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Instrumenting Premolars

The complex root anatomy of premolars poses a distinct challenge during hand instrumentation. Regardless of difficulty, mechanical debridement is an essential component of oral health care for patients with a healthy periodontium, gingival inflammation, or impaired junctional epithelium and loss of alveolar bone. How well versed are you in the successful debridement of premolar teeth?

Instrumenting Premolars

The complex root anatomy of premolars poses a distinct challenge during hand instrumentation. Regardless of difficulty, mechanical debridement is an essential component of oral health care for patients with a healthy periodontium, gingival inflammation, or impaired junctional epithelium and loss of alveolar bone. How well versed are you in the successful debridement of premolar teeth? Read more here.

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Importance of Root Anatomy

During instrumentation, clinicians should create a mental image of the root to effectively select and instrument these narrow and anatomically challenging posterior teeth. Patients’ assessment information is important to consider when determining the root anatomy that may be encountered during mechanical debridement. A thorough oral assessment includes a comprehensive periodontal evaluation completed annually, or more frequently.

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Where to Begin

Basic instrumentation, or scaling, of the premolars is indicated for healthy patients and those with gingival inflammation. Either a prophylaxis or scaling in the presence of generalized moderate or severe gingival inflammation is indicated for debridement of biofilm, calculus, and stain.

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Using the Universal Curet

Although universal curets are shaped similarly, various tip lengths and widths are available. In instances of shallow periodontal pocket depth, a universal curet with a short shank and/or working end might be selected. Alternatively, a universal curet with a long working end may suffice for completing the debridement.

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Problem of Pseudopocketing

Pseudopocketing may be another consideration during instrument selection due to increased probing depths; however, in this case, the root anatomy will not be exposed. The pseudopocketing will cause the gingival tissue to increase in size with no apical migration of the junctional epithelium or destruction of the periodontal ligament and alveolar bone.

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Instrument Selection

The maximum premolar width at the cervix is 7 mm, so it is likely that the working ends of either universal or area-specific curets will reach and overlap the midline of the proximal surface. However, if deep periodontal pockets exist and mini- or micro-mini bladed area-specific instruments are used, the risk of not covering the proximal surface near the cervix increases because of the short working ends. In this case, both universal and area-specific curets can be employed to ensure adequate coverage of the proximal surface from the epithelial attachment to the CEJ.

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