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Periodontal Flap Definition

Periodontal Flap: Periodontal Flap is a section of the gingiva and/or the mucosa surgically separated from the underlying tissues to provide visibility and access to the bone and the root surface

Periodontal Flap Important Notes

1. Basic requirements of flap

• It should provide adequate exposure to the surgical area
• The flap must have a broad base and good vascular supply
• When placed back after surgery flap should rest on healthy bone

Read And Learn More: Periodontics Question and Answers

2. Advantages of the flap technique

• Provides adequate visibility and accessibility to the root deposit
• Eliminates or reduces pocket depth
• Expose the area to perform regenerative procedures

3. Condition and the preferred flap

4. Apically displaced flap

• It can be used for pocket elimination or widening the zone of attached gingival
• The pocket wall is transformed into an attached gingival
• It increases the length of the clinical crown and is not indicated for palatal pockets
• The width of the attached gingiva is increased by approximately half the pretreatment pocket depth

Modified Widman Flap

Periodontal Flap Long Essays

Question 1. Define periodontal flap. Classify and describe in detail the modified Widman flap.
Answer:

Periodontal Flap:

Periodontal Flap is a section of the gingiva and/or the mucosa surgically separated from the underlying tissues to provide visibility and access to the bone and the root surface

Classification of Periodontal Flap: 

1. According to the thickness of the flap
   • Full thickness flap
   • Partial thickness flap
2. According to the placement of the flap
   • Non displaced flap
   • Displaced flap
3. According to the design of the flap
   • Conventional flap
   • Papilla Preservation flap

Modified Widman Flap:

• By Ramfjord and Nissle

Periodontal Flap Indication:

• Accessibility to root surfaces
• Pocket lining removal

Periodontal Flap Technique:

Periodontal Flap Short Essays

Question 1. Classification of periodontal flaps.
Answer:

According to Thickness of Flap

According to the placement of Flap

1. Non-displaced flap:
   • The flap is returned and sutured in its original position
2. Displaced flap:
   • The flap is placed apically, coronally, or laterally to its original position.

According to the management of the papilla

1. Conventional flap:
   • The interdental papilla is split beneath the contact point between the teeth
   • Modified Widman flap is a conventional flap
   • Indications:
   • Narrow interdental area
2. Papilla preservation flap:
   • It incorporates the entire papilla
   • Indications:
   • Esthetics
   • Regenerative procedures

Question 2. Types of periodontal flap surgical procedures for pocket therapy. Describe the apically displaced flap.
Answer:

Periodontal Flap:

• Periodontal Flap is a section of the gingiva and/or the mucosa surgically separated from the underlying tissues to provide visibility and access to the bone and root surface

Periodontal Flap Types Of Flap For Pocket Therapy:

• Modified Widman flap
• Undisplaced flap
• Apically displaced flap

Periodontal Flap Apically Displaced Flap:

• Periodontal Flap is described by Friedman

Periodontal Flap Indications:

• Elimination of pocket
• Better accessibility
• Widening of attached gingiva

Periodontal Flap Technique:

Flap Surgery

Question 3. Classify periodontal flaps and give indications of periodontal flap surgery.

Answer:

Periodontal flap surgery:

Periodontal Flap Surgery is a section of the gingiva and/or the mucosa surgically separated from the underlying tissues to provide visibility and access to the bone and root surface

Classification of periodontal flap surgery:

1. According to the thickness of the flap

• Full thickness flap
• Partial thickness flap

2. According to the placement of the flap

• Non displaced flap
• Displaced flap

3. According to the design of the flap

• Conventional flap
• Papilla preservation flap

Periodontal Flap Surgery Indications Of Flap Surgery

• To increase accessibility to root deposits
• To eliminate or reduce pocket depth by resectioning the pocket wall
• To expose the area to perform regenerative methods
• To reshape soft and hard tissues to physiologic architecture

Question 4. Apically Displaced flap.
Answer:

By Friedman

Displaced flap Indications:

• Elimination of pocket
• Better accessibility
• Widening of attached gingiva

Displaced flap Technique:

Question 5. Incisions.
Answer:

Horizontal incision:

1. Internal bevel incision:

• Extend: Marginal gingiva to the bone crest
• Synonyms: First incision
• Reverse bevel incision
• Advantages: Eliminates pocket
  • Preserves remaining structures
  • Provides good adaptation of tooth-to-bone
• The blade used: No. 15 and 11 – surgical scalpels

2. Crevicular incision:

1. Second incision
   • Extend – Base of the pocket to the crest of bone
   • Blade – No.12B
   • Effect – Formation of tissue wedge

Interdental incision:

• Third incision
• Purpose to separate the collar of the gingiva
• An instrument used – Orban knife

Vertical Incision:

1. On either side of the horizontal incision
   • Extend – Beyond the mucogingival junction
2. Indications: Displaced flap
   • Isolated deep pockets

Periodontal Flap Definition Short Question And Answers

Question 1. Envelope flap.
Answer:

Envelope Flap with only a horizontal incision without any releasing incisions given is called an envelope flap

Indication: Undisplaced flap

Question 2. Indications of Flap Surgery.
Answer:

• Root debridement
• Pocket elimination
• Reshaping of tissue
• Regenerative procedures

Question 3. Papilla Preservation flap.
Answer:

Reservation Flap by Takei et. Al and Cortellini

Reservation flap Technique:

Reservation flap  Advantages:

• Esthetic
• No root exposure
• No post-operative sensitivity

Question 4. Healing after flap surgery.
Answer:

Question 5. Name horizontal incisions for flap surgery.
Answer:

1. Internal bevel incision:

• Internal bevel incision extends from the marginal gingiva to the bone crest

Flap surgery Synonym:

• First incision
• Reverse bevel incision

Flap surgery Advantages:

• Eliminates pocket
• Preserves remaining structures
• Provides good adaptation of tooth to the bone

Flap surgery Blade Used:

• No. 15 and 11, surgical scalpels

2. Crevicular incision:

• The crevicular incision is the second incision
• Crevicular incision extends from the base of the pocket to the crest of the bone

Flap surgery Blade Used:

• No 12B is used

Flap surgery Effect:

• It leads to the formation of tissue wedge

3. Interdental incision:

• It is the third incision
• It is used to separate the collar of the gingiva

Flap surgery Instrument Used:

• Orban knife

Question 7. Two advantages and disadvantages of lateral pedicle graft.
Answer:

Lateral pedicle graft Advantages:

• One surgical site
• Good vascularity

Lateral pedicle graft Disadvantages:

• Risk of gingival recession at the donor site
• Dehiscence or fenestration at the donor site

Question 8. Indications and contraindications of lateral pedicle graft.
Answer:

Lateral pedicle graft Indications:

• Isolated denuded root
• Sufficient vestibular depth
• Sufficient width of interdental papilla

Lateral pedicle graft Contraindications:

• Deep pockets
• Prominent root surfaces
• Loss of interproximal bone

Periodontal Flap Viva Voce

1. Apically displaced flaps cannot be performed in the palatal aspect of maxillary posterior teeth
2. Unattached gingiva is absent in the palatal aspect of maxillary posterior teeth
3. Widening of the attached gingiva as well as pocket elimination is accomplished by apically displaced flap
4. An internal bevel incision is also called a reverse bevel incision
5. The second incision in the periodontal flap is a crevicular incision
6. The interdental incision is called the third incision
7. After flap surgery fully epithelized gingival crevice occurs after 1 month.
8. An undisplaced flap is essentially an excisional procedure of the gingival

Gingivectomy Important Notes

1. Indications of gingivectomy

• Elimination of supra bony pockets if the pocket wall is fibrous
• Elimination of gingival enlargements
• Elimination of supra bony periodontal abscess

2. Contra indications of gingivectomy

• The need for bone surgery or for examination of bone shape and morphology
• The bottom of the pocket is apical to the mucogingival junction
• Aesthetic regions

Read And Learn More: Periodontics Question and Answers

3. Disadvantages of gingivectomy

• Long time to heal
• Loss of attached gingiva

4. Electrosurgery

• It can be used for gingivectomy, gingivoplasty, relocation of frenal attachments, incisions of periodontal abscess, and periocoronal flaps
• It is not used for procedures that involve proximity to the bone

Gingivectomy Long Essays

Question 1. Define Gingivectomy. Describe indications, contraindications, and their types. Write a note on a surgical procedure.
Answer:

Gingivectomy:

• Excision of the soft tissue wall of the pocket

Gingivectomy Indications:

• Eliminate – Suprabony pocket

1. Pseudo pockets
2. Fibrous gingival enlargement

• • Creates a physiological form of the gingiva
  • Improves esthetics
  • Creates bilateral symmetry
  • Subgingival restoration
  • Correction of gingival craters

Gingivectomy  Contraindications:

• Thick bony ridges
• Poor oral hygiene
• Infrabony pockets
• Un-cooperative patients
• Dentinal hypersensitivity
• Medically compromised patients

Gingivectomy  Types:

1. Surgical
2. Electrosurgery
3. Laser
4. Chemosurgery

Gingivectomy Surgical Gingivectomy Technique:

Gingivectomy Short Essays

Question 1. Electrosurgery.
Answer:

Electrosurgery Electrodes Used:

• Single wire
• Loop electrodes
• Heavy bulkier electrodes
• Frequency used-1.5-7.5 million cycles/second

Electrosurgery Indications:

• Gingival enlargements
• Gingivoplasty
• Frenectomy
• Periodontal abscess
• Periocoronal abscess

Electrosurgery Advantages:

