Scale
Ensure modified pen grasp
General points
Ensure good illumination of the area in the cavity you are working on
Detect and check for deposits using the B{E probe, good lighting and vision and air dry. Do this before, during and after scaling
Safe retraction and protection of soft tissues
Ensure the mirror is following and retracting the area you are working on
Ensure the soft tissues are retracted fully and are not near the US shank as this could get hot and cause trauma to the soft tissues
Cross infection control
Key points
Flush units prior to starting
Check tip against wear guide
Fill sterimate with water prior to placing the tip
Adjust the water flow
Power button setting
Light hold of the sterimate
Finger rests same arch
Safe retraction of the soft tissue to ensure the tip nowhere near
Technique - rapping, left to right and repeat to remove the deposits
No additional force to be used
Remove tip from sterimate when not in use
Cavitron Powerline 1000 ultrasonic insert
Triple bend shank
Cross-section: square
Shape/design disperses energy
Line angles
Interproximal spaces
Moderate-heavy deposits
All power levels
2-3mm of tip
0-15 degree angulation
Subgingival (only where access allows)
Cavitron Powerline 100 ultrasonic insert
Shank double bend
Access to the posterior or teeth
Aids in adaptation
Moderate-heavy deposits
All power levels
2-3mm of tip
0-15 degree angulation
Cavitron Powerline 3 Ultrasonic insert
Rounded toe design
Blunt tip
Calculus bridges
Heavy stain
Vertical stroke (straight on, under the calculus)
All power levels
Anterior region
4mm of tip = active area
Lost length = loss of efficiency
2mm → 25-30% less active
40% more force/pressure
Ultrasonic scaler
Insert tip → grip → O-ring → stack
Ultrasonic scalers are indicated to debride the root surface, that is, to disrupt and reduce the biofilm, and remove calculus, but without causing intentional removal of cementum. This is a gentler, less destructive form of treatment that achieves the same clinical outcomes, but without causing tissue damage. It is also more time efficient and appropriate for use year-on-year in a typical periodontal maintenance patient.
Magnetostrictive
Materials which undergo change in shape due to a change in the magnetisation state of the material
A low-voltage electric current produces a magnetic field in the handpiece, which causes the insert to expand and contract, making its length, resulting in vibrations to the tip
Ultrasonic variable
Frequency of 25-30kHz
Power setting
Amplitude (strokes)
The more pressure you put on the tip, then this will decrease the strokes making the tip less effective.
High power = longer forceful strokes
Low power = shorter, less forceful stroke
System performance enhancement
SPS - sustained performance system (cruise control)
The ability of the systems to sense the need for additional power and automatically adjust to maintain the stroke.
Boost mode - activated with footpedal (30k technology only)
Tap on technology - activate scaling or air polishing with a songle tap of the foot pedal, allowing the foot to rest during the procedure
Modes of action
Cavitation
Acoustic-microstreaming
Lavage/irrigation
Mechanical vibration
Cavitation
Water supply meets vibrating tip and forms air bubbles
Bubbles grow in size and then collapse inward (implode) releasing a burst of energy (shock waves)
Removes calculus
Enhances biofilm removal
Potential to disrupt bacterial cell walls
Acoustic microstreaming
Forceful flow of cavitating fluid which enhances effectiveness beyond surface actually touched by the tip
Lavage/irrigation
Flushing action created by constant stream of fluid (lavage)
Washes debris, unattached biofilm and endotoxins
Keeps tip cool
Improves visibility
Adjustable
Mechanical vibration
Longitudinal sweeping action of an oscillating tip
Fractures the calculus off the tooth surface
Indications for use
Disruption and removal of plaque biofilm
Removal of supragingival and subgingival calculus
Removal of stains
Root surface debridement
Flushing out periodontal pockets
Implants (with correct tips)
Contraindications for use
Some types of cardiac pacemaker (need to check with cardiologist/manufacturer)
Communicable disease that can be transmitted by aerosol
Demineralised areas - would cause cavitation
Caution should be exercised for:
Care to be taken with crowns and composite restorations
Immunosuppresses patient
Patients with respiratory problems
Patients with swallowing problems
Cochlear implants
Hearing aids may be an interference
Patients with sensitive teeth
Immature teeth (large pulps - sensitivity)
Osseointegrated implants
Narrow periodontal pockets
Aims
Thorough instrumentation/debridement
Ability to contact the root surface
Efficacy of deposit removal
Efficiency of deposit removal
Effect on root surface
PAtient comfort
Ergonomic
Principles
0-15 degrees to tooth surface
Finger rest to stabilise
Insertion at gingival margin
Probing pressure
Keep the tip in motion
Bidirectional stroke
Power setting
Select the lowest power effective to accomplish the task
Biofilm = low setting
No further than 10 o’clock
Calculus = medium setting
No further than 2 o’clock
Rarely use the highest setting
Only for heavy deposits/stains
More uncomfortable for the patient
Tapping technique more important
Water flow/lavage
Integral to the tip
Focused spray (end)
Through flow (neck)
Water is needed
To flush the pockets
To cool the tip to prevent overheating
Deposit removal
Biofilm
Power = low
Water = rapid drip
Essential
To prevent overheating
To function correctly
Calculus
Power = kedium
Water = fine spray
Water flow control
Hold handpiece over the sink and activate the root canal edal. Adjust lavage control knob to ensure adequate flow for selected power setting
Increase or decrease water flow
Determines temperature of lavage
Lower flow rates produce warmer lavage. Higher rates produce cooler
At the start:
Flush the sterimate for 2 mins
In between patients:
Flush the sterimate for 30s
Range of cavitron inserts
Beavertail
FSI 1000
Slimline 10
Slimline L+R
Thinsert
Implant insert
Insert tips
Beavertail - for removal of heavy supragingival calculus stain
Standard - for removal of moderate-heavy supra and subgingival calculus and stain
Slimline - for removal of moderate-light deposits in deep pockets and furcation areas
Staged instrumentation of supragingival
Firstly, gross removal of moderate-heavy calculus or stain
Beavertail insert
Higher level of power required
Tip of the insert can be used during instrumenting
Then or if min/moderate supra calculus or stain then:
Standard insert indicated - 10,100,1000 thinsert
Moderate-high level of power dependent on tenacious deposits
Health and safety
Pace handpiece back in the holder when not in use
Do not place on the bracket table
Tip should be covered to avoid the risk of a needlestick injury
Protective caps are sometimes available or a cotton wool roll may be carefully applied to the tip
Maintenance
Tips should not be reshaped
Do not bend the metal stack
Flush with water after using the irrigating solution
Weekly
Recommended water systems are disinfected
Chemically flush the water lines
1:10 sodium hypochloride solution 5.25% (bleach) once a week
Mix 1 part bleach and 10 parts water
Then
Flush system with clean water
Fr at least 30s until sodium hypochlorite odour is gone
Water line filter maintenance
Replace filter when discoloured or water flow is diminished
Maintain all water lines in accordance with HTM01-05 recommendations
To remove filter:
Grasp fittings on either side of the filter disc
Twister counter-clockwise
Remove filter from either side of the water hose
Hand tightened clockwise
Reconnect hose to dental office supply
Check for leaks
Issues
Leakage between the insert and the handpiece
O-rings
Incorrect maintenance and servicing may invalidate warranty