Lecture 18 Flashcards
1
Q
Order of instrumentation for calculus removal:
A
ultrasonics, scalers (Towner/Jacquette, McCalls) then use curettes (Gracey’s)
2
Q
TF? 30 Jacquette is used to shave off calculus.
A
F. big chunks
3
Q
For breaking big chunks of calculus:
A
U15 Towner/ 30 Jacquette
4
Q
Best instrument for bicuspids:
A
McCalls #13/14
5
Q
Best instrument for molars:
A
McCalls#17/18
6
Q
Ultrasonics were first proposed for use for:
A
cavity prep, early 50’s
7
Q
When did the ultrasonic become an alternative to hand instrumentation?
A
60’s
8
Q
Todays use of ultrasonic:
A
plaque and calculus
9
Q
Indications for Ultrasonic Scaling:
A
calculus, soft tissue debridement (NUG), overhanging resto, excess cement, stain
10
Q
Is there more or less trauma with ultrasonic scaling?
A
less
11
Q
TF? The ultrasonic is a complete substitute for scaling.
A
F
12
Q
Benefits to using ultrasonic:
A
faster, less effort, less discomfort
13
Q
When to use ultrasonic for soft tissue debridement:
A
NUG
14
Q
Types of Powered Scalers:
A
Sonic, ultrasonic
15
Q
Hz for Sonic, ultrasonic:
A
up to 6,000, 20,000-50,000
16
Q
cycles per s for ultrasonic:
A
18,000: beyond hearing range
17
Q
Types of ultrasonic devices:
A
Magnetostrictive and Piezoelectric
18
Q
Drives rotor of sonic scalers:
A
compressed air
19
Q
cycles per s for sonic scalers:
A
2.5-7K cycles/s
20
Q
Tip motion of sonic/ ultrasonic scaler:
A
elliptical
21
Q
TF? Sonic scalers req cooling.
A
T, heat tissues
22
Q
TF? Sonic scalers are good for removing heavy, hard deposits.
A
F. Can’t remove
23
Q
Tip motion of piezoelectric scaler:
A
linear
24
Q
What powers the piezoelectric scaler?
A
piezoelectric transducer
25
How many sides of piezoelectric scaler are active?
2
26
Type of current used for piezoelectric scalers:
alternating, AC
27
TF? The tip of piezoelectric scalers are separate from the transducer.
T
28
Transduceer is aka:
handpiece
29
TF? piezoelectric scalers do not produce heat.
F. little heat Linear, Less heat
30
Adaptation is more critical for this type of scaler:
piezoelectric (WHY?)
31
What type of scalers are ultrasonics?
magnetostricitve and piezoelectric
32
How does an ultrasonic work?
oscillating magnetic field (25-30 kHz) across ferromagnetic stack
33
Which sides of the ultrasonic are active?
all
34
Is heat generated with an ultrasonic?
yes, water cools and flushes debris
35
Optimal freq of magnetostrictive, piezoelectric and sonic:
20-40 kHz, 29-50kHz, 2,500 to 7,000 cycles per s
36
Part that converts energy to vibration:
transducer
37
transducer for magnetostrictive, piezoelectric and sonic:
metal rod/ stack of metal sheets, ceramic, compressed air
38
Stroke patter for magnetostrictive, piezoelectric and sonic:
elliptical, linear, elliptical or orbital
39
Power dispersion on tip of magnetostrictive, piezoelectric and sonic:
all surfaces, lateral surfaces (more), all surfaces
40
Which 2 types have all tip surfaces active?
magnetostrictive and sonic:
41
2 MOA's for ultrasonic scalers:
vibrating tip, cavitation bubbles
42
disruption of biofilm is aka:
deplaquing
43
How do cavitation bubbles work?
bubble expands then collapses, -OH and H- radicals formed.
44
TF? Both -OH and H+ radicals are formed.