• Adequate tissue contour
• Control of hemorrhage

Electrosurgery Disadvantages:

• Unpleasant odor
• Bone damage
• Tissue damage

Question 2. Gingivectomy
Answer:

Gingivectomy Definition:

• Gingivectomy is the excision of the soft tissue wall of the pocket

Gingivectomy Rationale:

• To provide good visibility and accessibility for complete calculus removal and thorough smoothening of roots
• To facilitate gingival healing by creating a favorable environment
• To restore physiological gingival contour

Gingivectomy Indications:

• Eliminates
  • Suprabony pocket
  • Pseudo pockets
  • Fibrous gingival enlargements
• Creates a physiological form of the gingiva
• Improves esthetics
• Creates bilateral symmetry Subgingival restoration
• Correction of gingival craters

Gingivectomy Contraindications:

• Thick bony ridges
• Poor oral hygiene
• Infrabony pockets
• Un-cooperative patients
• Dentinal hypersensitivity
• Medically compromised patients

Gingivectomy Types:

• Surgical
• Electrosurgery
• Laser
• Chemosurgery

Gingivectomy Short Question And Answers

Question 1. Healing after surgical Gingivectomy.
Answer:

Gingivectomy Steps:

Question 2. Periodontal instruments for Gingivectomy.
Answer:

• Mouth mirror, probe
• Pocket markers
• Interdental knives
• Kirkland & Orban
• Surgical blade with BP handle
• Curettes
• Tissue forceps and scissors
• Periodontal dressing

Question 3. Types of Electrosurgical Techniques.
Answer:

Question 4. Gingivectomy by chemosurgery.
Answer:

• Gingivectomy can be done using chemicals such as 5% paraformaldehyde or potassium hydroxide
• It is not used nowadays because of many disadvantages

Chemosurgery Disadvantages:

• Depth of action cannot be controlled
• Injury to healthy attached tissue
• Gingival remodeling is not possible
• Delayed wound healing
• Slow epithelialization and reformation of junctional epithelium

Question 5. Electrosurgery.
Answer:

Electrosurgery is a technique in which electric current is used for incisions

Electrosurgery Indications:

• Gingival enlargement
• Gingivoplasty
• Frenectomy
• Periodontal abscess
• Pericoronal abscess

Electrosurgery Advantages:

• Adequate tissue contour

Gingivectomy Viva Voce

1. Gingivectomy is not indicated in infra bony pockets
2. After gingivectomy, complete epithelisation of the surgical wound is completed in about 1 month
3. Connective tissue repair is completed in about 2 months
4. The maximum flow of gingival fluid occurs 1 week after a gingivectomy
5. Gingivectomy may be performed surgically by means of scalpels, electrodes, laser beams, or chemicals
6. Gingivectomy incision apical to the pocket markings should be directed coronally
7. Complete epithelial repair after gingivectomy takes about 1 month
8. Complete repair of connective tissue after gingiva- tomy takes about 7 weeks
9. GCF flow reached the maximum level after 7 days of gingivectomy

Gingival Curettage Definition

Gingival curettage: It is the scrapping of the soft tissue wall of a packet to separate diseased soft tissue

Gingivoplasty: Gingivoplasty is the reshaping of the gingiva to create physiologic gingival contours with the sole purpose of recontouring the gingiva in the absence of pockets

Gingival Curettage Long Essay

Question 1. Define and classify Gingival Curettage. Describe ENAP.
Answer:

Gingival Curettage: It is the scrapping of the soft tissue wall of the packet to separate diseased soft tissue

Read And Learn More: Periodontics Question and Answers

Gingival Curettage Types:

1. Gingival Curettage
2. Surgical Curettage
3. Chemical Curettage
4. Ultrasonic Curettage

Enap: (Excisional New Attachment Procedure): By United States Naval Corps

Gingival Curettage Technique:

Gingival Curettage Indications:

• Deep infra bony pockets
• Prior to flap surgeries
• In patients with surgical contraindications:
• As part of maintenance therapy

Gingival Curettage Techniques

Question 2. Define curettage. Describe indications and techniques of subgingival curettage.
Answer:

Subgingival Curettage Definition: Curettage is the scrapping of the soft tissue wall of the pocket to separate diseased soft tissue

Subgingival Curettage: It refers to the procedure that is performed apical to the junctional epithelium and severing connective tissue at- tachment down to the osseous crest

Subgingival Curettage Indications:

• Deep infra bony pockets
• Prior to flap surgeries
• In patients with surgical contraindications
• As part of maintenance therapy

Subgingival Curettage Technique: Tissues attached between the bottom of the pocket and the al-alveolar crest are removed by scooping motion of curette to the tooth surface

Gingival Curettage Short Essays

Question 1. Different techniques of Curettage.
Answer:

1. Curettage Basic Technique:

2. Curettage Enap Technique:

3. Ultrasonic Curettage:

Ultrasonic Curettage Effects:

• Disrupt tissue continuity
• Scraping of epithelium
• Alters fibroblast
• Less removal of connective tissue

4. Caustic drugs:

• Drugs used are [PAS]
  • P- Phenol
  • A- Antiformin
  • S-Sodium sulfide

Gingival Curettage Techniques

Question 2. Rationale of subgingival curettage.
Answer:

• To reduce pocket depth
• To improve probing attachment levels
• To maintain esthetics
• To provide periodontal therapy in systemically compromised patients
• To remove chronically inflamed granulation tissue that forms in the lateral wall of the periodontal pocket
• During curettage when the root is thoroughly planned the major source of bacteria disappears and the path-logic changes in the periodontal pocket also disappear
• Eliminates all or most of the epithelium that lines the pocket wall and underlying junctional epithelium
• Used in a presurgical phase where there is persistent gin- give inflammation even after repeated scaling and root planning

Question 3. Gingivoplasty.
Answer:

Gingivoplasty is the reshaping of the gingiva to create physiologic gingival contours with the sole purpose of. It is a definitive subgingival curettage procedure per-recontouring the gingiva in the absence of pockets

Gingivoplasty Indications:

• Gingival enlargements
• Gingival clefts and craters
• Shelf-like interdental papilla caused by ANUG
• Gingival and periodontal diseases that interfere with normal food excursion

Gingivoplasty Steps:

Gingival Curettage Techniques

Gingival Curettage Short Question  And Answers

Question 1. Healing after Curettage.
Answer:

Question 2. Indications of Gingival curettage
Answer:

• Deep infra bony pockets
• Prior to flap surgeries
• In patients with surgical contraindications
• As part of maintenance therapy

Question 3. Define curettage
Answer:

Curettage Definition: Curettage is the scrapping of the soft tissue wall of the pocket to separate diseased soft tissue

Curettage Rationale:

• To reduce pocket depth
• To improve probing attachment levels
• To maintain esthetics
• To provide periodontal therapy in systemically compromised patients

Gingival Curettage Techniques

Gingival Curettage Viva Voce

1. Curettage causes shrinkage of the interdental papilla so not indicated in anterior teeth
2. Gingival curettage is done for the removal of inflamed soft tissue lateral pocket wall
3. During curettage an instrument is inserted to engage the inner lining of the pocket wall and the stroke is used horizontally
4. The motion of the curette is scooping
5. ENAP is performed with a knife
6. The incision used in ENAP is the internal bevel
7. The instrument used for ultrasonic curettage is a Morse scaler shaped
8. The extent of tissue destruction cannot be controlled by the use of caustic drugs in gingival curettage
9. For restoration and epithelisation of the sulcus after gingiva; curettage requires 2-7 days
10. Immediately after scaling and curettage, the color of the gingiva is bright red.

Principles Of Periodontal Surgery

Principles Of Periodontal Surgery Short Essays

Question 1. Indications and contra-indications of Periodontal surgery.
Answer:

Periodontal surgery Indications:

• Irregular bony contours
• Mucogingival problems
• Deep pocket
• Infrabony pockets
• Grade 2 and 3 furcation
• Persistent inflammation

Periodontal surgery Contra-Indications:

• Advanced age
• Presence of systemic diseases
• Where conventional procedures can treat the case
• Inadequate patient motivation
• Presence of infection
• In case of poor prognosis.

