Ultrasonic Scaling

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Department of Periodontics Seminar topic : ULTRASONIC SCALING Guided by : Dr. Roshan Lal Dr. Yashpal Dr. Amita Dr. Preetinder Singh Dr. Nitin Soni Dr. Sumit Kaushal Dr. Sarita Dr. Alka Submitted By : Yogesh Mehra 6099 B.D.S. Intern

Transcript of Ultrasonic Scaling

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Department of Periodontics

Seminar topic: ULTRASONIC SCALING

Guided by:Dr. Roshan LalDr. YashpalDr. AmitaDr. Preetinder SinghDr. Nitin SoniDr. Sumit KaushalDr. SaritaDr. Alka

Submitted By:Yogesh Mehra

6099B.D.S. Intern

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ULTRASONIC SCALING

Introduction:What is periodontal disease?• Periodontal disease is the infection of supporting structure of

teeth.• Most important cause of adult tooth loss• Begins with plaque which if not removed may hardens to form

calculus• This increases no. of harmful bacteria and resulting in

deepening spaces b/w teeth and gums c/a pockets.

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What is an ultrasonic scaler?To fight with periodontal disease we need to reduce

plaque, calculus & no. of bacteria in the pockets of mouth.

It consists of wand with scaling tip that produces ultrasonic vibrations in combination with water flow that removes the calculus.

Its an important tool in prevention and t/t of periodontal diseases.

Benefits of ultrasonic scaling:1) Increases efficiency of calculus removal 2) Less need of hand scaling3) More comfortable access to root surfaces

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Sonic: in 1960’s, eg. Denosonic Scaler,Titan S,Kavo Sonic flex• Air-driven scalers• Sonic scaler tips are large in diameter and universal in

design.• Operated by compressed air.• 6000 Hz to 9000 Hz frequency• Plaque and calculus removed by tapping motionUltrasonic scalers:Consists of wand with a scaling tip that produces quick

small ultrasonic vibrations.Types of Ultrasonic scalers:1) Magnetostrictive2) Piezoelectric

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Magnetostrictive ultrsonic scalers:• In 1950’s • Eg. Dentsply, Cavitron,Odontosson• Driven by either a metal stick• Consisting of Ni-Fe alloy strips or ferrite insert inserted

into hand piece• A live coil in hand piece generates air alternating

electromagnetic field that l/t expansion and contraction of ferro-magnetic material

• The resulting vibrations are conducted to the scaler tip in elliptical or orbital pattern.

• 25 KHz to 30 KHz• Less technique sensitive

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Piezoelectric Ultrasonic scalers:• Eg. Amdent, EMS Piezon Master, Satallec Suprasson• New generation of USS light in weight, compact

modern design,quick, effective, effortless, more hygienic.

• The vibrations are generated by changes in dimension of quartz crystals the resulting mode of oscillation is strictly linear.

• This uses pulsing voltage applied to ceramic crystals.• 32 KHz – 35 KHz• More technique sensitive

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Principles of Ultrasonic scaling:Are CAVITATION an ACOUSTIC STREAMINGCavitation:Cavitation is defined as the growth of subsequent violent collapse of a

small gas filled pre-existing inhomogenity in the bulk fluid.This motion results in development of shock wave, increased

temperature and pressure & free radical formation in the fluid.Acoustic streaming:def as generation of time independent steady unidirectional

circulation of fluid in the vicinity of a small vibrating object. This flow of liquid has small velocity of order of few centimeters/sec, but because of small dimensions involved there is formation of hydrodynamic stresses at the scaler tip.

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WORKING:• Keep the scaling tip parallel to tooth surface.• Scaling tip should not kept more than 15 degree angle to avoid

etching or grooving of the tooth surface.• Centre the spray on the middle 1/3rd of tooth & use a constant

circular motion • Working tip should come in contact with calculus to fracture and

remove it.• The scaling tip vibrates in elliptical, curved linear or figure “8”• Not to be used > 10 sec on any single tooth• Never to press harder than one ounce of pressure • Use light, vertical, horizontal , or oblique overlapping strokes.

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Patient position and finger rests:• For upper arch the patient is seated in supine

position with the chin slightly lifted• For mandible the back rest should be at 45

degree to floor• For lingual aspect of mandibular anterior teeth

lower the patient’s chin• Light pen or modified pen grasp is used, and

extra oral finger rest should be used for maxillary teeth and extraoral or intraoral finger rest for mandibular teeth.

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Role of coolant:• Keep tissues in physiologic temperature range• Flow rate 14 ml/min to 23 ml/min.• Water contributes to three physiological effects:

Acoustic streaming, Acoustic turbulence and cavitation.

Instrument Power setting :High power – produce aerosol and splatter

formation might reduce the volume of cooling agent that is delivered in to the periodontal pocket.

use lowest effective power setting

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DRAWBACKS OF ULTRASONIC SCALING :1. Thermal effects on dental pulp - performing USS without

irrigation leads to increase in temperature complete damage of pulp tissues .

2. Thermal effects on periodontium – very little effect is observed on surrounding tooth supporting tissues

3. Vibration hazards to patient – damage erythrocytes, leukocytes & platelets , blood platelets are sensitive to sheer stresses & such forces are produced by occurrence of acoustic micro streaming around an ultrasonically oscillating tip.

4. AEROSOL : aerosol & splatter formation during ultrasonic scaler contact with fluids whether the fluid is saliva , blood & water . The energy transmitted to fluid is enough to produce the aerosol suspension of the fine liquid particle . Fine aerosol mist may remain air borne for extended period of time, contaminating the dental operatory

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5. Auditory : potential hazard to auditory system of both operator & patient

For patient damage can occur through the transmission of ultrasound through tooth contact through the inner ear via the bones of the skull .

May l/t tinnitus , may cause permanent damage to inner ear 6.Cardiac pacemakers : it is well known that magnetic, electrical or

electromagnetic fields of sufficient strength can interfere with the action of pacemakers .

The handpiece of ultrasonic scaler produces an electromagnetic field

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INDICATIONS:• Adjunct to manual scaling but not a substitute• In followingCalculus and stain removalDisrupt microbial coloniesGingival CurettageOverhangs and excess cement removal after

cementation of orthodontic appliances

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CONTRAINDICATIONS:• Patient with unknown communicable disease• Immune compromised patient• Cardiac Pacemaker• Laser eye surgery• Demineralized areas• Children• Patient with swallowing/gagging problem• History of chronic pulmonary disease• Exposed dentinal surfaces• Respiratory diseases• Titanium implants• Porcelain crowns

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PRECAUTIONS:• avoid direct contact of cleaning jet with soft tissues • Avoid prolonged use of this system on cementum

and dentin .• Not use more than 10 sec on any single tooth • Never press harder than 1 ounce of pressure• Use consistent water spray • Use mask, gloves and protective eye wear and use

high speed evacuation to minimize inhalation of contaminated aerosols.

• Direct the patient to rinse for 1 min with 0.12% chlorhexidine.

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COMMON OPERATORS ERRORS:• Excessive pressure during scaling• Failure to use lowest effective power setting• Failure to use adequate water flow• Failure to flush water lines before and after

each use• Failure to keep tip in constant motion

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Reference:CarranzaLindhe

Thank You