Department of Clinical Education



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1301 Smile Way

York, PA 17404

800.989.8825

www.professional.dentsply.com


Department of Clinical Education

Win the Battle Against Biofilm: Leverage the Power of Ultrasonics”


COURSE DESCRIPTION

This course is based on current scientific literature and evidence based strategies to give the clinician practical guidelines regarding the use of ultrasonic instrumentation for nonsurgical periodontal therapy. Ultrasonic instrumentation techniques will be covered extensively following the dental hygiene process of care and utilizing hands-on activities.


COURSE GOAL

The goal of this course is to enable the clinician to identify modifying factors related to nonsurgical periodontal instrumentation, manage patient discomfort appropriately, and improve ultrasonic instrumentation skills to facilitate thorough periodontal debridement and enhance treatment outcomes.


COURSE OBJECTIVES

Upon completion of this course, participants will be able to:



  • Differentiate the advantages and limitations of the various technologies which drive power scaling units

  • Compare and contrast the three E’s of hand, sonic, and ultrasonic instrumentation techniques: effectiveness, efficiency, and ergonomics

  • Discuss current research findings which demonstrate the clinical advantages/benefits of ultrasonic instrumentation over manual instrumentation

  • Describe the technology of ultrasonics and define key terminology, including acoustic streaming, acoustical turbulence, cavitation, lavage, frequency, power and stroke pattern

  • Identify and assess pretreatment considerations for the use of ultrasonic instrumentation to include patient’s medical history, clinical indications, and contraindications

  • Incorporate appropriate pain management techniques to improve patient comfort and efficiency during instrumentation

  • Identify various modifying factors which influence and/or change instrumentation protocols such as root anatomy, furcations and oral conditions.

  • List criteria for the appropriate selection of ultrasonic inserts, both standard and modified.

  • Demonstrate the correct technique for utilization of the ultrasonic scaler to include insert and power selection, lavage flow, grasp, fulcrum, tip adaptation, and stroke


OUTLINE:

  1. Evolution of Instrumentation for Nonsurgical Periodontal Therapy

  2. Assessment

    1. Medical History

    2. Periodontal Status

    3. Morphology

  3. Diagnose and Plan Instrumentation Approach

  4. Implementation of Instrumentation Strategies

    1. Science of Ultrasonic Technology

    2. Ultrasonic Tip and Insert Designs

    3. Clinical Application of Ultrasonic Instrumentation

  5. Evaluation of Therapy

  6. Ultrasonic Lavage

Ultrasonics: An Evidence Based Approach to Nonsurgical Periodontal Therapy’
Assess

Diagnose

Plan

Implement

Evaluate
Assessment
Patient Assessment – assessment of the patient’s chief complaint, current periodontal and dental disease status
Biofilm Assessment – assessment of the quality and quantity of the biofilm present
Morphology Assessment - assessment of the root morphology to include furcations, challenge areas and root adaptability
Cementum Assessment – assessment of the cementum at the location of the biofilm
Diagnose
American Academy of Periodontally Periodontal Classification, 1999, Web site: www.perio.org


  • Gingival diseases

    • Plaque induced

    • Non-plaque induced

  • Chronic periodontitis

  • Aggressive periodontitis

  • Periodontitis as a manifestation of systemic diseases

  • Necrotizing periodontal diseases

  • Abscesses of the periodontium

  • Periodontitis associated with endodontic lesions

  • Developmental or acquired deformities and conditions



Plan
Nonsurgical Periodontal Therapy

  • Periodontal debridement

  • Lavage/Irrigation

  • Sustained-release antibiotic/antimicrobial agent

  • Remove iatrogenic biofilm retainers

  • Concurrent dental therapy

Periodontal Debridement



  • Therapeutic interventions

    • Scaling

    • Root planing

    • Root debridement

  • Definitive or complete treatment

  • Preparatory or initial therapy prior to surgery


Implement
Instrumentation Approach

  • Diagnostic instrumentation

  • Ultrasonic periodontal debridement including lavage

  • Evaluation - hand and/or ultrasonic

  • Ultrasonic subgingival irrigation/rinse


Hand Instrumentation
Choices in Hand Instrument Selection

Technique



  • Terminal shank

  • Work to base of pocket

  • Engage 1/3

  • Apply lateral pressure


Ultrasonic Instrumentation



Ultrasonic Technology

Acoustic streaming


  • Forceful fluid flow




Acoustic turbulence

  • Fluid moves in a swirling manner

Cavitation


  • Bubbles implode creating a shock wave

Sonic technology


  • Compressed air runs handpiece to activate tip

  • 2,500 to 7,000 cps

  • Circular/elliptical movement

  • All sides are active




Piezoelectric technology

  • Electrical energy activates piezo-ceramic disks in handpiece

  • 25,000 to 50,000 cps

  • Linear movement




Magnetostrictive technology


  • Electrical energy is applied to coils in the handpiece

  • 25,000 to 30,000 cps

  • Elliptical movement

  • All sides are active




Frequency


  • Number of cycles (one complete stroke path) per second

  • Frequency correlates to the active tip area

  • Example: 30k = 4.2mm of active tip area




Power






Ultrasonic Guidelines



Magnetostrictive

Standard Design

Power – Low to High

Slim-diameter Design

Power – Low to Medium

Perio Specialty Design



Inserts




Beavertail

Heavy stain or calculus





Straight

Light calculus and/or deplaquing in pockets less than 4mm




Furcation

Furcation access

Power – Low to Medium



Single bend

Light to moderate calculus




Modified / Curved

Light calculus and/or deplaquing in pockets greater than 4mm




Implant

Implant care

Power - Low



Double bend

Light to moderate calculus




Dental Specialty Inserts

1. Endodontic – canal debridement, cleansing, irrigation; for

dental use only

2. Diamond Coat – removal of tenacious calculus and soft tissue

in surgical treatment settings; for dental use only



Triple bend

Moderate to heavy tenacious calculus



Piezoelectric

Standard Design


Thin Design



Tips


Large scaling tips and bladed tips - tenacious calculus – medium to high power

light to moderate calculus – medium power

Furcation and deep periodontal pockets – utilize on high power to remove calculus deposites from root surface and to prevent burnishing









Specialty Tips

1. Thin Diamond Coated Tips

~ fine scaling and root planing in narrow furcations

~ can be utilized with Dental Endoscope for

subgingival areas

~ low power

2. Furcation ball tips – furcation areas

~ low power

3. Implant Carbon Composite Tip/ Restorative Margins







Clinical Application

Positioning

  • Modified pen grasp and fulcrum

Stroke Patterns

  • Vertical or tapping motion for moderate to heavy calculus




  • Horizontal or sweeping motion for light calculus and/or deplaquing




  • Oblique for interproximal and contact areas

Vertical Technique

  • Positioned like a probe

  • Vertical or horizontal strokes

Oblique Technique

Modified / Curved Design Technique


  • Subgingival application in pockets greater than 4mm

Hand Instrument Evaluation

  • Assess with probe, explorer, and/or inactivated tip

Ultrasonic Lavage/Rinse

  • Water

  • Chlorhexidine

  • Povidone-iodine

  • Other


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