University of Mosul college of Dentistry Oral and Maxillofacial dept. periodontics unit Periodontology . Lecture: Professional plaque control Rearranged by: Marwan Ramadan Fifth stage Objectives completely removing elements that provoke gingival inflammation (plaque, calculus, and endotoxin) from the tooth surface. Thus restoring gingival health 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. 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 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 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. 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) 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 Supra gingival scaling a. Modified pen grasping b. finger rest in close proximity to the area of instrumentation 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). 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. Technique / Sub gingival curette is preferred curved blade rounded toe curved back 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 Gracey B / Universal A Technique / Sub gingival Gracey curette Teeth (surfaces) 1-2anterior 3-dAnterior 3-