Read And Learn More: Periodontics Question and Answers

Question 2. Enumerate Principles of Periodontal Surgery. (or) General Principles of Surgery.
Answer:

1. Preparation of Patient:

• A patient has to undergo the initial or preparatory phase of therapy (scaling and root planning)

Preparation of Patient Reason:

• Eliminates completely some lesion
• Makes the tissue more firm and consistent
• To obtain a good relationship between clinician and patient

2. General conditions:

1. Premedication:
   • Prophylactic use of antibiotics to prevent the infections
   • Use of personal protective measures
   • Use of prophylactic mouth rinser
2. Sedation and Anaesthesia:
   • To prevent pain during surgery
   • Used in apprehensive patients
3. Tissue management:
   • Carry out the procedure as traumatically as possible
   • Use of sharp instruments
4. Suturing:
   • For hemostasis
   • Improves healing
   • Reduces post-operative pain
   • Prevents bone exposure
5. 3. Complication management:
   • Syncope
   • Hemorrhage

Question 3. Periodontal pack/Periodontal dressing types.
Answer:

Periodontal dressing Types Zinc Oxide Eugenol Composition:

• Zinc acetate – Accelerator
• Asbestos – Binder
• Tannic acid
• Zinc oxide
• Eugenol

Example: Wondre-Pak

Periodontal dressing Disadvantages:

• Allergy to Eugenol
• Burning Sensation
• Erythematous area

Non-Eugenol Composition:

1. One tube:

• Zinc oxide
• Oil – Plasticity
• Gentle handling of tissues
• Gum – Cohesiveness
• Lorothiodol – Fungicide

2. Other tube:

• Coconut fatty acid
• Rosin
• Chlorophyll

3. Miscellaneous:

• Cyanoacrylate

Methacrylate Application:

Question 4. Suture materials used in surgery
Answer:

• Suture materials are classified as

1. Absorbable sutures:

• Natural-Surgical gut
• Synthetic- Polyglycolic acid- Dexon

2. Non absorable sutures:

• Natural- silk
• Synthetic- Prolene

Question 5. Dentin hypersensitivity.
Answer:

Hypersensitivity Definition:

• It is pain or sensitivity caused by opened dentinal tu- blues caused by attrition, abrasion, or cemental wear of teeth

Hypersensitivity Theories:

• Neural theory
• Odontoblastic theory
• Hydrodynamic theory

Hypersensitivity Management:

1. At home
   • Dentrifices are used
2. In office
   • Corticosteroid
   • Varnishes
   • Dentin bonding agents
   • Fluoride compounds
   • Restorative resins
   • Patient’s education

Principles Of Periodontal Surgery Short Question and Answers

Question 1. Management of localized gingival bleeding.
Answer:

• Consult physician
• Carry out blood tests to rule out bleeding disorders
• Treat the cause
• Operate gently and carefully
• Use of sharp instruments
• Suture around the bleeding end
• Application of pressure
• Application of moist gauze soaked in sterile ice water for several minutes
• Use of local anesthesia with vasoconstrictor
• Use of hemostatic agents
• Gelfoam
• Oxidized cellulose
• Surgicel

Question 2. Types of periodontal dressing
Answer:

1. Zinc oxide eugenol Composition:

• Zinc acetate as an accelerator
• Asbestos as binder
• Tannic acid
• Zinc oxide
• Eugenol

2. Noneugenol Composition:

1. One tube:
   • Zinc oxide
   • Oil for plasticity
   • Gum for cohesiveness
   • Lorothiodol as fungicide
2. Other tubes:
   • Coconut fatty acid
   • Rosin
   • Chlorophyll
3. Miscellaneous:
   • Cyanoacrylate
   • Methacrylate

Question 4. Post-surgical Instructions.
Answer:

• Post-surgical Instructions To do
  • Take medication
  • Maintain pack for 1 week
  • Chewing from non-operated area
  • Application of ice
  • Follow daily activities
• Post-surgical Instructions Not to do
  • Avoid hot foods
  • Avoid citric juices
  • Avoid smoking
  • Avoid brushing

Plaque Control Important Notes

1. Chlorhexidine

• Chemically it is biguanidohexane with antiseptic properties
• Daily rinses with 10 ml of 0.2% aqueous solution effectively inhibit the development of plaque, calculus, and gingivitis
• The minimum concentration of chlorhexidine needed to inhibit plaque is 0.12%
• Chlorhexidine inhibits gram +ve, gram -ve organisms, and yeasts
• It is bacteriostatic at low concentrations and bacteriocidal at high concentrations
• Chlorhexidine causes local reversible side effects
• Side effects:
• Yellow-brown staining of teeth
• Mucosal soreness
• Desquamation
• Altered taste sensation

Read And Learn More: Periodontics Question and Answers

2. Types Of Brush

3. ADA’s specification of toothbrush

• Tooth head should be
• 1-1/4 inch in length
• 5/16-3/8 inches in width
• 2-4 rows of bristles
• 5-12 tufts per row
• 80-86 bristles per tuft

Plaque Removal Techniques

4. Brushing Techniques

4. BassTechnique

• In it, the bristles are placed at the gingival margin at an angle of 45° to the long axis of the tooth
• This forces the bristle ends into the gingival sulci and interproximal embrasures
• Produces blanching of the gingiva
• Helps in the cleaning of the cervical third of the tooth, gingival sulci, and interproximal areas.

5. Interdental cleansing aids

6. Composition of gentrifies

• Abrasives – CaCO3, Calcium phosphate
• Humectants – Maintains moisture
• Glycerine, sorbitol
• Preservatives – Benzoic acid
• Thickening agents – methylcellulose
• Foaming agents – Sodium lauryl sulfate
• Flavoring agents – Mint
• Sweetening agents – Mannitol, Saccharine
• Desensitizing agents – Sodium fluoride
• Anticalculus agent – Pyrophosphates

7. Anti-plaque mouth rinses

• Chlorhexidine
• Cetyl pyridine
• Essential oils
• Sanguinarine
• Sodium benzoate

8. Oral irrigating devices

• They disrupt and detoxify the bacterial plaque
• They effectively clean the nonadherent bacteria and debris in periodontal pockets
• Water and dilute chlorhexidine can be used as irrigating agents

9. Disclosing agents

• Disclosing agents stain bacterial deposits on teeth, tongue, and gingiva
• They help in the education and motivation of the patients
• It is a simple way to instruct the patients in the dental office
• Some disclosing agents are:
  • Erythrosin
  • Bismark brown
  • Two-tone solution
  • Mercurochrome
  • Malachite green

10. Chemical plaque control

• It is adjuvant to mechanical plaque control
• It is used
  • After periodontal surgery
  • In poorly motivated patients
  • Medically compromised patients
  • Prophylactic rinse during scaling
  • In gingival enlargements
  • In patients with fixed appliances
  • Mentally and physically handicapped patients

11. Local drug delivery system

Agents used for it are

• Activity tetracycline containing fibers
• Atridox-10% doxycycline
• Periocline- 2% minocycline
• Periochip – a small chip containing 2.5 mg of chlorhexidine

Plaque Removal Techniques

Plaque Control Long Essays

Question 1. What is plaque control? Describe various measures of plaque control.
Answer:

Plaque Control:

• Plaque Control is the removal of dental plaque on a regular basis and the prevention of its accumulation on teeth and adjacent gingival surfaces.

Plaque Control Mechanical:

Types based on the diameter of bristles:

1. Soft-0.007-0.009 inches
2. Medium -0.010 -0.012 inches
3. Hard-0.013-0.014 inches
4. Extra hard-0.015 inches

Based on use:

• Manual
• Automatic/Powered
• Frequency of brushing – every 12 hours
• Frequency of change of brush every 3 months
• Length of brushing time
• Initially 10-20 minutes
• Later 3-5 minutes

2. Dentrifices:

1. Used in the form of powders, pastes, and gels
2. Composition

• • Abrasives – CaCO3, Calcium phosphate
  • Humectants – Maintains moisture
  • Periodontics
  • Glycerine, sorbitol
  • Preservatives – Benzoic acid
  • Thickening agents – methylcellulose
  • Foaming agents – Sodium lauryl sulfate
  • Flavoring agents – Mint
  • Sweetening agents – Mannitol, Saccharine
  • Desensitizing agents – Sodium fluoride
  • Anticalculus agent – Pyrophosphates

3. Interdental Cleaning aids:

Use: In periodontally involved patients, open embrasures

• Various aids:
  • Dental floss
  • Interdental brushes
  • Wooden tips
  • Yarns, gauze strips

4. Gingival massage:

• Devices used
  • Toothbrush
  • Rubber tip stimulator
  • Interdental cleaning devices

Gingival massage Effects:

• Epithelial thickening
• Increased Keratinization
• Increased mitotic activity

5. Oral irrigation:

• Clean non-adherent bacteria and debris
• Disrupt and detoxify subgingival plaque
• Delivers antimicrobial agents into periodontal pockets
• Irrigator tips: Cannula type, soft rubber tip

Chemical Plaque Control.

Plaque Removal Techniques

Oral irrigation Use: As an adjunct

• Prevents recurrence of disease

Oral irrigation Classification:

1. First generation:

• Reduces plaque score by 20-50%

Example: Antibiotics

2. Second generation:

• Reduces plaque score by 70-90%

Example: bisbiguanides

3. Third generation:

• Effective against specific organisms

Chemicals:

1. Antibiotics Penicillin
   • Erythromycin
2. Enzymes – Lipase
   • Amylase
3. Quarternary Ammonium Compounds – Benzalkonium chloride
4. Bisbiguanides – Chlorhexidine
5. Metallic salts – Copper, Zinc
6. Herbal extracts
7. Phenols
8. Hydrogen peroxide
9. Fluorides
10. Others Triclosan

Question 2. Define oral hygiene and gingival physiotherapy. Describe various aids available for plaque control
Answer:

Oral Hygiene:

• The cleanliness of the oral cavity is appraised in terms of the extent of accumulated food debris, plaque, mate- ria alba, and tooth surface stains

Gingival Physiotherapy:

• Mechanical stimulation of the gingiva either by toothbrush- ing or interdental cleansing with various aids or simple finger massage leads to
  • Increased keratinization
  • Increased blood flow
  • The increased flow of GCF within the gingival sulcus

Measures Of Plaque Control:

Mechanical measures

1. Toothbrush:

• The frequency of brushing should be once every 12 hours
• Frequency of change of brush- every three months
• Length of brushing time
  • Initially-10-20 minutes
  • Later-3-5 minutes

2. Dentrifices:

• Used in the form of powders, pastes, and gels

Dentrifices Composition:

