Indications for Use: Contraindications: Benefits of Ultrasonics: Disadvantages: Some handpieces cannot be sterilized Portability Evacuation needed

Transcription

1 An Integral Part of Periodontal Therapy Indications for Use: Removal of calculus and stains Periodontal debridement Easier access to furcations Prior to oral surgery Removal of orthodontic cement & de bonding Removal of overhangs on restorations Benefits of Ultrasonics: With or w/o anesthesia Comfort Less operator fatigue No cutting edges Irrigation (flush debrisaids in visibility) De plaquing Effective as hand instrumentation Bacteriocidal effects cavitation & acoustic turbulence Faster No sharpening Better access to deep pockets/furcations Less damage to cementum Delivery of antimicrobials (in selected units) Contraindications: Communicable diseases Patients susceptible to infections Respiratory problems Pti Patients t with difficulty swallowing Cardiac pacemakers (magnetostrictive only) Age Demineralized enamel Porcelain crowns, composites, veneers, titanium implants Sensitive teeth Disadvantages: Some handpieces cannot be sterilized Portability Evacuation needed Aerosol production Less tactile sensitivity Noise /vibration Expense Heat production Primary Modes of Action: Cavitation Acoustic turbulence Flushing action Lavage Mechanical action/vibration 1

2 Types of Power Scalers: Magnetostrictive: Piezoelectric Magnetostrictive Stack or ferric rod causes vibration 360 degree activation of tip Interchangeable tips Produces heat & water cooled Use of antimicrobials (optional) Brand: Cavitron Dentsply Sonic Piezoelectric: Quartz or crystal transducer Tip screwed into handpiece with a wrench Power contained in handpiece not inserts Brands: Hu Friedy s d Symmetry, Pro Select Pro Dentec, & EMS System Sonic Slow speed handpiece; attaches to dental unit No heat generated Water used to cool friction & lavage Example: Titan Scaler Sonic or Ultrasonics: Power difference Cost Effects on heavy deposits Cavitation i Heat generated Need for water Operates in audible range Beneficial for implant maintenance Magnetostrictive vs Piezo: Elliptical motion/linear All id ti All sides active Stacks/crystal transducer Visibility Learning curve 2

3 Mechanisms of Action: Frequency # times tip vibrates per second (cps) Speed of movement only adjusted in manually tuned units Low moves few times; high moves many times Stroke distance tip moves during one cycle; adjusted by power knob Stroke = amplitude Swing harder pushed farther moves 8:00-9:00 ideal setting Blue zone Power: Higher power LONGER stroke Tip wears faster on high Lower power shorter, less powerful strokes Larger or heavier more tenacious calculusmedium power Automatic Units: 2 control knobs Power controls length of stroke Water controls flow Frequency automatically tuned to peak performance as insert tip is loaded against tooth surface Manually Tuned Units: Tuning 3 adjustment knobs: Water controls flow Power length of stroke Tuning knob controls frequency Tuned through sight & sound Frequency unpredictable under load Unit tells insert how to work ChSCC units are auto tuned 25 K versus 30 K: Active Tip Area: 25K is longer than 30K Higher frequency (above 32 khz); more frictional heat Higher frequency shorter active tip area 50kHz 2.3 mm, 30kHz 4.2, 25kHz 4.3 Studies find no difference in calculus removal between the two; 30 K quieter K same length as dental instrument * Most clinicians prefer lighter, smaller tips (we use 30K) Active tip area: portion of tip capable of doing workranges 2 4 mm in length Cycle one complete linear or elliptical stroke Cycle one complete linear or elliptical stroke Kilohertz (khz) equal to 1000 hertz or 1000 cycles per second (cps) 3

