Sharpening Stones

• Natural: India, Arkansas
• Artificial: Ruby, Carborundum, Ceramic

Surgical Equipment

• Dental loupes: 1.5 – 6× magnification
• Coe – pak working time: 15 – 20 minutes

Preventive Measures

• Calculus control toothpastes: Contain pyrophosphates
• Antibiotic prophylaxis: Amoxicillin 2.0g, 30 – 60 min before procedure

Abrasion Rates

• Dentin: 25× faster than enamel
• Cementum: 35× faster than enamel

• Bone Defects:
  • Most common: Osseous craters.
  • Best graft success: Three-walled defects.
  • Bone graft types:
    • Autogenous cancellous: Most osteogenic.
    • Xenograft: From different species.
  • Osteoplasty: Recontouring without removing supporting bone.
  • Osteotomy: Removes supporting bone.
• Implants:
  • Minimum 5 mm from mental foramen.
  • Blade implants: Linkow; Cylindrical: Schroeder.
  • Micro-movement >150 µm: Fibrous tissue formation.
  • Connective tissue near implant: No blood vessels, many fibroblasts.
  • Probing: Use plastic probes; max force = 25 N.
  • Florida probe tip: 0.4 mm.

Acquired Pellicle in the Oral Cavity

The acquired pellicle is a crucial component of oral health, serving as the first line of defense in the oral cavity and playing a significant role in the initial stages of biofilm formation on tooth surfaces. Understanding the composition, formation, and function of the acquired pellicle is essential for dental professionals in managing oral health.

Composition of the Acquired Pellicle

1. Definition:

   • The acquired pellicle is a thin, organic layer that coats all surfaces in the oral cavity, including both hard (tooth enamel) and soft tissues (gingiva, mucosa).

2. Components:

   • The pellicle consists of more than 180 peptides, proteins, and glycoproteins, which include:
     • Keratins: Structural proteins that provide strength.
     • Mucins: Glycoproteins that contribute to the viscosity and protective properties of saliva.
     • Proline-rich proteins: Involved in the binding of calcium and phosphate.
     • Phosphoproteins: Such as statherin, which helps in maintaining calcium levels and preventing mineral loss.
     • Histidine-rich proteins: May play a role in buffering and mineralization.
   • These components function as adhesion sites (receptors) for bacteria, facilitating the initial colonization of tooth surfaces.

Formation and Maturation of the Acquired Pellicle

1. Rapid Formation:

   • The salivary pellicle can be detected on clean enamel surfaces within 1 minute after exposure to saliva. This rapid formation is crucial for protecting the enamel and providing a substrate for bacterial adhesion.

2. Equilibrium State:

   • By 2 hours, the pellicle reaches a state of equilibrium between adsorption (the process of molecules adhering to the surface) and detachment. This dynamic balance allows for the continuous exchange of molecules within the pellicle.

3. Maturation:

   • Although the initial pellicle formation occurs quickly, further maturation can be observed over several hours. This maturation process involves the incorporation of additional salivary components and the establishment of a more complex structure.

Interaction with Bacteria

1. Bacterial Adhesion:

   • Bacteria that adhere to tooth surfaces do not contact the enamel directly; instead, they interact with the acquired enamel pellicle. This interaction is critical for the formation of dental biofilms (plaque).

2. Active Role of the Pellicle:

   • The acquired pellicle is not merely a passive adhesion matrix. Many proteins within the pellicle retain enzymatic activity when incorporated. Some of these enzymes include:
     • Peroxidases: Enzymes that can break down hydrogen peroxide and may have antimicrobial properties.
     • Lysozyme: An enzyme that can lyse bacterial cell walls, contributing to the antibacterial defense.
     • α-Amylase: An enzyme that breaks down starches and may influence the metabolism of adhering bacteria.

Clinical Significance

1. Role in Oral Health:

   • The acquired pellicle plays a protective role by providing a barrier against acids and bacteria, helping to maintain the integrity of tooth enamel and soft tissues.

2. Biofilm Formation:

   • Understanding the role of the pellicle in bacterial adhesion is essential for managing plaque-related diseases, such as dental caries and periodontal disease.

3. Preventive Strategies:

   • Dental professionals can use knowledge of the acquired pellicle to develop preventive strategies, such as promoting saliva flow and maintaining good oral hygiene practices to minimize plaque accumulation.

4. Therapeutic Applications:

   • The enzymatic activities of pellicle proteins can be targeted in the development of therapeutic agents aimed at enhancing oral health and preventing bacterial colonization.

• Normal count + ↑ BT: Platelet functional defect
• Small platelets: Wiskott – Aldrich syndrome
• ITP: Antibody against platelets, ↑ bleeding time
• Platelet transfusion not indicated in immunologic thrombocytopenia
• Thrombocytopenia not seen in Henoch – Schönlein purpura

Blade Angulation Protocols

Scaling & Root Planing

• Angulation: 45-90 degrees to tooth surface
• Purpose: Effective calculus removal and root surface debridement

Gingival Curettage

• Angulation: >90 degrees
• Technique: Removal of infected soft tissue from pocket wall

Curette Sharpening

• Optimal Angle: 100-110 degrees
• Maintenance: Critical for effective instrumentation

Curette Design

Gracey Curettes

• Offset Angle: 60 degrees
• Specificity: Area-specific design for different tooth surfaces

Universal Curettes

• Angle: 90 degrees
• Application: Suitable for all tooth surfaces

After-Five Curettes

• Modification: Terminal shank extended by 3mm
• Purpose: Access to deep pockets (>5mm)

Probing Systems

CPITN Probe

• Tip Diameter: 0.5mm
• Markings: 3.5, 5.5, 8.5, 11.5mm
• Use: Community periodontal index assessment

Florida Probe

• Tip Diameter: 0.4mm (more precise)
• Technology: Computerized probing system

Implant Probing

• Maximum Force: 25N
• Probe Type: Plastic probes recommended to prevent implant surface damage