ADEX Periodontal Instrumentation and Care 4 — Questions and Answers
Question 1: Subgingival air polishing with glycine or erythritol powder is MOST indicated for:
- Removal of heavy subgingival calculus deposits
- Biofilm disruption and maintenance debridement in periodontal pockets (Correct answer)
- Whitening of root surfaces exposed by recession
- Removing endotoxins from the cemental wall
Correct answer: Biofilm disruption and maintenance debridement in periodontal pockets
Low-abrasive amino acid powders like glycine are effective and gentle for biofilm removal during supportive periodontal therapy.
Question 2: A patient presents with 6 mm pockets on the mesial surfaces of molars with bleeding on probing. The tissue appears fibrotic. Which statement is TRUE regarding instrumentation?
- Fibrotic tissue will bleed more profusely than inflamed tissue during scaling
- Fibrotic tissue may mask true pocket depth and resist retraction, complicating instrument access (Correct answer)
- Fibrosis indicates the tissue has healed and no scaling is needed
- Fibrotic pockets always require surgical intervention before scaling
Correct answer: Fibrotic tissue may mask true pocket depth and resist retraction, complicating instrument access
Fibrotic tissue is dense and firm, which can limit visibility and instrument access while still harboring pathogenic biofilm.
Question 3: Which instrument is BEST suited for removing heavy ledge-like supragingival calculus from the facial surface of mandibular anterior teeth?
- Gracey 1/2 curette
- Sickle scaler (H6/H7) (Correct answer)
- Periodontal file
- Morse scaler
Correct answer: Sickle scaler (H6/H7)
The sickle scaler's straight cutting edges are effective for breaking away large supragingival calculus deposits on smooth surfaces.
Question 4: When using a piezoelectric ultrasonic scaler, the clinician should use which tip motion for most efficient calculus removal?
- Circular scrubbing strokes
- Overlapping vertical, horizontal, and oblique strokes with light pressure (Correct answer)
- Heavy lateral pressure with a push stroke
- Rapid stabbing strokes toward the junctional epithelium
Correct answer: Overlapping vertical, horizontal, and oblique strokes with light pressure
Overlapping multi-directional strokes with light pressure maximize the cavitation effect and tip efficiency of piezoelectric units.
Question 5: Sharpening an instrument to restore its cutting edge is indicated when:
- The instrument appears visually dull or reflects light along the edge (Correct answer)
- The patient complains the instrument feels uncomfortable
- The instrument has been used for more than five appointments
- The cutting edge has a 45-degree bevel angle
Correct answer: The instrument appears visually dull or reflects light along the edge
A sharp edge will not reflect light; a dull edge creates a rounded, reflective surface visible under light.
Question 6: Which local delivery antimicrobial agent is FDA-approved for subgingival placement as an adjunct to scaling and root planing?
- Triclosan gel
- Doxycycline hyclate (Atridox) or minocycline microspheres (Arestin) (Correct answer)
- Amoxicillin tablets
- Sodium hypochlorite irrigation
Correct answer: Doxycycline hyclate (Atridox) or minocycline microspheres (Arestin)
Both Atridox (doxycycline hyclate) and Arestin (minocycline microspheres) are FDA-approved for subgingival use adjunctive to SRP.
Question 7: The concept of 'closed debridement' refers to:
- Scaling performed under a rubber dam
- Non-surgical scaling and root planing without surgical flap reflection (Correct answer)
- Debridement using ultrasonic tips only
- Instrumentation with the mouth closed using an extraoral approach
Correct answer: Non-surgical scaling and root planing without surgical flap reflection
Closed (non-surgical) debridement means SRP is performed through the gingival sulcus without surgically reflecting a flap.
ADEX Periodontal Instrumentation and Care 4
Subgingival air polishing with glycine or erythritol powder is MOST indicated for: