![]() These new inserts or any thin piezoelectric tip that has an edge can remove moderate to heavy subgingival calculus from interproximal and subgingival areas when used on medium to higher power levels using a deliberate, moderately paced technique. ![]() These magnetostrictive inserts include: the SlimLine ® 1000 insert (DENTSPLY Professional) Swivel XT™ Ultrasonic Insert (Hu-Friedy Mfg Co Inc) and the Burnett Power Tip™ (Parkell). New magnetostrictive inserts have been designed for use at higher power levels, and are thus more effective at removing subgingival calculus. CALCULUS REMOVAL WITH ULTRASONIC INSERTS/TIPS Two o’clock back position for scaling a deep distal pocket with a mini-bladed Gracey 13/14. Once calculus becomes burnished, its removal requires skilled, precise hand instrumentation or a combination of ultrasonic scaling with a beveled or higherpowered UIT and hand instrumentation. Using an explorer throughout scaling and root planing can aid in the discovery of these deposits. Tenacious calculus deposits are difficult to detect. Thin UITs are not ideal for heavy or tenacious calculus removal unless they are designed for use at increased power levels and can break calculus cleanly away from the root. Clinicians must remain mindful of the UIT’s pattern of movement across the surface while it is activated, keeping strokes slow and methodical-not haphazard. Try to dislodge the calculus from the edge using the UIT point in a probe-like stroke that is parallel to the root surface, or use a series of very short, overlapping horizontal strokes starting from the top or the side edge of the deposit. 3,8 Medium to higher power is more effective, but any UIT that is smooth and round in cross section can burnish because it tends to remove tenacious calculus incrementally layer by layer-especially if it is obliquely stroked across the thickest part of the calculus. While viewing root surfaces with the periodontal endoscope, I have seen that the use of UITs on low power can burnish calculus into sheets-especially in developmental depressions, CEJs, and furcations. Burnishing can also happen when too little lateral pressure is used on the working stroke. 1-3,7 If the blade-to-tooth angle is too closed (less than 70º) or if the blade is dull, deposits can be easily smoothed instead of removed. Worse, a burnished veneer of calculus may cover entire portions of the root.īurnished calculus can occur when a deposit is smoothed before it can be removed. In these cases, root surfaces may still harbor residual or embedded calculus (Figure 1). Patients may also present with very hard calculus deposits due to previous instrumentation with inadequate technique or insufficient power. The edge of the calculus is visible after the marginal gingiva is distended. Thus, the CEJ will only feel smooth about one-third of the time. The cementum overlaps enamel in 60% to 65% of teeth and the dentin is exposed 5% to 10% of the time. The curvature ranges from 2.5 mm to 3 mm on mesial surfaces of mandibular anterior teeth, and from 1 mm to 2 mm on distal surfaces. ![]() On mesial surfaces of maxillary anterior teeth, the curvature ranges from 2.5 mm to 3.5 mm on distal surfaces, it ranges from 1.5 mm to 2.5 mm. However, if there is bleeding on probing with roughness along the CEJ, burnished calculus may be present. If the CEJ feels rough but the adjacent tissue is healthy with no bleeding, there is no need to scale this area. If you rotate the tip of an explorer and feel up and down with the point, you can sometimes detect a grainy texture. ![]() Burnished calculus along the CEJ is often so smooth that it is almost impossible to detect with the tip of an explorer or probe. When scaling or exploring along the CEJ, clinicians must distinguish between the calculus deposit and the normal CEJ anatomy, and then try to carefully remove the calculus from this concave area. Removing calculus from the cemento enamel junction (CEJ) is particularly difficult. Removal of tenacious calculus is no small task, even with the addition of innovative ultrasonic inserts/tips (UITs) and hand instruments to the dental hygiene armamentarium over the past several years. ![]() 1-3 Despite the dedication of dental hygienists to thorough periodontal therapy, research shows that approximately 17% to 64% of calculus still remains after scaling and root planing, and 7% to 24% remains after surgical intervention. As much calculus as possible must be removed during scaling and root planing because persistent inflammation will remain next to any residual calculus left behind. As dental hygienists, we know that periodontal health cannot be maintained without the removal of both supragingival and subgingival calculus. Periodontal diseases remain the leading cause of tooth loss among Americans. Residual burnished calculus on the mesial surface of a maxillary right first premolar. ![]()
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