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Advanced Periodontal Instrumentation ­ What They Didn't Teach You in Hygiene School

Copyright © 2008 Anna Matsuishi Pattison, R.D.H., M.S.

Trends in General Practice Increase in initial therapy by dental hygienists Increase in the utilization of dental hygienists to do local anesthesia Increase in the use of ultrasonics Increase in the use of antimicrobials Trends in Dental and Dental Hygiene Education No change or decrease in hours of periodontology taught More regional and state board exams allow ultrasonics for perio exam Increase in teaching of ultrasonics Less emphasis on hand instrumentation Increase in teaching use of antimicrobials Trends in Instrumentation Use of magnification/microscopes Use of endoscopy Use of calculus detection probes Use of lasers Miniaturization/thinning of manual and powered instruments Increase in use of ultrasonics Use of diamond coated instruments Use of adjunctive antimicrobials or local delivery antibiotics Problems Lack of early diagnosis Inability of dentists and hygienists to scale & root plane adequately Misuse of ultrasonics ("drive-by ultrasonic scaling") Misuse of antibiotics and antimicrobials Importance of Local Anesthesia for Dental Hygienists More states are allowing local anesthesia by dental hygienists Hygienists able to do more thorough periodontal scaling and root planing Changes treatment planning from rounds of gross scaling to more careful, definitive quadrant scaling Changes instrument selection and sequence

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What's New? OraVerse ­ phentolamine mesylate - (Novalar Pharmaceuticals, Inc., San Diego) For reversal of local anesthesia Approved by FDA in May, 2008 OraqixTM local anesthetic gel (Dentsply) 2.5% lidocaine and 2.5% prilocaine

Ultrasonographic probing deviceUltrasound waves are directed subgingivally through water Probings print out digitally like other automated probing devices Research by US Navy and Old Dominion University Ultreo Ultrasound Toothbrush ­ first ultrasonic power brush ­ no longer available Oral B Triumph with Smart Guide ­ wireless remote feedback display Automated Probing Devices Florida Probe - automated constant force of pressure, software produces periodontal chart STM Probe - ProDentec automated probe Dentrix Voice - compliments Dentrix practice management software periodontal charting system. Hygienists can perform a comprehensive periodontal examination speaking into a conventional headset. PerioPal - voice driven periodontal program allows hygienist to verbally record periodontal measurements Dental R.A.T. ­ not a probing device ­ foot operated mouse enables hands free periodontal charting that works with current dental software. Digital Subtraction Radiography Diagnostic saliva tests PreViser Risk Assessment On line risk assessment tool - $7 per patient Calculates risk for periodontal disease, explains treatment options www.previser.com Oral cancer detection systems Vizilite Plus (Zila Corp.) VELscope System (LED Dental Inc.) Oral CDx ­ brush biopsy (OralCDx Laboratories, Inc.)

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Devices for caries detection ­ DIAGNOdent (Kavo) ­ laser caries detection aid DIFOTI (Digital Imaging Fiber-Optic Trans-Illumination) (Electro Optical Sciences, Inc./Kavo) QLF (Quantitative LuminoFluorescence) (Omnii) NEW ! MIDWEST CARIES ID (Dentsply) HealOzone ­ Ozone Therapy for Caries Amorphous Calcium Phosphate Products 3M Espe/Omni Soothe RX­ NovaMin® (calcium sodium phosphosilicate) paste (3M/Omnii ) GC Corp. MI Paste and MI Paste Plus - ReCaldent® (CPP-ACP) paste (GC America) NEW! 3M Espe/Omni ClinproTM 5000 1.1% Sodium Fluoride Anti-Cavity Toothpaste Arm & Hammer Toothpaste- ACP Premier Enamel Pro prophy paste - Remin® polishing paste (Premier) Butler NuCare Prophy Paste with NovaMin® (Sunstar Butler) NEW! NUPRO® NUSolutionsTM with NovaMin®- contains fluoride, calcium and phosphate Other AntiHypersensitivity Products ProClude and Denclude - arginine bicarbonate/calcium carbonate paste (Ortek) Butler Protect Desensitizing Varnish (Sunstar Butler) Fluoride Varnishes ­ 5% Sodium Fluoride ­ superior uptake compared to gels, foams 3M Espe/Omni Vanish ­ tooth colored varnish, good flavors 3M Espe/Omni Cavity Shield ­ yellow color, easy to apply Dentsply All Solutions Varnish ­ yellow color, nice applicator system NEW - Premier Enamel Pro Varnish ­ tooth colored, only varnish that includes ACP NEW ­ 3M Espe/Omni VanishTM XT Extended Contact Varnish ­ light cured varnish With Fl, calcium and phosphate, lasts for 6 months NEW!! ­ IMPEDE® prescription mouthrinse from Orapharma ­ not an antimicrobial ­ Disrupts existing plaque matrix by reducing the viscosity of plaque glucans and creates a bioadhesive surface barrier that prevents new plaque from forming by interfering with bacterial aggregation and colonization . In the United Kingdom, it is called DecapinolTM anti-plaque mouth rinse. Alcohol Free Chlorhexidine Mouthrinse ­ Butler GUM® Chlorhexidine Gluconate Oral Rinse USP, 0.12%

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Controlled Release Antimicrobials Fiber - Actisite (Tetracycline) Gel - Atridox (Doxycycline Hyclate ) Microspheres - Arestin (Minocycline) Chip - PerioChip (Chlorhexidine gluconate ) New local antibiotic/antimicrobial delivery systems PerioWave ­ photodynamic light activated subgingival antimicrobial gel Developed in Canada, waiting for FDA Approval in the USA Perio Protect ­ Tray system with antimicrobial gel Subgingival Irrigation Chlorhexidine Gluconate .12% (Periogard, Peridex) Not effective subgingivally at .12% Can use full strength but need higher concentration than .12% Higher concentration only available in Europe. Povidone Iodine 10% (Betadine) In office only, not for home use. Full strength in an endodontic syringe for subgingival irrigation in office only For ultrasonic irrigation ­ 1 part Betadine to 9 parts water Contraindicated for patients with iodine allergy, thyroid disorders, or pregnancy Short term effect ­ 5 weeks Sodium Hypochlorite (Bleach) Accepted by the ADA as an antiseptic mouthwash 1 to 1/2 teaspoon/300 ml of water for Water Pik For home use 2 times per week (with PikPocket tip) Helpful for patients with pockets, furcas, implants, reconstruction Overuse (eg. Daily irrigation with bleach solution) can result in: Overgrowth of Strep. = generalized brown stained supragingival calculus Erosion of enamel in swimmers (daily exposure to chlorine in pool water) Waterpik® Ultra Cordless Dental Water Jet ­ cordless rechargeable power system. Ultra Waterpik® Dental Water Jet ­ newest model, quieter, large selection of tips - Danger of masking inflammation from residual burnished calculus with use of antimicrobials or antibiotics - Not enough head to head studies looking at PerioWave or Perio Protect Vs. Betadine or Arestin

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Lasers Dental/Surgical uses Used by dental hygienists only for soft tissue curettage NOT for calculus removal New "soft" lasers for calculus removal being developed Isolite Systems ­dryfield illuminator Provides retraction, aspiration, fiberoptic illumination. Isolite mouthpiece isolates maxillary and mandibular quadrants simultaneously, retracts and protects tongue and cheek, delivers bright, shadowless illumination, continuously aspirates and obturates the throat. Piezosurgery Systems New piezoelectric bone surgery technique that is less traumatic than traditional high speed burs for implantology, periodontal surgery, endodontic and orthodontic surgery. Provides micrometric cutting with maximum surgical precision and maximum safety for soft tissues. Mectron, Satelec and EMS are manufacturers of these systems. Subgingival Air Powder Prophylaxis Device Air-Flow®Handy Perio from EMS For removal of biofilm from subgingival root surfaces and implants Specially designed plastic subgingival tip Gentler than conventional supragingival air powder polishers Different powder ­ finer, less abrasive glycine crystal powder For periodontal maintenance Objectives of Root Debridement Calculus Removal Subgingival Plaque Removal Endotoxin Removal Cementum Removal?? Endotoxins Not bound to root surface Hughes & Smales 1986 Not bound or integral to calculus Hughes 1988, Chiew 1991 Does not penetrate cementum Nakib 1982 Root Surface Alterations Mineral changes Structural changes Retention of cytokines Embedded calculus

