Ultrasonic scaling (US) Flashcards
POWERED SCALERS
Powered instrumentation uses
_________ inserts to remove _____
and ________ deposits, disrupt plaque
biofilm, and flush ______ products and free–
floating ______ from pockets
Powered instrumentation uses ________
pressure with ________ strokes to
remove deposits.
powered instrumentation uses INTERCHANGEABLE inserts to remove SUPRA and SUBGINGIVAL deposits, disrupt plaque and biofilm, and flush toxic products and FREE FLOATING BACTERIA out of pockets
powered instrumentation uses GENTLE pressure with OVERLAPPING strokes to remove deposits
powered ultrasonic scalers
power driven units that convert _______ to __________ by flowing electricity over _______ or _________ in form of rapid vibrations to the instrument tip
these rapid vibrations fracture and shatter ______, ______, and _______ from teeth
ultrasonic scalers are power-driven units that convert ELECTRICAL ENERGY to MECHANICAL ENERGY by flowing electricity over QUARTZ CRYSTALS or FERROMAGNETIC METALS in the form of rapid vibrations
these rapid vibrations fracture and shatter CALCULUS, PLAQUE, AND STAIN from teeth
what are the benefits to ultrasonic scaling
- takes less times (20-60% less depending on skill)
- less operator fatigue
- ergonomics; less repetitive movements, larger handle size, no need to wrist motion
- sulcular irrigation
- no need to sharpen tip, just replace overtime
what are the 3 types of positive tissue response
ACOUSTIC TURBULENCE/MICROSTREAMING: intensified swirling and pressure effect that disrupts biofilm (loss of fimbriae)
CAVITATION: imploding bubbles that produce shock waves in the water that kill bacteria
LAVAGE/IRRIGATION: constant subgingival flushing
what are the contraindications to US (7)
- primary teeth
- severe respiratory diseases
- dysphagia
- active communicable diseases
- demineralized teeth
- immunosuppressed individuals (medical consult)
- pacemaker (medical consult)
aside from contraindication, what other obstacles come with using US (3)
- hearing impacts
- musculoskeletal issues
- aerosol generation
POWERED DEVICE CLASSIFICATION - sonic (3)
- 2500-7000 cycles per second (cps)
- elliptical motion
- all sides are active
POWERED DEVICE CLASSIFICATION - ultrasonic magnetostrictive (3)
- 18000-45000 cps
- elliptical motion
- all sides active
POWERED DEVICE CLASSFICATION - ultrasonic piezoelectric (3)
- 25000-50000 cps
- linear motion
- only lateral sides active
MAGNETORESTRICTIVE US (in our kits)
driven by _________
___________ inserts use stacks of _______ strips in the handpiece
ferromagnetic units use a _____ rod to do the same thing with less ____ byproduct
magnetic field created by ______ and ________ of metal pieces
driven by ELECTRICAL CURRENTS
CONVENTIONAL inserts use stacks of METAL strips in the handpiece
ferromagnetic units use a FERRIC rod to do the same thing with less HEAT byproduct
magnetic field created by the EXPANSION and CONTRACTION of metal pieces
MAGNETORESTRICTIVE US
-power source
-movement pattern
-power
-amplitude
-active sides
POWER SOURCE: electricity over magnetic field when ultrasonic sound waves are dissipated in form of heat and cooled by water
MOVEMENT PATTERN: elliptical
POWER: oscillating frequencies of 25000-45000 cps
AMPLITUDE: more powerful than sonic scalers
ACTIVE SIDES: all sides are active (lateral sides are stronger and preferred)
what determines the range of cps
brand, age of the device, etc.
PIEZOELECTRIC SCALERS
tip coupled to _________ subjected to ________ voltages which causes them to expand and contract
_________ transducer converts __________ into ___________
amplitude:
power:
tip coupled to CERAMIC CRYSTALS subjected to PULSATING voltages which causes them to expand and contract
QUARTZ CRYSTAL TRANSDUCERS converts ELECTRICAL ENERGY into US VIBRATIONS
AMPLITUDE: more powerful than sonic scalers
POWER: oscillating frequencies of 25000-50000 cps
PIEZOELECTRIC SCALERS
no interference with _________
tip movement is ______ (windshield wiper)
active sides:
generates less _____; _____ cools
no interference with PACEMAKERS
tip movement is LINEAR (windshield wiper)
active sides: ONLY LATERAL
generates less HEAT; WATER cools
SONIC SCALERS
driven by:
amplitude:
power:
attaches directly to _______; activated by _______
mostly _______ shape
active surface:
no ________
DRIVEN BY: compressed air by dental unit
AMPLITUDE: least powerful
POWER: 3000-8000 cps
attaches directly to the DENTAL UNIT; activated by CONVENTIONAL HANDPIECE FOOT CONTROL
mostly ELLIPTICAL shape
ALL SURFACES ACTIVE
NO HEAT GENERATION
quick comparison of US: magnetostrictive vs piezoelectric
- frequency
- stroke pattern
- energy conversion
- power dispersion
FREQUENCY: m=20-40kHz; p=29-50kHZ
STROKE PATTERN: m=elliptical; p=linear
ENERGY CONVERSION: m=metal rod/stack of metal sheets; p=crystals activated by ceramic handpiece
POWER DISPERSION: m=all surfaces active; p=only lateral sides active
the powerline 100 AND powerline 1000 are used for: (5)
medium-heavy tenacious calculus and stain deposits
necrotic root tissue
overhanging restorations
cement removal
supra and subgingival
what is the Hu Friedly equivalent of the powerline 100 and 1000
P10 and Triplebend
what are 3 additional indications for powerline 100 and 1000 use
- ANUG (acute necrotizing ulcerative gingivitis) debridement
- pre-scaling for oral surgery
- clearing abscesses/acute periodontal infections
powerline 1000 or triple bend design:
Gross removal of _____________
____ and ____
what are the bends for
more useful at removing tenacious calc compared to ________
Gross removal of MOD-HEAVY TENACIOUS CALC
SUPRA and SUB
bends facilitate access to line angles and interproximal surfaces
