welcome to your explorers module explorers provide significant information to the clinician explorers are used during the assessments to gather information on the roots of the teeth to assess them for calculus or irregularities or and irregularities also to assess the restorations in the teeth themselves explorers are also used during the treatment phase of the dental hygiene process of care so with treatment you remove the calculus that you have found in the biofilm but you will go and back and assess your work and feel with your explorers if there is still calculus present so you're evaluating your Effectiveness in calculus removal explorers have many functions they're used for calculus detection to detect the sub jingal calculus the amount of calculus the type and the location they're used before scaling during scaling and after scaling they are also used to detect other irregularities and tooth anomalies that you cannot see there can find irregularities in the tooth surfaces defective margins of restorations carries even sub jingal carries on root surfaces that you may not see they're used to determine the treatment needs of the patient even what instruments you may be using to remove the deposits that you have found how does it do it how is it telling you what's below the gum line the flexible working in Quivers as it goes over the tooth surface irregularities calculus deposits and defective margins of restorations so it's that those Quivers are fine Vibra that's why that tactile sensitivity is so important explorers are used to assess the progress and completeness of calculus removal you got to know how well you're doing right it's also the instrument of choice for any detection of sub jingal calculus deposits or root irregularities you can't see below the gum line so the Explorer and your hand are your eyes that's you're feeling with your hands and your Explorer is quivering over any root surface irregularities or deposits and telling you what's there that you can't see below that gingerful margin so explorers are used to evaluate you're going to evaluate your completed treatment again you're evaluating your effectiveness of calculus removal if there's deposit remaining that you need to go back over and remove and evaluating the Restorations and margins of restorations explore design and features explorers have fine wirelike working ends a flexible shank they are circular in crosssection meaning if you cut them in half they would be round explorers can be the the functional shank can be straight or it can be curved and the working ends could be paired or unpaired paired means that their working ends are mirror images of each other and unpaired it's the working ends are completely different so if you look at your 23x Explorer it's a 23 Explorer shepherd's hook Explorer on one end but it's a probe on the other end that's an example of an unpaired instrument if you look at your 1112 explorer that is a paired instrument because the working ends mirror each other so just to stress as well that the Explorers are fine flexible wire metal that conduct vibrations from the working into the clinician's fingers resting on the shank and handle especially on that middle finger that's that tactile sensitivity finger got to have that light pressure to feel those Quivers and vibrations so that you're assessing effectively what's below the gum line that you can't see so we're going to talk about the shank every instrument has a functional shank and a terminal or lower shank the functional shank is the entire shank it is long complex it begins just below the working end and extends to the last Bend in the shank nearest the handle the terminal shank or lower shank is the part of the functional shank nearest the working in that's the area in the yellow circle that is the lower shank or terminal shank Shanks can be simple meaning that they are completely straight with no bends or they can be complex if you look at your 1112 explorer that is a complex shank if you look at your shepherd's hook that has a simple shank Explorer tip the actual point of the Explorer tip is never used to detect calculus rather we use the side of the Explorer tip applied to the root surface for paranal instrumentation the Explorer tip is defined as the last 1 to 2 mm of the Explorer of this this tip is adapted to the tooth for detection of dental calculus or root surface irregularities so we're using the side of the tip the last 1 to 2 mm of the tip and the point is never put directly on the to surface and we'll practice that it's easy much easier to see that in person on a typodont or on a mouth what we're talking about and that is actually the term is what we're describing is the term adaptation that we need to that will say your instrument needs to be adapted adapted means that the leading or last 1 to 2 mm of an instrument is actually touching the tooth let's talk about the working end in this slide you can see the 1112 Explorer on the left and the shepherd's hook number 23 shepherd's hook on the right the shepherd's hook is for used for carries detection only and to feel Restorations and irregularities of restorations it is only used Supra gingerly so only above the gum line you're still going to use the you will actually use the point of this in a with very light pressure with the 1112 Explorer you're going to use the tip 1/3 or the tip third that