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The Use of the Periodontal Endoscope DentalView DV2 dental endoscope - .99mm lens with fiberoptic light and 24-48X magnification Allows magnified, illuminated clear image of subgingival root surface, calculus, biofilm, etc. Vision allows precise and thorough instrumentation of deposits Extraction Studies Previous Periodontal Literature: In pockets deeper than 4 mm over 50% of the root may have residual calculus after traditional root planing Significant calculus also remains after surgical root planing New Endoscopy Studies: Only 1.2% of the endoscope aided root surfaces had residual calculus 98-99% complete calculus and biofilm removal with endoscopy because of accuracy of instrumentation and water irrigation Most of the Residual Calculus was found at the CEJ Where deposits are left: a) Deepest part of pocket b) Furcations ­ even in earliest stages c) Between non-overlapping strokes Endoscope has also shown us: d) e) f) g) CEJ Root concavities Line Angles ­ root prominences All Furcations

Retrospective Study of 626 Sites Deeper than 4 mm (Stambaugh) 1-2 mm. reduction of pocket depths after traditional scaling/root planning An additional average of 2.25 mm of pocket depth reduction with endoscopy Problem ­ Burnished Calculus 1.. Ultrasonics and hand instruments are equally effective. (World Workshop on Periodontics 2003-4) 2. Commonly quoted studies often have 30% bleeding sites 3. Ultrasonics and hand instruments are equally INeffective.

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Influence of Perioscopy on Periodontal Instrumentation Perioscopy shows residual burnished calculus in depressions, furcations and at the CEJ Perioscopy shows residual inflammation on the soft tissue wall opposite the burnished calculus Low powered ultrasonic scaling and improper hand instrumentation results in burnishing rather than removal of calculus Subgingival plaque recolonizes rapidly especially on burnished calculus Complete removal of calculus results in pocket closure by long junctional epithelium

The DetecTar Probe (formerly by NEKS ­ now being developed by Dentsply) Subgingival calculus optical detection system Detects presence of subgingival dental calculus Unit beeps and flashes a small green light Works in the presence of contaminants (saliva, water, plaque or blood) Temporarily off the market ­ being redeveloped by Dentsply Professional

New Devices in Development PerioScan TM Ultrasonic scaler with calculus detection capability in the tip (Sirona - Germany) New "soft" lasers for calculus removal Endoscope combined with ultrasonic or laser

Instrument Selection and Sequence Instrumentation of Deep Pockets Standard Ultrasonic Inserts - Medium to High Power Gracey and/or Universal Curets - Rigid Shanks Mini-Bladed Gracey Curets or Gracey Curvettes Hirschfeld Files Diamond Coated Files or Thin Ultrasonic Diamond Coated Tips ­ Low Power Thin Ultrasonic Inserts ­ Low to Medium Power

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Instrumentation of Furcations Large Ultrasonic Insert Sugarman bone files Mini-bladed Gracey curets or Gracey Curvettes Quetin furcation curets Diamond coated files Ultrasonic thin diamond coated inserts or furcation (ball-tipped) inserts Thin ultrasonic inserts Dimensions of Dental Hygiene ­ Journal website is www.dimensionsofdentalhygiene.com Articles on: Dental endoscopy Hand Instrumentation Ultrasonic Instrumentation Periodontal disease/Systemic disease link Ergonomics Caries detection/sealants/fluorides Hand Instrument Design Universal Curets: Columbia 4R/4L ­ Heavy to medium universal curet Good for general scaling or root planing Columbia 2R/2L ­ Universal with a long shank and short blade Similar to the newer mini-bladed curets Columbia 13/14 - Very small short blade Too short for deep posterior perio pockets McCall's 17/18 Large universal curet (also Indiana U. 17/18) Wide curved blades (curvature like a Nabers probe) For heavy calculus in 4-6 mm. pockets with loose tissue Younger-Good 7/8 Medium universal curet Smaller version of the McCall's 17/18 Curved blades (like a Nabers probe) For general scaling and maintenance Loma Linda 10-11 (or U.O.P. 10-11) Medium universal curet Similar to a Barnhart 1-2 but not as curved Longer, flatter blade adapts well to buccal and lingual surfaces (deep palatal pockets and line angles) Goldman-Fox 4 Large heavy universal curet Long lower shank (like an After Five) Very good for tenacious calculus on distals of molars