• Abrasives- calcium carbonate, calcium phosphate
  • Mechanically clean the teeth
  • Removes stained pellicles from the tooth surface
  • Restores natural lustre
  • Aids in eliminating plaque from the tooth surface
• Humectants
  • Maintains moisture
  • Glycerine, sorbitol
• Preservative- benzoic acid
  • Prevents microbial growth
• Thickening agent-methyl cellulose
  • Binds the solids to form a homogenous paste and ease dispersion of paste in the mouth
  • Controls stability and consistency of tooth-paste
• Foaming agents- sodium lauryl sulfate
  • Produces foam which aids in the removal of food debris
  • Antimicrobial property
• Flavoring agents-Mint
  • Render the product pleasant to use
• Sweetening agents- mannitol, saccharine
  • Imparts sweetness and makes it pleasant
• Desensitizing agents- sodium fluoride
• Anticalculus agent-pyrophosphates

3. Interdental cleaning aids:

Interdental cleaning aids Use:

• In periodontally involved patients
• Open embrasures

Interdental cleaning aids Various Aids:

• Dental floss
• Interdental brushes
• Wooden tips
• Yarns, gauze strips

4. Gingiva massage:

Gingiva massage Devices Used:

• Toothbrush
• Rubber tip stimulator
• Interdental cleaning devices

Gingiva massage Effects:

• Epithelial thickening
• Increased keratinization
• Increased mitotic activity

5. Oral irrigation:

• Clean non-adherent bacteria and debris
• Disrupt and detoxify subgingival plaque
• Delivers antimicrobial agents into periodontal pockets

Oral irrigation Irrigation Tips:

• Cannula type
• Soft rubber tip

Chemical plaque control

Oral irrigation Uses:

• As adjunct
• Prevents recurrence of disease

Oral irrigation Classification:

1. First generation:

• Reduces plaque score by 20-50%
• Example: antibiotics

2. Second generation:

• Reduces plaque score by 70-90%
• Example: bisbiguanides

3. Third generation:

• Effective against specific organisms

Chemicals Used:

• Antibiotics- Penicillin, Erythromycin
• Enzymes- Lipase, Amylase
• Quaternary ammonium compounds- Benzalkonium chloride
• Bisbiguanides- Chlorhexidine
• Metallic salts- Copper, zinc
• Herbal extracts
• Phenols
• Hydrogen peroxide
• Fluorides
• Others- Triclosan

Question 3. What is oral physiotherapy? Describe the indications, contraindications, advantages, and disadvantages of modifying Stillman’s method.
Answer:

Oral Physiotherapy

• It is mechanical stimulation of the gingiva either by toothbrushing or interdental cleansing with various aids or simple finger massage leads to
• Increased keratinization
• Increased blood flow
• The increased flow of GCF within the gingival sulcus

Modified Stillman’s Technique:

Modified Stillman’s Technique Indications:

• In gingival recession
• Dental plaque removal from cervical areas below the height of the contour of the enamel
• Gingival massage

Modified Stillman’s Technique:

Modified Stillman’s Technique Advantages:

• Prevents abrasive tissue destruction

Modified Stillman’s Technique Disadvantages:

• Time-consuming
• Improper brushing can damage the epithelial attachment

Question 4. Define plaque. Describe the formation and maturation of plaque. Add a note on the chemical method of plaque control.
Answer:

Plaque Definition:

• Plaque is defined clinically as a structurally resilient, yellowish-grey substance consisting of bacterial agree- nations that adhere tenaciously to teeth and other in- intraoral hard surfaces such as restorations

Formation of Plaque:

1. Formation of an organic pellicle
   • A thin, saliva-derived layer called acquired pellicle covers the tooth surface and it consists of numerous components including glycoproteins, proline-rich proteins, phosphoproteins, and histidine-rich proteins. enzymes and other molecules that can function as adhesion sites for bacteria
   • This involves the adsorption of positively charged salivary crevicular fluid and other environmental macromolecules to negatively charged hydroxyapa- tite surfaces of teeth
   • Its formation on the teeth surfaces forms the sub- strate for colonization and subsequent proliferation of micro-organisms
2. Initial adhesion and attachment of bacteria

• • Formation of the organic pellicle aids in the adherence of certain bacteria to the tooth surface
  • These are the initial colonizers
  • Bacterial adherence occurs through specific at-attachments
  • With the multiplication and growth of the primary colonizers, the extra-cellular matrix also increases through the accumulation of bacterial products

Dental Plaque Prevention

Plaque Maturation:

• Initial colonizers make use of available oxygen, leading to the reduced oxygen level
• This becomes favorable for anaerobic bacteria to grow
• These organisms then adhere to the cell surface receptors of the initial colonizers
• Hence the plaque matures

Chemical Plaque Control

Chemical Plaque Control Uses:

• As adjunct
• Prevents recurrence of disease

Chemical Plaque Control Classification:

1. First generation
   • Reduces plaque score by 20-50%
   • Example: antibiotics
2. Second generation
   • Reduces plaque score by 70-90%
   • Example: bisbiguanides
3. Third generation
   • Effective against specific organisms

Plaque Control Chemicals Used:

• Antibiotics- Penicillin, Erythromycin
• Enzymes- Lipase, Amylase
• Quaternary ammonium compounds- Benzalkonium chloride
• Bisbiguanides- Chlorhexidine
• Metallic salts-Copper, zinc
• Herbal extracts
• Phenols
• Hydrogen peroxide
• Fluorides
• Others- Triclosan

Dental Plaque Prevention

Plaque Control Short Essays

Question 1. Chlorhexidine.
Answer:

Chlorhexidine Indications:

• As an adjunct to the mechanical method
• Immediately after pack removal
• After oral surgical procedures
• In patients with fixed appliances
• For handicapped patients
• Drug-induced gingival enlargements
• Medically compromised patients
• Acute infections
• As prophylactic rinse

Chlorhexidine Adverse Effects:

• Staining of teeth
• Burning sensation
• Impaired taste sensation
• Rarely, parotid swelling

Chlorhexidine Mechanism:

Chlorhexidine Efficient concentration

• 10 ml of 0.2%

Question 2. Brushing Techniques.
Answer:

Dental Plaque Prevention

Question 3. Modified Bass Techniques.
Answer:

• Placement of head – 45° to the long axis of teeth
• Initial most posterior teeth

Modified Bass Techniques Method:

Question 4. Dentrifices
Answer:

• Used in the form of powders, pastes, and gels

Dentrifices Composition:

• Abrasives- calcium carbonate, calcium phosphate
  • Mechanically clean the teeth
  • Removes stained pellicles from the tooth surface
  • Restores natural lustre
  • Aids in eliminating plaque from the tooth surface
  • Humectants
  • Maintains moisture
  • Glycerine, sorbitol
  • Preservative- benzoic acid
  • Prevents microbial growth
  • Thickening agent-methyl cellulose
  • Binds the solids to form a homogenous paste and ease dispersion of paste in the mouth
  • Controls stability and consistency of toothpaste
  • Foaming agents- sodium lauryl sulfate
  • Produces foam which aids in the removal of food debris
  • Antimicrobial property
  • Flavoring agents- Mint
  • Render the product pleasant to use
  • Sweetening agents- mannitol, saccharine
  • Imparts sweetness and makes it pleasant
  • Desensitizing agents- sodium fluoride
  • Anticalculus agent-pyrophosphates

Question 5. Merits and limitations of toothbrush (or) Uses and abuses of toothbrush
Answer:

Merits Or Uses Of Toothbrush:

• Cleans teeth and interdental spaces and prevents plaque formation
• It disturbs and removes plaque
• Stimulates and massages gingival tissues
• Increases patient motivation
• Increased accessibility in interproximal and lingual tooth surfaces

Limitations Or Abuses Of Toothbrush:

• Horizontal or vertical scrubbing toothbrushing method with pressure results in a scuffled epithelial surface with denuded underlying connective tissue
• Overuse of toothbrush results in punctuate lesions that appear as red pinpoint spots
• Penetration of gingiva by filament ends due to the use of a toothbrush with frayed broken bristles results in diffuse redness and denuded attached gingiva
• Gingival recession exhibits receded margin of the gingiva
• Gingival contour exhibits rolled out, bulbous, hard, firm marginal gingiva

Dental Plaque Prevention

Plaque Control Short Question And Answers

Question 1. Chemical Plaque Control.
Answer:

Chemical Plaque Control Uses:

• As adjunct
• Prevents recurrence of disease

Chemical Plaque Control Classification:

1. First generation:

• Reduces plaque score by 20-50%

Example: Antibiotics

2. Second generation:

• Reduces plaque score by 70-90%

Example: bisbiguanides

3. Third generation:

• Effective against specific organisms

Chemical Plaque Control Chemicals:

1. Antibiotics Penicillin
   • Erythromycin
2. Enzymes – Lipase
   • Amylase
3. Quarternary Ammonium Compounds – Benzalkonium chloride
4. Bisbiguanides – Chlorhexidine
5. Metallic salts – Copper, Zinc
6. Herbal extracts
7. Phenols
8. Hydrogen peroxide
9. Fluorides
10. Others Triclosan

Plaque Reduction

Question 2. Modified Stillman method.
Answer:

Question 3. Charter’s method.
Answer:

Charter’s method Indication: After surgery

Question 4. Powered Toothbrush.
Answer:

Powered Toothbrush Indications:

• Patient lacking motor skills
• Handicap
• Hospitalized patients
• Patient with the orthodontic appliance

Powered Toothbrush Types Of Motion:

1. Reciprocating – back-and-forth movement
2. Arcuate Up and down movement
3. Elliptical – Combination

Question 5. Dentrifices.
Answer:

• Used in the form of powders, pastes, and gels

Dentrifices Composition:

• Abrasives- calcium carbonate, calcium phosphate
• Humectants
  • Maintains moisture
  • Glycerine, sorbitol
• Preservative- benzoic acid
• Thickening agent-methyl cellulose
• Foaming agents- sodium lauryl sulfate
• Flavoring agents-Mint
• Sweetening agents- mannitol, saccharine
• Desensitizing agents- sodium fluoride
• Anticalculus agent-pyrophosphates

Question 6. Interdental cleaning aids
Answer:

Interdental cleaning aids Use:

• In periodontally involved patients
• Open embrasures

Interdental cleaning aids Various Aids:

• Dental floss
• Interdental brushes
• Wooden tips
• Yarns, gauze strips

Question 7. Adverse effects of chlorhexidine.
Answer:

• Staining of teeth
• Burning sensation
• Impaired taste sensation
• Rarely, parotid swelling

Question 8. Desensitizing agents
Answer:

Agents Used:

• Dentrifices
• Varnishes
• Fluoride compounds

Desensitizing Agents Mode Of Action:

Question 9. List three chemical plaque control agents.
Answer:

• Antibiotics- Penicillin, Erythromycin
• Enzymes- Lipase, Amylase
• Quaternary ammonium compounds- Benzalkonium chloride
• Bisbiguanides- Chlorhexidine
• Metallic salts- Copper, zinc
• Herbal extracts
• Phenols
• Hydrogen peroxide
• Fluorides
• Others- Triclosan

Question 10. Interdental brushes
Answer:

• Made of bristles mounted on a handle
• Suitable for cleaning large, irregular, or concave tooth surfaces
• Inserted interproximal and are activated with short back-and-forth strokes
• The diameter of the brush should be slightly larger than the gingival embrasures
• Single-tufted brushes are highly effective on the lingual surfaces of mandibular molars and premolars

Plaque Reduction

Question 11. Oral irrigation devices.
Answer:

Direct high-pressure, steady, or pulsating stream of water through a nozzle to the tooth surfaces is applied

Oral irrigation devices Uses:

• Clean nonadherent bacteria and debris
• Removes non-structured debris from inaccessible areas
• Used as adjuncts to tooth brushing

Oral irrigation devices Advantages:

• Retards accumulation of plaque and calculus
• Reduces gingival inflammation

Oral irrigation devices Types:

1. Home use irrigator tip:

• Soft rubber tip
• The plastic nozzle is bent at 90 degrees at the tip
• Attached to a pump

2. Subgingival irrigator:

• Cannula type- office use
• Soft rubber tip- home use
• Effective penetration of irrigant up to 70%

Question 12. Perio-aid
Answer:

• Wooden toothpicks on a handle are known as period-aid They can be used on facial or lingual surfaces throughout the oral cavity
• Deposits are removed by using either the side or the end of the tip.
• The device is particularly efficient for cleaning along the gingival margin and into periodontal pockets

Question 13. Functions of gentrifies
Answer:

• Removal of food debris, and stains and minimizing the build-up of plaque
• Anticaries action
• Mouth freshener
• The use of triclosan with copolymer Gantrez in toothpaste reduces plaque and gingivitis
• It reduces periodontitis
• Aid in cleaning and polishing tooth surfaces

Question 14. Indications of chlorhexidine
Answer:

• As an adjunct to mechanical methods
• Immediately after pack removal
• After oral surgical procedures
• In patients with fixed appliances
• For handicapped patients
• Drug-induced gingival enlargements
• Medically compromised patients
• Acute infections
• As prophylactic rinses

Question 15. Abuses of toothbrush
Answer:

• Horizontal or vertical scrubbing toothbrushing method with pressure results in a scuffled epithelial surface with denuded underlying connective tissue
• Overuse of toothbrush results in punctuate lesions that appear as red pinpoint spots Penetration of gingiva by filament ends due to use of a toothbrush with frayed broken bristles results in diffuse redness and denuded attached gingiva
• Gingival recession exhibits receded margin of the gingiva
• Gingival contour exhibits rolled out, bulbous, hard, firm marginal gingiva

Plaque Reduction

Question 16. Ideal toothbrush
Answer:

• It should fulfill an individual patient’s requirements in size, shape, and texture
• Should be easy and efficiently manipulated
• Should be readily cleaned and aerated
• Should be durable and inexpensive
• Should be designed for utility, efficiency, and cleanliness

Question 17. Gingival massage
Answer:

• It is mechanical stimulation of the gingiva either by toothbrushing or interdental cleansing with various aids or simple finger massage leads to
• Increased keratinization
• Increased blood flow
• The increased flow of GCF within the gingival sulcus

Question 18. Proxabrush
Answer:

• Proxy brushes are small interdental brushes used in type 2 embrasures
• In type 2 embrasures, dental floss is less effective in these cases because interproximal gingival recession usually leads to the exposure of concave root depressions

Question 19. Objectives of brushing teeth
Answer:

• To clean teeth, tongue, and interdental spaces of food
• remnants, debris, stains, etc
• To prevent plaque formation
• To disturb and removes plaque
• To stimulate and massage gingival tissue

Question 20. Dental Floss.
Answer:

Dental Floss Types:

1. Twisted or non-twisted
2. Bonded or non-bonded
3. Waxed or un-waxed
4. Thick or thin

Dental Floss Technique:

Question 21. Disclosing agents.
Answer:

• They are prepared in liquid, tablet, or lozenge form that contains a dye or other coloring agent.
• It is used to identify bacterial plaque deposited for in-construction, evaluation, and research

Disclosing agents Purpose:

• Patient’s education
• Evaluate the effectiveness of the treatment
• Evaluate plaque indices
• Self-evaluation

Disclosing agents Requirements:

• Color should contrast normal color of the oral cavity
• It should not rinse off immediately
• It should not have bad taste
• It should not cause any irritation
• It should be thin enough

Disclosing agents Agents:

• Iodine containing preparations
• Bismarck brown
• Merbromin
• Erythrosin
• Fast green
• Two-tone

Question 22. Atridox
Answer:

• Atridox is 10% Doxycycline
• Atridox is biodegradable
• Used as a mixture in syringes

Atridox Advantages:

• Used in periodontal chemotherapy
• Used as a local drug delivery system
• Used as an adjuvant to mechanotherapy

Plaque Reduction

Question 23. Anticalculus agents.
Answer:

• Calculus control kinds of toothpaste also known as tartar control toothpaste.
• Dentrifices that are widely used as an aid in oral hygiene containing either soluble pyrophosphate or zinc compounds have demonstrated a 10 – 50% reduction in calculus.
• Pyrophosphatase and zinc compounds are thought to produce their anti-calculus effects by absorbing small hydroxy apatite crystals, thus inhibiting growth as larger and more organized crystals.
• The inhibitory effects reduce the deposition of new supragingival calculus but will not affect existing calculus deposits.
• Before starting the use of anti-calculus agents, patients’ teeth must be cleaned & completely free of supragingival calculus to achieve the greatest effect from the toothpaste.

Principles Of Periodontal Instrumentation

Principles Of Periodontal Instrumentation Long Essays

Question 1. Describe the principles of oral prophylaxis.
Answer:

Oral Prophylaxis Definitions:

1. Scaling:

• It is a process by which plaque and calculus are removed from both supragingival and subgingival tooth surface

2. Root planning:

• It is the process by which residual embedded calculus and the portion of cementum are removed from the roots to produce a smooth, hard, and clean surface

Read And Learn More: Periodontics Question and Answers

Oral Prophylaxis Principles:

• To restore gingival health by completely removing elements that provoke gingival inflammation
• Removal of extensive amounts of dentin and cementum is not necessary to render roots free of toxins and
• The number of appointments should be estimated based on
  • Number of teeth present
  • Severity of inflammation
  • Amount and location of calculus
  • Pocket depth
  • Presence of furcation
  • Patient’s comprehension
  • Need of local anesthesia
• Good visual and tactile detection is required
• Visual examination is carried out by good lighting and a clean field
  • The explorer/probe is held with lightly modified pen grasp pads of thumb and fingers and perceives slight vibrations conducted through the instrument shank and handle as tooth surface irregularities are encountered

Oral Prophylaxis Supragingival Scaling: Sickles, curettes, and ultrasonic and sonic instruments are used

Oral Prophylaxis Technique:

Oral Prophylaxis Subgingival Scaling

• Done by universal/Gracey curettes

Oral Prophylaxis Technique:

1. Curette is inserted with the face of the blade flush against the tooth.
2. Working angulation (45-90 degrees) is established at the base of the pocket.
3. Lateral pressure is applied and the scaling stroke is activated in the coronal direction.