is the very last 2 millimet 1 to 2 millim of that working in nearest the point and the side of that tip third is what you're going to have touching the tooth that's that adaptation you're adapting the tip third to the tooth that 1112 Explorer again is used for calculus detection and root surfaces root surface irregularities below the gingerful margin explorers come in various designs used for assessing the texture of the root surface for the detection of biofilm retentive factors such as calculus defective Restorations root surface irregularities and root carries the 1112 explorer that exd 1112 is ideal for subgingival use the tip is at a 90° angle to the lower shank it has a long complex shank it makes it equally useful in the anterior and the posterior regions of the mouth with within normal sulkus and deep pero Pockets the point is not used to detect calculus we talked about that in the previous slide it has a curved design and for a normal sulcus or shallow P Pockets you don't have to go any deeper than the cervical third of the root the curved lower shank causes stretching of the gingiva so you do have to keep that tip 1/3 adapted meaning adapted to the tooth and not going into the gingera you can see in this image that at exd 1112 is on the left but there's all kinds of explorers the one on the right is a shorter has a slightly curved shank and that one would be much harder to get deeper in below the gingerful margin because you don't have the complexities of the shank and the working ends a little bit longer so the one on the right would only be used in healthy patients healthy sulk eye of 1 to 3 mm deep a pel or C horn Explorer has an extremely curved terminal shank it is only used in normal sulkus steps so 1 to 3 mm the curved lower shank causes considerable stretching of the tissue away from the root surface and that can only be used in Shallow Pockets due to this if you try to get the pigtail or cow horn deeper it will be uncomfortable to the patient and can in injure the tissue easily on the right side you see the orband type the orband type has a straight lower shank and that permits insertion into deep narrow Pockets the tip is bent at 90° to the lower shank the orband type is limited to use in anterior teeth and buckle and lingual surfaces of posterior teeth so not going around the line angles and not going onto the proximal surfaces remember proximal surfaces are the mesial and distal surfaces of teeth you have a misal proximal and a distal proximal interent proxim is the space in between the teeth all design types of explorers are not well suited for sub jingal use as explained in the pigtail and the cow horn the clinician needs to be knowledgeable about the recommended use of each tip design and there's more than that are in your textbook and that we have on campus you'll find that when you go out to a dental conference and you go up to a a booth of a company that uh has instruments there's going to be a bunch but you need to know the basics of the design so that you know how that instrument can be used and where should it be used and how and you can also ask informed questions s super gingival instrumentation is used of use of an instrument coronal or above the gingival margin for example the shepher Explorer determining and examining the margins of restorations or for dental sealant even subgingival instrumentation is use of an instrument apical or below the gingival margin for example the use of an explorer to detect calculus deposits hidden beneath the ginger margin hidden beneath the gum line car's detection explorers are the shepher hook 23 and there's also straight explorers that you may find out and you may see out in a dental office or at a at a dental vendor the shepher took Explorer is used by almost every dental office I don't think I've ever been in a dental office that did not have or use shepherd's hook explorers those 23 explorers the important thing to know for the 23 is they are only used super gingle they do not go never go sub gingival and the point of the tip is used to trace the grooves of restorations and margins and Carries what's important is not pushing and using a lot of pressure especially in an area where there is a suspected cavity because you could make the cavity bigger so we use very light tracing pressure with the point of the tip remember with your 1112 Explorer we're using the side of the tip but with your 11 with your 23 or straight you would be using the tip itself you will be using your explorers to perform your dentition exam and dental charting the 23 Explorer specifically will help you detect carious lesions faulty margins of restorations anomalies in tooth anatomy And even helping you detect composite resins or Restorations those tooth colored fings that can be hard to see because the margins and the Aesthetics are so good the dental materials now are just really really good and some dentists are just wonderful Artisans and make Restorations that match tooth colors that you just cannot see them it's really hard you can feel slightly a little bit of a difference in the texture and then you would also use your radioraps to help you determine whether or not that is real tooth surface or if it is a composite resin restoration and you're going to use some light we'll teach you some other things on your detti exam your 1112 Explorer would be used to detect