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Barnhart 1/2 (Suter) Still one of the best perio maintenance and general use universal curets Thinnest blade (face to back) available Gracey Curets: Regular (Finishing) Graceys For fine scaling and root planing, flexible shanks Rigid Graceys For heavy scaling and for root planing Extra Rigid Graceys For very tenacious calculus Initial preparation quadrant scaling and root planing Hu-Friedy EverEdgeTM ­ very hard steel, requires less sharpening American Eagle XPTM ­ does not require sharpening, instruments are replaced when dull, now available with cone socket replaceable tips Gracey 15/16 Gracey 11/12 blade on a 13/14 shank For mesials of posteriors, esp. good for mesials of molars Gracey 17/18 Modified Gracey 13/14 For distals of molars, esp. good for distals from lingual approach Longer, angled shank, blade is 1 mm. shorter After Fives Regular or Rigid or Extra Rigid 3 mm. longer in lower shank Good for deeper posterior pockets, esp. second and third molars Mini Fives Use large #4 handles Regular for maintenance, Rigid for initial quadrant scaling For furcations, line angles, deep narrow pockets, concavities or depressions, CEJ areas On buccals and linguals, scale with toe directed distally Micro Minis ­ NEW FROM HU-FRIEDY Smaller and thinner than Mini Fives Excellent for furcations, line angles and deep pockets Gracey Curvettes: Curvette Sub-0 Best instrument for deep maxillary or mandibular anterior pockets Excellent for palatal aspect of maxillary anteriors

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Curvette 1/2, 11/12, 13/14 Good for posterior pockets and furcations Be very careful Potential for severe gouging of root surfaces because of extreme curvature of the blades Langer Curets: Regular Langers Universal blade on Gracey shanks Langer 1/2 = Gracey 11/12 shank Langer 3/4 = Gracey 13/14 shank Langer 5/6 = Gracey 5/6 shank After Five Langers Longer lower shank, universal blade Mini Five Langers Mini Fives with universal blade

Ideal for furcations because both cutting edges can be used

Sickles: Indiana University, Fort Wayne 204(SIUFW 204) Very large posterior sickle Curved blades for heavy calculus in 4-6 mm. pockets on molars Best for interproximal heavy ledges Requires very good control Potential for tissue trauma 204S (Hu-Friedy) and 204 SD (Hartzell) Medium posterior sickles Rigid, curved blades for heavy calculus in 4-6 mm. pockets on bicuspids and anteriors 204SD (Hu-Friedy) Small posterior sickle Thinner sickle for moderate to small ledges of calculus on bicuspids and anterior H 6/7 Very large anterior sickle (double-ended) Best for heavy ledges or rings of calculus, 4-6 mm. pockets Can be used on molars and bicuspids with extraoral or opposite arch fulcrums Requires very good control Potential for tissue trauma HG 6/7 (Goldman 6/7) Smaller version of the H6/7 Good for moderate to heavy ledges or rings Can be used on molars, bicuspids or anteriors with extraoral or opposite arch fulcrums Nevi 1 (Hu-Friedy) Anterior sickle with one end like HG6/7 and other End like an oval spoon excavator for supragingival calculus and stain removal On mandibular and maxillary anterior lingual surfaces

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Nevi 2 (Hu-Friedy) Posterior sickle with medium blades, contra angled at 90 degrees for use on mesials and distals of posterior teeth, does not insert very deeply subgingivally due to acute angulation of the shank Montana Jack (PDT) Medium posterior sickle with rigid, thin curved blades Excellent for scaling light to moderate calculus NEW - Montana Jack Rigid (PDT) Rigid version of the Montana Jack with a heavier shank and larger, stronger blade.- resin handle Designed for moderate to heavy calculus H5/L5 Mini (PDT) Curette/Sickle combination has a H5 sickle scaler on one end and a mini bladed Langer 5 on the other end ­ very efficient for anteriors and premolars NEW ­ MJ1/2 (Hartzell) Large posterior sickle with rigid blades and metal handle Excellent for scaling moderate to heavy calculus NEW - Nevi 3 (Hu-Friedy) Thin bladed posterior sickle ­ adapted from the Wiland Carver, a restorative instrument, shank is less acutely angled than the Nevi 2 Designed for light to moderate calculus NEW - Nevi 4 (Hu-Friedy) Large bladed posterior sickle ­ modification of the Montana Jack design with a stainless steel handle. Designed for moderate to heavy calculus Files: Hirshfeld files ­ #3/7, #5/11 Good for burnished calculus or sheet-like calculus For crushing heavy calculus, use a bigger file such as an Orban or Univ. of Wash. Bedbug file Sugarman files - Good for furcations and fused furcation root grooves O'Hehir Debridement Curets: Spoon excavator/chisel type blades Push/pull technique in different directions Good for burnished calculus in depressions OH 1/2 ­ Posterior, buccal, lingual OH 3/4 ­ Posterior, mesial, distal OH 5/6 ­ Anterior OH 7/8 ­ Anterior/Premolar, deeper pockets

