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List the three categories of fulcrums
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Contemporary Dental
Fulcruming, Adv. Instrum., Root Planning
| Question | Answer |
|---|---|
| Fulcrum | a finger rest used to stabilize the clinician's hand during periodontal debridement. |
| List the three categories of fulcrums | Intraoral, Extraoral, Advanced Fulcrum |
| Intraoral Fulcrum | Stabilization of hte clinician's dominant hand by placing pad of the ring finger on a tooth near to the tooth being instrumented |
| Extraoral Fulcrum | stabilization of hte clinician's had outside the patient's mouth, usually on the chin or cheek |
| When is an extraoral fulcrum useful? | In gaining acess to root surfaces within deep periodontal pockets. |
| Which type of fulcrum is a variation of an intraoral or extraoral finger rest? | Advanced Fulcrum |
| Advanced Fulcrums are useful when... | to gain access to root surfaces withing deep periodontal pockets. |
| Fulcruming the ring finger on a tooth provides... | Stability while working in a patient's mouth with sharp instruments |
| Which type of fulcrum provides the best stability for the clinician's hand | Standard intraoral fulcrum |
| What is the technique for an intraoral fulcrum | tip of ring finger on a stable tooth surface |
| What is the location for an intraoral fulcrum | on the same arch as the treatment area, naer the tooth being instrumented |
| List the advantages of intraoral fulcrums | provides the MOST stable, secure support for the hand; provides leverage and power for instrumentation; |
| Advantages of intraoral fulcrums | provides excellent tactile transfer to the fingers; allows hand & instrument to work together effectively; |
| Advantages of intraoral fulcrums | permits precise stroke control; allows forceful stroke pressure w/ the least amt of stress to the hand & fingers; |
| Advantages of intraoral fulcrums | decreases the likelihood of injury to the patient if (s)he moves unexpectedly during instrumentation |
| Disadvantages of intraoral fulcrums | may be dificult to obtain parallelism of the lower shank to the tooth surface of access to deep pockets; |
| Disadvantage of intraoral fulcrums | may not be practical for use in edentulous areas |
| What are advanced fulcruming techniques useful in obtaining? | Parallelism |
| Advanced fulcrums should be used? | Selectively |
| T/F: It is difficult to obtain parallelism with the lower shank or to adapt the cutting edge when using a standard intraoral fulcrum | True |
| Advantages of advanced fulcruming technique | easier access to max 2nd & 3rd molars, easier access to deep pockets on the molar teeth |
| Advantages of advanced fulcruming technique | improved parallelism of the lower shank to molar teeth, facilitate neutral wrist position for molar teeth |
| Disadvantages of advanced fulcruming technique | requires a greater degree of muscle coordination & instrumentation skill to achieve calculus removal |
| Disadvantages of advanced fulcruming technique | greater risk for instrument stick, reduced tactile information to fingers; |
| Disadvantages of advanced fulcruming technique | may cause more muscle strain, not well tolerated by patients w/ limited opening or TMJ |
| Advanced fulcruming | helpful when working in areas of limited access, such as narrow deep pockets |
| Advanced fulcrms should be used selectively in areas of limited access to: | maintain neutral body position |
| T/F: An advanced fulcrum should be used if an intraoral fulcrum is NOT effective/possible | True |
| Advanced fulcruming techniques are NOT intended to replace the intraoral fulcrum | True |
| List the advanced fulcruming techniques | modified intraoral, cross arch, opposite arch, finger-on-finger, basic extraoral, finger assist |
| The modified inraoral fulcrum is achieved by | combining and altered modified pen grasp w/ a standard intraoral fulcrum |
| The modified intraoral fulcrum is praticulary useful when | instrumenting the maxillary teeth |
| The modified intraoral fulcrum involves altering the point of contact: | between the middle and ring fingers in the grasp |
| For the modified intraoral fulcrum, the middle and ring fingers contact one another: | Near the middle knuckle region of hte fingers |
| The intraoral fulcrum should NOT be confused w/ a split fulcrum. In a split fulcrum | there is NO contact between the middle and ring fingers |
| The cross arch fulcrum is accomplished by | resting the ring finger on a tooth on the opposite side of the arch from the teeth being instrumented |
| Resting on the left side of the mandible to instrument a mandibular right molar is an ex | This is an example of a cross arch fulcrum |
