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Scaling and root planing on model
2006/11/1 王英斌雅康牙醫診所
www.oral-health.com.tw
General principles of instrumentation
* 位置 Accessibility (position of operator & patient)
* 視野 Visibility, illumination and retraction
* 器械狀況 Condition of instruments
* 能見度 Maintaining a clean field
* 穩定度 Instrument stability
* 操作方式 Instrument activation
正確的坐姿側面觀 :頸放鬆、頭略為前傾 ;手臂自然下垂 ;大腿放鬆，平行地面；腳掌著地；眼睛到手指的距離，跟日常看錶的距離同。
Patient --- mouth is close to resting elbow of operator
maxi. --- raise the chin slightly
mand. --- lower the chin until mandible is parallel to floor
Position of operator & patient
General principles of instrumentation
* 位置 Accessibility (position of operator & patient)
* 視野 Visibility, illumination and retraction ----善用口鏡
* 器械狀況 Condition of instruments---- sharp
* 能見度 Maintaining a clean field
* 穩定度 Instrument stability
* 操作方式 Instrument activation
General principles of instrumentation
* 位置 Accessibility (position of operator & patient)
* 視野 Visibility, illumination and retraction
* 器械狀況 Condition of instruments
* 能見度 Maintaining a clean field
* 穩定度 Instrument stability
* 操作方式 Instrument activation
Instrument grasp
Modified pen grasp
-- Tripod effect, enhance control -- enhanced tactile sensitivity
Finger rest --
to use wrist-arm motion to activate strokes Serves to stabilize the hand and instrument by providing a firm fulcrum as movement are made to activate the instrument.
Intraoral finger rests
(1) Conventional (2) Cross arch
Intraoral finger rests
(3) Opposite arch
(4) Finger on finger
b. Finger rest
* Extraoral fulcrum
(1) Palm up
(2) Palm down
General principles of instrumentation
* 位置 Accessibility ( position of operator & patient)
* 視野 Visibility, illumination and retraction
* 器械狀況 Condition of instruments
* 能見度 Maintaining a clean field
* 穩定度 Instrument stability
* 操作方式 Instrument activation
*Visual examination--- good light and a clean field. Compressed air
supra-gingival calculus chalky white sub-gingival calculus dark shadow * Tactile sensation --- light exploratory strokes are
activated vertically up and down on root surface
Detection skillsDetection skills
* Instrument activation
1. Adaptation
2. Angulation --- Different angulation
position will cause different effective
3. Lateral pressure
4. Strokes
* Adaptation
The lower third of the working end must be kept
in constant contact with the tooth while it is moving over varying tooth contours
*Angulation : the angle between the face of a bladed inst
rument and tooth surface, also called “ tooth-blade relationship ”
0 degree : insertion <45 degree : not for Sc/RP 45-90 degree : Sc/RP >90 degree : gingival curettage
• Lateral pressure :
the pressure created when force is applied against the surface of a tooth with the cutting edge of a blade instrument The exact amount of pressure applied must be varied according to the nature of the calculus and according the stroke is intended
* Determine cutting edge of Gracey curette
1. Hold face of curette blade parallel with floor and looking down on the face 2. Notice the blade curve 3. Larger, outer curve is the correct cutting edge
Principles for Gracey curettes usage
Finger rest
lower shank is parallel lower shank is parallel with root surfacewith root surface
lateral lateral pressurepressure
Scaling stroke is a short, powerful pull stroke
*The wrist and forearm motion, pivoting in an arc on the finger rest, produce a more powerful stroke --- for scaling
*Finger flexing--- for precise control over stroke length in areas such as line angles and when horizontal strokes are used on the lingual or facial aspects narrow-rooted teeth
Root planing stroke:
-- moderate to light pull stroke for final smoothing and planing of root surface
-- continuous series of long, overlapping shaving stroke is achieved
To avoid over-instrumentation, a delicate
transition from short, powerful scaling strokes
to longer, lighter root planing strokes must be
made as soon as calculus and initial roughness have been eliminated
Practice makes perfect!!
