advanced instrumentation

  1. HOES
    used to dislodge heavy supramarginal calculus deposits
  2. FILES
    used to crush and remove heavy calculus deposits
    used to dislodge brides of calculus on anterior mandibular teeth
  4. what are 6 design features for a HOE
    • 1. single, straight cutting edge
    • 2. cutting edge beveled at a 45 degree angle to the end of the blade
    • 3. blade turned at 99-100 degree angle to the shank
    • 4. strong, straight, rigid shank used for adaptation in anterior
    • 5. curved shank used for adaptation in posterior sextants
    • 6. paired instrument; set of 4 working ends of 4 areas
  5. what are some of the purposes of a HOE
    1. removal of heavy, tenacious SUPRAgingival calculus

    2. removal of heavy, tenacious SUBgingival calculus in easily accessible areas, above the junctional epitherlium

    3. most effective on the facial and lingual surfaces OR on proximal surfaces next to edentulous areas.
  6. Where do you only use the HOE
    only in easily accessible areas
  7. what kind of stroke is used for a HOE
    VERTICAL PULL STROKE toward the incisal/occlusal
  8. How do you hold a HOE
    hold instrument in a modified pen grasp utilizing a fulcrum near the tooth surface to be instrumented
  9. HOEAdapt the of cutting edge to the tooth surface
    full width
  10. Shank section of instrument adjacent to the blade is to the long axis of the tooth placing the cutting edge at a 90 degree angle to the tooth surface when dealing with a HOE
  11. Contraindications for HOE
    1. NOT for use on proximal surfaces EXCEPT in edentulous areas

    2. Can gouge cemental surface

    3. NOT adaptable to curved root surfaces

    4. NOT to be used subgingivally unless tissue is SPONGY and FLEXIBLE bc blade size and shape will tear pocket wall

    5.ALL instrumentation must be followed by curets
  12. What are some design features of the FILE?
    1. Multiple cutting edges, like a series of hoe scalers

    2. each blade is at a 90-105 degree angle to the shank

    3.shank comes in various angles. curved shanks are designed for the posterior and straight shanks are for the anterior

    4. base can be round, rectangular or oval
  13. What are 4 the purpose of the FILE?
    1. calculus removal through crushing or fragmentation prior to definitive scaling with curets

    2. SUBgingival use of the file must be away from the junctional epithelium

    3. most effective on the facial /buccal and lingual surfaces OR on proximal surfaces next to edentulous areas

    4. Smooth overhanging restorations
  14. Where do you use a FILE?
    only in easily accessible areas
  15. Entire cutting edge is placed against area to be treatedfile
  16. fileshank is to the long axis of the tooth
  17. what kind of contact do you want to maintain when using a FILE
    a two-point contact between the instrument shank and the cutting edge to provide stability
  18. What kind of stroke is used with a FILE
    VERTICAL PULL STROKE toward the incisal/occlusal.

    Pressure applied allows cutting edge to grasp surface
  19. List contraindications when using FILE
    1. Can gouge tooth surface and traumatize tissue

    2. Inaccessible areas

    3. lack of tactile sensitivity

    4. Base of pocket inaccessible without trauma

    5. Proximal use is difficult
  20. what do u use when wanting to remove burnished calculus?
  21. what are 3 design features of the CHISEL
    1. single, straight, flat cutting edge

    2. Blade is continuous with slightly curved shank

    3. Cutting edge is bevealed at a 45 degree angle
  22. What are some of the purposes of the CHISEL?
    1. extremely limited to areas where interdental papilla are missing

    2. Removal of heavy supragingival calculus that bridges mandibular anteriour teeth and premolars where the lip allows access.
  23. Where do you want to establish a finger rest when using the CHISEL?
    on the facial surface of teeth adjacent to tooth being instrumented
  24. chiselPosition instrument shank to the long axis of the tooth
  25. what edge of the cutting edge is adapted
    full width
  26. what is the stroke of the CHISEL
    HORIZONTAL PUSH (thrusting) motion from facial to lingual
  27. List the contraindications for the chisel
    1. must utilize entire cutting surface or sharp corners will gouge tooth surface

    2. all instrumentation must be followed by curets
  28. How do you sharpen a HOE
    • stationary stone, moving instrument
    • 1. maintain 45 degree bevel, establish finger rest on stone

    2. PULL toward the cutting edge, use a short stroke

    3. Round the corners by gently rolling stone across corner
  29. How do you sharpen a FILE?
    1. use professional sharpening service or BUY a new one

    2. too difficult and time-consuming with limited results
  30. How do you sharpen a CHISEL?
    • stationary stone, moving instrument
    • 1Maintain 45 degree bevel

    2. PUSH instrument foward, toward the cutting edge

    3. round corners by gently rolling stone over corners
  31. Maxillary Canine description
    *Root surfaces are broad and flat in faciolingual direction

    *longitudinal groove possible, more common on distal surface

    *concavity exists with longitudinal groove
  32. what is the adaptation technique for maxillary canine?
    roll handle to direct toe third of cutting edge into concavity
  33. maxillary first premolar description
    most commonly bifurcated in apical or middle third, forming facial and lingual roots

    2 kinds BIfurcated and SINGLE rooted
  34. maxillary first premolar that is bifurcated
    mesial surface has deep developmental groove running from bifucation to crown, causing a concave mesial surface.

    distal surface has a groove reduced in depth and length, causing a convex or flat distal surface at the cervical third
  35. maxillary first premolar single rooted
    mesial and distal surfaces have longitudinal grooves similar to the grooves on the root trunk of a two rooted tooth.

