Instrumentation Review Answers
1.
What are the ideal angles for plaque and calculus removal? 0-40 degrees (face to tooth
surface angulation) to INSERT the instrument. Debridement – (face to tooth) is between 4590 degrees and 60 degrees works well for removing plaque, where 70-80 degrees is ideal for
calculus
2.
What are all codes for PSR and what do they mean?
CODE 0: • Color-coded reference mark is completely visible in the deepest sulcus or
pocket of the sextant.
• No calculus or defective margins on restorations are present.
• Gingival tissues are healthy with no bleeding evident on gentle probing.
CODE 1: • Color-coded reference mark is completely visible in the deepest sulcus or
pocket of the sextant.
• No calculus or defective margins on restorations are present.
• Bleeding IS present on probing.
CODE 2: • Color-coded reference mark is completely visible in the deepest sulcus or
pocket of the sextant.
• Supragingival or subgingival calculus and/or defective margins are detected.
CODE 3: • Color-coded reference mark is partially visible in the deepest sulcus or pocket
in the sextant.
• This code indicates a probing depth between 3.5 and 5.5 mm.
CODE 4: • Color-coded reference mark is not visible in the deepest sulcus or pocket in
the sextant.
• This code indicates a probing depth of greater than 5.5 mm.
CODE *: The * symbol is added to the code of a sextant exhibiting any of the following
abnormalities: furcation involvement, mobility, mucogingival problems, or recession
extending into the colored area of the probe. Pictured here is an example of a sextant that
has teeth with furcation involvement; therefore, the symbol should be recorded next to the
sextant code.
Recession This sextant exhibits gingival recession and mucogingival problems and therefore
should include the * symbol next to the sextant code.
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Can graphite instruments be used on implants? Some plastic instruments include GRAPHITE
FILLERS and these are OK to use on an implant superstructure BUT NOT on the abutment
itself (to avoid scratching)
Can stain be removed with calculus? Yes, most of the stain is due to plaque or calculus. If
stain still remains then selective polishing can be done
Can you polish gold crowns? No, you cannot polish restorations as it could scratch the
surface due to the abrasiveness
Can the prophy paste remove the enamel of the tooth? YES – stain removal with an
abrasive agent remove the surface layer. Polishing for 3 minutes with pumice removes 3-4
micrometers of enamel. Over time the loss of enamel can be significant
Can air polishing be used on composites? No, not on composites, luting agents or glass
ionomers
What are two types of instrument handles? Single ended and double ended (one working
end or two working ends
Where are long functional shanks used? Short functional shanks – used on teeth crowns
(NOT the root), Long functional shanks – used on both teeth crowns AND roots
What types of calculus is the sickle scaler supposed to remove? Sickle scaler – removal of
medium to large calculus deposits, supragingival use
What type of mirror produces a magnified lens? Concave – the reflecting surface is on the
front surface of the mirror lens; produced a magnified but slightly distorted image
What does transillumination mean? reflecting light from the mirrored surface through
anterior teeth
What is a Nabers probe used for? A curved, blunt-tipped instrument used to detect and
access bone loss in the furcation areas
What is a pigtail explorer? A paired universal explorer with short broadly curved lower
shank, detects calculus in normal sulci or shallow pockets
What is a periodontal file used for? Burnished calculus, smoothing a rough amalgam or
overextended margin, and crushing larger calculus deposits
What type of instrument is a cross-section – semi-circular; lateral surfaces meet at the face
at 70-80 degrees? Universal curet.
What angle is used when inserting an instrument? 0-40 degrees.
For proper ergonomics, how far should the back of the chair be from the floor? 10 to 15
degrees from the floor
Is sidesitting at the 8-9 o’clock position the best position for the dental hygienist to use
when avoiding pain? Sidesitting in the 8 to 9 o’clock position is one of the most damaging
positions the hygienist can assume, and should be eliminated or minimized to avoid injury.
This can lead to pain and musculoskeletal disorders in the hips, back, shoulders, neck, and
arms.
What technique and stroke should you use when probing? The walking stroke and this is
the movement of a calibrated probe around the perimeter of the base of a sulcus or pocket.
Walking strokes are used to cover the entire circumference of the sulcus or pocket base. It is
essential to evaluate the entire “length” of the pocket base because the junctional
epithelium is not necessarily at a uniform level around the tooth. In fact, differences in the
depths of two neighboring areas along the pocket base are common.
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What is CAL? This is the measurement of the position of the soft tissue in relation to the
cemento-enamel junction (CEJ) that is a fixed point that does not change throughout life,
albeit at times it is hard to visualize (e.g. in case of abfraction lesions or chemical root
erosions). Two measurements are used to calculate the CAL: the probing depth and the
distance from the gingival margin to the CEJ.
After extreme debridement, how long should you wait for the tissues to heal again? Tissue
healing happens slowly, you need to wait at least 1 month to really determine the health of
the tissue. This is why the re-evaluation appointment is typically 4-6 weeks later
What is the fulcrum? The fulcrum or finger rest serves as a stabilizing point for the
instrument, prevents injury to the patient and operator, and enables the hand and
instrument to move as a single unit. The pad, specifically the lateral (outer) tip of the ring
finger of the dominant hand, serves as the fulcrum finger. When activating the instrument,
the clinician exerts downward pressure on the fulcrum finger and slightly squeezes the
instrument with the index finger and thumb to increase stability and control during scaling
while not causing patient discomfort. A flat finger fulcrum where the clinician uses the
middle of the pad can hinder the maneuverability or pivot of the fulcrum finger, thereby
limiting the ability to adapt, angle, and activate the instrument properly. General guidelines
for an appropriate intraoral fulcrum include the placement of the ring finger on solid tooth
surface in the same arch and close to the work area.
What does burnished calculus mean? Burnishing occurs readily when instruments are dull,
but even sharp instruments can burnish calculus on a root surface when insufficient lateral
pressure is applied to the blade. When inadequate lateral pressure is used, small increments
of deposit are shaved from its outermost surface, leaving the base layer of the calculus
intact— smooth and burnished rather than cleanly removed. This may be one of the most
common errors in periodontal therapy.
Where is the oblique stroke used? Diagonal to the long axis of the tooth, used mostly on
facial and lingual surfaces
What stroke is perpendicular to the long axis of the tooth, used at the line angles of
posterior teeth, furcations, and within narrow pockets? The horizontal stroke.
What type of strokes should be used for thick calculus removal? Large calculus deposits
should be removed in sections with a series of short, firm strokes
Which implant is the most commonly used? Endosseous implant – MOST COMMONLY USED
type, placed into bone
How do you remove intrinsic stain? Bleaching can be used, veneers, crowns..etc, any type
of restoration depending on the case.