faulty margins like of crowns that went below the gum line root carries and things like that so carries 101 in the gentle world we use the term carries your patients will not know what you're talking about so you want to use layman's terms and that word is cavity that's what you all know your explorers with with carries let's talk about um Frank obvious open lesions so you can see in the image that these teeth have the the prol or these are actually baby teeth or deciduous teeth um you can see that there's holes on a couple of those teeth on four of those teeth actually and with an Explorer you would never ever explore an open carious lesion one you can make it bigger but two more importantly it could be very uncomfortable and painful to the patient with even carious lesions if they haven't fully cavitat or have created a hole they can be chalky white gray brown or black in color as you can imagine the holes there may retain food shallow carious lesions previously detected with light pressure we used to really push hard I was taught to push really hard to try to see if I could get my Explorer to stick and that is something we don't do because research has shown that we can actually cause more harm when we're trying to determine those we still use light pressure to feel if the tooth surface feels sticky tacky soft or leather like pit and Fisher carries carries and pits and Fishers may be sticky as well but again we still no longer recommend the poking of that suspected lesion because you could cavitate and make it worse so cavitating means that there's like a thin layer of enamel still covering the cavity that's underneath and as soon as it opens up it breaks then that is now cavitated there's a hole now and the cavity that was underneath that little thin layer of enamel is now exposed to the whole mouth and can grow and get bigger much faster Pitt and Fisher carries just by looking you're can look for discolorations chalkiness around pits and fissures chains and trans translucency in and in color you can see in the image on the left with the three arrows there's a little bit different color on that distal portion of that tooth and then on the accusal surface of that molar there's some staining it looks like and some chalkiness as well root surface carries develop on exposed root surfaces you can feel them with an Explorer your Explorer will dip in and out so it's like falling into a hole the tooth surface or the root surface may feel rough or leathery recurrent carries and restoration margins you can feel those as well they you may also feel a dip or a catch along the margin smooth surface carries can be found on the facial and lingual and even mesial and disle aspects of tooth surfaces so they're not found in those accusal pits and fissures they're found at the gingival margin sometimes mostly at the ginger Bal margin but they can go in approximal as well with smooth surface carries you want to visually check for any discoloration they may feel rough or soft or with a side of the Explorer you don't want to use any pressure we talked about this already because you don't want to cavitate that lesion and make it bigger and make it open making an assessment stroke the clinician relies on his or her sense of touch to locate calculus deposits hidden Beneath The Ginger Bible margin you want to hold this Explorer in a very light grasp light enough so that someone could grasp the instrument and pull it out of your hand easily just slide it right out remember tactile sensitivity is the ability to detect tooth irregularities by feeling vibrations transferred from the Explorer tip to the handle that fine wirelike working end and flexible shank of an explorers are used to enhance tactile information to the clinician's fingers the superior tactile conductor of an Explorer makes it an instrument of choice for initially locating subgingival calculus deposits and re-evaluating removal a curate can also be used with an assessment stroke to Fu calculus but with its more rigid shank that reduces that tactile sensitivity or tactile information being transferred to the clinician's hand so out of your Garrick textbook going through the different things with the assessment stroke your grasp you should have a a relaxed grasp the middle finger rests lightly on the shank so that nice soft sea with middle finger relax resting lightly on the shank adaptation remember that's the leading 1 to 2 mm of the tip 1/3 so the 1 to 2 mm of the side of the tip is adapt to the tooth surface lateral pressure should be feather light pressure with working end against the tooth activation should be wrist activation that's what is preferred and recommended however you can use some digital activation that is acceptable because the Explorer does not require any physical strength to make the assessment or exploratory stroke but again wrist activation is preferred and that's what we want you to do the stroke characteristics themselves should be fluid and sweeping not short and choppy the stroke number there should be many overlapping multi-directional Strokes used to cover every square millimeter of the tooth surface so it's a maybe more than you think it's not two or three Strokes it's a lot common errors that clinicians find and the should be avoided are holding a tense having like too much pinch grassp but like having that death grip on the handle applying too