more useful at removing tenacious calc compared to the powerline 100/p10
what considerations regard the powerline 1000 or triple bend
- narrow pockets
- restorative materials: laminate veneers, composites, porcelain jacket crowns
BEAVER TAIL TIP (not in our kits)
__________ calc removal on _____ teeth
best for ____ deposits and _________
________ strokes on proximal surfaces
________ strokes on facial/lingual surfaces
SUPRAGINGIVAL calculus removal on ALL teeth
best for HEAVY deposits and CALCULUS BRIDGES
HORIZONTAL strokes on proximal surfaces
VERTICAL strokes on facial/lingual surfaces
MODIFIED/SLIMLINE TIPS
includes _______, ________, and ________ inserts
indicated for: (5)
typically includes: straight, left, and right inserts
indicated for: deep pockets, bone loss, removal of plaque/biofilm/endotoxins/and light-moderate calc and stain
what questions to ask when deciding which tip to use in a treatment area
what size of calc? small, medium, large deposits
where is it located? above FGM, 4mm or less below FGM, more than 4mm below FGM
integrated vs portable
integrated US are fixed to the unit
portable US must be obtained from sterilization
how to set up to use the US (5)
- Disinfect, place barriers
- bleed the lines for 3 minutes
- install and lubricate the O ring
- Check the water flow and adjust as
needed - prepare the patient
US instrumentation
____ grasp and stroke pressure
_____ or ________ fulcrum with ____ grasp
______ for water control
________ power to remove deposits
higher calc class = ________ power
____ to control ________
LIGHT grasp and stroke pressure; let the oscillations do the work for you
INTRA or EXTRAORAL fulcrum with PEN grasp; opposite arch, cross arch, etc.
SUCTION for water control
LOWEST power to remove deposits
Higher calculus class = HIGHER power
HVE to control AEROSOL GENERATION
how to adapt the US
what part of the tip is active
how to scale a tooth
roll the insert between your fingertips (same as hand instrumentation)
last 3mm
work from the most coronal part of the deposit and work apically (channeling)
what are the two basic types of stroke motions used with ultrasonic scaling
sweeping strokes against the tooth surface
tapping strokes against the calculus deposit
describe the sweeping US motion (5)
- short, small, controlled strokes
- multiple overlapping strokes
- heavier deposits need more strokes
- tip should CONSTANTLY be moving to avoid heat
- eraser motion
describe the tapping motion
- used for large calculus deposits
- lateral surface against the tooth
- slower, repetitive strokes
what is the correct technique when using the magnetostrictive US
- adapted with the lateral surface or back surface against the tooth
- slow, repetitive strokes
- channeling (coronal > apical)
how to adapt to the interproximal
how to adapt to the buccal/lingual
- lateral surface adapted like a curet; active lateral edges
- lateral surface adapted to the facial surface like a probe; active lateral edges
describe the back of an US tip
- check manufacturers recommendations to see if the instruments allows adaption of the back; most MR tips do
- less powerful than lateral sides
what is one of the most common technique mistakes
using too much pressure (moderate-heavy); we need to use light pressure
DESCRIBE THE PROCESS/TECHNUE!
- adapt the lateral surface in a VERTICAL position at the DB LINE ANGLE of the most distal tooth
- move distally keeping the lateral surface adapted; use horizontal and oblique strokes to scale the distal surface of mod-heavy deposits
- transition below the distal contact like you’re using a curet
- return to vertical strokes adapting the lateral surface to the DB line angle; move mesially and subging using horizontal and oblique stroke to debride the buccal
- move mesially and adapt the lateral surface using horizontal and oblique strokes on the mesial surface of mod-heavy deposits
- go below the mesial contact like using a curet
*repeat on lingual
CAUTION
the point of an electronically powered instrument tip should NEVER be adapted to the __________
__________ dispersed by the point could damage the _______
the point of an electronically powered instrument tip should NEVER be adapted to the DIRECT TOOTH SURFACE
the HIGH ENERGY dispersed by the point could damage the TOOTH
what is burnished calculus
when a clinician uses LOW POWERED ultrasonics to try to remove TENACIOUS calculus, deposits can be rapidly SMOOTHED over, making them difficult/impossible to DETECT and REMOVE
how to reduce patient sensitivity (5)
- lighten your pressure
- decrease the power to prevent root sensitivity
- change the tip motion
- increase the water compared to powder
- increase the speed of your movement
usage tips:
prevent _________ with lower power
minimize _______ by cupping not retracting
use _____
when not in use, lay __________; do not __________
_________ movement is critical
keep _______ filled
with integrated units:_________ before polishing
tips are ________
prevent ROOT SENSITIVITY with lower power
minimize WATER BUILD UP by cupping not retracting
use HVE
when not in use, lay FLAT ON THE BRACKET TABLE; do not PLACE IN THE HANDPIECE HOLDER
CONSTANT movement is critical
keep WATER filled
with integrated units: REMOVE THE INSERT before polishing
tips are STERILIZED
TREATMENT PLANNING
no ________
only work on ________
always follow with __________
- no gross scaling
- only work on the TEETH TO BE COMPLETED IN THAT SESSION
- always follow with hand instrumentation
does powered scaling replace hand instrumentation
NO, they compliment each other
HANDPIECE CORD MANAGEMENT
reduce the pull of the cord by: (3)
- wrapping it around your forearm
- running it between the little and ring finger
- rest the cord on your palm around the thumb
