Periodontal Assessment &

Introduction to Instrumentation Concepts

Basic Dental Care Periodontology

Pre-Laboratory Lecture 1
16th October 2023

Peter Harrison
 Introductory Lectures – Some Key Concepts
• Periodontal diseases are common

• Periodontal diseases are multi-factorial. Plaque biofilm is identified as the primary aetiologic agent for
gingivitis and periodontitis

• Periodontitis progression has negative impact for patients in terms of clinical outcomes (clinical
attachment loss, bone loss and ultimately tooth loss) and possible systemic effects

• Gingivitis and periodontitis represent a continuum of disease wherein gingivitis precedes periodontitis but
not all cases of gingivitis progress to become periodontitis

• Since disease is frequently asymptomatic and unevenly distributed in the population, clinicians must
evaluate the gingival/periodontal tissues for signs of health and disease

• Since plaque biofilm & calculus have a major aetiologic role – their control represents an important step in
modifying disease → rationale for prevention & instrumentation
 Aims of BDC Periodontology course

To provide foundational skills in:

• Examination of the periodontal tissues

• Preventive approaches for plaque control

• Non-surgical treatment of gingivitis/periodontitis

 Learning Objectives

• Highlight the purpose of periodontal screening & examination

• Compare and contrast screening assessment Vs comprehensive examination

• Overview the technique used for screening assessment – the Basic Periodontal Exam (BPE)

• Introduce the basic technique for periodontal probing

• Overview the instruments used for non-surgical therapy at DDUH, and their basic characteristics

• Discuss the (sickle) scaler instrument – used for supragingival instrumentation

Periodontal assessment
 Purpose of Periodontal examination

Why do we assess for periodontal diseases?

• Periodontal diseases are prevalent

• Negative outcomes of untreated disease and Purpose of assessment – individual

“delayed” treatment
• Establish whether disease is present
• Positive impact of prevention and treatment
• Quantify nature, extent, severity.

• Establish possible contributory factors

• Allow us to make a diagnosis

• This guides treatment delivery
 Patient History
Gathering information before we start

• Presenting Complaint • Social & Family History

• Symptoms • Risk Factors
• Case history • Tobacco Use
• Genetic predisposition
• Socioeconomic predisposition
• Patient Expectations • Stress
• Understand motivations for seeking care
• Are they realistic Vs likely outcomes?
• Dental History
• Attendance history
• Medical History • Previous treatment
• Allergic reactions • Symptoms & signs
• Systemic disease • Attitude to dental care
• Medications
• Risks (Cardiovascular/Infective/Bleeding disorders)
• Oral Hygiene Habits
• Interest/motivation – context for plaque control
• COVID-19 History • Appliances/aids used
• Symptoms
• Close contacts
• Overseas travel
• Vaccination status
 Assessment of the Periodontium

Visual Clinical Radiographic

assessment measurements assessment
 Visual Assessment
Characterise Gingival Appearance Note Biofilm/Local Factors
• Plaque/Calculus
• Colour • Malposition/Restoration Margins etc.
• Contour
• Tone Assess for possible signs of disease exposure/history
• Texture • Gingival Recession/Attachment Loss
• Missing Teeth
 Healthy periodontium
Clinical Features
• Favorable gingival colour, contour , tone
• No visual signs of inflammation
• Pocket depths ≤3mm
• No clinical attachment loss

Radiographic Features
• Height of bone crest 1-2mm apical to CEJ
• Crest appears radiopaque; runs parallel to a line between the CEJs.
• Lamina dura – visible radiopaque line (cortical bone) around the root
• PDL space visible and relatively uniform thickness
 Gingivitis

• Visual signs: redness of the gums and evidence of

inflammation

• Clinical sign: Bleeding on Probing (BoP)

• Associated with plaque (biofilm) accumulation at the

gingival margin (gum line)

• Reversible if plaque control can be instituted effectively

 Periodontitis
• Visually: more notable inflammatory signs and often evidence
of changes in tissue architecture. Impact of historic changes
may be evident

• Clinical signs:
• Bleeding on probing
• Increased probing depth
• Various signs of damage to periodontal tissues (Gingival recession,
furcation involvement, tooth mobility etc.)