much lateral pressure with the middle finger against the instrument shank this will reduce that tactile sensitivity the critical factor for of exploring effectively is pressure meaning the absence thereof having basically very little no pressure that feather light pressure so we've already talked about this this gives a good visual of what you're detecting below the gingival margin or detecting margins of restorations you can see the calculus on the left image and the restoration that's overhanging on the Right image so explore application so what are we using it for they have two basic uses detection and evaluation detection of calculus detection for carries faulty Restorations overhangs the texture of the tooth and root surfaces and evaluation evaluation of a restoration that you just put in or your doctor put in are the overhangs undercut or overcut overhanging are that margins are they nice and flush is there still calculus left but after you've completed some scaling of a tooth so you're working on a patient that has heavier calculus you can or even light to moderate calculus you're still going to reassess that those tooth surfaces or teeth surfaces on how well you've done and if there's still calculus that needs to be removed so tactile sensitivity if you look at the image you see the brick but the Brick's have different textures on them so you can picture running your Explorer over the the brick wall and feeling the different textures of the different bricks and the spaces in between the bricks so tactile sensitivity again you're feeling those vibrations transferred from the instrument tip through the shank to the handle to the clinician's fingers specifically that middle finger that's your tactile sensitivity finger it is a learned ability what that means is it's a psycho motor skill it takes practice and it requires that featherlike grasp examples of tactile Sensations that you will feel when using an Explorer below the Ginger Bible margin you can catch on an over contoured restoration dropping into a hole or a cavity carries lesion below the gingival margin bouncing over an elevated deposit kind of like a speed bump you'll feel that sometimes you can even hear it it'll click make an audible sound like you when you it'll jump over it and feeling roughness calculus 101 we're not going to focus on the actual makeup of the calculus and the bacteria and how that forms you're going to get that later in your Calculus and biofilm module what we're going to talk about is little brief information so calculus builds up slowly over time due to layering it's layering of deposits mineral deposits it forms on super Gible and subgingival surfaces super gingival calculus tends to be more chalky and white or yellow sub jingal calculus tends to be brown and it is often more tenacious than super jingal calculus meaning it's harder to remove since subgingival calculus cannot be seen the clinician has to rely on that tactile sensitivity that sense of touch to feel the deposits and it's a vital skill for you to develop and practice wilin states that the importance of calculus detection because a a plaque bofilm is the main cause C of parodontal disease however calculus removal is a CR is critical to the successful treatment of parodontal disease calculus deposits harboring biofilms are directly related to more than 60% of the disease sites in parodontal disease the Explorer is the best instrument for assessing the texture of root surfaces and for the detection of bofilm retentive factors such as calculus defective Restorations surface irregularities and root carries calculus detection for super gental calculus use your air we practiced that day one in the Sim lab you can see the Calculus if you dry the teeth off well if there's a very little bit of calculus and it's wet with saliva it makes it harder to see and you may not see it but if if you dry the teeth and dry the calculus you can see the calculus deposits that are above the gum line but you have to use your air if you do not use your air you will miss deposits for sub jingal calculus again you can't see it so you have to feel for it some pieces will be bigger than others it's going to be in different shapes and sizes right you it can be in Rings or little spicules and on the next slide we'll talk about that but developing that Keen tactile sensitivity is a must for a hygienist to achieve good calculus detection you can see in the image on the right there is super gingival calculus and it is stained you can see the image on the left that has the radiat grass or x-rays you can see the little triangles on those teeth that are in a couple of teeth have the yellow circles but you can see more of those thins or rose thorns if you will on those teeth and that is sub jingal calculus that you'll be feeling for that's why we talk about calculus detection even using xray sometimes for the heavier calculus to help guide you but it is not what you rely on your tactile sensitivity is what you rely on for calculus detection types of calculus calculus comes in spicules so little pieces here and there around the root surface Ledges Ledges will tend to make your Explorer jump or bump over depending how big they are rings that means it's the ledge but now there's it encircles the whole too so it's all connected all the way around the tooth and then you have the near calculus and that's harder