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FI Module 21: Advanced Techniques of Root Instrumentation (Benefits of…
FI Module 21: Advanced Techniques of Root Instrumentation
Instrumentation of a periodontally involved patients require advanced instrumentation skills
this is because of the concavities found on the roots of most teeth and furcation areas exposed on some posterior teeth
in disease, bone support is lost exposing the root to dental plaque biofilm and requiring instrumentation of these surfaces
difficult for patients to successfully remove biofilm from root concavities
effective instrumentation of the root surfaces requires the clinician to have a complete knowledge of root morphology
majority of instrumenation on roots is performed on surfaces that are hidden beneath the gingival margin
clear mental picture of root anatomy and a keen tactile sense are necessary for subgingival instrumentation to be successful
Root Concavity:
a linear developmental depression in the root surface
Commonly occur:
on Proximal surfaces of anterior and posterior teeth
on Facial and Lingual surfaces of molar teeth
More specific/ Concavities, Depressions, and Grooves:
Palatal groove
on maxillary lateral incisor that extends onto the cervical third of the root surface
Deep linear root concavities
on the proximal surfaces of mandibular canine
Wide shallow root concavity
on the mesial surface of mandibular molar
Deep linear proximal root concavities and furcation
on maxillary first premolar
Deep depression on root trunk and furcation
on mandibular molar
Proximal concavities
extending from the furcation to CEJ on maxillary molar
Concavities on a Mandibular First Molar
on distal surface of the distal root
on distal (interior, furcal) aspect of the mesial root
root trunk just coronal to the furcation area
Correct Technique for Adaptation to the Concavity
correct instrumentation involves rollng the handle to direct the leading third of the explorer tip into the root concavity
Instrumentation Sequence
Begin with Root Trunk
using an area-specific use the distal curet on the distal surface of the root trunk and mesial curet on the facial and mesial surfaces of the root trunk
Then, Instrument Root Branches
first use the distal curet on the distal aspect of both roots
second use mesial curet on the mesial aspect of the roots
Advanced Intraoral Techniques
Cross Arch Intraoral Fulcrum
accomplished by resting the ring finger on a tooth on opposite side of the arch from the teeth being instrumented
most useful when using horizontal strokes in proximal root concavities with curet in either a toe-up or toe-down position
Opposite Arch fulcrum
accomplished by resting the ring finger on the opposite arch fro the treatment area
Finger on Finger fulcrum
accomplished by resting the ring finger of the dominant hand on a finger of the non-dominant hand
WHEN TO USE
required when working in a deep periodontal pocket, especially when instrumenting maxillary posterior teeth
Benefits of Extraoral Fulcrum Techniques
easier access to maxillary molars
easier access to deep pockets on molar teeth
improved parallelism of the lower shank to molar teeth
facilitate neutral wrist position for molar teeth
Disadvantages of Extraoral Fulcrum Techniques
greater risk for instrument stick
require a greater degree of muscle coordination and instrumentation skill to achieve calculus removal
reduce tactile information to the fingers
not well tolerated by patients with TMJ problems
Basic Extraoral Fulcruming Techniques: Right-Handed Clinician
Resting the fingers against the patients chin to stabilize the hand
when working on maxillary right posterior sextants, clinician stabilizes his or her hand by resting the fingers against the patients chin
cupping the patients chin to stabilize the hand
when working on maxillary left posterior sextants
Technique Comparisons for Intraoral and Extraoral Fulcrums
Intraoral Fulcrum
Grasp: handle held in a modified pen grap near the junction of the handle and the shank, close to the working-end
Stabilization: pad of ring finger rests securely on a stable tooth. ring ringer acts as a "support beam" for the hand . middle, ring, and little fingers are in contact acting as a unit
Extraoral Fulcrum:
Grasp: handle grasped lower on the handle, farther away from the working end
Stabilization: length of the middle , ring, and little fingers rest securely against the skin and underlying bone of the mandible. all three fingers press against the mandible. middle, ring and little fingers are in contact acting as a unit
Instrumentation stroke with a Finger assist
accomplished by using the index finger of the nondominant hand against the shank of a periodontal instrument to assist in the instrumentation stroke