Powered Instruments for Periodontal Debridement Flashcards
how do powered instrumentation devices dislodge calculus
use a rapidly vibrating irrigated working end
what do powered instruments usually consist of
an ultrasonic generator, a handpiece, interchangeable tips or inserts
the three A’s of powered instrumentation
adaptation -2-3mm of insert tip
angulation - 0-15 degrees
activation - short, 2-3mm overlapping strokes
primary goal of periodontal debridement
removal of bacterial plaque and by-products
secondary goal of periodontal debridement
calculus removal
therapeutic endpoint of periodontal debridement
decrease in microbial load
clinical endpoint of periodontal debridement
tissue response
hand vs powered instrumentation
ultrasonic inserts produce smoother roots with: the least amount of damage, better calculus and biofilm removal, less operator fatigue
ultrasonic scalers
piezo and magneto
magnetorestrictive ultrasonic scaler
electrical energy is applied to coils in handpiece and magnetically changes dimension of metal stack to produce vibrations
elliptical movement
four active surfaces… can use any side of the instrument
piezoelectric ultrasonic scalers
electrical energy is applied to crystals in handpiece which emits vibrations
linear movement
two active surfaces… can only use lateral sides
what is ideal for furcation due to easy access
thin ultrasonic inserts
frequency
of strokes per second
does not change
amplitude
length of stroke
affected by power setting and is adjustable
increase in power increases amplitude
decrease in power decreases amplitude
tuning
water knob controls water flow
power knob controls length of the stroke
amplitude and deposit removal
lower: shorter strokes, less powerful, light calculus, biofilm, endotoxin removal
higher: longer strokes, more powerful, moderate-heavy calculus, moderate-heavy stain
4 mechanisms of action of powered instrumentation
mechanical: longitudinal sweeping action of oscillating tip
irrigation: lavage from the water
cavitation: bubbles collapse inward, releasing energy
acoustic microstreaming: forceful flow of cavitating fluid which enhances effectiveness
tip wear reduces
efficiency
efficiency lost from worn tips
1mm wear: approx 25%
2mm wear: approx 50%
powerline (standard) inserts
beavertail
FSI 10
FSI 100
FSI 1000
beavertail - rounded toe
removes heavy cal
used on all power settings
vertical strokes
FSI 10 - one bend
all surfaces
curved shank
tapered tip
moderate-heavy deposit
low-high power settings
FSI 100 - two bend
straight shank
tapered tip
moderate-heavy deposit removal
low-high power settings
FSI 1000 - triple bend
line angles and IP surfaces
square edges to provide more energy
moderate-heavy deposit removal
low-high power settings
moderate to heavy calculus use
cavitron powerline ultrasonic inserts
slimlines
straight - 30% slimmer
right and left - curved shank, allows adaptations
area specific
light to mod deposit and biofilm removal
low-med power
light to moderate calculus use
cavitron slimline ultrasonic inserts
cavitron thinsert
access to tight tissue, interproximal surfaces, misaligned teeth, increased tactile sensitivity because of thinness, light to mod deposit and biofilm removal, usable at all power levels
to remove biofilm/light calculus use
cavitron thinsert ultrasonic insert
staged instrumentation
initial debridement: gross removal of mod-heavy calculus or stain, standard insert indicated and higher level of power required
debridement: definitive removal of light deposits, biofilm, endotoxins, slim inserts indicated and low level of power required
biofilm vs calculus removal
biofilm: small sweeping strokes, methodical, slim/thin inserts with round cross sections, low power level
calculus: tapping and sweeping strokes, power/standard inserts, power level as needed
blue zone
a low power setting which maximizes patient comfort but may need to turn the power beyond depending on the nature of the deposit
standard and beavertails operate on what power settings
all
slimlines operate on what power settings
low to medium
general contraindications to powered instrumentation
-patients with communicable diseases that can be transmitted by aerosols
-immunocompromised patients
-susceptibility to infection: diabetes, systemic lupus, chrohn’s disease, chemo
-hearing aids
-avoid with patients likely to overreact to stimuli
cardiovascular contraindications
take caution when using on automatic implanted cardioverter defibrillators and pacemakers more than 10 years old
respiratory contraindications
-COPD or other respiratory conditions
-acute pulmonary infections
-impaired swallowing
-severe gag reflex
-muscular dystrophy
-paralysis
-MS
tooth conditions/anomalies contraindications
-demineralized teeth
-restorative materials
-dentin hypersensitivity
cavitron SPS
offers the blue zone
offers power boost
offers sleeve with swivel
offers balance between efficiency and patient comfort
automatically maintains power and frequency settings as it meet the tooth/root
piezo technology
has a fibreoptic light
works from the base of the pocket up
magnetorestrictive technique review
fill handpiece with water
keep handpiece vertical
lubricate O ring
slide insert into handpiece vertically
adjust water flow
patient preparation for powered instrumentation
explain procedure to patient
a preprocedure rinse is recommended to reduce the bacterial load in aerosols
personal protective equipment for the patient
clinician preparation for powered instrumentation
wear a gown with a high neck and long sleeves, mask and protective eyewear and gloves
change mask every 20 minutes