to detect because it's flatter and burnish calculus burnish calculus will look almost like veneer calculus but it will be smoothed that because it hadn't been removed effectively by a hand instrument and we when we get into hand instrumentation we instrumentation we'll talk about burnish calculus much it's the most difficult to detect burnished in veneer calculus is the most difficult to detect veneer calculus sometimes you will find it on um anterior teeth but it can be found in posterior teeth as well super gingerful calculus detection again it's coronal to the Ginger Bible margin meaning above the gum line it's rough chalky white beige or stained can be yellow you're going to visually detect that you're going to dry with compressed air or a 2X two piece of cotton gauze we're going to use air predominantly it's going to help you see it the most common places to find super Ginger calculus are the lingual surfaces of the mandibular anterior teeth the Buckle surfaces of the maxillary molers and crowded teeth super gingival calculus also collects collects on prosthetic appliances orthodontic appliances and anything worn in the mouth for an extended period of time including piercings sub jingal calculus detection again you've got to use your Explorer and you're going to feel either grainy uh speed bumps you can have clickable calculus it can almost feel smooth so different types of calculus will feel different subal calculus is apical to the gingle margin it's located in the sulcus OR pocket on the root surfaces of the teeth it's heaviest on the mesial and distal surfaces those proximal surfaces you can only feel it with the tactile sensitivity it may or may not be radiographic if it's radiographic the piece is always much bigger than appears on the X-ray because you can't an x-ray just can't show you exactly how big it is and it's usually brown or black and can be very tenacious you can see the line in the image the little dotted line that is representative of the cemento enamel Junction or the CJ going from the crown of the tooth onto the root surface of the tooth this person has had their gums flapped back that gingiva is flapped back for parodontal surgery and sometimes that is required to actually see and access the calculus for removal but that's getting into advanced paranormally involved patients so we won't talk about that until next fall so calculus detection spicules versus Ledges of subgingival calculus spicules will fill rough kind of like an Emory board Ledges will feel more like that speed bump they can cause the Explorer to jump over it spicules will sound scratchy Ledges will be clickable in our Clinic we use a calculus ID form to chart calculus that we have found in the patient's mouth you will be doing calculus detection or calc Cal ID for super gingival calculus we mark it in blue and subgingival calculus we mark it in red we have laminated forms in the clinic so when you get into next spring and you're doing Cal IDs on all of your patients it's part of your assessment um you will be using these forms and we'll practice this in class as well always always always use your air to as help you identify that super Ginger Bible calculus as you're exploring and you're feeling subgingival calculus you have to put it where it is on the tooth surface so you can see the image on the top the teeth are divided into four the boxes are divided into four so you have the mesial distal facial and lingual if you detect a spot on the lingual you put the dot on the lingual you don't put it on the line angle you determine is it on the lingual surface or is it on the mesial surface or on the distal surface it can be close to the line angle but you want to identify and document exactly where that calculus is on the tooth surface that you feel and you may have rings that go all the way around so you may have four dots on a tooth you may have two dots on a tooth you'll get to practice this in class again and the next spring detecting Restorations if we're detecting Restorations that go below the gum line go below that gingival margin we're going to use our our 1112 Explorer overhangs will catch the Explorer and may cause it to jump over the margin a deficient margin the Explorer will fall in and you can see that on the images above so the left image is an overhang the Right image is a deficient margin with the margins of restorations especially metal Restorations you can have a metallic sound it actually make an audible metallic sound when it kind of jumps over the margin or even falls into the margin with subing of volarus lesions the Explorer will fall in to the hole so will fall into that that's why you got to use your light pressure um but you'll feel that indentation on the root surface so we use an 1112 Explorer in class we're going to practice determining the correct working end for posterior teeth and anterior teeth this will be easier to visualize once we are in class and you're holding instruments if you are following along and you have your resin kit at home if you pick up your 1112 Explorer you can see that the working end is curved the tip third or that side tip of the one leading 1 to 2 millimet is what we use you can see that in the circled in the image and the last bend that on the you have your whole functional shank but that very last Bend closest to the working end forms a very slight V the V will help