| The opposite arch fulcrum is an | advanced fulcrum used to improve access to deep pockets & to facilitate parallelism to proximal root surfaces |
| Resting on the mandibular arch to instrument maxillary teeth is an example of | Opposite arch fulcrum |
| The opposite arch fulcrum is accomplished by | resting the ring finger on the arch opposite the treatment area |
| The finger-on-finger fulcrum is accomplished by | resting the ring finger of the dominant hand on hte index finger of the nondominant hand |
| This technique allows the clinician to fulcrum in line with the | long axis of the tooth to imporve parallelism of the lower shank to the tooth surface |
| The nondominant index finger provides a | stable rest for the clinician's dominant had & provides improved access to deep periodontal pockets |
| The finger-on-finger can | strengthen your stroke, can be used all over the mouth, improves access & parallelism |
| What are the basic extraoral fulcrums? | Knuckle-rest technique & chin-cup technique |
| The knuckle-rest technique involves: | resting the knuckles of the clinician's dominant hand against the patient's chin or cheek. |
| The chin-cup technique involves: | the clinician cupping the patient's chin in the palm of his or her dominant hand. |
| The finger assist fulcrum is accomplished by: | using the index finger of the nondominant hand AGAINST THE SHANK of a periodontal instrument to assist in the instrumentation stroke. |
| the finger of the nondaminant hand is placed against the instrument shank to: | (1) concentrate lateral pressure against the tooth surface and (2) help control the working-end throughout the instrumentation stroke. |
| The finger assist fulcrum is most commonly used with: | an extraoral fulcrum or an opposite arch fulcrum |
| (T-F) the finger assist fulcrum gives the clinician better lateral pressure | true |
| (T-F) while exploring, only the tip-one-third of the explorer should touch the tooth | true |
| (T-F) interproximal deposits can be felt from both the lingual and buccal/facial aspects. | true (doesn't say "can ONLY be felt") |
| concavities can be more effectively explored by positioning the explorer in a tip-_____ position | up |
| standard area-specific curets are designed for instrumenting root surefaces in pockets of ___mm or less in depth. | 4mm |
| in the extended gracey curet, the ____shank is ___mm longer than the standard curet. | in the extended gracey curet, the LOWER shank is 4mm longer than the standard curet. |
| the miniature gracey curet has a _____, _____ working-end than is ___mm longer than a standard curet. | the miniature gracey curet has a SHORTER, THINNER working-end that is 3mm longer than a standard curet. |
| The extended shanks come in the Hu-Friedy "____" and the American Eagle Gracey "____" | The extended shanks come in the Hu-Friedy "AFTER 5 CURETS" and the American Eagle Gracey "+3 DEEP POCKET CURETS" |
| The design characteristics of the AFTER 5 and GRACEY +3 DEEP POCKET curets differ from those of a standard Gracey curet in 2 important repects: | (1)longer lower shank and (2)thinner working-end |
| The thinner working-end facilitates insertion beneath the _____ _____ and reduces ____ _____ away from the root surface. | The thinner working-end facilitates insertion beneath the GINGIVAL MARGIN and reduces TISSUE DISTENTION away from the root surface. |
| Mini's are designed for use in: | narrow deep pockets more than 4 mm in depth to debride root branches, midlines of anterior roots, root concavities, and furcation areas. |
| the Hu-Fiedy Mini Five and American Eagle Gracey +3 Access curets differ from those of standard gracey's in 3 important respects: | (1)Longer lower shank, (2)Thinner working-end, and (3)shorter working-end |
| The mini's lower shank is ___mm longer than the standard | 3mm |
| the mini's working end is ___percent thinner than the standard | 10 percent |
| the mini's shorter working end is ___ the length of a standard curet. | half |
| the mini's also have an extra "___" | hook |
| the design characteristics of the Vision Curvette area-specific curets differ from the standard graceys in several respects: | Working-end length, working-end curvature, and shank design. |
| the working end of the curvette is: | half the length of a standard |
| the working end curvature of a curvette is: | more curved more curved than that of a standard to be able to reach curved root surfaces. |
| The shank design of the curvette: | allows access to root surfaces within perio pockets greater than 4mm. The lower shank also has two bands at 5 and 10 mm. |
| the vision curvette sub-zero is used on: | anterior teeth |
