module 9- movement and orientation to the tooth surface

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Copyright © 2017 Wolters Kluwer • All Rights Reserved Copyright © 2014 Wolters Kluwer • All Rights Reserved Module 9—Technique Essentials: Movement and Orientation to Tooth Surface Section 1 Learning Periodontal Instrumentation

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Page 1: Module 9- Movement and Orientation to the Tooth Surface

Copyright © 2017 Wolters Kluwer • All Rights ReservedCopyright © 2014 Wolters Kluwer • All Rights Reserved

Module 9—Technique Essentials: Movement and

Orientation to Tooth Surface

Section 1Learning Periodontal Instrumentation

Page 2: Module 9- Movement and Orientation to the Tooth Surface

Copyright © 2017 Wolters Kluwer • All Rights Reserved2

Acquiring Psychomotor Skills

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What is Instrumentation?

-Instrumentation is a fine motor (psychomotor) skill-Involves small movements-Brain, nervous system, and muscles all work together-Psychomotor skills require complex movements and repeated practice

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Stages of Psychomotor Development

1. Observing2. Imitating3. Practicing4. Adapting

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Observing

-Mental attention to steps of psychomotor skill-Learned during preclinical instrumentation sessions

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Imitating

-Attempted copying of the psychomotor skill-Learner attempts each step following instructions-Movements are not smooth or automatic yet-Learner receives feedback on performance

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Practicing

-Attempting a psychomotor skill over and over-Entire sequence is performed repeatedly-Movements become smoother

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Adapting

-Fine-tuning of psychomotor skills-Minor adjustments are made to perfect the skill-Mentor provides perspective on how to improve or perfect the skill

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Psychomotor Skills and the Brain

-“Muscle memory”: frequently enacted muscle tasks that are stored in the brain-With practice movements become smoother, myelination occurs-Myelination is the process of forming myelin sheath around nerve to allow nerve impulses to move more quickly

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Psychomotor Skills and the Brain (cont.)

-Evidence suggests repeated practice of fine motor skills creates a denser myelin matter-Quality of practice is important, as the learner needs to repeat and improve movements toward perfection-Automaticity is the ability to perform a psychomotor skill smoothly, easily, and without frustration-We use automaticity everyday, for example, driving a car

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Strategies for Psychomotor Learning

-Guidance: step-by-step instructions-Practice: practice frequently with feedback-Feedback: obtain simple and timely feedback-Recognition self-assessment: recognize incorrect technique and assess performance-Practice beyond “getting it right”: frequent, sustained practice, each movement a permanent part of your brain

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Copyright © 2017 Wolters Kluwer • All Rights Reserved

Moving the Working-End

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Page 13: Module 9- Movement and Orientation to the Tooth Surface

Copyright © 2017 Wolters Kluwer • All Rights Reserved

Motion activation is the muscle action used to move the working-end of an instrument across a tooth surface.

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Page 14: Module 9- Movement and Orientation to the Tooth Surface

Copyright © 2017 Wolters Kluwer • All Rights Reserved

Finger Rest and Motion Activation

-During activation the fulcrum finger supports weight of hand to increase stability-Fulcrum assists in controlling movement of working-end-Fulcrum acts as a “brake” to stop movement at end of stroke

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Page 15: Module 9- Movement and Orientation to the Tooth Surface

Copyright © 2017 Wolters Kluwer • All Rights Reserved

Tiny Movements

It is important to remember that instrumentation strokes are TINY movements.The working-end moves only a few millimeters with each stroke.

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Page 16: Module 9- Movement and Orientation to the Tooth Surface

Copyright © 2017 Wolters Kluwer • All Rights Reserved

Types of Motion Activation

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Page 17: Module 9- Movement and Orientation to the Tooth Surface

Copyright © 2017 Wolters Kluwer • All Rights Reserved

Two Types of Motion Activation

-Wrist-rocking motion -Digital activation

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Page 18: Module 9- Movement and Orientation to the Tooth Surface

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Wrist-Rocking Motion

-The hand, wrist, arm work as a unit to produce a rotating motion used to move the working-end of an instrument-Less fatigue using wrist-rocking motion than finger movements-Motion similar to action of turning a door knob

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Wrist-Rocking Motion (cont.)

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Wrist-Rocking Motion (cont.)

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Page 21: Module 9- Movement and Orientation to the Tooth Surface

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Uses of Wrist-Rocking Motion

-Used for all calculus removal with hand-activated instruments-Allows the clinician to maintain a neutral upper body posture-Keeps the workload on forearm and wrist, instead of hand and fingers-The fulcrum finger supports the weight of the hand

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Page 22: Module 9- Movement and Orientation to the Tooth Surface

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Digital Motion Activation

-Moving the instrument by flexing the thumb, index, and middle fingers-Used whenever physical strength not required during instrumentation-Moves the instrument by making push-pull movements with fingers

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Digital Motion Activation (cont.)

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Uses of Digital Motion Activation

-Used primarily with ultrasonic instruments, also used with periodontal probes, explorers-Not recommended for calculus removal with hand instruments-May be used to instrument restricted areas, such as furcations of multirooted teeth

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Page 25: Module 9- Movement and Orientation to the Tooth Surface

Copyright © 2017 Wolters Kluwer • All Rights Reserved

Recap

Brain–Body coordination is needed to learn psychomotor skills.Motion activation is the muscle action used to move the working-end of an instrument across a tooth surface.Wrist-rocking motion activation is used for calculus removal with hand-activated instruments.Digital motion activation is used with ultrasonic instruments when physical strength is not required.