you identify the correct working in in posterior Seance Seance in anterior too but really in posterior Seance the V should always be pointed towards the distal or the back of the mouth this will translate learning this now will translate when you get into your hand instruments your Calculus removal instruments because we still use the to the distal to determine correct working ends for areas we're working in in the mouth so for posterior teeth with your 112 Explorer selecting their correct working in you're going to hold the instrument you're going to find a fulcrum on the accusal surface or in size of ledge 1 to four teeth away and you're going to put the working end on the distal surface of a premolar and you're going to point the working end or the tip should be pointed towards the tongue or the pallet you're going to look at a lot of things and we're going to go through this in class the functional shank should go up and over like the roof of a house so roof over tooth the terminal shank should be par parallel think posterior parallel the V should be facing or pointing towards the distal that all of those visual Clues let you know that you have the correct working in for the aspects that you are wanting to work on facial or lingal aspects of a quadrant or seant with the incorrect working end the lower shank will not be parallel to the distal surface it'll actually wrap around it'll be down and around instead of up and over the V is pointed more towards the meal anterior selecting the correct working end with the correct working end the correct working end should be or the working end needs to be facing the direction that you want to work so the surfaces you want to work on whether toward or away the working in needs to be pointed towards to the towards surfaces or to the away surfaces first that's important then the correct working end will either it hugs or wraps around the tooth another thing that you can do is lay the V directly on the facial surface of the tooth and then whichever way the working end is pointing that is telling you which end it's supposed to go and that's something that you need to I had to see it to actually see um not just in a two-dimensional picture to help V you visualize that the important thing I think the the knowing that the it should wrap around or hug the tooth that's helps me remember it the best and if it's incorrect it will be lifting up off of the tooth and that will be uncomfortable you've got some good uh supplemental videos to look at clinicians identifying the correct working in if you're working on surfaces toward on the facial aspect to go to surfaces towards on the lenal aspect all you have to do is flip the ends of the instrument we'll practice that in class too sub jingal exploration this is straight out of your Garrick textbook it has all of the steps of going through subgingival air exploration you're going to always start in the get ready zone so the get ready zone is the middle third of the tooth that is the safe zone for getting ready and get getting set up to insert an instrument below the gingerful margin so that you can check and make sure everything is correct that you've got the correct working in and your adaptation is correct and all of all of all of the things so that you can visually see it before you go below the gum line so you're going to be in the get ready Zone gently insert to the base of the pocket always keep the tip in contact with the root surface perform many overlapping assessment Strokes with featherlike grasp and lateral pressure feel for the Quivers and your stroke length should be 2 to 3 mm so not really really long or super short and you need to assess every square millimeter it's good to divide the tooth kind of thinking it in thirds to explore areas if there's a lot of bone loss you need to stay sub gingle when you get below that Ginger Bible margin and you're exploring stay below as you explore because every time you come in and out of the ginger bow margin you can traumatize the the gum line so again you're going to start in your get ready Zone adapt the Explorer to the tip of the tooth surface above the Ginger Bible margin in the middle third of the crown and then gently slide the tip under the Ginger Bible margin insert to the base of the pocket keep the tip constantly in contact with the root surface gently slide the Explorer in an apical Direction until the back of the tip touches the soft tissue of the base of the sulcus or pocket the attached tissue will have a soft elastic feel initiate assessment stroke in coronal Direction move the tip forward slightly and use a vertical or oblique stroke to move the Explorer up the surface of the root surface keep the tip in contact with the root surface as you pull the tip towards the Ginger Bible margin concentrate as the tip moves over the Sur tooth surface and then be alert for the Quivers of the tip that indicate there's a calculus deposit or a root irregularity control your stroke length don't remove the Explorer tip from the sulcus or pocket as you may as you make your upward Ward Strokes removing and reinserting the tip repeatedly can traumatize the tissue in the at the gingival margin bring the Explorer tip to a point just beneath the gingival margin and then move the tip forward slightly reposition at the base of the pocket maintain the tip in contact with the toot surface