    The mesial surface groove is more pronounced than the distal and therefore more concave on mesial surface.
  36. Maxillary first molar description
    three roots are lingual, mesiobuccal, distobuccal

    short root trunk

    grooves ar epresent from trifurcation to cervical line on mesial, distal, and facial surfaces

    lingual surface of lingual root has longitudinal groove more pronounced at cervical third
  37. mesiobuccal root is concave on distal surface

    distobuccal root is concave on mesial surface
    maxillary first molar
  38. mandibular canine description
    longitudinal groove usually present on mesial and distial surfaces, making them concave in the faciolingual direction

    sometimes this root is bifurcated in the apical third
  39. mandibular first molar description
    bifurcation in cervical third forms mesial and distal roots

    developmental depression on facial and lingual root trunk extends from bifurcation to CEJ, becoming more shallow toward CEJ

    each root has longitudinal grooves on the mesial and distal root surfaces, which are more prominent on mesial roots
  40. what are some limitations when using after-five mini gracey curet
    extension to the midline of proximal surfaces

    and longevity is limited by sharpening often
  41. working blade is half the length and thinned for ease of insertion and reduced tissue distention for narrow deep pockets, convexites and concavites.

    3 mm longer in lower shank
    after-five mini gracey curet
  42. where are after five gracey's helpful?
    for narrow facial and lingual surfaces of anterior teeth
  43. standard gracey usage.....
    light to moderate calculus

    fine scaling, root planing, debridement

    adjuction to ultrasonic scaling

    more flexible shank that bends under pressure
  44. what are rigid and extra rigid shanks used for?
    heavy scaling
  45. list advantages of using a rigid or extra rigid shank
    does not dissipate the power used in generating a working stroke

    does not diminish tactile sensitivity

    enhances control and energy needed

    available in mini, traditional, and after five series
  46. indications for use of rigid and extra rigid curet
    moderate to heavy calulus

    scaling and debridement

    periodontal surgery
  47. design for R or E curets
    wider shank

    same shank angulation as standard Gracey Curette

    same blade width as standard Gracey Curette
  48. What are SOH curettes used for?
    to smooth root surfaces and remove small residual deposits after ultrasonic scaling
  49. What curette is described as disc shaped and look like a small spoon excavator?
    O'hehir curettes

    SOH 1/2, SOH 3/4 SOH 5/6 SOH 7/8
  50. blade design that enables a push or pull stroke in ALL directions
    SOH (o'hehir)
  51. list some features of the diamond file scaler
    360- degree diamond coating

    thin tips and unique bends

    active in both push and pull motion

    medical grade diamond coating
  52. what are some benefits of the diamond scaler
    scaling efficiency

    superior access

    provides accessto scale in small and narrow pockets

    ensures consistency of coated surface
  53. DIAMOND Scalers style
    paried ends R/L

    universal application

    access for class III furcations

    extended shank and pronounced curvature

    large diameter handle
  54. who designed vision curvettes?
    Barbara Long RDH from Saskatchewan
  55. Blade tip of a vision curvette is to the handle and shank is closer to with the handle.

  56. vision curvette compared to standard gracey
    50% shorter blade

    straight shank permits insertion into narrower deeper pockets especially anterior.

    improved adaptation at line angles, and for removal of deposit once it had been dislodged
  57. subzero curvette design
    long shank, facial and lingual line angles on anterior and premolars
  58. 1/2 curvettes
    anteriors, premolars, and interproximal surfaces
  59. 11/12 curvette
    mesial of molars and furcations
  60. 13/14 curvette
    distals of molars and furcations
  61. what marker indicates the right cutting edge?
    small "X"
  62. List the mm marks on a shank
    5 mm

    10 mm

    helps clinician visually assess pocket depth during instrumentation, to compare with perio charting and tactile sensation
  63. What are some disadvantages of curvettes
    1. short working end limits extension to midline of proximal surfaces

    2. upward curve could gouge if not adapted properly
  64. who designed the langer curettes
    Dr. Burton Langer

  65. what two features does the langer curette have
    combines best features of the gracey and universal curette blade

    allows you to scale the mesial and distal surfaces with the same instrument
  66. langer vs gracey
    langers have a slightly shorter, thicker terminal shank making them less flexible

    shank is not parallel to long axis of tooth when a good working blade angulation is achieved
  67. langer 1-2
    similar to 11/12

    mandibular posterior mesial and distal
  68. langer 3-4
    maxillary posterior

    similar to 13/14

    but suitable for both mesial and distal of surfaces of maxiallary teeth
  69. langer 5-6
    anterior and premolar teeth

    similar to gracey 5-6
  70. langer 17/18

    advantageous when scaling 2nd and 3rd molars

    angled shank allows for a more horizontal hand position
  71. Morse sickle
    scaler has a miniature sickle with a straight shank
  72. morse curet
    has a straight shank with miniature curet
  73. index finger reinforcement
    used to gain additional stability and control

    non-dominanthand is used for additional support, additional lateral pressure, and longer pull strokes
  74. furcation curets
    designed for scaling root concavities and furcations:

    available in: buccal-lingual or mesial-distal

    • blade width is 2 sizes either
    • .9mm 1.3 mm
  75. name the 8 different kinds of finger reinforcement
    • 1. extraoral palm up hand rest
    • 2. extraoral palm-up reinforced hand rest
    • 3. intraoral finger on finger rest
    • 4. intraoral opposite arch finger rest
    • 5. intraoral opposite arch reinforced finger rest
    • 6. cross arch finger rest
    • 7. horizontal strokes in anterior and using an 11/12 on the distal of most posterior tooth
    • 8. opposite end of 13/14 for horizontal strokes with toe down
Card Set
advanced instrumentation
DH 2 theory quiz on advanced instrumentation