Perio 17 - Periodontal Powered Instruments (Dr. Ogata)

Manual

___________ instrumentation was the only method available for the removal of supra and subgingival calculus until the ultrasonic devices were introduced in dentistry in the 1950s.

Power-driven (sonic and ultrasonic)

___________ instruments/scalers generate high frequency vibrations. They are used for deplaquing, supragingival scaling, and subgingival scaling.

- Increased efficiency in removing heavy calculus deposits

- Reduced time for the procedure

- Less fatigue to the clinician, more ergonomic

- Water lavage and cavitation

- Greater access in furcation areas and narrow/deep defects (with thin tips)

- No need to sharpen

- Less tissue trauma

What are all of the advantages of power-driven instrumentation?

- Aerosol production

- Patient discomfort (water, noise, and increased root sensitivity)

- Need for constant suction

- Less tactile sensation

- More precautions and limitations

- Inability to root plane

- (More equipment costs)

What are all of the disadvantages of power-driven instrumentation?

- Magnetostrictive

- Piezoelectric

What are two examples of ultrasonic instruments?

Sonic scaler

What type of power scaler is composed of a handpiece and tips?

Sonic scaler

What type of power scaler is driven by compressed air?

Sonic scaler

What type of power scaler has 2,000-6,500 vibration cycles per second?

Sonic scaler

What type of power scaler's movement of the tip is elliptical or orbital?

Sonic scaler

What type of power scaler has surfaces that are all effective?

Sonic scaler

What type of power scaler is portable?

Sonic scaler

What type of power scaler is less expensive?

Sonic scaler

What type of power scaler has a power that is NOT adjustable?

Sonic scaler

What type of power scaler is rather noisy?

sonic scaler

What type of power scaler generates minimal heat - needs water?

Ultrasonic scaler

What type of power scaler is driven by electricity and generates heat?

piezoelectric

What type of ultrasonic scaler?

- Linear motion

- Only active on lateral sides

magnetostrictive

What type of ultrasonic scaler?

- Elliptical motion

- All sides active

Ultrasonic scaler

What type of power scaler has 18,000-50,000 vibration cycles per second?

Ultrasonic scaler

What type of power scaler's movement of the tip is elliptical OR linear?

Ultrasonic scaler

What type of power scaler has adjustable power?

ultrasonic scalers

What type of power scaler mechanically disrupts and removes biofilms, calculus, endotoxin, and stains through mechanical action?

Piezoelectric scaler

ID the instrument:

Magnetostrictive scaler

ID the instrument:

Ultrasonic

While the _________ instrument is operating, a flow of

cooling water (or antibacterial mouthwash) passes over the vibrating tip, reducing heat

Ultrasonic scaler

What type of power scaler you must adjust the water to a fine mist?

Ultrasonic scaler

this type of power scaler has coolant options (water or antibicrobial) which passes over the vibrating tip, reducing heat

sonic scaler

These are advantages of what type of scaler?

- Inexpensive

- Portable

ultrasonic scaler

These are advantages of what type of scaler?

- Adjustable power

- Higher power

- Adjustable water

- Coolant options (water, antimicrobial)

sonic scaler

These are disadvantages of what type of scaler?

- Less power for calculus removal

- Non-adjustable power

- Noisy

- Mechanical vibration

- Lavage

- Cavitation

- Acoustic microstreaming/turbulence

What are the 4 modes of action of an Ultrasonic scaler?

Mechanical vibration

What is the primary mode of action of an Ultrasonic scaler?

Lavage

What mode of action provides a...

- Constant flushing of the sulcus or periodontal pocket during instrumentation

- Can disrupt and flush away bacterial biofilm, and is is believed to be of therapeutic benefit

Cavitation

What mode of action...

- Refers to the formation of pulsating minute bubbles that are generated in cooling water around the scaler

- Studies have suggested that the "_________ effect" can break up colonies of bacteria and destroy a spirochaete cell membrane

Acoustic microstreaming

What mode of action refers to the unidirectional fluid flow generated by ultrasonic waves?

