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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
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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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Moving the Working-End
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Motion activation is the muscle action used to move the working-end of an instrument across a tooth surface.
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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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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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Types of Motion Activation
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Two Types of Motion Activation
-Wrist-rocking motion -Digital activation
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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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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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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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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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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
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Topics
-Rolling the instrument handle-Pivoting on the fulcrum
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Rolling the Instrument Handle
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Rolling the instrument handle is turning the handle between the thumb and index finger.
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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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Rolling
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Pivoting on the Fulcrum
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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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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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Pivot
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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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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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Orientation of Instrument to Tooth Surface
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Topics
-Angulation of teeth in dental arches-Orientation to tooth surface
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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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Positions of Teeth
-Most teeth are not positioned vertically in dental arches-Most teeth are tilted in dental arches
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Maxillary Roots Incline Inward
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Mandibular Roots
Mandibular anteriors: tilt inwardMandibular premolars: more verticalMandibular molars: tilt outward
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Mandibular Roots Orientation
A. Incorrect angulation to proximal B. Correct angulation to proximal
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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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Tooth Surface Planes
-Colored lines show surface orientations
-Note differences in orientations between crown and root surfaces
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Proximal Surfaces
Incorrect Correct
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Facial and Lingual Surfaces
Incorrect Correct
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Proximal Surfaces (cont.)
Incorrect Correct
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Facial and Lingual Surfaces (cont.)
Incorrect Correct
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Probe: Correct Orientation Maxillary
-Correct orientation to mesial surface
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Probe: Correct Orientation Mandibular
-Correct orientation to mesial 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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