Principles Of Periodontal Instrumentation Short Essays

Question 1. Principles of Instrumentation.
Answer:

1. Accessibility: Thorough accessibility should be provided

Operator’s Position:

• • Chair position – 9-12’0 clock
• Forearm parallel to the floor
• Thighs parallel to the floor
• Feet rest on the floor
• Back straight

Patient’s Position:

• Supine position
  • Maxillary – Back of chair parallel to the floor
  • Mandibular – It is slightly raised
• The patient’s mouth close to the elbow of the clinician
• Chin – Maxillary – position upward
• Mandibular – positioned downward

2. Visibility, Illumination, and Retraction:

• Direct vision and direct illumination through dental light
• Indirect vision and indirect illumination through mouth mirror

Visibility, Illumination, and Retraction Method:

• Operator’s position 12’0 clock
• Placement of mirror behind the central incisor
• Position unit light such that the light beam is incident on the mirror and reflected

Visibility, Illumination, and Retraction Retraction – Through:

• Mouth mirror
• Fingers of the non-operating hand

3. Condition of Instruments:

• Instruments must be sharp enough to provide efficient use
  • Reduced treatment time
  • Comfortable with patient and clinician
• Dull instruments lead to
  • Incomplete plaque removal
  • Need of excessive force
  • Trauma to soft tissues

4. Maintaining a clean field:

• The operating field must be free of saliva, blood, and debris
• To obtain it, various measures can be undertaken
  • Use of suction
  • Flushing with water
  • Use of compressed air
  • Packing the reflected tissue with a gauze square

5. Instruments stabilization:

• Use effective instrumentation
• Avoid injuries to patient and clinician

Instruments Stabilization Factors:

1. Instrument Grasp:
   • Commonly used – modified pen grasp Advantages:
   • Precise control
   • Permits all movements
   • Facilitates good tactile sensation
2. Finger rest:
   • Stabilizes hand and instrument
   • Provide firm fulcrum
   • Prevents soft tissue injury

Commonly used Finger Types: Ring finger

Intraoral:

• Standard
• Modified
• Piggybacked
• Cross arch
• Opposite arch
• Finger on finger

Extraoral:

• Knuckle-rest technique palm up
• Chin-cup technique palm down

6. Instrument Activation:

1. Adaptation: It is the manner in which the working end of a periodontal instrument is placed against the surface of a tooth.

The leading third of cutting edge is more often used.

Adaptation Use:

• Prevent soft tissue trauma
• Ensures maximum effectiveness

2. Angulation: It refers to the angle between the face of a bladed instrument and the tooth surface

• Subgingival scaling-0-400
• Supragingival scaling-45-900
• Gingival curettage – >90°

3. Lateral pressure: Refers to the pressure created when force is applied against the surface of a tooth with the cutting edge of a bladed instrument

4. Strokes – Types: Placement stroke, exploratory stroke, scaling stroke, root planning stroke

Question 2. Modified Pen Grasp.
Answer:

Commonly used grasp

Modified Pen Grasp Position:

Middle finger:

• Rests over shank
• Guides working end
• Feels vibration

Index finger:

• Bend from middle phalanges
• Placed over the middle finger

Thumb:

• Placed over the opposite side
• All together creates a tripod effect

Question 3. Rest/Finger Rest.
Answer:

Intra-oral:

1. Standard Intraoral finger rest:

• The finger rests on a stable tooth surface immediately adjacent to the working area
• Not used in the edentulous area

2. Advanced:

1. Modified intraoral fulcrum
   • Combination of modified pen grasp with the standard intraoral fulcrum
   • Used for maxillary teeth
2. Piggybacked fulcrum
   • The middle finger rests on top of the ring finger
   • Not used with limited mouth opening
3. Cross arch fulcrum
   • Resting the ring finger on a tooth on the opposite side of the arch
4. Opposite arch fulcrum
   • Resting ring finger on the opposite arch
5. Finger on finger fulcrum
   • Resting ring finger on index finger

Extra Oral fulcrums:

1. Palm up:

• Used for procedures carried out with clinician’s palm resting against patient’s chin

2. Palm down:

• Here the clinician holds the patient’s chin with the palms of his hands.
• Principles Of Periodontal Instrumentation Short Question and Answers

Question 1. Instrument stabilization.
Answer:

• Instrument stabilization avoids injuries to patients and clinicians
• Instrument stabilization is carried out by

1. Instrument Grasp:

• A commonly used grasp is a modified pen grasp

Instrument Grasp Advantages:

• Precise control
• Permits all movements
• Facilitates good tactile sensation

2. Finger Rest:

Finger rest Uses:

• Stabilizes hand and instrument
• Provides firm fulcrum
• Prevents soft tissue injury

Finger Rest Types:

1. Intra-oral rest:
   • Standard intraoral finger rest
   • Modified
   • Piggybacked
   • Cross arch
   • Opposite arch
   • Finger on finger
2. Extraoral rest:
   • Knuckle rest technique- palm up
   • Chin-cup technique- palm down

Question 2. Instrument angulation
Answer:

• Instrument Angulation refers to the angle between the face of a bladed instrument and the tooth surface
  • Subgingival scaling-0-40 degree
  • Supragingival scaling-45-90 degrees
  • Gingival curettage- .90 degrees

Question 3. Strokes.
Answer:

Strokes Types:

1. Exploratory:

• Use to evaluate pocket depth
• Detects calculus
• Detects irregularities over tooth structure with the help of curettes

2. Scaling strokes:

• These are short, powerful, pull strokes

3. Root planning strokes:

• These are moderate, light pull strokes
• Hoe, files, and ultrasonic instruments used in it

Principles Of Periodontal Instrumentation Viva Voce

1. Instrument grasp and finger rest provide stability to the instrument during instrumentation
2. Modified pen grasp is the most effective and stable grasp
3. In a standard pen grasp, shank of the instrument rests on the side of the middle finger
4. The fourth finger is mostly preferred as a finger rest
5. In the conventional technique, finger rest is established on teeth surfaces immediately adjacent to the working area
6. Palm up and palm down is commonly used extra oral fulcrums
7. Adaptation is placing the instrument against the tooth sur- face
8. Tooth blade angulation during gingival curettage should be >90°
9. A scaling stroke should be initiated in the forearm
10. Curettes are a most effective and versatile instrument for root planning

Periodontal Instrumentation

Periodontal Instrumentation Important Notes

1. Differences between Gracey curette and universal curette

2. Gracey Curettes

Read And Learn More: Periodontics Question and Answers

3. Extended shank curettes

• Extended Shank Curettes Example: After five curettes
• The shank is extended 3 mm than the standard Gracey which allows extension into deeper periodontal pockets
• They are available in all standard Gracey numbers except 9 and 10

4. Minibladed curettes

• Minibladed curettes Example: Mini five curettes
• Minibladed curettes are modified after five curettes with the blade length half of that of conventional curettes
• The shorter blade allows easier insertion and adaptation in deep, narrow pockets and furcation
• Minibladed curettes are available in all standard Gracey numbers except 9 and 10

5. American gracey curettes

• American Gracey curettes are four mini-bladed curettes
• The blade length is 50% shorter than that of conventional curettes
• The blade has been curved slightly upward
• American gracey curettes allows the curettes to adapt more closely to the tooth surface, especially on the anterior teeth and online angles

6. Langer and mini langer curettes

• Langer and mini langer curettes set of 3 curettes combines the shank design of the standard Gracey 5-6, 11-12, and 13-14 curettes with a universal blade angled at 90 degrees rather than the offset blade of the Gracey curettes
• Langer and mini langer curettes allows the advantage of the area-specific shank to be combined with the versatility of a universal curette blade

7. Angles in instrumentation

8. Sharpening of instruments

• During the sharpening of instruments
• The face of the blade is parallel to the floor and the stone makes a 100-110° angle with the face of the blade
• This automatically preserves an angle of 70-80° angle between the face and the lateral surface

9. The sharpness of instruments can be tested by

• Keeping the cutting edge under light, a dull instrument would reflect light while a sharp instrument does not
• The instrument is lightly drawn across an acrylic rod called a test stick. A dull instrument will slide smoothly but a sharp one would raise a light-shaving

10. Angulation

• It refers to the angle between the face of the bladed instrument and the tooth surface
• Correct angulation is essential for effective calculus removal
• For subgingival insertion of a bladed instrument such as a curette, the angulation should be close to 0°
• During scaling strokes on heavy calculus angulation should be just less than 90° so that the cutting edge bites into the calculus
• An angulation of less than 45° and greater than 90° will cause the instrument to slide over calculus and causes burnishing of calculus

11. Mounted rotary stones are not recommended because

• They are difficult to control precisely and can ruin the shape of the instrument
• They tend to wear down the instrument quickly
• Generates frictional heat which may affect the temper of the instrument

12. Hoes

• They are used for removing ledges or rings of calculus
• It makes two-point contact with the tooth and this stabilizes the instrument and prevents nicking of the root
• The blade is bent at 99° and the cutting edge is beveled at 45°

13. Ultrasonic and sonic instruments

• Used for scaling, curettage, and removing the stain
• They produce vibrations at the tip of the instrument which when adapted to the tooth causes dislodgement of calculus
• Vibrations range from 20,000 to 45,000 hertz
• The spray which is directed at the tip of the instrument dissipates heat and forms tiny vacuum bubbles that collapse quickly and release energy by a process called cavitation
• They contain a water knob that controls the volume of water being delivered to the insert tip
• Water contributes to 3 physiologic effects that enhance the efficacy of power scalers

The combination of these 3 effects disrupts microflora

Types of Ultrasonic Instruments:

1. Magnetostrictive
   • The pattern of vibration is elliptical
2. Piezoelectric
   • The pattern of vibration of the tip is linear

Contraindications:

• Patients with communicable diseases that can be transmitted by aerosols
• Patients at risk of respiratory diseases
• Patients who are immunocompromised or suffering from chronic pulmonary diseases
• Patients having porcelain or bonded restorations because they can be fractured or removed

14. Modified pen grasp

• Modified pen grasp is the most effective and stable grasp for all periodontal instruments
• Modified pen grasp creates a tripod effect with the thumb, index finger, and the pad of the middle finger
• Modified pen grasp ensures the greatest control over the instrument and also enhances maneuverability and tactile sensitivity