Acoustic turbulence

What mode of action is created when the movement of the tip causes the coolant to accelerate, producing an intensified swirling effect? This continues until cavitation occurs.

Magnetostrictive ultrasonic scaler

What type of ultrasonic unit is this?

Magnetostrictive Ultrasonic scaler

What type of ultrasonic scaler has magnetized metal stacks in the handpiece convert electrical impulses into mechanical vibrations?

Magnetostrictive Ultrasonic scaler

What type of ultrasonic scaler's tip moves in elliptical pattern?

Magnetostrictive Ultrasonic scaler

All surfaces are active on what type of ultrasonic scaler?

Lateral surface

ID #1 of the magnetostrictive ultrasonic scaler:

Convex back surface

ID #2 of the magnetostrictive ultrasonic scaler:

Point

ID #3 of the magnetostrictive ultrasonic scaler:

Lateral surface

ID #4 of the magnetostrictive ultrasonic scaler:

Concave front surface

ID #5 of the magnetostrictive ultrasonic scaler:

True

T/F: The decision of which instruments to use is based on

type and location of calculus, health or disease status of

the patient, and root anatomy

- Straight

- Curved

What are the two shapes of the tip of an ultrasonic scaler?

- Standard

- Slim

- Ultra slim

What are the three diameteres of the tip of an ultrasonic scaler?

- #10 universal

- #1000 triple bend

- Original prophy

What ultrasonic scaler tips are the following?

- Light to moderate calculus deposits

- Heavy deposits orthodontic cement

- Tenatious subgingival deposits

Swivel XT

What ultrasonic scaler tip is the following?

- Tenatious subgingival deposits

#3 Beavertail

What ultrasonic scaler tip is the following?

- Heavy deposits orthodontic cement

After five inserts (left, straight, right)

What ultrasonic scaler tip is the following?

- Light to moderate deposits in periodontal pockets

- Furcation areas

- Developmental concavities

#10 (Universal thick)

the number ___ tip has a single bend, standard diameter

#100 (Universal thin)

the number ___ tip has a double bend, standard diameter

#1000

the number ___ tip has a triple bend, standard diameter

Universal design

What type of tip is this?

Site-specific design insert

What type of tip is this?

#10 (Universal thick)

What # tip should you use on heavy/large deposits and tenacious subgingival deposits?

Supragingivally

Where should the #10 (universal thick) tip should mainly be used?

#100 (Universal thin)

What # tip should you use on light to moderate deposits and subgingival- periodontal pockets?

subgingival

what is the main area of use for a #100 Universal thin tip?

40%

The universal thin tip is ____% thinner than the standard #10

Probe Sized Tip

What type of tip should be used deep periodontal pockets with improved adaptation in interproximal areas, furcation areas and developmental concavities?

Implant Tip

What type of tip is used for implant maintenance: gently removes light to moderate plaque and calculus without damaging implant titanium abutment surfaces?

Implant tip

What type of tip is this?

Piezoelectric Ultrasonic scaler

What type of ultrasonic scaler has ceramic discs or quartz crystals located in the handpiece converts electrical energy into mechanical vibrations?

Piezoelectric Ultrasonic scaler

What type of ultrasonic scaler's tip moves in linear pattern?

Piezoelectric Ultrasonic scaler

Only the lateral surfaces are active on what type of ultrasonic scaler?

Piezoelectric Ultrasonic scaler

Which type of ultrasonic scaler is more technique sensitive?

Piezoelectric Ultrasonic scaler

Which type of ultrasonic scaler is the most expensive of all powered scalers?

Piezoelectric Ultrasonic scaler

which type of ultrasonic scaler requires a wrench to screw into handpiece?

Piezoelectric Ultrasonic scaler

which type of ultrasonic scaler is more light weight and ergonomic?

Piezoelectric Ultrasonic scaler

which type of ultrasonic scaler is more quiet?