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Specialized Furcation "Curets": Mini Fives Regular for maintenance Rigid for initial quadrant scaling Mini Five 13/14 ­ most effective and versatile for furcations Any Mini Five can be adapted for furcations with alternative fulcrums Quetin Furcation Curets Convex hoe-like blades SQMD1 ­ small, mesial, distal SQBL1 ­ small, buccal, lingual SQMD2 ­ large, mesial, distal SQBL2 ­ large, buccal, lingual SQBL3 ­ large, concave blades for buccal and linguals of anteriors DeMarco Furcation Curets Spoon excavator- type blades on a contra-angled shank DM1 ­ large blade DM2 ­ smaller blade Brasseler periodontal diamond files (curettes) Good for burnished calculus in furcations and deep pockets F1-F2, F3-F4 ­ smaller, better for furcations W1-W2, W3-W4 ­ very wide and better for wider pockets Hu-Friedy Diamond-Tec Files ­ New ­ coated with fine grit diamond dust SDCN7 - Nabors design For furcations and root depressions ­ universal application SDCM/D7 - Mesial-Distal design For mesial/distal line angles and developmental grooves Plastic Instruments for Implants: ProDentec Plastic Probes ­ various kinds of white and black mm. markings Premier PerioWise ­ red, green, white markings Hu-Friedy Color-Vue Probe ­ yellow and black markings Hu-Friedy Implacare ­ Stainless steel handles with plastic screw-on tips Tips are 4R-4L curet, 204SD sickle and H6/7 sickle designs Premier Implant Curet ­ dark grey hard plastic curet shaped like a universal curet Implant Prophy + System: High quality hard resin plastic curets (Gracey 5/6, 11/12, 13/14 and Columbia 13/14) with ceramic sharpening stone

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Brasseler Titanium Implant Curets ­ Titanium blades, Gracey and Universal designs Hartzell Titanium Implant Curets ­ Titanium coated blades, Universal and Gracey designs

Schwartz Periotrievers: Highly magnetized instruments for retrieval of broken curet tips Set of two double-ended instruments ­ one for furcations, one for deep pockets

Comparison of Ultrasonic Units, Tip Design, Adaptation and Use Magnetostrictive Ultrasonic Scalers Dentsply Cavitron Plus Dentsply Cavitron Jet Plus Dentsply SPS (30K) Thin Ultrasonic Tips Dentsply Slimline Dentsply FSI (Focused Spray Insert) Slimline NEW! Dentsply Cavitron Steri-Mate Light! Hu-Friedy Ultrasonic Inserts Tony Riso Ultrasonic Scaler (30K or 25K) and Inserts Parkell Turbo Sensor (30K/25K) Burnett Power Tip ­ can be used on high power USI 25 MPLC (30K) Odontoson (42K) Discus Dental Protégé Ultrasonic Inserts Magnetostrictive insert with fiberoptic light Piezoelectric Ultrasonic Scalers Prodentec Pro Select ­ three bottles for irrigation, only three tips EMS Piezon Master 400 and 600 Perio Pro Line Tips Perio and Perio Slim Tips EMS MiniPiezon (smaller version)

