explorer?
side of the pad near shank and handle
what is the posterior sequence when using an 11/12 explorer? (where do you begin?)
start the distofacial line and work back toward the distal surface
what is the first step when exploring with an 11/12?
step 1: place the explorer tip in the get ready zone
what is the second step when exploring with an 11/12?
step 2: lower the instrument handle, gently insert beneath the gingival margin, make feather-light strokes toward the distal surface as you approach the distal surface, roll the instrument handle slightly to maintain adaptation and explore at least halfway across the distal surface ** you are now ready to explore the facial and mesial surfaces of the tooth - begin at the distofacial line angle**
what is the function of the 11/12 explorer?
the 11/12 explorer is utilized to locate calculus deposits, tooth irregularities, and defective restoration margins an assessment instrument with a flexible wire-like working end used to detect (by tactile means) the texture and character of tooth surfaces before, during, and after periodontal instrumentation to assess the progress and completeness of instrumentation
what is the name of the soft tissue base that the probe touches when it extends under the contact area while the upper portion touches the contact area?
the Col
what is tactile sensitivity?
the ability to detect calculus deposits by feeling vibrations transferred from the explorer tip to the instrument shank and handle
what determines an instrument's function?
the design of the instrument's working end (in order to determine an instrument's use, you must recognize the design characteristics of the working-end)
what is probing depth?
the distance in millimeters from the gingival margin to the base of the sulcus or periodontal pocket as measured with a probe
what is the drive finger when rolling the instrument handle?
the drive finger is either the thumb or index finger and is used to turn the instrument
what is the functional shank portion of an 11/12 explorer?
the functional shank is the portion of the shank that allows the working-end to be adapted to the tooth surface begins below the working-end and extends to the last bend in the shank nearest the handle
what is the gingival sulcus?
the gingival sulcus is the v-shaped shape between the free gingiva and the tooth surface the periodontal probe is inserted into this space to assess its health
what is the lower shank?
the lower shank is the portion of the functional shank that is nearest to the working-end; also called the "terminal" shank
what should you do is a calculus deposit is encountered when attempting to take depth measurements?
the probe is gently teased out and around the deposit or the calculus deposit is removed so that the probe can be inserted to the base of the pocket. JE should feel resilient not hard if you encounter calculus, move your probe laterally to get to the base of the pocket
what is the considered the probe tip?
the probe tip is 1 to 2 mm of the side of the probe
where should the probe tip be when performing the walking stroke on a pt?
the probe tip is kept in contact with the tooth surface throughout the walking stroke it should be positioned parallel to the long axis of the root surface (the tip should be kept as flat against the root surface as possible as the working-end is inserted into the base of the pocket)
what is adaptation of your periodontal instruments?
the relationship/placement of the instrument on the tooth surface - always the terminal 1-2 mm of the working end
what defines the sulcus?
the sulcus is defined as the distance from the gingival margin to the coronal-most part of the junctional epithelium
what defines the tip of the 11/12 explorer?
the tip is 1 to 2 mm of the side of the explorer
at what degrees is the 11/12 explorer bent at?
tip is bent at a 90 degree angle to lower shank the tip is adapted to the tooth for detection of calculus deposits
during subgingival instrumentation, the clinician relies on his or her sense of ____________ to locate calculus deposits beneath the gingival margin
touch
what is a walking stroke?
walking stroke: a series of bobbing strokes that are made within the sulcus or pocket while keeping the probe tip against the tooth surface walking strokes are used to cover the entire circumference of the sulcus (the junctional epithelium is not always a uniform depth)