F. -OH and H-
45
Effect of free radicals on biofilm:
kills bacteria in biofilm
46
Which is more technically demanding, hand scaling or ultrasonic?
hand
47
When to sharpen ultrasonic tip:
never
48
__% prefer ultrasonic over hand instruments:
74%, may influence compliance w PM (perio maintenance)
49
Benefits of hand scaling over ultrasonic:
better subgingivally, no irrigation, no infectious aerosols, good tactile sensitivity, good visibility, hard to damage roots
50
What type of therapy is irrigation considered?
chemotherapy (check)
51
Possible damage that may occur to roots w ultraonic scaler:
root gouging
52
How many positions does the foot pedal of the ultrasonic provide?
2, half/ fully depressed
53
Steps to setting up ultrasonic:
Convenient location, water, flush tubing, fill with water, lubricate O-ring, seat insert in handpiece, adjust water spray
54
Dental unit waterlines bc infected w:
microorganisms
55
Options to control contamination:
Self-contained reservoirs, point-of-use filters, flushing of water tubing
56
How long to flush ultrasonic handpiece:
2 min at start of each day, 30s bw pts
57
Why add water to hand piece before inserting tip:
expel bubbles from hand piece, prevent overheating
58
Bubbles in an ultrasonic hand piece can cause:
over heating
59
Lubricate the O-ring with:
water
60
Do you need to twist the ultrasonic tip into place?
yes
61
Where to adjust water spray:
unit or handpiece
62
This passes thru instrument tip:
water coolant
63
Adjust water flow at this power setting:
lowest
64
More aerosol for __, less for ___.
moderate-heavy calculus, light calculus, plaque
65
The ultrasonic is __ _ __ (3 words) when using for light debris and deplaquing (plaque, not calculus!)
"out of phase"
66
When to readjust water spray:
When changing power level or tips
67
Why wrap cord of handpiece around pinky or arm?
weighs down, may cause handpiece to twist during instrumentation
68
Power =
freq X amp
69
Freq =
number of vibrations
70
Amplitude =
length of vibration
71
When to use low power, low frequency, low amplitude
light calculus, staining, deplaquing
72
When to use med power, med frequency, med amplitude
mod to heavy calculus, stain
73
Power rarely goes above:
medium
74
most comfortable power range zone:
Blue zone
75
Fully depressed foot control
Boost mode
76
% increased power w fully depressed foot control:
25%
77
1/2 depressed pedal:
tip activated, irrigating water flows
78
How to get to "boost" mode:
fully depress pedal
79
Type of strokes dentists should use for ultrasonic:
short, light
80
What will happen if ultrasonic is used at 90d angle to tooth?
gouging
81
How to reduce aerosol effect of ultrasonic:
high speed evacuation
82
This happens with heavy pressure of the ultrasonic:
oscillation dampening
83
9 groupings of ultrasonic tips:
scaling, resto, maintenance, perio, V-tip restorative, V-tip endo, endo, retrograde endo, and prosthetics
84
All perio tips for ultrasonics are used:
subgingivally
85
TF? Heavy deposits require more tactile sense.
F. less
86
There are special tips for:
subgingival, furcations, implants
87
Thin tips for ultrasonics are used for:
light deposits
88
When to use standard diameter insert:
general debridement
89
Tip to access subgingival area:
subgingival insert
90
2 types of irrigation with ultrasonic:
External, Internal (Dr. Culotta: external, align both tips, internal seems less likely to break)
91
Use implant tips for:
Debridement of implants, cosmetic restorations
92
Are the ultrasonic tips and/or point adapted to tooth surface?
No
93
Covers for ultrasonic for implants:
carbon composite or plastic
94
Parts of ultrasonic that should not be directly adapted to tooth:
point or face
95
Parts of ultrasonic that should be directly adapted to tooth:
back, lateral surfaces
96
Surfaces of ultrasonic for deposit removal:
back and lateral
97
Surface(s) most effective for tenacious calculus:
lateral
98
Highest to lowest power dispersion of magnetostrictive insert tip:
point, face/ concave, back/ convex, lateral
99
When to use ultrasonic tip:
fracture large calculus ledges, rings
100
TF? Brief contact of tip to sound enamel is probably harmful.
