Explorers

Explorers

1. about

   • most tactile & sensitive
   • skill achieved thru repeated use & self assessment

2. use

   • detect subgingival calculus
   • timing
     • exploration b4 therapy
       • aids in instrumentation
     • after therapy
       • eval. roughness of calculus removal

3. design

   • Working end
     • sm. diameter & flexible wire
       • allows vibration & mvmt thru handle to fingers
   • other parts
     • Handle, shank, tip
   • features:
     • circular in x-sextion
     • last few mm= tip
     • sharp end of tip= point
       • never used for calc. exploration

4. Types

   • Shepherd's Hook
     • #23 Hook design
     • for caries detection
     • working end not as fine as perio explorer
       • not as diagnostic for subgingival calc. detection & root sfx eval.
   • Right-angle End
     • TU 17; fine, short working end; bent @ angle last 2-3mm
       • use
         • supra/subgingival calc detect. on ant.
         • on straight L &B sfx of post. teeth
         • do not adapt to post. interprox. sfx due to short straight working end
   • 3-A
     • calc detection longer gradually curved working end
     • use supra/subgingival sfx
     • curve only exits in 1 plane
       • keep side of tip adapted to tooth in interprox. areas
         • limiting for post areas (many root concavities & surface furcation
   • pigtail/cowhorn
     • large x-sectional diameter than other explorers
       • best for interprox eval for caries & gross deposits
     • long curved working in; curved in 2 planes
     • Short shank
       • access to deeper subgingival areas limited
   • ODU 11/12
     • Old Dominion university; gracey explorer=sim. curves in shank as gracey curets
       • For eval of deeper pkts 4 calculus & root sfx irreg.
       • fine diameter Working end has curves in multp directions & planes
         • shank length+multidirectional curves=best eval. subgingivalareas w/ periodontal disease & attach. loss
     • universal design
       • do not have to switch ends; used for both M & D on same tooth sfx
     • difficult to keep sharp side of tip adapted to tooth structure when turning into interprox areas
       • overall to prevent from poke/hook sft. tiss.

5. instrument technique

   • Grasp
     • modified pen grasp
       • middle finger on shank= better roll/control
       • light pressure so you don't mask tactile sensation
     • Fulcrum
       • best=same tooth & adjacent to tooth being eval.
         • not always possible so fulcrum position can accommodate proper instrument adaption
   • insertion
     • lower shank parallel to area being explored; side of tip of working end against tooth @ ALL TIMES to prevent tip from hooking soft tissue
     • posterior
       • insert @ D line angle whether leading w/ tip in a D or M direction
     • anteriors
       • insert @ midline
         • due to extreme changes in curvature from one line angle to another
           • ALWAYS lead w/ tip in direction of exploration
     • technique
       • subging. eval. is not complete until the side of the tip has meet the j(x)nal epi. @ the base of pocket/sulcus before activation begins
   • adaptation
     • terminal third=working end
       • side should ALWAYS engage tooth NOT point
     • "leading w/ the tip"
       • direct the point toward area being evaluated before inserting the tip subgingivally and activating the stroke
       • never "back in"
         • instrument will not adapt interprox. =blocked by contact, sharp poing will not adapt to tooth structur by leading with the curve
   • activation
     • activate after insertion using multidirectional strokes for full assessment of the area
       • use light pressure to maintain tactile sensation
   • selecting correct instrument end
     • ODU 11/12
       • "hugging the mesial"
       • terminal shank parallel to long axis of tooth

6. Tactile Sensation

   • Rough Cementum
     • pebbled, slightly rough
   • calculus
   • CEJ
   • enamel
   • debrided CEJ
   • root decay
   • overhang

7. 3 easily missed areas

   • col
     • avoided by overlapping strokes from B & L approaches
   • line angles, straight B, straight L
     • don't just focus on interprox areas bc u will miss these
   • fully evaluate all sfx; bone/attachment levels vary leaving irreg. sfx to be explored

8. multirooted tooth

   • common to explore "fluting" of furcation entrance
   • when entering furcation/interradicular areas, each must be explored like single root tooth
   • activation
     • multidirectional strokes covering ea. sfx of ea. root

9. sequence of exploration

   • doesn't matter; develop sequence and stick to it

10. Sextant approach anteriors

    • eliminates confusion of M becoming D toward midline and allows variation in seating created by R/L hand operators
      • surfaces away
        • 11-1 o'clock for all
      • surfaces toward
        • Rt. Hand-9'oclock; Lt. Hand 11 oclock

11. nature of calculus deposits

    • spicules, ledges, rings, mult. layers, interradicular
    • longer undisturbed, more tenacious
    • color
      • supragingival
        • white creamy unless stained by food, chemicals, nicotine
      • subgingibal
        • brown-blackish due to pigment from bleeding
    • clinical ways to detect
      • compressed air
        • unstained supragingival
          • becomes lighter almost white, and non-reflective when air dried
        • supragingival w/ no calculus
          • reflect light, no color change
        • subgingival
          • direct stream of air toward gingival margin of tissue
            • w/ periodontal involved, flaccid tissue, the air blows back tissue, allow direct visualization of dark subgingival deposits
      • observing inflamm. & darkness of marginal sft. tissue
        • good chance subgingival calculus present, harboring plaque, and contributing to disease process

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