| the vision curvette 1/2 is used on: | anterior teeth and premolar teeth |
| the vision curvette 11/12 is used on: | mesial, facial and lingual surfaces of molars |
| The vision curvette 11/12 is "sister" to: | 15/16 |
| The vision curvette 13/14 is used on: | distal surfaces of molar teeth |
| The vision curvette 13/14 is "sister" to: | 13/14 |
| The Langer curet can be thought of as a ___ design. | hybrid |
| The Langer curet can be thought of as a hybrid design because: | it combines features of a universal curet with features typical of an area-specific curet |
| Langer curets differ from other universal curets in 3 important respects: | (1)each curet is limited to use only on certain teeth and certain areas, (2)each curet has a long complex functional shank, (3)a set of 3 Langer curets is needed to instrument the entire dentition. |
| (T-F) the Langer 17/18 may be used on molars. | True |
| The Langer 5/6: | Anterior teeth |
| Langer 1/2: | mandibular posterior teeth |
| Langer 3/4: | Maxillary posterior teeth |
| Langer 17/18: | posterior teeth |
| A periodontal file is used to: | PREPARE calculus deposits before removal with another instrument. |
| a file is used to ___ or ___ a heavy deposit | a file is used to CRUSH or ROUGHEN a heavy deposit |
| files have multiple cutting edges, at an angle of ___ to ___ degrees to the base. | 90-105 |
| Examples of files are: | Hirschfield 3/7, 5/11, and 9/10 and Orban 10/11 and 12/13 |
| the scaling stroke should be __-__mm long | 1-2mm |
| the grasp when using an ultrasonic should be: | light, pressure against the tooth |
| the adaptation when using an ultrasonic should be: | use tge correct part of the active tip (sides/back/face) and tip on the piece of calculus |
| the activation when using an ultrasonic should be: | initiated by wrist motion or rocking from the fulcrum finger, moving at all times, strokes are overlapping and multidirectional, oblique and vertical predominantly used although horizontal strokes are also used. |
| Gracey +3, access 00-0 is used for: | cuspid to cuspid, deep pockets |
| Gracey 1-2: | cuspid-cuspid |
| gracey 3-4: | cuspid-cuspid |
| gracey 5-6: | cuspid-cuspid |
| gracey 7-8: | premolars and molars, facial and lingual |
| gracey 9-10: | molars, buccal and lingual, more adaptable to roots than gracey 7-8 |
| gracey 11-12: | mesial surfaces of premolars and molars (better than 15-16) |
| gracey 13-14: | distal surfaces of premolars and molars. |
| gracey 15-16: | mesial surfaces of premolars and molars, requires less cheek retraction and greater access than 11-12 |
| gracey 17-18: | distal surfaces of premolars and molars,smaller blade, slightly longer shank, designed specifically for 3rd molars. |
| Neb 128: | ultra-thin, cuspid-cuspid |
| McCalls 13-14S | universal, molars, designed for tight posterior contacts with pockets 3mm or less. |
| (T-F) McCalls 13-14S can have a tip or toe | true |
| Columbia 13-14: | universal, molars, designed for tight posterior contacts with pockets 3mm or less. |
| HG6-7: | sickle scaler, very effective for interproximal areas, shank angulation provides access to all surfaces of anteriors and premolars |
| Nevi-1: | anterior universal scaler, cuspid-cuspid, scoop end is a bet discoid designed to clean lingual stain and calculus. |
| Nevi-2: | posterior scaler, thin, designed for distal and mesial surfaces of molars |
| Define Scaling | The process by which plaque & calculus is removed from all tooth surfaces coronal to the junctional epithelium |
| Subgingival scaling | Plaque & calculus removal apical to the margin of the gingiva |
| Supragingival scaling | Plaque & calculus removal coronal to the margin of the gingiva |
| Root Planning | the process by which residual plaque, calculus, & portions of cementum are removed to produce a smooth, hard, clean root surface |
| T/F: Reattachment is more difficult if cementum is removed | True |
| Why is it possible for plaque to seep into the cementum? | because cementum is permeable allowing for toxic substances to seep into it |
| What was the historical belief to bring the pocket back to health? | To remove ALL the altered cementum (toxins taken up into the root surface) |
| How is the altered cementum accomplished? | By creating a glassy smooth surface through root planning. |
| The thought that plaque removal was enhanced because of the irregularities that tend to retain plaque would be removed is an example | It is an example of the Historical Information |
| T/F: Intentional removal of cementum is more detrimental to healing | True |
| The goal of removing plaque & calculus, creating a smooth root, is the goal for: | Producing a "healthy" root surface. It is called peridontal debridement |