return the tip to the base of the pocket or or sulkus and then as you move the tip remain alert for for those tactile sensitivity Quivers you want to divide the tooth into apical middle and cervical sections in the beginning next semester you'll be seeing patients that do not have paranormally involved teeth so you'll be working more in that apical and medical middle section as you get into next fall you'll be going even deeper because you'll be seeing more paranormally involved people you want to keep your assessment stroke short approximately 2 to 3 mm so you may actually have to explore all of the aicle and then all of the middle and then all of the cervical if you're working in a normal sulcus your Strokes will extend from the base of the sulcus to the point just beneath the gingival margin and that's going to be you predominant but our typodont have some paradon involved teeth and allow you to explore if you will going deeper considerations for proximal surfaces on the distal amial proximal surface you want to lead with the point of the Explorer tip you do not back the proximal back in you never back into the proximal surface you're always going leading into it with the with the point your stro your stroke should reach underneath the contact area at least halfway on the proximal surface underneath the the contact from the facial aspect and distal lingal aspect that means you're exploring all the way all the surfaces and we'll see that when we practice in class that you're going at least halfway on the meal at least halfway on the distal underneath the contact of the tooth sequencing and posterior Seance start each seant on the distal of the most posterior tooth you want to follow the same type of sequencing for each of the posterior Seance when you begin start with the tip of your Explorer just in front of the distal Buckle line angle so that you don't miss any surfaces this will cause you to work towards the midline as you set up for the next tooth so we always start in the most posterior tooth working towards the front of the mouth or working towards that midline otherwise we're working backwards and it's not efficient that means if you're starting on 28 and then going to 29 we don't explore it that way we start always on let's say 31 and then go to 30 29 28 and just taking seeing that in practice as well helps make sense of the efficiency of why we work from the distal of of the most posterior tooth towards the midline as you begin exploring on the distal of the most posterior tooth you want to follow the steps as outlined in your textbook you're going to ex insert and explore and you're going to roll I say up down Roll Up Down Roll Up Down roll and rolling very slightly to keep that tip third adapted teeth are not flat they have Conca concave areas and convex areas and curves and Corners so we're constantly rolling our instrument with our driver fingers right our thumb and our index fingers to keep our instrument adapted and we're pivoting on our fulcrum to move around those line angles and then we're rolling around the line angles as well so to insert Explorer and roll is lower the handle and adapt the face to the to surface slide the tip Beneath The Ginger Bible margin you need to stand back up on your fulcrum to return the handle to a normal position begin in front of the distal facial line angle and make feather light Strokes toward and onto the distal proximal surface at least halfway underneath the contact then you're going to back out reposition and roll roll your instrument a quarter of a turn so that now that the working in is pointed towards the misal or to the front of the mouth then you're going to reinsert and repeat the process of making exploratory assessment Strokes across the facial up down Roll Up Down roll exploring keeping adapted and rolling around that mesial facial line angle and exploring onto the mesial pro imal surface at least halfway underneath the contact then you move to the next tooth and you do it all over again and then when you're done with that tooth you go to the next tooth and you do it all over again until you've done all of those aspects in that seant with the Explorer so you've just finished exploring the distal surface of tooth number 30 that's where the Explorer is on the image on the slide so now you've got to explore the facial and the meal remember you're going to back out of the distal surface reposition roll it a quarter of a turn then you're going to to where the working end is facing the direction you want to go which is towards the mesial aspect or across that facial you're going to reinsert stand back up your on your fulcrum and explore making those overlapping many overlapping strokes and then roll and keep your tip adapted pivot on your fulcrum and Explorer onto that mesial proximal surface at least halfway underneath the contact sequencing for anterior teeth anterior teeth are divided at the midline so it's the midline of the tooth itself we have the midline of the mouth as well where those two mesial surfaces meet and that's where it can get confusing for um for students so with teeth the facial and lingual aspects are surfaces away or surfaces towards so you have your facial and lingual surfaces towards those are the same and then your facial lingual surfaces away are the same that means that for example if tooth number 2 seven the purple is shaded that's