Dentaltown November 2017 - 115

PICTORIAL

CURVED ULTRASONIC INSTRUMENTS
Maximizing the benefits of any ultrasonic
instrument is multifactorial. Instrument
adaptation is certainly not the only key to
success, but it is an important one. In the
presence of biofi lm or light calculus, it's
important to not only contact the tooth or
root with an instrument but also to strive
to select an instrument that will conform to
the tooth or root; our objective is to remove
or disrupt as much etiology as possible.

Selecting the orientation
of a curved instrument
To maximize subgingival access, the most
upright vertical orientation is often needed
(Fig. 6a); vertical orientation positioned
more obliquely will not access the same
depth (Fig. 6b). Note the differences in
instrument point location to the yellow line
of Figs. 6a and 6b. Transverse orientation
(Fig. 6c) is used to access supragingival
deposit and is especially effective to reach
under contact points.

Vertical orientation: Selecting
the correct curved instrument
The best insert choice for Q1 posterior
buccal is a left-curved instrument. Note the
incorrect orientation when using the rightcurved instrument in this area. In vertical
orientation, the point of the curved-right
instrument (Fig. 7a) contacts the tooth
surface. Continued subgingival penetration
on the buccal surface of this tooth with this
instrument would only lead to increased
point-to-root contact.
An overwhelming advantage of curved
ultrasonic instruments is the ability of the
back convex surface of the active tip to

conform to any concave tooth/root surface.
Therefore, when deciding between a curvedright and -left insert, choosing the instrument
whereby the back can adapt to the tooth/
root surface (Fig. 7c) will improve access.
In some areas, such as the distals of many
posterior teeth, the back cannot physically
be adapted. With these cases the lateral is
the surface of choice (Fig. 7b).

Sequencing of a
curved instrument
Subgingival access on buccal surface of
maxillary right molar is best done with a
curved-left insert. Using vertical orientation,

Fig. 6a

Fig. 7a

Fig. 8a

Fig. 6b

Fig. 7b

Fig. 8b

place the curved-left instrument at the
DB line angle (Fig. 8a). Work distally
as far into the distal subgingival space
as needed, based on the depth of pocket
(Fig. 8b). With a goal of reaching the
halfway point across the interproximal
space, maintain as much of an upright
vertical position (vertical orientation)
as possible. Compromising the vertical
orientation will compromise access.
Once debridement is complete in the
subgingival distal space, work or position
back toward the DB line angle (Fig. 8c), pass
this line angle now instrumenting the direct
buccal surface (Fig. 8d, p. 116). At the MB line

Fig. 6c

Fig. 7c

Fig. 8c

Disclosure:
The author declares that in the past 12 months she has had a financial interest, arrangement
or affiliation within the field of dentistry or health care with Dentsply Sirona Canada.
dentaltown.com \\ NOVEMBER 2017

115


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Table of Contents for the Digital Edition of Dentaltown November 2017

Dentaltown November 2017 - Intro
Dentaltown November 2017 - Cover1
Dentaltown November 2017 - Cover2
Dentaltown November 2017 - 1
Dentaltown November 2017 - 2
Dentaltown November 2017 - 3
Dentaltown November 2017 - 4
Dentaltown November 2017 - 5
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