• Inflammation progresses to result in irreversible damage to

supporting structures of the tooth
• Clinically, manifests in loss of clinical attachment
• Radiographically, manifests in radiographic bone loss
• Ultimately, may result in tooth loss
 Visual Assessment - Clinical Signs

SIGN HEALTHY GINGIVA GINGIVITIS PERIODONTITIS

COLOUR Coral pink – Light red Increased redness Red/Bluish red

Change first at papillae and margins
Thin Swelling occurs at margin and may Swelling &
CONTOUR Well-adapted extend over time to rest of gingiva Recession may be present
Scalloped (wavy) profile
Papillae fill embrasures
TONE Firm, resilient Decrease in tone Poor tone
May be poorly adapted
TEXTURE (SURFACE) Stippling (orange-peel appearance; ~ Spongy Spongy
40% patients) May become smooth and shiny
PROBING DEPTH ≤3mm May increase due to pseudo-pockets Increased

BLEEDING ON PROBING No Increased Increased

(BOP) (Gingivitis “case”: BOP≥ 10%)
ADDITIONAL SIGNS Suppuration (pus)
Tooth migration
Mobility / Furcation involvement
Radiographic bone loss
 Assessment of the Periodontium

Visual Clinical Radiographic

assessment measurements assessment
 Clinical periodontal examination
Armamentarium Aids
• Periodontal probe • Good lighting
• Mirror • Clean and dry environment
• Furcation (Nabers) probe
• Explorer • Air deflection
• Radiographs
• Special tests
 What clinical parameters are considered?
• Plaque
• Periodontal pockets (probing pocket depth)
• Bleeding on probing
• Suppuration (pus) on probing
• Gingival recession
• Furcation involvement
• Tooth mobility

• To do this for every patient would be very time consuming.

→ Hence, screening tools have been developed for general practice to help
determine which patients might need comprehensive examination
 Options: Screening Vs Comprehensive periodontal exam

Screening Assessment Comprehensive Periodontal Exam

Detail (Parameters included) All parameters considered All parameters recorded

Recording Method Mouth divided into sextants for recording Recording at all teeth

Measurements/Data One record per sextant Extensive data (6 sites per tooth)

Time Fast (<5 minutes) Time consuming (20-30 minutes)

Level of Detail Not detailed enough for severe periodontal Overly detailed for non/mild periodontal
conditions conditions
 Screening Vs Comprehensive perio exam
• Periodontal diseases are common but not everybody is affected
• Recognise that comprehensive examination takes much longer than screening assessment

Practical Approach
• Every new patient → periodontal screening
• If screening suggests periodontal disease → comprehensive periodontal exam
• If past history of periodontitis → comprehensive periodontal exam

Screening: BPE Comprehensive Periodontal Exam

 Periodontal Screening

Overview
• Various screening tools exist
• Mostly devised in 1990s and based on World Health Organisation (WHO) assessment tool (CPITN)

Basic premise
• Ideally, use a specialised probe
• Ball-end 0.5mm
• Black band from 3.5-5.5mm
• Examine probing depth and core clinical signs in each sextant
• Clinical index: Record the worst finding per sextant
• Denoted by a single number
• “*” can be used to identify additional clinical disease factors

Common variations in use

• PSR (Periodontal Screening & Recording) devised in 1992 by AAP
• (BPE) Basic Periodontal Exam is modified version by BSP
• Guidelines are periodically updated & align with Flowchart used at DDUH to apply the 2017 Classification
 Periodontal Screening - Advantages

• Simple
• Cheap
• Cost-effective
• Simplifies record keeping
• Satisfies medico-legal requirements*
• Motivates & educates patient

* Once you act appropriately on scores

 Screening - Basic Periodontal Exam (BPE)
Screening Process
• Mouth divided into 6 zones (sextants)
• All teeth in each sextant examined (except for
3rd molars)
• Sextant must have ≥2 teeth to be scored
• Ideally, a specialised probe is used
• Scores are recorded on a grid
• Sextants:
BPE codes
• 0 = Health, all pockets ≤ 3.5mm
• 1= Bleeding on probing, all pockets ≤ 3.5mm
• 2 = Calculus or other plaque-retentive factor
present, all pockets ≤ 3.5mm
• 3 = Pocket depth between 3.5-5.5mm
• 4 = Pocket depth >5.5mm
• * = Furcation involvement

17-14 13-23 24-27

47-44 43--33 34-37

Actions
• Code 3 in one sextant: Perform detailed periodontal charting in that sextant
• Code 3 in >1 sextant: Perform full-mouth charting
• Code 4: Perform full-mouth charting
• Where * is recorded, both the number and * should be recorded for that sextant