| What is assessed after periodontal debridement? | Tissue response |
| What is the instrument of choice for root planning and Why? | Curets because the design allow them to be adapted subgingivally w/ less chance of tissue damage or gouging of root surfaces |
| It is essential to use ________ ___________ for root planning | Sharp instruments |
| Describe scaling strokes: | modified pen grasp, firm lateral pressure, short, controlled, overlapping strokes (oblique, horizontal, vertical) |
| Describe root planning strokes: | moderately firm grasp, wrist-forearm motion, continuous series of long strokes, even lateral pressure |
| Which 3 strokes are suggested to perform during root planning: | horizontal, oblique, vertical |
| Lateral pressure is progressivley reduced when? | When the surface becomes smooth and resistance to the blade diminishes |
| With each stroke in root planning a thin layer of tooth substance should be shaved off, why? | so that gradually planing away surface irregularities until a hard, glassy smooth surface remains |
| T/F: Root planning is the standard treatment | False, it should be used judiciously. |
| When should a patient recieve root planning? | after periodontal debridement and assessing the surface. If small irregularities remain, root planing strokes may be used to smooth out area(s) |
| If calculus deposits are found utilize: | Scaling strokes to remove calculus |
| If small irregulatiries are found utilize: | Root planing strokes |
| curettage: | the scraping or debriding of soft tissue, especially in a body cavity, with an instrument that usually is a curet. |
| gingival curettage: | the deliberate debridement of the soft tissue wall of the pocket with a curet or other instrument to remove the inflamed pocket wall, which includes junctional and pocket epithelium as well as the immediately subjacent diseased connective tissue. |
| subgingival curettage: | a gingival curettage procedure is performed with a curet, but apically to sever the connective tissue attachment to the tooth down to the osseous crest without incising and reflecting a flap. (sometimes used synonymously with gingival curettage) |
| Open Curettage procedures include: | include surgical curettage, open curettage,flap curettage, open-flap curettage, excisional new attachment procedure (ENAP), and the modified widman flap. |
| Open curettage procedures: . | are surgical procedures done with a scalpel to excise the inflamed pocket wall as well as the connective tissue attachment apical to the base of the pocket down to the osseous crest |
| Inadvertant curettage: | the unintentional, unavoidable disruption or removal of positions of the pocket wall and junctional epithelium during subgingival scaling and root planing. |
| Inadvertant curettage is caused by: | caused by opposite cutting edge of the curet blade coming in contact with the pocket wall. |
| hard tissue cruettage: | debridement and smoothing of root surfaces with a curet. AKA root planing |
| chemical curettage: | the use of a caustic solution to facilitate removal of the soft tissue lining of the pocket. |
| chemical curettage has been done with: | sodium sulfide, alkaline sodium hypochlorite solution, and phenol |
| definitve porcedures should result in: | the correction of the defect and elimination of the disease. |
| definitive gingival curettage would result in: | reduction of pocket depth and elimination of inflammation. |
| a nondefinative result from gingival curettage would be: | a reduction of inflammation but the persistence of a pathologically deepened pocket. |
| a definative result can be expected from: | edematous pockets where reduction of inflammation is accompanied by a reduction of edema and shrinkage of the marginal gingiva. |
| new attachment: | the reunion of gingival connective tissue with a root previously exposed by peridontal disease. |
| reattachment | rejoining and repair of intact connective tissue fibers severed during a surgical procedure. |
| new attachment occurs by means of: | new cementum deposited on the root into which gingival connective tissue fibers insert. |
| (T-F) pocket closure following instrumentation in fibrotic pockets is common. | False. (uncommon- when it occur it does so by formation of a long junctional epithelium and NOT by a new connective tissue attachment.) |
| what are the indication for gingival curettage? | periodontal abscesses to promote drainage, highly edematous pockets with large amounts of granulation tissue, management of recurrent inflammation and pocket depth during treated perio cases during maintenance. |
