Manual_of_Clinical_Periodontics_-_1st_ed

Periodontal Instruments and Instrumentation  93

Contd... Assessment Calculus removal/ Root planing
stroke scaling stroke stroke
Lateral Moderate to firm Light to
pressure Contacts tooth scraping moderate
Character surface, but no
Direction pressure Powerful strokes Lighter strokes
Number applied short in length of moderate
length
Fluid stroke Vertical, oblique, Vertical,
of moderate horizontal oblique,
length horizontal
Limited, to area Many, covering
Vertical, where needed entire
oblique, root surface
horizontal

Many, covering
entire root
surface

TYPES OF STROKE BY DIRECTION (FIG. 3.37)

• Diagonal or oblique stroke
• Vertical stroke
• Horizontal stroke

Fig. 3.37: Types of instrument strokes

94  Manual of Clinical Periodontics
To summarize, the principles of periodontal instrumentation,
the ten commandments should be followed during
supragingival hand scaling as given below:
• Direct vision is desirable but it is always better to

visualize the area with indirect vision focusing on all the
surfaces to identify the presence of calculus.
Note: Identifying the calculus deposits is most essential
for successful scaling procedure.
• While adapting the instrument, the tip of the scaler should
be placed away from the soft tissues.
• The tip of the instrument should be mostly pointing
downwards for the upper teeth and upwards for the lower
teeth (Fig. 3.38).
• Do not try and adapt the cutting edge of the instrument
along the entire cervical portion, then the tip of the
instrument will invariably contact the papilla and can
cause the tissue damage.

Fig. 3.38: Instrument adaptation on lower anteriors

• The cervical portion should be divided into mesial and
distal halves and the instrumentation should be done
accordingly.

Periodontal Instruments and Instrumentation  95
• Interproximally, it is more challenging to perform scaling

because, the calculus may be attached to the proximal
surfaces of two adjacent teeth, as well as it may fill the
entire embrasure area. Keep this in mind, while performing
interdental scaling.
• It is just not enough to remove the calculus from only
the embrasure areas, the proximal surfaces also need to
be scaled especially in the lower anterior teeth where the
embrasures are narrow. In these situations, the best way
to perform scaling is to detach the calculus from both
the labial and lingual surfaces simultaneously (Figs 3.39
and 3.40).
• Any type of finger rest can be utilized, but what is
important is that, the finger rest should remain in place
throughout the entire scaling stroke, i.e. do not displace
the finger while instrument is being activated (No
freehand scaling).
• Instrument should be adapted to engage the base of
calculus (below the undercut) get a firm grip and then

Fig. 3.39: Instrument adaptation in the embrasure area

96  Manual of Clinical Periodontics

Fig. 3.40: Instrument adaptation in
the posterior embrasure area

perform the scaling stroke, this will avoid burnishing of
the calculus.
• Scaling is never complete, unless and until one
systematically checks all the surfaces (mesial, distal,
buccal, palatal/lingual) through direct and indirect vision
for any remnants of calculus.

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INDEX

A F
Acute gingivitis 16, 20 Fibrotic chronic gingivitis 24
Alveolar mucosa 14 Free
Amount of attached gingiva 28
Angle’s classification 6 gingiva 13
Anterior sickles 63 gingival groove 14
Attached gingiva 14 Fremitus test 29
Frenulum 14
B Frenum 14
Bleeding on probing 27 Furcation examination 29, 37
Bone topography 48
Bright erythema 16 G
Gingival
C
Cementoenamel junction 32 enlargement 22
Characteristics of curette 71 recession 18
Chisel scaler 63, 67 status 4
Chronic Glickman’s
classification 5
desquamative gingivitis 18 furcation classification 38
gingivitis 16, 18, 20 Gracey curette 72
periodontitis 53
Classification of periodontal H
Hard tissue examination 28
instruments 58 Hoe scaler 63, 66
Coral pink 16 Hyperplasia 22
Crown to root ratio 48 Hypertrophy 22
Cumine scaler 63, 65
Curette 72 I
Infrabony pockets 34
D Initial
Determination of level of
bone level 48
attachment 34 probing depth 48
Diagnostic instruments 58 Interdental gingiva/papilla 14
Different types of probes 60 Islet scaler 63, 68

E J
Examination of Junctional epithelium 32

gingiva in health and K
disease 16 Keratinized gingiva 14

lymph nodes 11
Extended shank curettes 70
Extraoral examination 3, 11

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98  Manual of Clinical Periodontics

L S
Langer and mini-Langer Sample periodontal chart 37
Scaler 72
curettes 70 Scaling
Limitations of
and root planing
automated probes 61 instruments 63
conventional probe 61
instruments 63
M Schiller’s potassium iodide
McCall’s
solution 29
festoons 18 Shank 59
hoe scalers 66 Sickle scaler 63
Measurement of true Small miniature blade 65
Stillman’s cleft 18
pockets 32 Subgingival scalers 63, 66
Miller’s classification 5 Sulcus 14
Model case summary 56 Suprabony pockets 33
Morse scaler 63, 65 Supragingival scalers 63
Mouth mirror 58 Surface scaler 63, 65
Mucogingival line/junction 14
T
N
Necrotizing ulcerative gingivitis Tension test 29
Tissue response to periodontal
18
therapy 54
O Tooth mobility 46
Occlusal analysis 6 Treatment of gingivitis 52
Overall prognosis 45 Types of

P handle 57
Parts of prognosis 46
shank 57
curette 71 working ends 57
instrument 57
periodontal instruments 57 U
Periodontal
charting 5 Universal curette 72
file 63, 67
instruments and instrumen- V

tation 57 Vascular
pocket probing 30 proliferation 16
probes 60, 61 supply 16
prognosis checklist 47
treatment plan 49 Vesicle formation 20
Posterior sickles 63
W
R
Roll test 29 Working end of
Root planing instruments 69 scaler 73
Rugae 14 universal curette 73

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