Piezoelectric Ultrasonic scaler

which type of ultrasonic scaler is more powerful?

Magnetostrictive Ultrasonic scaler

which type of ultrasonic scaler less technique sensitive?

Magnetostrictive Ultrasonic scaler

which type of ultrasonic scaler generates more heat and thus requires more water?

true

t/f: There is no difference in the efficacy of subgingival debridement using ultrasonic/sonic scalers versus hand instruments in the treatment of single-rooted teeth

false, no differences in outcomes

t/f: there are big differences in outcomes between sonic, magnetostrictive and piezoelectric scalers

true

t/f: Hand instrumentation and ultrasonic debridement provided comparable clinical results.

- Respiratory disease (COPD, asthma, emphysema, cystic fibrosis, pneumonia)

- Patient with difficulty in breathing

- Patients with difficulty in swallowing (dysphagia) and sensitive gag reflexes

- Patients with unshielded cardiac pacemakers

- Communicable disease that can be transmitted by aerosols (TB, hepatitis, HIV)

- Patients susceptible to infection (immunosuppression from disease, chemotherapy, uncontrolled diabetes, debilitation, and kidney or other organ transplants)

What are the general health contraindications when using an electric scaler?

- Demineralized teeth

- Exposed dentinal surfaces- tooth sensitivity

- Margins of restorations (porcelain, amalgam, composite, gold)

- Primary teeth and newly erupted permanent teeth

- Surfaces of titanium implant

What oral conditions is use of an electric scaler contraindicated on certain teeth or the full mouth?

50

Aerosol refers to fine, airborne particles (liquids and solids) less than ____ um in size

True

T/F: A universal precaution with aerosol production is to use personal protective equipment (clinic gown, mask, gloves, face shield, safety glasses)

True

T/F: With aerosol production, you should use a high-speed evacuation device

Antimicrobial pre-procedural rinse: One-minute swishing with an antimicrobial rinse prior to ultrasonic debridement

How can you significantly reduce the bacterial count in a dental aerosols of a patient?

Aerosol control

The following are for control of what?

- Funnel-shaped autoclavable attachments are available at the dispensaries.

- Attach this to the high-speed evacuation "snake" and position it against the chin of the patient as close as you can.

- Use the second high-speed evacuation line intraorally .

At least 2 minutes

how long should your flush the waterline of the Cavitron® at the beginning of the day?

30 seconds

how long should your flush the waterline of the Cavitron® between patients?

fine mist without signficiant droplets

when setting up your ultrasonic (cavitron), you will place a sterilized insert into the handpiece with water in the handpiece, set power to desired setting, and want to adjust the water and create a ________ of water dripping off the tip

- Grasp

- Pressure

- Angulation

- Adaptation to tooth morphology

- Stroke

What are the 5 factors affecting instrumentation efficacy?

Pen grasp: The index finger and thumb hold the instrument handle. The middle finger rests on the instrument shank.

how should you hold to ultrasonic handpiece?

extraorally

when holding the ultrasonic handpiece, where should you find a fulcrum?

light lateral

when holding the ultrasonic handpiece, use _______ pressure for optimal efficacy and patient comfort.

point of tip

what is the #1 most powerful part on an ultrasonic tip?

concave surface

what is the #2 most powerful part on an ultrasonic tip?

convex surface

what is the #3 most powerful part on an ultrasonic tip?

lateral surfaces

what is the weakest (and #4 most powerful) part on an ultrasonic tip?

Parallel

Regarding angulation of ultrasonic instrumentation, you want to keep side of the tip _________ to the long axis of the tooth

90°

Regarding angulation of utlrasonic instrumentation, the tip of the blade of the insert should never be applied at _____° to the tooth surface except when cleaning calculus from the enamel grooves on the occlusal surfaces of posterior teeth

7-15°

when holding the ultrasonic handpiece, apply working end at no more than a ____-____° angle to tooth surface.