| what are the contraindications for gingival curettage: | firm, fibrotic tissue, infrabony pockets, NUG, and MGI's |
| (T-F) gingival curettage by itself treats only the inflammatory effects of the disease process, not its cause and cannot be expected to be successful without conscientious scaling and root planing to eliminate local irritants | TRUE!! |
| when using a universal curet, the angulation should be: | more than 90 degrees |
| when using a universal curet, the working end chould be: | the opposite working end should be used. (the "wrong" end) same is true for GRACEY'S!! |
| when using a Gracey curet, the angulation should be: | 45-90 degrees against the tissue |
| the curettage stroke should be: | long, horizontal strokes with even, moderate pressure |
| why would the clinician place the finger of their opposite hand against the pocket wall with the curet blade? | to lend support to the tissue |
| immediately after the procedure, histologically, the JE (junctional epithelium) looks: | the JE and pocket epithelium have been completely removed leaving underlying connective tissue exposed. This is covered by a blood clot. |
| 1-2 days after the procedure, histologically, the tissue looks: | an acute inflammatory reaction to the surgery occurs within the first few hours and PMN's are found at the wound surface beneath the blood clot. |
| 4 days after the procedure, histologically, the tissue looks: | the acute inflammatory reaction is waning and is being replaced by granulation tissue at the wound surface. Epithelialization is prograssing but incomplete. |
| 6-7 days after the procedure, the tissue looks: | edema is gone. shrinkage has occured producing recession of the gingival margin. color is normal, and there is little or no BOP. |
| 6-7 days after the procedure, histologically, the tissue looks: | epithelialization is about complete. the connective tissue is organizing, collagen is being produced. |
| 10-14 days after the procedure, clinically, the tissue looks: | the gingiva looks normal, pink in color, firm, and no BOP |
| reevaluation after gingival curettage chould be in: | 1-2 weeks to reprobe, evaluate plaque control, examine for residual calculus, and reinstrument as necessary. |
| what are the indication for gingival curettage? | periodontal abscesses to promote drainage, highly edematous pockets with large amounts of granulation tissue, management of recurrent inflammation and pocket depth during treated perio cases during maintenance. |
| what are the contraindications for gingival curettage: | firm, fibrotic tissue, infrabony pockets, NUG, and MGI's |
| (T-F) gingival curettage by itself treats only the inflammatory effects of the disease process, not its cause and cannot be expected to be successful without conscientious scaling and root planing to eliminate local irritants | TRUE!! |
| when using a universal curet, the angulation should be: | more than 90 degrees |
| when using a universal curet, the working end chould be: | the opposite working end should be used. (the "wrong" end) same is true for GRACEY'S!! |
| when using a Gracey curet, the angulation should be: | 45-90 degrees against the tissue |
| the curettage stroke should be: | long, horizontal strokes with even, moderate pressure |
| why would the clinician place the finger of their opposite hand against the pocket wall with the curet blade? | to lend support to the tissue |
| immediately after the procedure, histologically, the JE (junctional epithelium) looks: | the JE and pocket epithelium have been completely removed leaving underlying connective tissue exposed. This is covered by a blood clot. |
| 1-2 days after the procedure, histologically, the tissue looks: | an acute inflammatory reaction to the surgery occurs within the first few hours and PMN's are found at the wound surface beneath the blood clot. |
| 4 days after the procedure, histologically, the tissue looks: | the acute inflammatory reaction is waning and is being replaced by granulation tissue at the wound surface. Epithelialization is prograssing but incomplete. |
| 6-7 days after the procedure, the tissue looks: | edema is gone. shrinkage has occured producing recession of the gingival margin. color is normal, and there is little or no BOP. |
| 6-7 days after the procedure, histologically, the tissue looks: | epithelialization is about complete. the connective tissue is organizing, collagen is being produced. |
| 10-14 days after the procedure, clinically, the tissue looks: | the gingiva looks normal, pink in color, firm, and no BOP |
| reevaluation after gingival curettage chould be in: | 1-2 weeks to reprobe, evaluate plaque control, examine for residual calculus, and reinstrument as necessary. |
Created by:
Jenny teeth