15. Palm and thumb grasp

• Palm and thumb grasp is unsuitable for precise and controlled movements
• Palm and thumb grasp inhibits maneuverability and tactile sensitivity
• Palm and thumb grasp is used for stabilizing instruments during sharpening and for manipulating air and water syringes

16. Rests and fulcrum

17. Chisel scaler

• It is used in the anterior part of the mouth for the proximal surfaces of teeth that are too closely spaced to permit the use of other scalers
• The instrument is activated with a push motion while other scalers are activated with pull motion

18. Adaptation

• It refers to the manner in which the working end of a periodontal blade is placed against the surfaces of a tooth
• The objective of adaptation is to make the working end of the instrument conform to the contour of the tooth surface
• Precise adaptation minimizes trauma to the soft tissues and root surfaces and ensures maximum effectiveness of instrumentation

19. Kirkland knives

• Commonly used for gingivectomy
• Used on the facial and lingual surfaces of incisors and those distal to the terminal tooth in the arch

20. Basic characteristics of scaler and curette

21. Florida probe

• It is an automated probe system
• Consists of a probe handpiece, digital readout, foot switch, computer interface and computer
• The end of the probe tip is 0.4 mm in diameter
• The probing method combines the advantages of constant probing force with precise electronic measurement and computer storage of data
• It eliminates the potential errors associated with visual reading and the need for an assistant to record the measurements

Florida probe Disadvantages:

• Lack of tactile sensitivity
• Patient discomfort
• Inaccurate measurements
• Underestimation of deep probing depths by the automated probe

22. Scaling stroke

• It is a short, powerful pull stroke that is used with a bladed instrument for the removal of both supragingival and subgingival calculus
• The muscles of the fingers and hands are tensed to establish a secure grasp and lateral pressure is firmly applied against the tooth surface

23. Uses of explorer

• To locate sublingual deposits and various areas
• To check the smoothness of root surfaces after root planning

Periodontal Instrumentation Long Essays

Question 1. Classify periodontal instruments. Describe anyone in detail.
Answer:

Periodontal Instruments Classification: According to purpose, instruments are classified as

1. Periodontal probe
2. Explorer
3. Scaling, root planning, and curettage instruments
   • Sickle scalers
   • Currencies
   • Hoe, chisel, file scalers
   • Ultrasonic and sonic instruments
4. Periodontal endoscope
5. Cleansing and polishing instruments
   • Rubber cups
   • Brushes
   • Dental tapes

Periodontal Instrumentation Short Essays

Question1. Universal Curettes.
Answer:

As can be used for most areas of the dentition

Universal Curettes Indication:

• Deep sub-gingival scaling
• Cementum alteration
• Removal of the soft tissue lining of a pocket

Universal Curettes Parts:

• Removal of the soft tissue lining of the pocket
• Face-90° to lower shank
  • Adapted towards tooth surface
• Shank
• Cutting edge-Two edges
  • Both can be used

• Curvature – Blades curve upward
• Blade Angle – 90°

Question 2. Gracey Curettes/Area-specific curettes.
Answer:

• Area-specific curettes
• Angle – 60° offset
• Cutting edge – Outer end only is used Curvature
• Curves upwards and sideways
• Use – Sub-gingival scaling and root planning

Gracey Curettes Types:

• 1-2 and 3-4-For interiors
• 5-6-Anteriors, premolar
• 7-8, 9-10 – Posteriors – Facial and lingual
• 11-12 – Posteriors – mesial
• 13-14 – Posteriors – distally

Gracey Curettes Recent Advances – 15-16 and 17-18

Question 3. Corvettes.
Answer:

Types-Sub-O:

• 1-2- anterior and premolars
• 11-12-posteriors medial
• 13-14-posteriors distal

Modification From Conventional Gracey Cu- Rettes:

• 50% shorter blade length
• The curvature of the blade upwards

Corvettes Importance:

• Due to curvature, there is a better adaptation to tooth surfaces

Question 4. Endoscope/Perioscope.
Answer:

Endoscope Use:

• Diagnosis and treatment of periodontal diseases

Endoscope Part:

• Fibre optic – Reusable
• Sterile sheath – Delivers water for irrigation
• Covering fiber optic
• Periodontal probe/ultrasonic instruments

Endoscope Advantages:

• Clear visualization subgingivally
• Detects the presence and location of sub-gingival deposits
• Guides the operation
• Helpful in root debridement in inaccessible areas

Periodontal Instrumentation Short Question and Answers

Question 1. Langer’s curettes.
Answer:

• Langer’s curettes is a set of 3 curettes
• These contain combined features of Gracey and univer- sal curettes
• Can be adapted both on the mesial and distal surfaces
• Consist of shank design of the standard Gracey #5-6, 11- 12, and 13-14 curette
• Has a universal blade angled at 90 degrees.

Question 2. Cleaning and Polishing instruments.
Answer:

1. Rubber cups: Rubber shell

• Used in handpiece

2. Bristle brushes: Wheel and cup-shaped

• Used in handpiece with paste

3. Dental tape: For polishing proximal surfaces

• Air powder polishing – Uses air-powdered slurry of warm water and sodium bicarbonate

Question 3. Prophyjet.
Answer:

Special handpiece

Prophy jet Use:

• Removal of extrinsic stains and soft deposits:

Prophy jet Method:

• Delivers air-powdered slurry of warm water and sodium bicarbonate

Prophy jet Disadvantages:

• Loss of tooth structure
• Transient gingival tissue damage
• Roughening of restoration

Prophy jet Contraindications:

• Systemic diseases
• Patients on medications that affect electrolytic balance

Question 4. Kirkland knife
Answer:

• Used for gingivectomy
• The entire periphery is cutting-edge
• Shape- kidney-shaped

Kirkland knife Types:

1. Double-ended and single-ended
2. Disposable and reusable
3. Flat-bladed and interproximal

Question 5. Naber’s probe.
Answer:

• Naber’s probe is a curved blunt probe
• Color-coded markings are present at 3, 6, 9, and 12 mm It is used to detect furcation areas

Question 6. Classify periodontal instruments
Answer:

Periodontal Instruments Classification: According to purpose, instruments are classified as

1. Periodontal probe
2. Explorer
3. Scaling, root planning, and curettage instruments
   • Sickle scalers
   • Currencies
   • Hoe, chisel, file scalers
   • Ultrasonic and sonic instruments
4. Periodontal endoscope
5. Cleansing and polishing instruments

• • Rubber cups
  • Brushes
  • Dental tapes

Question 7. Sharpening stones
Answer:

• Sharpening stones is obtained from natural mineral deposits or artificially
• Sharpening stones surface is made up of abrasive crystals

Sharpening Stones Types:

1. Based on crystal size:

1. Coarse stones:
   • Have larger particles
   • Cut more rapidly
   • Used for dull instruments
2. Finer stones
   • Have smaller crystals
   • Cut more slowly

2. Method of use:

1. Mounted rotary stones:
   • Mounted on a metal mandrel/handpiece
2. Unmounted stones:

Sharpening Stones Examples: Carborundum, ruby, and ceramic stones

Question 8. Excisional and incisional instruments
Answer:

1. Periodontal knives
2. Interdental knives
   • Ex-Orban knife
   • Used for interdental areas
   • They are pear-shaped knives
   • Cutting edges are present on both sides of the blade
3. Surgical blades
   • Used for periodontal surgery
   • They are beak-shaped
   • Cutting edges are present on both sides
   • Used with pushing and pulling cutting motion
   • Commonly used- 12D, 15 and 15C

Question 9. Florida probe.
Answer:

Florida Probe is a computerized periodontal probe

Florida Probe Consists of:

• Probe handpiece
• Footswitch
• Digital readout
• Computer
• Computer interface

Florida Probe Method of Use:

• The probe tip is 0.4 mm in diameter
• Insert probe tip
• Measures are made electronically
• Transfer to the computer when the foot switch is pressed
• Constant probing provided by coil springs inside the probe handpiece and digital readout

Q.ultrasonic 10. Cavitation
Answer:

Seen with the use of ultrasonic instruments

Cavitation Production

Question 11. Contraindications of ultrasonic instruments
Answer:

• Patients with
• Cardiac pacemakers
• Communicable disease
• Respiratory disease
• Gag reflex
• Porcelain crowns
• Titanium implants
• Dentinal hypersensitivity
• Newly erupted teeth
• Young teeth with a large pulp chamber

Question 12. Mechanism of ultrasonic scalers
Answer:

Ultrasonic scalers work by converting electrical energy into mechanical energy in the form of vibrations of the working tip

Ultrasonic Scalers Frequency Used: 18000-50000 cycles/sec

Ultrasonic Scalers Types:

1. Piezoelectric

• Ceramic disc is present
• When electrical energy is applied the tip moves in a linear path creating two active surfaces

2. Magnetostrictive

• Consist of the metal stalk
• When electrical energy is applied vibration travels from the stalk to connect the body to tip
• Tip travels in an elliptical motion covering all surfaces

Question 13. Hazards of ultrasonic scalers
Answer:

• Aerosol production
• Heat production
• Damage to the restoration
• Roughening of cementum
• Enamel abrasion
• Tissue damage

Question 14. Instrument grasps
Answer:

• A proper grasp is essential for precise control of movements made during periodontal instrumentation

1. Modified pen grasp

• It is the most effective and stable grasp for all periods on- all instruments
• It creates a tripod effect with the thumb, index finger, and the pad of a middle finger
• It ensures the greatest control over the instrument and also enhances maneuverability and tactile sensitivity

2. Palm and thumb grasp

• It is unsuitable for the precise and controlled movements
• It inhibits manoeuvrability and tactile sensitivity It is used for stabilizing instruments
• during sharpening and manipulating air and water syringes

Question 15. Mini curettes
Answer:

• After five curettes have a shank 3 mm longer
• Mini-bladed curettes are modifications after five curettes
• It has a shorter blade
• This allows easier insertion and adaptation in deep pockets, furcation, developmental grooves, line angles
• Available in all standard Gracey numbers except for #9, 10

Periodontal Instrumentation Viva Voce

1. In sonic units, the tip will have the orbital type of vibrating action
2. Periotrievers are a set of two double-ended, highly magnetized instruments used for retrieval of broken tips from pockets and furcation
3. Scaling and root planning are done to restore gingival health by completely removing elements that provoke gingival inflammation
4. India and Arkansas oilstones are examples of natural abrasive stones
5. Carborundum, ruby, and ceramic stones are synthetic- locally produced
6. The primary goal of scaling and root planning is to restore the gingiva to health by removing the irritants which provoke the inflammation
7. After scaling the gingiva which is edematous and swollen undergoes shrinkage
8. The function of an explorer is to locate caries
9. The sickle scalers are used to remove supragingival calculus
10. Hoe is used for the removal of tenacious subgingival calculus and altered cementum
11. Perioscope is used to visualize deeply into subgingival pockets and furcation
12. Furcation areas are best evaluated by Naber’s probe
13. UNC 15 probe has color coding at 5, 10, and 15 mm
14. The smoothness of the root surfaces after root planning is checked by the explorer
15. Sickle scalers are used with a pull stroke
16. The cutting edge of a curette is present on both sides of a working end
17. Langer and mini Langer curettes is combination of standard Gracey and universal curettes
18. Schwartz periotrievers are designed for removal of broken instruments from deep pockets
19. The part function of a periodontal file is to fracture or crush large deposits of calculus

Rationale For Periodontal Treatment

Rationale For Periodontal Treatment Short Essays

Question 1. Treatment Modalities.
Answer:

Local Therapy:

• Removal of plaque and plaque retentive factors
• Reduces/prevents the progression of periodontal disease

Systemic Therapy:

• Used as an adjunctive
• Used for a specific purpose
  • Acute infections
  • Post-treatment bacteremia
  • Presence of systemic disease
  • Example: Juvenile periodontitis
• Use to eliminate the bacteria that have invaded gingival tissues

Read And Learn More: Periodontics Question and Answers

Question 2. Factors affecting Healing.
Answer:

1. Local Factors: Delay healing

• Excessive tissue manipulation during treatment
• Trauma to tissue
• Reduced blood supply
• Presence of foreign bodies
• Repetitive treatment
• Cortisone administration
• Ionizing radiation

Improves healing:

• Increase in temperature
• Bone cells
• Debridement
• Immobilization
• Pressure
• Adequate blood supply

2. Systemic Factors:

• Delays in
• Older patients
• Generalized infections
• Malnutrition
• Increased levels of cortisone
• Stress
• Increased estrogens

Rationale For Periodontal Treatment Short Question and Answers

Question1. Define various aspects of healing after therapy.
Answer:

1. Regeneration:

• Regeneration is the growth and differentiation of new cells and intercellular substances to form new tissue and parts.

2. Repair:

• Repair is the healing of tissues without complete re- Lateral extension of inflammation from an inner surface of storing lost tissues

3. New attachment:

• New attachment is the embedding of new periodontal ligament fibers into new cementum and the attachment of the gingival epithelium to the tooth surface previously. denuded by disease

4. Re-attachment:

• Re-attachment refers to repair in areas of the root not previously exposed to the pocket, such as after surgical de- tachment of the tissues or after traumatic tears in the cementum, tooth fractures, or treatment of peri- apical lesions.

Question 2. Healing of periodontal pocket.
Answer:

The area is invaded by cells from 4 different sources

Question 3. Periodontal Abscess.
Answer:

Periodontal Abscess Definition:

Periodontal Abscess is a localized purulent infection of periodontal tissues which may lead to the destruction of the periodontal ligament and alveolar bone.

Periodontal Abscess Classification:

1. Based on Location:
   • Along the lateral aspect of the root
   • Along the soft tissue wall of pocket
2. Based on onset: Acute and chronic
3. Based on number: Single and multiple

Periodontal Abscess Etiology:

• Deep extension of infection from periodontal pocket
• The lateral extension of inflammation from the inner surface of the pocket
• Presence of a tortuous pocket
• Incomplete removal of calculus
• Impaction of foreign bodies
• Perforation of root

Periodontal Abscess Clinical Features:

• Presence of pocket
• Tenderness
• Tooth mobility
• Vital/non-vital tooth
• Localized pain

Periodontal Abscess Treatment:

• Drainage
• Scaling and root planning
• Anti-microbial therapy
• Amoxicillin 500 mg TID for 3 days
• Clindamycin 300 mg QID for 3 days
• Azithromycin 500 mg QID for 3 days
• Extraction as a last resort

Question 4. New attachment.
Answer:

New attachment is the embedding of new periodontal ligament fibers into new cementum and the attachment of the gingival epithelium to the tooth surface previously denuded by disease

Treatment Plan

Treatment Plan Important Notes

1. Treatment plan:

Read And Learn More: Periodontics Question and Answers

Treatment Plan Short Essays

Question 1. Phases of treatment plan.
Answer:

Treatment Plan Phase 1: Non-surgical (Etiotropic phase]

• Directed to the elimination of etiologic factors of gingival and periodontal disease
• When successfully performed this phase stops the progression of the disease

Treatment Plan Phase 1 Steps Involved:

• Oral prophylaxis
• Occlusal correction
• Excavation of caries
• Antimicrobial therapy
• Permanent restoration
• Minor orthodontic movement
• Provisional splinting

Treatment Plan Phase 2:

• The surgical phase involved – the placement of implants
• RCT

Treatment Plan Phase 3:

• Restorative phase
• Patient’s education
• Fixed prosthesis

Treatment Plan Phase 4:

• Maintenance phase
• Recall visits
• Rechecking the progression/improvement
• Examining pathologic changes

Treatment Plan Importance:

• Phase 1: Elimination of etiological changes
• Phase 2: Repair/improve the periodontal condition
• Phase 3: Rebuild lost structures
• Phase 4: Preserves the results obtained
• Prevent the recurrence of disease

Treatment Plan Short Answers

Question 1. Emergency Phase.
Answer:

Emergency Phase Involves:

1. Drainage of abscess

• Periapical abscess
• Periodontal abscess

2. Extraction of hopeless teeth

• If the teeth are so mobile that their function causes pain

Question 2. The sequence of Periodontal therapy.
Answer:

Question 3. Etiotropic Phase.
Answer:

• Etiotropic Phase is a non-surgical phase of the treatment plan
• Etiotropic Phase is phase I of the treatment plan

Etiotropic Phase Steps Involved:

• Patient’s education
• Oral prophylaxis
• Occlusal correction
• Excavation of caries
• Antimicrobial therapy
• Minor orthodontic movement
• Provisional splinting

Etiotropic Phase Importance:

• Elimination of etiological factors
• When successfully performed this phase stops progress- sion of the disease

Question 4. Maintenance phase.
Answer:

Maintenance Phase is phase IV of the treatment plan

Maintenance phase Steps Involved:

• Recall visits
• Rechecking the progression
• Examining pathologic changes

Maintenance phase Importance:

• Preserve the results obtain
• Prevent the recurrence of disease

Related Risk Factors Associated With Periodontal Diseases Short Essays

Question 1. Risk factors for periodontal disease.
Answer:

1. Environmental Smoking:

• Smoking increases the prevalence of periodontal disease

2. Systemic diabetes:

• Prevalence and severity of disease increases in diabetic patients

3. Biological pathogenic bacteria:

• Not the quantity but quality of bacteria determines the disease

Read And Learn More: Periodontics Question and Answers

4. Anatomic factors:

• Anatomic variations predispose to periodontitis as they are inaccessible area

Question 2. Define the following with examples.
Answer:

• Risk
• Risk determinants
• Risk Indicators
• Risk markers
• Risk factors

Risk: It is the probability that an individual will get a specific disease in a given period which may vary from one individual to other

Risk Determinants: Those risk factors that cannot be modified

Example: Genetic factors, Gender, Age, Stress, socioeconomic status

Risk Indicators: Probable/Putative risk factor that has been associated with the disease through cross-sectional studies

Example: HIV, osteoporosis, Infrequent dental visits

Risk markers: A factor that is associated with an increased probability of future disease. Ex. Previous dental history, bleeding on probing

Risk factor: This may be an environmental, behavioral/biological factor that when present increases the likelihood that an

Examples: Smoking, Diabetes, and Pathogenic bacteria.

Related Risk Factors Associated With Periodontal Diseases Short Question and Answers

Question 1. Cervical enamel projection.
Answer:

• Cervical Enamel Projection is a flat, ectopic extension of enamel
• Cervical Enamel Projection occurs primarily on molars- buccal surfaces of maxillary 2nd molars
• Cervical Enamel Projection extends beyond the cementoenamel junction
• Cervical Enamel Projection is associated with furcation involvement

Question 2. Palatogingival groove. individual will get the disease.
Answer:

• The Palatogingival Groove is a developmental groove
• Palatogingival Groove is found primarily on maxillary incisors
• Palatogingival Groove extends from the enamel to the root surface
• Palatogingival Groove is associated with
  • Increased plaque accumulation
  • Clinical attachment and bone loss