Restorative dentistry

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ORAL PROPHYLAXIS
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A scaling and polishing procedure performed on dental
patients in a normal or good periodontal health to
remove coronal plaque (biofilm), stain and deposits to
prevent caries and periodontal disease
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Instrumentation
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Scaling – preventive (prevents periodontal diseases)
Biofilm / Dental Plaque
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Consists of soft bacterial deposits firmly attached to the
teeth
It can be removed by tooth brushing and by scaling
It reforms rapidly after removal
A complex metabolically interconnected, highly
organized bacterial ecosystem
Occurs as distinct supragingival and subgingival
microbial colonization
Biofilm is “the soft tenacious material found on the
tooth surface which is not readily removed by rinsing
with water
It is estimated that 1mm of biofilm weighing about 1mg,
contains more than 200 million bacteria
There is well over 350 sorts of bacteria (opportunistic)
in the oral cavity
Tenacious: can’t be mechanically removed
30-45 mins. After brushing
Calculus / Calcular Deposits
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Calcified biofilm
Calcified deposits occur as hard, firmly adhering
masses on the clinical crowns of the teeth
May also form on dentures and other oral appliances
Always covered with uncalcified biofilm
Where it exists in contact with gingiva, the gingiva is
inflamed.
o Because of the presence of toxic substances
within the calculus
o It irritates the gingiva due to its hard structure
Significance of Calcular Deposits in Periodontal Disease
1. Calculus is rough, porous and facilitates retention of
dental biofilm
2. Calculus is permeable and may store products noxious
to the adjacent gingiva
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2. Subgingival Calculus
May be found on any tooth in the mouth and in any
periodontal pocket
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Chisels
Hoes
Sickles
Files
Curettes
Chisel, Hoe and Sickle are designed for the removal of
heavy calculus
Curettes and Files are intended to remove finer or
residual deposits and to smooth root surface
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Pocket Explorer
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Is held in the modified pen grip. Use a light grasp;
between the thumb, the index finger, and the middle
finger. Never use the sharp tip on the surface of the
teeth
Used for detection of irregularities on the surface of the
tooth and for supra- and subgingival detection of
calculus (up to 3mm subgingival)
Used as root feeler, this indicates the extends of the
subgingival calculus present before and after scaling
Scalers
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Are held in modified pen grip. Since instruments for
scaling and root planning are used with a certain
amount of pressure a correct grasp, proper point of
support and stable but flexible finger rest are very
important
Chisel
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Designed for the removal of extensive coronal calcified
deposits
Mandibular anterior region
Used with a push stroke in labiolingual direction
Hoes
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Classification of Calcular Deposits
1. Supragingival Calculus
Most abundant opposite the openings of major
salivary glands
a. Oral surfaces of lower anterior teeth
b. Vestibular surfaces of the upper molars
Creamy white to yellowish color
Consistency is moderately hard
Recurrence after removal is rapid
Most often found on the approximal surfaces and
with the lower frequency on the buccal surface
More dense than supragingival calculus
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For anterior and lingual surfaces. This scaler can also
be used for the proximal surfaces of premolars and
molars. It can be remove very large, heavy sub and
supragingival calculus. Hoes are particularly suitable
for deep, narrow pockets and concave root surface
Pull instrument
Can be used subgingivally but only to the extent that
the gingiva can be displaced
Sickle Scalers
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Strong instruments that remove large calculus
Has 2 cutting edges per working edges
Can be used on all aspects of the tooth
Working end is triangular in cross section
May be used with pull or push strokes
Cutting edges on both sides of the blade
a. Large Hooked Sickle – lingual surface of
mandibular incisors
b. Contra-angled Sickle (Jacquette) – interproximal
use in premolar and molar area
c. Curved Sickle Scaler
d. Straight Sickle Scaler
Files
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Having an action similar to that of 3-5 hoes on a row
Designed for use in deep, narrow-mouthed pockets
and in pockets inaccessible to other instruments
Difficult to sharpen
When improperly used, may score or nick the
cementum surface
