1. University of Mosul college of Dentistry Oral and Maxillofacial dept. periodontics unit Periodontology د. فهد الدباغ Lecture: Professional plaque control Rearranged by: Marwan Ramadan Fifth stage

2. Objectives  completely removing elements that provoke gingival inflammation (plaque, calculus, and endotoxin) from the tooth surface.  Thus restoring gingival health

3. Objectives  Reduction of spirochetes and putative pathogens such asActinobocillus actinomycetemcomitans, Porphyromonas gingivalis, and Prevotello intermedia  Increase in coccoid cells occur.  reduction or elimination of inflammation clinically  must be sustained by the periodic scaling and root planing performed during supportive periodontal therapy.

4. Scaling  is the process by which plaque and calculus are removed from both supra-gingival and sub-gingival tooth surfaces. No deliberate attempt is made to remove tooth substance along with the calculus

5. Root planing  is the process by which residual embedded calculus and portions of cementum are removed from the roots to produce a smooth, hard, clean surface

6. Difference  enamel surfaces are relatively smooth and uniform. So the deposits are superficially attached to the surface and are not locked into irregularities.  Deposits on root surfaces are frequently embedded in cemental irregularities.

7. Technique.. supra gingival VS sub gingival  Supra gingival calculus (less tenacious and less calcified) adaptation and angulations easier  allows direct visibility as well as a freedom of movement.  Sickles, curettes, and ultrasonic and sonic instruments ( most common), Hoes and chisels ( less frequently)

8. Technique..Supra-gingival  instrument held with a modified pen grasp  firm finger rest is established on the teeth adjacent to the working area.  The blade is adapted with an angulations of slightly less than 90 degrees to the surface being scaled  The cutting edge should engage the apical margin of the supra gingival calculus  scaling strokes are short, powerful, overlapping, activated coronally in a vertical or an oblique direction

9. Supra gingival scaling a. Modified pen grasping b. finger rest in close proximity to the area of instrumentation

10. Technique..supra-gingival  The sharply pointed tip of the sickle is positioned on surface to be scaled to prevent laceration of marginal tissue  Checked visually and tactilely free of all supra gingival deposits  (If the tissue is retractable enough) the sickle may be used slightly below the free gingival margin, (final scaling and root planing should always follow).

11. Technique.. Sub-gingival  Subgingival calculus is locked into root irregularities(more tenacious)  Vision is obscured by the bleeding  clinician must rely heavily on tactile sensitivity.  the adjacent pocket wall limits the direction and length of the strokes.

12. Technique / Sub gingival  curette is preferred curved blade rounded toe curved back

13. Gracey / Universal Gracey universal Area of use Set of many curettes designed for specific areas and surfaces. One curette designed for all areas and surfaces Cutting Edge One cutting edge usedBeth cutting edges used: use work with outer edge onlywork with either outer or inner edge Curvature Curved in two planes blade curves up and to the side Curved m one plane; trade curves up, not to the side Blade angle Offset blade: face of blade beveled at 60 degrees to shank Blade not offset: face of blade- beveled at 90 degrees to shank

14. Gracey B / Universal A

15. Technique / Sub gingival Gracey curette Teeth (surfaces) 1-2anterior 3-dAnterior 3-<SAnterior and premolar 7-SPosterior (buccal and lingual) 9-10Posterior (buccal and lingual) 11-12Posterior (mesial) 13-14Posterior (distal)

16. Technique.. sub gingival

17. Technique sub- gingival

18. Technique..sub-gingival

19. technique / Sharpening

20. Ultrasonic instrumentation  The working end must come in contact with the calculus deposit to fracture and remove it  light touch and light pressure  keeping the tip parallel to the tooth surface  constantly in motion  a series of rapid, overlapping strokes

21. Ultrasonic instrumentation  Avoid Leaving the tip in one place for too long using the point of the tip against the tooth ( roughening of the root surface or overheating of the tooth)

22. Ultrasonic instrumentation indications  Supragingival scaling With fine tips for subgingival scaling and root debridement of deep pockets and furcations (used with low power)  Gingival curettage  Remove overhangs and excess cement after cementing orthodontic appliances. Gingival curettage

23. Ultrasonic VS Hand Ins.  It can cause the patient less discomfort.  The instruments are cheaper to buy and maintain.  There are no aerosols.  A chair side dental nurse is not essential.

25. Ultrasonic VS Hand Ins.  It is easier for the operator.  There is generally a shorter instrumentation time.  It requires minimal stroke pressure.  There is less iatrogenic damage to the periodontium.  There is minimal cementum removal.  Generally quicker than hand scaling to acquire the necessary skills.  It is not dependent on permanently sharp instruments.  The fluid lavage flushes out debris, bacteria and unattached plaque.  Precision-thin tips have been shown to penetrate deeper than hand instruments.

26. Final evaluation  carefully inspected visually with optimal lighting,a mouth mirror and compressed air  examined with a fine explorer or probe. Sub gingival surfaces(hard and smooth).