Salud: Uses BPE screening as standard from 2022/2023

 BPE – Codes & Implications for Treatment

Score 0 1 2 3 4
Description Coloured area of probe completely PD<3.5mm PD<3.5mm Coloured area of probe remains Coloured area of probe
visible (PD< 3.5mm) - Healthy Bleeding on probing (BOP) is Supra- or sub-gingival calculus is partially visible (PD 3.5mm – disappears (PD >5.5mm)
gingivae present detected 5.5mm)
And/or
• No BOP • No calculus Defective margins detected
• No calculus • No defective margins
• No defective margins

Treatment 1. Reinforce Preventive Care 1. OHI 1. OHI 1. Comprehensive periodontal 1. Comprehensive (Full
2. Therapy as indicated, 2. Therapy as indicated, including: charting of affected sextant mouth) exam &
Implication including: • Calculus removal indicated charting indicated to
• Subgingival plaque removal • Subgingival calculus removal assess treatment
• Correction of plaque retentive needs
margins Classic PSR Approach
A. If ≥2 sextants score Code 3:
• Comprehensive (Full mouth)
exam & charting to assess
treatment needs
 Screening assessment in practice: Summary
New patients
• All new patients should have screening assessment
• If scores of 0/1/2 recorded, should treat as necessary and then conduct screening at each subsequent assessment
appointment
• If scores 3/ 4/ * recorded, assess in greater detail and treat according to findings

Following periodontal treatment

• Screening cannot be used to monitor the response to periodontal therapy → doesn’t provide information about
how sites within a sextant change after treatment.
• To assess the response to treatment, a comprehensive examination (6-point pocket chart) should be recorded
before and after treatment

Periodontitis cases in supportive care

• For patients who have undergone initial therapy for periodontitis, and who are now in the maintenance phase of
care, then comprehensive periodontal assessment should be recorded at least annually

Remember
• Screening is solely a tool to assist you in patient management.
• Use your clinical judgment to decide what is most appropriate in individual cases
If comprehensive examination is indicated…
 Comprehensive Periodontal Examination
– What Should Be Assessed?
• Visual gingival • Periodontal Pockets
assessment (Probing Depth)
• Bleeding on Probing • Recession/Attachmen
• Suppuration t Loss
• Tooth Mobility
• Furcation
Involvement
Assessing the Assessing Loss of
gingiva Supporting Tissue

Radiographic Assessing
assessment Compliance

• Is bone loss present? • Plaque Control Record

• If so…Pattern/Extent/
Severity
Periodontal Examination - Salud
 Periodontal Probing
• Measures the distance from gingival margin to the most apical part of the
gingival sulcus or, (in pathologic situations), the gingival pocket

• Gingival margin ↔ base of sulcus/pocket

 Probing Technique - Summary
• Grasp
• Probe is held with light pen grasp

• Probing force
• Light, akin to dabbing a paintbrush (15-25g)

• Adaptation
• Side of probe tip kept in contact with tooth surface
• Angle probe slightly at interproximal to assess fully

• Parallel to tooth surface

• Mesiodistal direction & Buccolingual direction

• Probing sequence
• Buccal (Right to Left)
• Palatal (Left to Right)

• Walking Stroke
 Probing in action - Walking Stroke
• Maintain light pressure - insert probe into sulcus until it meets gentle resistance

• Probe tip is maintained against tooth surface

• Cover the full circumference of the sulcus/pocket base

→ Base of pocket not necessarily at a uniform level around tooth

The “Walking Stroke”

• Probe moved in:
• Short vertical “bobbing” strokes (↕) and
• Progressed laterally about 1mm at a time (↔)
• Each time returning to base of pocket
• Not a “pogo” action!
• Don’t remove probe from pocket with each motion
 Probing Sequence
Maxillary Arch
1. Buccal
Start at DB of 1.8, move left across arch
1
2. Palatal
Return from DL 2.8, advancing right 2

Mandibular Arch
4
3. Buccal 3
Start at DB of 4.8, move left across arch
4. Lingual
Return from DL 3.8, advancing right
 Probing - Salud

• Follows the same sequence (as in previous slide)

• Next site to chart is highlighted in yellow
 Probing Depth Measurements - Zones

• 6 readings per tooth

• Rounded to nearest full millimetre
DB B MB

• 6 zones (a.k.a. “sites”) per tooth

• Distobuccal DL L ML
• Buccal (Facial)
• Mesiobuccal
• Distolingual
• Lingual (Palatal)
• Mesiolingual
B
DB MB

• Dividing point between adjacent zones is the

line angle
• An imaginary line formed where 2 tooth surfaces DL L ML
meet i.e. where each flat surface meets
interproximal surface
 Periodontal Probing - Challenges

• Gingival margin is not a fixed reference point

• Can move due to inflammation/overgrowth or receding etc.

