module 11-instrumentation strokes

Module 11—Technique Essentials:

Instrumentation Strokes

Section 1The Instrumentation Stroke

Characteristics of Instrumentation Strokes

The instrumentation stroke is the act of moving the working-end against the tooth surface.Instrumentation strokes can be:

– Calculus removal strokes– Exploratory strokes to detect calculus

Movement of the Working-End

As the working-end moves across the tooth surface, consider the location of the junctional epithelium.

Junctional epithelium is the soft epithelial tissue forming the base of a gingival sulcus.

Sharp cutting edges or tips of instruments could injure the junctional epithelium.

Stroke Direction

Instrumentation Strokes

Instrumentation strokes are made in a coronal direction, away from the soft tissue base of the sulcus or pocket.Stroke direction varies depending on the tooth surface being instrumented.

Three Stroke Directions

Vertical/ObliqueHorizontalMultidirectional

Stroke Directions

Vertical Strokes

-On anterior teeth, vertical strokes are used on the facial, lingual, and proximal surfaces.-On posterior teeth, vertical strokes are used on mesial and distal surfaces.

Oblique Strokes

-Used on the facial and lingual surfaces of posterior teeth

Horizontal Strokes

Used:-At line angles of posterior teeth-In furcation areas-In deep, narrow pockets

Horizontal Strokes (cont.)

-Used on the narrow root surfaces of anterior teeth

During instrumentation sharp cutting edges or tips should not come in contact with the junctional epithelium.Instrumentation strokes can be made in different directions: vertical, oblique, horizontal, or multidirectional, which are a combination of all three directions.

Module 11—Technique Essentials: Instrumentation

Strokes

Section 2Use of Pressure During

Instrumentation

Types ofInstrumentation Strokes

Three Types of Instrumentation Strokes

Assessment strokeCalculus removal strokeRoot debridement stroke

1. Assessment Stroke

Assessment Stroke

-Used to evaluate the tooth surface-Used with explorers to locate calculus deposits-Also known as exploratory stroke-Used to reevaluate tooth surface after calculus removal

Characteristics of Assessment Stroke

-Fingers relaxed in modified pen grasp-Flowing, feather-light stroke of moderate length-Contacts the tooth, but no pressure is applied against the tooth surface for this stroke

2. Calculus Removal Stroke

Calculus Removal Stroke

-Used to remove calculus deposits off of the tooth surface-Used with curets and sickle scalers

Characteristics of Calculus Removal Stroke

-Short, controlled, biting stroke used to remove a calculus deposit from tooth-Firm lateral pressure of cutting edge applied against the tooth during this brief stroke-At start of stroke, press fulcrum finger down against the tooth

3. Root Debridement Stroke

Root Debridement Stroke

-Used to remove residual calculus deposits, bacterial plaque, and byproducts from (1) root surfaces that are exposed in the mouth because of gingival recession and (2) root surfaces within deep periodontal pockets

Characteristics of Root Debridement Stroke

-Lighter, shaving stroke of moderate pressure-Used with curets-Stroke length slightly longer than calculus removal stroke-Light pressure is applied against the cementum during this stroke

Root Surfaces

-Conservation of cementum facilitates tissue healing-Important function of cementum is to attach periodontal ligament fibers to root surface-Root debridement stroke used with light pressure -Conservation of cementum should not be confused with failure to remove calculus deposits

Use of Pressure During Instrumentation

During instrumentation, different tasks will require different applications of pressure. There are three pressure forces of the instrumentation stroke.

-Pinch pressure of fingers in modified pen grasp

-Pressure of the fulcrum finger to stabilize the hand

-Lateral pressure against the tooth during instrumentation stroke

Assessment Stroke and Pressure

-Light pinch pressure with grasp-Light pressure on fulcrum-Feather-light pressure as working-end moves over the tooth surface

Calculus Removal Stroke and Pressure

-Instrument held with moderate pinch pressure-Firm pressure against fulcrum-Firm lateral pressure applied as cutting edge “bites” into tooth surface (hand rests between strokes)

Root Surface Debridement Stroke and Pressure

-Instrument held with moderate pinch pressure-Moderate pressure applied on fulcrum finger-Moderate lateral pressure applied as cutting edge performs “shaving” stroke

Recap: Three Types of Strokes

Assessment strokeCalculus removal strokeRoot debridement stroke

Recap: Ergonomics of Stroke Pressure

-The three pressure forces of instrumentation strokes should be balanced during strokes-Unnecessary or constant firm pressure becomes a bad habit-Gauge amount of pressure, apply with brief pressure, and relax after each stroke

Step-by-Step Technique

Assessment Stroke

1. Get Ready

Place working-end of the explorer in the middle-third of the crown.

Slide the explorer tip beneath the gingival margin, keeping tip against tooth. Insert until the explorer touches the soft tissue at the base of the pocket.

2. Insert

3. Make a Stroke

Make a light stroke away from the soft tissue base of the pocket.Keep your fingers very relaxed in the grasp.

4. Stop the Stroke

Stop each stroke just beneath the gingival margin.

5. Make a Series of Strokes

Make a series of feather-light strokes across the facial surface.

Characteristics of Assessment Strokes

-Flowing, feather-light stroke of moderate length-Contacts the tooth, but no pressure applied against the tooth surface for this stroke

module 11-instrumentation strokes

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