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Page 26: Module 9- Movement and Orientation to the Tooth Surface

Copyright © 2017 Wolters Kluwer • All Rights ReservedCopyright © 2014 Wolters Kluwer • All Rights Reserved

Module 9—Technique Essentials: Movement and

Orientation to Tooth Surface

Section 2Moving the Instrument’s Working-End

Page 27: Module 9- Movement and Orientation to the Tooth Surface

Copyright © 2017 Wolters Kluwer • All Rights Reserved

Topics

-Rolling the instrument handle-Pivoting on the fulcrum

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Page 28: Module 9- Movement and Orientation to the Tooth Surface

Copyright © 2017 Wolters Kluwer • All Rights Reserved

Rolling the Instrument Handle

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Page 29: Module 9- Movement and Orientation to the Tooth Surface

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Rolling the instrument handle is turning the handle between the thumb and index finger.

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Page 30: Module 9- Movement and Orientation to the Tooth Surface

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Purpose of Rolling the Handle

-Maintains precise contact of the working-end to the tooth surface as it moves around the tooth-Drive finger is either the index finger or the thumb, which determines the direction in which the working-end turns

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Page 31: Module 9- Movement and Orientation to the Tooth Surface

Copyright © 2017 Wolters Kluwer • All Rights Reserved

Rolling

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Page 32: Module 9- Movement and Orientation to the Tooth Surface

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Pivoting on the Fulcrum

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Page 33: Module 9- Movement and Orientation to the Tooth Surface

Copyright © 2017 Wolters Kluwer • All Rights Reserved

Pivoting is a slight swinging motion of the hand and arm carried out by balancing on the fulcrum finger.The pivot is a tiny movement used to reposition the hand.The pivot supports an object as it turns or rotates.

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Page 34: Module 9- Movement and Orientation to the Tooth Surface

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Purpose of Pivoting on the Fulcrum

Pivoting assists the clinician in maintaining adaptation as the working-end moves around the tooth.Pivoting is used principally when moving around a line angle onto a proximal surface.

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Page 35: Module 9- Movement and Orientation to the Tooth Surface

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Pivot

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Page 36: Module 9- Movement and Orientation to the Tooth Surface

Copyright © 2017 Wolters Kluwer • All Rights Reserved

RecapRolling the instrument handle helps the clinician maintain precise contact of the working-end to the tooth surface.Pivoting on the fulcrum finger assists the clinician in keeping the working-end against the tooth as it moves around the tooth.

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Page 37: Module 9- Movement and Orientation to the Tooth Surface

Copyright © 2017 Wolters Kluwer • All Rights ReservedCopyright © 2014 Wolters Kluwer • All Rights Reserved

Module 9—Technique Essentials: Movement and

Orientation to Tooth Surface

Section 3Rolling the Instrument Handle

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Copyright © 2017 Wolters Kluwer • All Rights Reserved

Orientation of Instrument to Tooth Surface

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Page 39: Module 9- Movement and Orientation to the Tooth Surface

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Topics

-Angulation of teeth in dental arches-Orientation to tooth surface

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Page 40: Module 9- Movement and Orientation to the Tooth Surface

Copyright © 2017 Wolters Kluwer • All Rights Reserved

Angulation of Teeth in Dental Arches

The placement of the working-end in relation to the tooth surface being instrumented is a critical element in periodontal instrumentation.A correct visual picture of true angulation of teeth in dental arches assists in correct placement of the working-end on root surfaces.

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Page 41: Module 9- Movement and Orientation to the Tooth Surface

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Positions of Teeth

-Most teeth are not positioned vertically in dental arches-Most teeth are tilted in dental arches

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Page 42: Module 9- Movement and Orientation to the Tooth Surface

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Maxillary Roots Incline Inward

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Page 43: Module 9- Movement and Orientation to the Tooth Surface

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Mandibular Roots

Mandibular anteriors: tilt inwardMandibular premolars: more verticalMandibular molars: tilt outward

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Page 44: Module 9- Movement and Orientation to the Tooth Surface

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Mandibular Roots Orientation

A. Incorrect angulation to proximal B. Correct angulation to proximal

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Page 45: Module 9- Movement and Orientation to the Tooth Surface

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Orientation to Tooth Surface

-Each tooth has many surfaces, each with its own orientation or surface plane-Orientations of crown surfaces differ from the orientations of root surfaces

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Page 46: Module 9- Movement and Orientation to the Tooth Surface

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Tooth Surface Planes

-Colored lines show surface orientations

-Note differences in orientations between crown and root surfaces

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Page 47: Module 9- Movement and Orientation to the Tooth Surface

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Proximal Surfaces

Incorrect Correct

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Page 48: Module 9- Movement and Orientation to the Tooth Surface

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Facial and Lingual Surfaces

Incorrect Correct

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Page 49: Module 9- Movement and Orientation to the Tooth Surface

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Proximal Surfaces (cont.)

Incorrect Correct

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Page 50: Module 9- Movement and Orientation to the Tooth Surface

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Facial and Lingual Surfaces (cont.)

Incorrect Correct

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Page 51: Module 9- Movement and Orientation to the Tooth Surface

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Probe: Correct Orientation Maxillary

-Correct orientation to mesial surface

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Page 52: Module 9- Movement and Orientation to the Tooth Surface

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Probe: Correct Orientation Mandibular

-Correct orientation to mesial surface

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Page 53: Module 9- Movement and Orientation to the Tooth Surface

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Recap

A correct visual picture of true angulation of teeth in dental arches assists in correct placement of the working-end on root surfaces.Initial placement of the working-end begins by correct orientation to the tooth surface plane.

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