• Potential for inaccuracy

• Probing technique
• Angle of probe insertion
• Probing force
• Size/diameter of probe tip
• Accuracy of probe calibration
• Inflammatory status of tissues
• probe penetration is increased in inflamed tissues
 Assessment of the Periodontium

Visual Clinical Radiographic

assessment measurements assessment
 Radiographic Assessment
What features are we looking at?

Indicators of Health Periodontium

• Alveolar Crest

• Crestal Bone height 1-2mm apical to CEJ

• Lamina Dura • Crest appears radiopaque and runs
parallel to a line between the CEJs.
• Lamina dura intact - Radiopaque line
continues around the root
• Periodontal Ligament (PDL)
space • PDL space visible and relatively uniform
thickness
 Radiographic signs of periodontal disease
• Radiographic assessment is conducted only following clinical assessment
• It is an adjunctive measure to clinical evaluation

• Radiographic bone loss - described in terms of:

• Distribution (localised/generalised/molar-incisor)
• Pattern (horizontal/vertical)
• Severity (proportional bone loss relative to root length)
 Radiographic signs of periodontal disease
• Radiographic bone loss - Described in terms of: Distribution / Pattern / Severity
• Additional evidence of pathology and/or local complications may also be evident

Separate lecture on this in 3rd Year

Introduction to Non-surgical treatment concepts
 Treatment of Periodontal Disease
EFP Clinical Practice Guideline 2020

Step 4
• Supportive
Step 3 periodontal care
• To maintain
• Treatment of areas
Step 2 not responding to
stability
Step 2 • Personalised,
• Subgingival biofilm lifelong
Step 1 control & calculus
• Repeated sub-
gingival
removal
• Address OH & instrumentation
other risk factors • Surgical therapy
• Supragingival
biofilm control

BDC: focus on steps that every patient receives

 Goals of Periodontal Treatment
• Remove deposits from tooth surfaces

• Eliminate micro-organisms in biofilm

• Eliminate plaque-retentive irregularities

• Create environment that helps in maintaining gingival tissue health

• Increase effectiveness of patient’s home care

 How do we create an effective process for
plaque and calculus removal?

• PLAQUE – easy!
• Soft deposit
• Generally visible/accessible

• CALCULUS – not so easy!

• Mineralised (hard) deposit
• Sub-gingival deposits “hidden” and challenging to access
 Non-Surgical Treatment Approaches
Scaling
– Instrumentation of the crown and/or root surfaces to remove plaque, calculus and stains

Root Planing
– Removal of the plaque or calculus and softened cementum from periodontally-involved root surfaces, so
the root surfaces are made hard and smooth.

Root Debridement
– Removal of plaque biofilm and calculus deposits from crown and/or root surfaces and within the pocket
space
– Does not include intentional removal of cementum

Under new treatment guidelines, these procedures are now collectively referred to in the literature as:
PMPR (Professional Mechanical Plaque Removal)
Non - Surgical: Instrument selection options

Non –Surgical
Instrumentation

Hand Powered
Instruments Instruments

Files
Scalers Curettes Hoes Sonic Ultrasonic
Chisels

Area-specific
Universal Piezoelectric Magnetostrictive
(Gracey)
 Non-Surgical Instruments @ DDUH – Your Kit

Powered Instruments
Diagnostic Hand Instruments Sharpening
 Non-surgical instrumentation at DDUH
Hand instruments
• Supra-gingival plaque & calculus removal: Sickle scaler

• Sub-gingival calculus removal: Gracey curettes

Powered instruments
• Supra-and sub-gingival plaque & calculus removal: Ultrasonic scaler