4 Energy Output: Point: generates most energy; not used on tooth; (used on deposit) Face: (concave) 2 nd most powerful; do not adapt to tooth Back: (convex surface) less energy then face/point; can be adapted to tooth Lateral surfaces: (sides) least amount of energy; used directly on tooth; recommended by all power instruments Selection Tip Criteria: Type of calculus deposits (light, medium, or heavy) Location of deposits (above gingival margin or more than 4mm below) Insert Considerations: 1. Removal of moderate heavy deposits Large diameter Universal or triple bend design 2. Removal of light moderate deposits Slim design Straight Curved Hu Friedy s Instrument Tip Designs: Beavertail Standard Diameter Triple Bend Standard Diameter Universal Slim Diameter Straight Slim Diameter Curved (Right & Left) Slim Diameter Furcation Others: carbon composite or plastic tips, diamond coated Beavertail Standard Diameter Triple Bend Broad, bulky tip Supragingivally moderate heavy calculus, stain, & ortho cement Not for sub g Medium power Hu-Friedy UI 30 SS-1000 Shank bends for access to proximal surfaces & line angles Medium heavy deposits; supragingivally Sub g if tissue allows 4

5 Standard Diameter Universal: Slim Diameter Straight: Hu-Friedy UI- 30 SD10 Curved shank & tapered tip Supragingival small large calculus & stain Subgingival if tissue allows Use on low med power Tip extended shank & tapered Similar to periodontal probe Sub g: root surfaces, calculus, & deplaquing Used universally for deplaquing Posterior < 4mm Anteriors any pocket depth UI 30 SDS Slim Diameter Curved: Extended shank; tapered tip; similar to furcation probe Easier access to interproximals & root surfaces Posterior teeth > 4mm Hu-Friedy s UI30 SDL & SDR Slim Diameter Furcation: Tip with ball end Sub g deplaquing of furcations & root concavities Straight & right/left TX on periodontal patients Basic Instrumentation: Select appropriate insert Lowest effective power setting Adjust water for rapid drip or small spray (halo effect) Light pen/modified pen grasp Light lateral pressure Light, stable intraoral or extraoral fulcrums Point not directed into tooth Basic Instrumentation: Strokes overlapping horizontal, vertical, or oblique, or multidirectional (eraser like) Point tip apically & tap against Point tip apically & tap against deposit Explore/evaluate root surface w/insert Insert tip parallel to long axis of tooth 0 15 degree angle to tooth surface Work in coronal apical direction toward junctional epithelium 5

6 Oblique Technique: Straight Slim Tip on Anterior Teeth: Effective for removing calculus above or slightly below gingival margin Vertical Technique: Straight Slim Tip on Anterior Teeth: Straight Slim Tip on Posterior Teeth: Right/Left Inserts Adaptation: Right Tip: Mandibular right buccal & mandibular left lingual & maxillary right lingual & maxillary left buccal Left Tip: Mandibular right lingual & mandibular left buccal & maxillary right buccal & maxillary left lingual Holbrook/Dragoo Methods: Holbrook: Tip hugs tooth & tip to tooth Technique may damage cementum Dragoo: Tip away from tooth, toward tissue Opposite of what you think Used in ChSCC clinic Ultrasonic Inserts: Inspect resin handle for warping or cracking Check stack for flexibility or separation O rings act as water seal Replace O rings if break or leak Lubricate O ring with water (do not use petroleum jelly) Fill handpiece until overflowing Life of insert approximately 12 mo Efficiency Indicators: 1 mm 25% less efficient 2mm loss 50% less efficient (these tips should be discarded & replaced) 3mm 75% 6

7 Care & Maintenance of Inserts: Selection of Instruments?? DO: Handle with care Rinse & dry inserts Wipe tip w/disinfectant if dried blood Leave in sealed bag/cassette until ready to use Sterilize (Steam or Clemiclave) Follow manufacturer s directions DON T: Drop or mishandle Put in ultrasonic cleaner Expose resin handles to phenols Sterilize by dry heat or cold sterilization Use all plastic bags with inserts (they don t ventilate properly) Avoid contact with incompatible chemicals (chlorides & sulfates 7