F. probably not
101
Active portion of ultrasonic tip:
last 2-3mm of the back or lateral surface
102
tip-to-tooth surface angulation should be close to:
0d
103
Lateral surfaces of an ultrasonic is adapted in a similar fashion to a:
curet working-end
104
Lateral surface adapted to the facial surface in a similar manner to a:
periodontal probe
105
How does the approach to calculus removal differ bw ultrasonic and hand instruments?
top-down vs pocket base to CEJ
106
Work in this direction in a pocket with an ultrasonic:
apical
107
Two techniques for orientation of tip to tooth:
Transverse / vertical tip orientation
108
vertical tip orientation:
back or lateral surface positioned similar to probe
109
transverse tip orientation:
back or lateral surface positioned similar to curet, R angle to long axis
110
Powered instrument tips break up heavy calculus deposits by creating:
microfractures
111
When to leave the tip of ultrasonic in one spot for a few seconds:
never, keep it moving
112
Motion/ stroke used against large calculus deposits:
tapping
113
Motion/ stroke used on light calculus deposits and deplaquing:
sweeping
114
How to make sure all calculus is removed with ultrasonic:
Overlapping, multidirectional strokes
115
Most common mistake in using ultrasonic:
heavy or moderate pressure, stops vibrations
116
Standard diameter tips are used for:
med to heavy calculus, coronal surface, subg deposits easily accessed
117
HVE stands for:
high volume evacuation
118
Magnetostrictive scalers operate at either:
25kHz or 30kHz
119
How to reduce bacteria in aerosols while using ultrasonic:
Pre-procedural rinse (chlorhexidine) (ask, does this also reduce bacteremia?)
120
Is hearing protection recommended during US use?
yes
121
How much of a difference in effectiveness are high and medium power settings for US?
NO DIFFERENCE
122
Too little water will lead to:
pulp damage
123
Difference in calculus removal between 25kHz and 30kHz scalers:
No substantial difference
124
Main difference bw 25kHz and 30kHz units:
less noise
125
Are the inserts bw 25 and 30kHz interchangeable?
No
126
Will a 25kHz vibrate a 30kHz insert?
no
127
Occupational risks with ultrasonic scalers:
Neurological, musculoskeletal, tinnitus (ringing/ buzzing in ear)
128
Possible neurological, musculoskeletal problems assoc w vibrating devices:
Loss of strength, tactile sense, sensory perception, hearing
129
Patient contraindications for US:
Unshielded (define) cardiac pacemakers / defibrillators (except piezoelectric, no electric field), communicable diseases (TB), at risk of respiratory disease, primary/ newly erupted perm teeth, large pulp chambers, difficulty swallowing, prone to gagging
130
Pts at risk of respiratory disease:
immunosuppressed, chronic pulmonary disease, asthma
131
How long can aerosols stay in the air after US use?
many hours
132
Pts prone to difficulty swallowing or prone to gagging:
MS, ALS, muscular dystrophy, Parkinson's, paralysis (MMAPP)
133
Tooth Contraindications for US:
demineralization, sensitivity, implants (wo special tip), restorative materials (ask)
134
1 mm tip wear = __% loss calculus removal ability. (Markings on tips?)
25
135
2 mm tip wear = __% loss calculus removal ability.
50
136
When should US tips be discarded?
2mm of wear
137
power is localized here in US insert:
last 2 to 4 mm of tip
138
Slim-Diameter straight tip work well on these roots:
anterior, straight roots, shallow pockets of posteriors
139
Part of curved slim tips that adapts best:
Back of working-end
140
Curved slim tip w ball end, ideal for use in:
furcation area
141
technique to contain water during US use:
cupping
142
Pt pos during US use:
supine, side, down
143
Is there a sig. difference between manual and ultrasonic?
No
144
To clean furcations:
Roll ball of working-end across furcation roof
145
Should the US be on or off when locating the furcation?
off
146
Stroke type to use to locate furcation:
oblique
147
What fits into a furcation better, ball tip or curette?
ball tip
148
To get best tactile sense with US:
release pedal
149
When to use transverse technique:
above or slightly below gingival margin
150
When to use vertical technique:
below gingival margin
151
Tip for posterior tooth surfaces more than 4 mm apical to CEJ:
curved
152
Tip for anterior teeth even in deep pockets, posterior tooth surfaces 4 mm or less apical to CEJ:
straight