• ± Stain (and supra-gingival plaque) removal: Coronal polishing (Prophy

handpiece)
Non - Surgical: Instrument selection options

Non –Surgical
Instrumentation

Hand Powered
Instruments Instruments

Files
Scalers Curettes Hoes Sonic Ultrasonic
Chisels

Area-specific
Universal Piezoelectric Magnetostrictive
(Gracey)
Overview of Hand Instruments
Dental Science Scaling Kit – Hand instruments

⚫Periodontal Probe
⚫Mouth Mirror
▪ Supra-gingival
⚫H6/H7 (Sickle) Scaler ▪ Universal
⚫SAS 1/2 R6 Curette
⚫SG 5/6 R6 Curette
⚫SG 9/10 Curette ▪ Supra- & sub-
gingival
⚫SG 11/12 Curette ▪ Area-specific
⚫SG 13/14 Curette
Non-surgical hand instruments - parts
• Handle
• Shank
• Blade (a.k.a. “working end”)
 Innovation and Modification– Summary

• Focus: Improving operator comfort & instrumentation efficiency

• Curettes and scalers have seen design modifications affecting handle, shank, and tip/blade.

• Instrument handles
• Use of wider, lighter weight handles with a more ergonomic design.
• Resin covered for a more comfortable grip (e.g., elliptically shaped “cushion” grips)
• Texturing for improved rotational control.

• Instrument shank
• Elongated shanks allow improved access in deeper pockets (≥5 mm)
• Rigid Gracey curettes more normally used for medium-to-heavy calculus removal - shank diameter thicker and less flexible than
standard Graceys to reduce operator hand fatigue.

• Instrument tip
• Thinner, shorter blades allow easier access/insertion & improved control in deeper pockets (≥5 mm).
• Instrument tip materials may be modified, e.g.”EverEdge® Technology (Hu-Friedy) –stays sharper longer
 Hand Instruments - DDUH
• Scaler
• Used for supragingival calculus removal/scaling
• 2 cutting edges
• Triangular cross-section
• Pointed tip
• Instrument face at 90° to terminal shank

• Curette (Area-specific curettes (Gracey) used at DDUH)

• Used primarily for subgingival instrumentation (Can also be used supra-
gingival)
• One-cutting edge
• Semi-circular cross-section
• Rounded toe
• Instrument face offset relative to terminal shank → lower edge is cutting
edge

Most efficient angle for calculus removal is achieved when terminal (lower) shank is parallel to long-axis of
root surface
 Instrument Surfaces
SICKLE SCALER (CURVED BLADE) GRACEY CURETTE

Tip Face Toe

Face

Back Lateral surface Lateral surface

Back

Face Cutting edge

Face

Lateral surface
Lateral surface

Back
Back
 Supra-gingival instrumentation: Sickle Scaler
Functions
• Removal of medium-large supragingival calculus deposits
• Excellent at proximal surfaces of anterior crowns and surfaces apical to contact points of posterior
teeth
• Supragingival use only - NOT recommended for use subgingival
• Anterior and posterior instruments available

Design features
• 2 cutting edges per working end (4 total) – “universal”
• Triangular cross-section (more rounded towards heel)
• Lateral surfaces meet face at approx. 70 angle
• Pointed tip
• Face is perpendicular to lower shank Cutting edge

Use
• Correct angulation achieved by tilting lower shank
slightly toward tooth surface*
• Adaptation: Use tip-third of working end
 Subgingival Instrumentation: Curettes
Curette Universal Area-specific (Gracey)
Cutting edges 4 total (2 each end) 2 total (one each end)
Tip/Toe form Rounded toe Rounded toe
Cross-sectional shape Semi-circular Semi-circular
Face of face relative to lower shank Face at 90⁰ to lower shank Face offset at 70⁰ - tilted so one side is
lower
Cutting edge location One on each side of working end Lower edge is cutting edge
Use Universal – any tooth surface Area-specific
Shank usually angulated to accommodate Designed for use at specific teeth/surfaces
 Subgingival Instrumentation: Gracey curettes
• A selection of of these is usually sufficient…DDUH scaling kit has 5 Gracey curettes

• Anterior instrument (1/2)

• Anterior & premolar (multipurpose) (5/6)
• Posterior mesial (11/12)
• Posterior distal (13/14)
• Buccal/lingual (premolar & molar) (9/10)