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Satelec Suprasson P-Max Newtron­ with fiberoptic light, scaling, endo, perio debridement settings Satelec P-5 Newtron (smaller, compact version) Satelec P-5 Newtron XS ­ with reservoir Satelec PerioHard Tips ­ H3 (universal curet - bladed) H4R, H4L (similar to After Five 13/14) PerioSoft Tips ­ round, smooth stainless tips BDR Tips (Biofilm disruption and removal) ­ Composite and diamond coated Parkell Turbo Piezo Vista Piezo Advantage Brasseler NSK Varios 350 Piezo Scaler ­ Similar to Satelec P5 Large selection of tips Only compact piezo with fiberoptic light in handpiece NEW!!! Hu-Friedy Symmetry IQ Piezo Scaler 360° fiberoptic light in an ergonomic handpiece Full line of tips Color coded Guardian tip carrier/wrench system Touch pad with three digital color coded power modes Hu-Friedy Piezo tips also available with Satelec, Brasseler NSK or EMS threads NEW ­ PERIOSCAN from Sirona Sirona Perioscan ­ piezo scaler with calculus detection capability in the tip Diamond Ultrasonic tips: Satelec H1 ­ probe shaped diamond Satelec H2R, H2L ­ thinnest diamond tips available Brasseler NSK ­ thin diamond tips EMS HPL3 Diamond tip ­ for PERIO SURGERY ONLY Vista ­ BRAND NEW! Harrel Diamond Safety Tip Available with Vista, EMS, Satelec threads Dentsply Cavitron Diamond Coat tip ­ for PERIO SURGERY ONLY NOT for scaling by the dental hygienist

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Ultrasonic Tips for Implants:

Dentsply Implant Tip (NEW! Magnetostrictive) Tony Riso Blue Plastic Tip (Magnetostrictive) EMS Implant Tip (Piezo) Satelec Carbon Composite Tips (Piezo) Brasseler NSK Implant Tips (Piezo)

Sonic Scalers: Titan-S Densonic Softip (Dentsply) Sonic Tips for Implants: Blue plastic tips Common Clinical Problems and Solutions Grasp ­ Hyperflexible fingers Fifteen Principles of Instrumentation (first four of fifteen) Index Finger Cocked Back Side of Middle Finger for Pressure Thumb Position for Lateral Pressure Index and Middle Finger Together Access Problems/Problems with Complete Root Debridement Failure to Insert to the Base of the Pocket Selection of Blade Size Use of Mini-Bladed Curets or Thin Tipped Ultrasonics Use of Horizontal Strokes Failure to Adapt Hand or Ultrasonic Instrument Tip to Root Anatomy Failure to Use Sufficient Lateral Pressure Ineffective Fulcrums/Ineffective Angulation Intraoral Fulcrums vs. Extraoral Fulcrums Tradition vs. Analytical Approach to Fulcrums

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USC Alternative Fulcrum Positions: Extraoral Extraoral reinforced Finger-on-Finger Opposite-Arch Cross-Arch Maxillary Right Posteriors: 9:00 palm up extraoral Also 5:00 standing position reaching down 8:00 front position, Mandibular teeth reaching up 9:00 palm down extraoral Also 1:00 back position reaching down 9:00 reaching down from maxilla/cheek Also 5:00 resting back of hand on cheek 1:00 back position, Maxillary teeth reaching down 5:00 reaching down from maxilla/cheek

Maxillary Anteriors: Maxillary Left Posteriors:

Mandibular Left Posteriors:

Mandibular Anteriors: Mandibular Right Posteriors:

Failure to Use Careful, Even-pressured, Close, Overlapping Strokes Stroke Direction Stroke Activation Channel Scaling Evaluation of Scaling and Root Planing Burnished Calculus

Success of Non-Surgical Therapy (Greenstein, 1992) Meticulous root debridement Compliance with personal and professional oral hygiene regimens Success of Root Debridement (Pattison, 1993) Access Adaptation Angulation Thoroughness

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RESOURCES Pattison Book - Periodontal Instrumentation (2nd ed.) is available from: Title: Periodontal Instrumentation, Second Edition Authors: Anna Matsuishi Pattison and Gordon L. Pattison Prentice Hall Publishing Co./ Pearson Education Call toll free to order: 1-800-947-7700 Cost: $65 Book ID #: ISBN 0-8385-7804-7 Or place an order on their website: www.pearsoned.com OR Contact your nearest dental school or dental hygiene school bookstore and ask them if they have it in stock or can order it for you and mail it to you. OR Go to www.amazon.com or www.barnesandnoble.com to order online. Used copies are available at a discounted price with many online booksellers. If you type in Pattison, Anna or Periodontal Instrumentation Pattison on most search engines like Yahoo or Google, you will get a list of booksellers who carry the book. Periodontal Dentoform and Bench-Mount Pole available from: Kilgore International, Inc. 36 West Pearl Street Coldwater, Michigan 49036 www.kilgoreinternational.com 1 (800) 892-9999 Model Number: P15DP-TR. 56C (has deep periodontal pockets and Class III furcations) Bench Mount Pole Model Number: CBM3 Schwartz Periotriever instruments are available from: Dr. Murray Schwartz, Daness Dental Distributors, Inc., Dept C, Nyack, NY 10960 [email protected] $179.95 for a set of two instruments Dental Endoscope information available from: Perioscopy, Inc. www.perioscopyinc.com Contact Dr. John Kwan, Oakland, California (510) 547-1300