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Dental Disclosing – tablets and solutions stain the plaque
build up in your teeth, allowing you to see how thoroughly
you are brushing and flossing your teeth. They stain the
bacteria making it easier to see where to remove dental
plaque and calculus deposits
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Scaling Technique (Five Step Technique)
1. Position the instrument at the correct angle against
tooth surface
2. Change the angle of the instrument – the cutting edge
should be in the right position against the tooth surface
3. Use light lateral pressure and push the cutting edge
against the surface (do not use heavy lateral pressure)
4. Pull the instrument along the tooth surface towards the
incisal/occlusal (pulling stroke)
5. Relax
H6 / H7 – sickle
11A/12A – is used for the removal of calculus in the
whole mouth; universal; identical to scaler S204SD;
bigger and the working part is thicker; curette
S204SD – smaller
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Curette
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The Gracey 1/2 is used for the removal of subgingival
plaque, calculus, and root planning in the upper and
lower anterior areas
Assigned for specific areas, but it is possible to use
them in other areas as well. When the instrument is
inserted the last part of the shank of is parallel to the
surface of the tooth
Usually used subgingivally
The curette 11/12 is used for the removal of
subgingival plaque, calculus, and root planning of the
mesial surfaces in the premolar and molar areas
The Gracey curette combination 11/14 and 12/13
improves efficiency during treatment; the mesial and
distal surfaces in specific (pre)molar areas can be
cleaned with one instrument
The curette 13/14 is used for the removal of
subgingival plaque of the distal surfaces in the
(pre)molar areas
The curette 15/16 is used for the removal of
subgingival plaque in the mesial surfaces of (pre)molar
areas; more accentuated angulation of the shank
Design of the Gracey curettes is unique in that each
end had only one cutting edge and that is designed so
that it can adopt closely to the specific tooth surface for
which it is intended
The cutting/useable edge of the blade is the lower
outer aspect of the blade. It can be identified by holding
the terminal shank of the end in question, the blade
side lower, in a vertical position and viewing the blade
portion head on. The blade of the curette is machined
at 70 degree angle and the cutting edge exhibits a
curve, which is longer
When adapting the Gracey instruments to tge teeth to
perform scaling, the cutting edge must be first
identified, the terminal shank should be parallel to that
surface
Plaque Disclosing
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Available without prescription
Erythrosine is the most common dental plaque dye in
disclosing tablets and solutions
Modified Pen Grip
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Improves control, prevents slipping of instrument,
reduces hand fatigue and improves tactility
The point of support should be close to the working area
and should be stable but flexible
The 4th finger (ring finger) is often the support point
It is not recommended to support the hand on the soft
tissues (cheeks/lips) or on mobile teeth
The blade of the instrument should always be into
contact with the tooth surface
The instrument should be moved over the surface with
overlapping movements. It is recommended to scale from
the bottom of the pocket towards the gingival margin
It is preferable that all tooth surfaces should be
completed in one session
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Angulation
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Efficient cutting angulation is between 45, 90 and 70
degrees is considered ideal. Less than 45 degrees is
considered “closed” and more than 90 degrees is
considered “open”
Insertion
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To avoid damaging the soft tissues, the working end is
inserted into the sulcus with the face of the blade
“closed” or flattened to the tooth surface. Once in the
depth of the pocket, the blade is opened.
Strokes
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The action of the working end as it is moved across the
tooth surface
Exploratory Strokes – provide light tactile feedback from
the instrument tip
a. Working Strokes – provide controlled pressure against
a tooth surface using an appropriate cutting angulation
b. Scaling Strokes – are short pulling strokes made with
firm pressure to remove increment from root and enamel
surfaces
c. Root Planing Strokes – to remove deposits and smooth
the root surface
d. Working strokes – are ideally a series of overlapping
strokes covering the entire tooth surface
Polishing
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May be performed with pumice of Zirconate applied
with a rubber cup
1. Remove disclosing solution
2. Render surface smooth
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