1/2 5/6 9/10 11/12 13/14

 Area-specific curettes (Graceys)
Functions
• Debridement of crown and root surfaces
• Standard curettes: use for removal of plaque and light calculus deposits
• Rigid/extra-rigid curettes: Can also use for larger/tenacious deposits

Design features
• Area-specific - Anterior & posterior instruments available
• 1 cutting edge per working end
• Lower edge is always the cutting edge
• Shank shape varies by location of use → single-digit first number designation implies straight shank

Use
• For correct angulation: Lower shank is parallel to tooth surface to be instrumented
• Adaptation:
• Vertical/Oblique strokes (most strokes): Adapt tip-third of working end against tooth
• Horizontal strokes: Larger area of working end can be in contact with tooth surface
 “Area – specific”
Determining area of appropriate use:

• Shank shape (turn shank with toe down)

• Straight – anterior/easily accessible surface (flat buccal/lingual)
• Curved – posterior interproximal (curved to adapt to hard-to-reach areas)

• Number designation
• Single-digit first number designation (e.g. “5/6”) implies straight shank
• Double-digit first number designation (e.g. “11/12”) implies curved shank
Core Concepts: Grasp & Fulcrum
 Preparation for hand instrumentation
• Understanding your instruments

• Grasp Lab: Day 1

• Modified pen grasp

• Maximising positioning (operator/patient)

• Ergonomics - repetitive task Lab: Later sessions

• Positioning
• Grasp
• Direct vs indirect vision
• Instrument design
• Instrument selection: Hand instrument vs Powered (ultrasonic)
 Instrument Grasp

▪ Proper grasp will:

▪ Increase:
▪ Tactile sensitivity
▪ Control
▪ Stability

▪ Decrease:
▪ Finger fatigue
▪ Trauma to hard and soft tissues
 Instrument Fulcrum
Functions
• Stabilizes the hand
• Supports the weight of the hand
• Provides a firm support to “activate” the instrument

Benefits
• Enables the hand and instrument to move as a unit
• Minimises potential for slippage/unsupported movement → prevents
laceration or injury to gingiva

Positioning
• Ideal placement is as close as possible to the tooth being instrumented
• This is not always possible → alternative fulcrum options often required
Instrumentation – Basic Concepts
 Hand instrumentation for plaque and calculus removal
Basic concepts
• Select the appropriate instrument

• Adaptation of instrument
• Place the instrument correctly in contact with tooth

• Staying adapted
• Stabilise your working hand – Use a fulcrum for support and flexibility
• Apply appropriate (lateral) pressure against the tooth so the instrument engages to remove deposits

• Activating the instrument (Movement & effort)

• Probing/ plaque removal - Light effort required - Digital (finger) – like using a paintbrush
• Calculus removal - Requires more effort - Wrist activation – like opening a doorknob

• Instrument strokes
• Move the instrument effectively to disengage deposits
• Strokes should overlap and their nature depends on the site and tenacity of the deposit
Scaling
 Scaling - Treatment Approach

• Instrumentation of the crown (and/or root*) surfaces to remove plaque, calculus

and stains

• Generally considered in the context of supragingival instrumentation

• Conceptually, this is most likely to address

• Plaque deposits

• Accessible (and probably less mineralized) calculus deposits, at the locations most associated

with supragingival accumulations

Summary
 Pre-Laboratory Lecture 1 - Summary
• Distinctive visual and clinical features can be used to differentiate periodontal health
from disease

• Clinical & radiographic changes may result from the disease process (These changes
correspond to histologic changes evidenced within the supporting tissues)

• All patients should receive periodontal screening, which will assist the clinician in
determining who needs more detailed examination

• Periodontal probing is a key step used by clinicians in the clinical examination

 Pre-Laboratory Lecture 1 - Summary

• Non-surgical treatment includes the control of plaque biofilm and local factors that favour
plaque accumulation e.g. calculus

• Various instruments may be used in treatment

• Powered Vs Hand
• Supragingival Vs Subgingival

• Scaling is used as the principal method for removal of supragingival plaque biofilm and
calculus
 Next Steps...
Laboratory Session 1

• Introduction to Periodontal Manikin - Uses & Limitations

• Periodontal Probing Technique
• Scaling kit – Instrumentation identification
➢ What’s in your kit?
➢ Identify instrument surfaces
➢ Differentiate Scaler Vs Curette
➢ Distinguish different curettes using basic design features

• Instrument grasp
• Supragingival instrumentation – sickle scaler