the distal the distal facial and the distal lingual of tooth number 27 would be a surface towards for a right-handed clinician and a surface away for a left-handed clinician but if I'm looking at tooth number 22 the purple is the mesial facial and mesial lingual that's a surface towards for a right-handed clinician or a surface away for a left-handed clinician you are always going to work from your dominant hand side towards your non-dominant hand side making horizontal Strokes why is a horizontal stroke useful clinicians often miss the distal facial and distolingual line angles and the midlines of anterior teeth can you guess why that's where we insert so we insert on that distal Buckle line angle or distal lingual line angle and then we come back and we insert at a distal Buckle line angle to go across on the facial and mesial so we can if we don't it insert just behind that distal Buckle line angle when we go to the facial amisial we can miss a spot same thing with the midline if we don't go right behind the midline so that we can explore it we will miss part of the midline so these are areas that clinicians Miss with Calculus detection and removal so horizontal Strokes come into play a horizontal stroke is used on the dof facial and distolingual line angles and the midlines on the facial and lingual aspects of anterior teeth so dof facial and distolingual line angles of posterior teeth midlines of anterior teeth again that's where you're inserting your instrument so that's why that's where they're used the horizontal stroke you actually point the tip of the Explorer or instrument directly down towards the sulcus and then you drag it horizontally across the tooth from the distal over the facial and we'll practice those and on the same thing on the you drag the you're pulling them kind of towards you we'll practice that on the typodont it's a lot um easier to understand horizontal Strokes when you can actually physically see them and do them the get ready zone is basically your safe Zone and it is used for all instrumentation Strokes not just your exploratory SL assessment Strokes when you get into your Calculus removal Strokes you will still use the get ready zone so that you can check that you have the correct working in and that your adaptation and angulation and things like that are correct that your modified pen grasp is correct your fulcrum is correct your neutral all of the things you can assess before you actually get below that gingle margin the get ready Zone the instrument is never touching that gingle margin that way it's safer because if you are touching it and you're checking all of these things you could traumatize that Ginga so let's go through the Explorer technique and just follow along with your textbook it has more specific information and gives more detail start in your get ready Zone insert the Explorer carefully to the base of the sulcus before initiating strokes use your feather light pressure and grasp your soft sea keep that tip 1/3 adapted to the tooth and make multi-directional cross-hatching Strokes about 2 to 3 mm in length never come out of the gingival margin so once you're in and sub jingal stay in until you've completed that surface of the tooth like on the dists or then the facial and lingual or lingual and Fa facial amial and lingual amial okay you want to keep the tip pointed in the direction that you are working and you need to explore every millimeter of the tooth every square millimeter steps to mastering exploring use your steps talk out loud as you do in clinic me my patient my equipment my light my non-dominant hand my dominant hand my finger rest my adaptation sub interval calculus detection and Carries detection errors are caused by a failure to maintain constant adaptation with the side of the tip third of the Explorer failure to extend The Strokes halfway unto into the contact and under the contact from both the facial and lingual aspects failure to insert the Explorer to the junk epithelium before initiating assessment Strokes using too much lateral pressure not making multidirectional cross hatching Strokes of 2 to 3 millimet in length that cover every square millimeter of tooth surface other reasons improper chair position improper patient position so improper clock position patients to High the patient's head isn't turned towards you not having adequate light not having um the patient in the chin down or chin up position not using your air as you're learning all of your instruments but your Explorer and your probe remember you're learning psycho motor skills and it they are going to take tons of practice practice practice and more practice and then again some more practice after that assessment instants require very light pressure I think we've hit on that and honed in on that and sure you understand that by now you want to be systematic in your approach following the steps to get yourself ready and get in prision following the steps to insert and make your instrument Strokes following the proper sequence for how for the areas of the teeth to Explorer for the each of the areas of the mouth the Seance and the anterior Seance so all of these sequences and systems um will help you be a better clinician and not miss things thank you for your time and attention with your Explorer module if you have any questions please reach out to your instructor for clarification