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RESOURCES ­ Page 2 HAND INSTRUMENTS:

American Eagle Instruments available from:

Hu-Friedy Instruments available from: Hu-Friedy Mfg. Co., Inc. 3232 N. Rockwell Chicago, IL 60618-5982 www.hu-friedy.com 1 800 483-7433

American Eagle Instruments 6575 Butler Creek Missoula, MT 59808-2161 www.am-eagle.com 1-800-551-5172 Brasseler Diamond Files available from: Brasseler USA One Brasseler Blvd. Savannah, GA 31419 www.brasselerusa.com 1-800-841-4522 Hartzell Instruments available from: G. Hartzell & Son 2372 Stanwell Circle P.O. Box 5988 Concord, CA 94520 www.ghartzellandson.com 1-800-950-2206

Premier Instruments available from: Premier Products Co. 1710 Romano Drive Plymouth Meeting, PA 19462 www.premusa.com 1 888-670-6100

PDT Instruments available from: Paradise Dental Technologies 12201 Moccasin Court Missoula, MT 59801 www.pdtdental.com 1-800-240-9895

Suter Instruments available from: Suter Dental Mfg. Co., Inc. P.O. Box 1329 632 Cedar St. Chico, CA 95927 www.suterdental.com 1-800-368-8376

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Resources - Page 3 MAGNETOSTRICTIVE ULTRASONIC SCALERS/TIPS: Dentsply ultrasonic units/tips available from: Dentsply International Professional Division 1301 Smile Way York, PA 17404-0807 www.dentsply.com 1-800-989-8825 Discus Dental ultrasonic tips available from: Discus Dental 8550 Higuera Street Culver City, CA 90232 www.discusdental.com Toll-Free: (800) 422-9448 Hu-Friedy ultrasonic tips available from: Hu-Friedy Mfg. Co., Inc. 3232 N. Rockwell Chicago, IL 60618-5982 www.hu-friedy.com 1 800 483-7433 PIEZOELECTRIC ULTRASONIC SCALERS/TIPS: Brasseler NSK Piezo scalers/tips available from: Brasseler USA One Brasseler Blvd. Savannah, GA 31419 www.brasselerusa.com 1-800-841-4522 EMS Piezo scalers/tips available from: EMS Corporation 12092 Forestgate Drive Dallas, TX 75243 www.ems-dent.com 1-800-367-0367 Hu-Friedy Piezo scaler/tips available from: Hu-Friedy Mfg. Co., Inc. 3232 N. Rockwell Chicago, IL 60618-5982 www.hu-friedy.com 1 800 483-7433 ProDenTec Piezo scalers/tips available from: Parkell ultrasonic units/tips available from: Parkell, Inc. 155 Schmitt Blvd. P.O. Box 376 Farmingdale, NY 11735 USA www.parkell.com 1-800-243-7446 Tony Riso ultrasonic units/tips available from: Tony Riso Company 17070 Collins Ave. #263 Miami Beach, FL 33160 www.tonyriso.com Tel: (305) 940-3043 Professional Dental Technologies, Inc. P.O. Box 3749 Batesville AR 72501 www.prodentec.com 1- 870-698-2300 Satelec Piezo scalers/tips available from: Acteon/Satelec Inc. 130 Gaither Drive, Ste.100 Mt. Laurel, N.J. 08054 www.satelecusa.com 1-800-289-6367 Vista Dental Piezo scalers/tips and Harrel Diamond Safety Tip available from: Vista Dental Products 2200 Northwestern Ave Racine, WI 53404-2500 www.vistadental.com 1-877-418-4782

USI ultrasonic units/tips available from: Ultrasonic Services, Inc. 7126 Mullins Drive Houston, TX 77081 www.usiultrasonic.com 1-800-874-5332

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