RSD

RSD

1. Modified Pen grasp

   • For support and stability
   • Fulcrum/thumb= lateral pressure
   • handle roll + steady stroke
   • increased tactile sensation-due to modification of tip of finger

2. Positioning

   • Feet flat -balance
   • Thighs parallel to floor- 90 deg
   • Back straight- reduce curvature of spine
   • 7-L (PAL/Ling) + R (BUC)
   • Bum flat for balance- equal weight distribution-reduced leaning
   • Shoulders relaxed and equal level

3. Detection

   • Vision- Direct/indirect
   • Tactile Sensation- using probe (ball ended- > s/a) + incremental 1mm walking. Interproximal detection-imp. as under CP food packing and PRF
   • Radiographs- limitations: 2D/ small calculus deposits may not be detected
   • Disclosing solution - Limitations: Plaque sub gingival not detected

4. Anatomy of Instruments

   • Working end-
     • curette= Rounded toe (less iatrogenic trauma sub gingival
     • Sickle scaler= Triangular tip- to reach interproximal
     • Always keep 3mm in contact w/ tooth surface at all times
     • Cutting edge/ Lateral surface: (x2 sickle + universal) and (x1 Graceys- 70 degree angle)
     • Back: triangular for sickle- access gingival sulcus / Round for curette (less iatrogenic)
     • Face: no ray of light= wrong angulation of working end
   • Terminal Shank
     • Needs to be parallel w/ line angle -Mes/mid/dist
   • Functional shank
     • Angled/ straight- site specific -Allows for access
   • Handle
     • Light+hollow= less fatigue +strain
     • Width wider= Less pressure
     • Textured= Increased grip= less strain

5. Morphological Limitations

   • Furcation
     • Fontix=PRF
   • Root fusion
   • Enamel Pearls
   • Root concavities
   • additional grooves

6. Secondary Local Factors

   • Overhangs

7. Fulcrums

   • Intra-oral
     • Pref. Occlusal surface-Adjacent tooth
   • Extra-oral
     • Careful w/ elderly can cause bruising
     • Helps reach base of deep pockets of 1st molars
   • Pivot Point
   • Stability and protection for pt

8. Instrumentation motion

   • two types
     • Wrist motion activation- hand scaling
     • Digital motion activation- Power driven scaling
   • Handle roll- adapt to all surfaces of the tooth

9. Scaling

   • 5. Insertion- close angle (0 degree)- Exploratory stroke
     • Avoid burnishing calculus-harder to remove
     • Detection of calculus
     • Lightly- against tissue
   • 6. reach base of pocket
   • 7. Open angle of the working end towards gingival tissue- adapt cutting edge
   • 8. In--> out--> Pull--> Roll--> Reset- Working stroke
     • Use lateral Pressure to pull up
     • Right angulation-or calculus left behind/ iatrogenic trauma (face to tooth 45-90 deg)
   • 4. Start at midpoint and go either mesial/distal
   • 1. BPE code
   • 2. Instrument selection +check working end
   • 3. Consider line angles

10. Gracey vs Univeral

    • Rounded back and toe / semi-circular cross section
    • Differences
      • Gracey= Site specific/ Univeral all sites
      • 1 vs 2 cutting edge
    • Gracey= 1-6 (ant all sites)/ 7-10 (facial surfaces/ 11-12 +15-16 (m)/ 13-14+ 17-18 (d)

11. Hoe

    • In--> Pull--> out (hook)
    • 1 straight cutting edge = no adaptation to surface
    • Used occasionally for heavy tenacious deposits
    • TC tip= cannot sharpen