Periodontic instrumentation ppt

1. Sonic and Ultrasonic
Instrumentation

2. Hand instruments like curettes have been used
since ages for scaling and root planing.
 Technically demanding
 Time consuming
 Tiring
Introduction to electronically powered
instrumentation

3.  Initially introduced in the late 1950’s : Bulky and limited to removal
of supragingival calculus
 Late 1980’s : Slim diameter instrument tips developed
 1990’s: New approach to instrumentation and cementu,
conservation
TODAY : Modern electronically powered slim diameter instrument
tips as effecetive as hand instruments
HISTORY OF ELECTRONICALLY POWERED DEVICES

4. Electronically powered instruments use rapid energy
vibrations of a powered instrument tip to fracture calculus
from the tooth surface
Physical factors playing a role in the mechanism of power
scalers include
 FREQUENCY
 STROKE
 WATER FLOW
Mechanism of Action

5.  FREQUENCY : Number of time the insert tip moves back and forth
during one cycle .
 STROKE: How far the instrument tip moves during one cycle.
Another term is amplitude
 WATER FLOW: Water flow can be controlled by a water knob that
controls the volume of water being delivered to the insert tip.

6. 2 Basic types of electronically powered
devices
SONIC DEVICE
ULTRASONIC DEVICE

7.  in 1955 Zinner reported the first application of ultrasound for the
removal of calculus from tooth surfaces.
In the 1960s, recognized as an effective tool in accomplishing the healing
of diseased periodontal tissues
vibrations with frequencies in the range of 25,000–42,000 Hz
Free standing units with electric generator
ULTRASONIC SCALERS

8. Ultrasonic unit
4 components
 Electric generator
 Foot control
 Hand piece assembly
 Interchangeable inserts
Two types
Manual and Automatic
Manual – Amplitude, Frequency
And water adjustment
Automatic- Only frequency
And water adjustment

9.  MAGNETOSTRICTIVE DEVICES
 ULTRASONIC DEVICES
2 Basic types

10.  Consists of an electronic generator, a handpiece and
Interchangeable instrument inserts.
 Transducer consists of metal stacks that change dimension when
electric energy is applied leading to vibration of the tip
 Tips move in elliptical or orbital stroke pattern
 4 active working surfaces
Magnetostrictrive

11.  Transducer
- Stack of flat metal strips (nickel iron alloy), (Cavitron
25kHz, DENTSPLY, Des Plaines, IL)
- Rod of ferromagnetic material (Odontoson 42kHz)

12. Point Ferromagnetic
stack
Water Outlet O Ring
Grip
Tip
PARTS OF A MAGNETOSTRICTIVE INSERT

13.  Length of active tip area  energy output and frequency
 Frequency  18- 45 kHz
 All surfaces active  flexibility in adaptation
Frequency Active tip
25kHz Terminal 4.3mm
30kHz 4.2mm
50kHz 2.3mm

14.  Transducer completely into the hand piece
 Ceramic discs located in the hand piece : change in
dimension as electrical energy is applied to it
 Tips move in a linear pattern that give it 2 active surfaces
Piezon Master – 27-30 kHz (EMS, Nyon)
ENAC – 30 kHz (Osada Electronics)
Solphy – 27-29 kHz
Piezoelectric

15. Comparison of Magnetostrictive
and Piezoelectric units
Magnetostrictive Piezoelectric
Mechanism Metal stack or ferrite rod Aligned ceramic discs
Tip movement Elliptical Linear
Active surfaces 4 (back, face and lateral) 2 (lateral)
Positioning of tips Flexible Must be lateral to surface
Effective calculus removal Yes Yes

16.  Directly attach to the dental unit’s high speed handpiece tubing.
 Air driven scalers
 Work at a frequency of 2000-6500
 Stroke pattern is elliptical to orbital in shape
 Larger in diameter and universal in design
 Introduced into the dental market in the 1970s as
less expensive alternatives to ultrasonic scalers
SONIC SCALERS

17.  Hand piece  hollow rod, a rotor, rubber O- rings
 Rotor  6mm wide thin metal ring  encircles hollow
rod
 Compressed air is forced through hollow rod
 Air escapes through the 10 holes and causes rotor to
vibrate  triggers rod to vibrate
 All surfaces of the tip - active
 Coolant  not necessary

18. Sonic scalers used in conjunction with hand instruments were more effective
for the removal of subgingival calculus than either method used alone
(Gellin et al, 1986).
Sonic scalers produce no difference in clinical response compared with
ultrasonic scalers and that sonic scalers provide an effetive alternative to
hand instruments (Loos et al, 1987 )
Several studies with conlicting results created a controversy

20. Instrument Tips

21.  The type of calculus deposits
 The location of calculus deposits
Instrument tip selection criteria
STANDARD DIAMETER SLIM DIAMTERER

23. MODIFIED POWER DRIVEN SCALERS

24.  Developed for use in deeper
pockets.5-12mm pockets
 Straight slim diameter inserts
effective in anterior teeth
 Recommended for use on root
surfaces located 4mm or less below
the CEJ.
Slim periodontal probe type
inserts

25. Dragoo et al. 1992 examined a manual scaler (universal curette)
and ultrasonic scalers (Cavi-tron ) with modified (contra-angled tips
EW-P10which resemble a periodontal probe. and an unmodified (P-
10 type) inserts in debridement of hopeless single or multi-rooted
teeth. They evaluated the pocket depth, instrument limit, and
instrument efficiency. The modified inserts showed added benefits

26.  Designed to facilitate adaptation to
the curved root surfaces of
posterior teeth
 Back of the working end adapts
best to the curved root surface
The Curved Slim tips

27.  Yukna et al (1997)
- diamond coated ultrasonic tip which resembled the
traditional Cavitron scaler tip.
- more efficient
- roughest surface

Diamond Coated ultrasonic tips

28. Burnett Power tip
Unique slim diameter tip
Can withstand higher Power
settings and more lateral pressure
than typical slim diameter tip

29. Furcation Slim Tips
More effective than Hand
instruments in treating class 2 or 3
furcations
( Hou, G.L et al, 1994)
Gracey curettes too wide to enter
furcation areas in over 50% of
All maxillary and mandibular
molars
First introduced by Osha and
Ishikawa In the year 1987.

30.  Beuchat et al (2001) - Periosonic
- modified version of endodontic system
- 2 types of files  sonic handpiece
- Periosonic 1  reamer , 16mm working tip ( heavy calculus)
- Periosonic 2  flexible, 21mm working tip
Split mouth study
- equally effective
- better clinical attachment gain
- less recession
Periosonic

31. Tip motion
 Scanning laser vibrotomy studies-
-variability in tip vibration
 Three dimensional scanning laser
vibrotomy studies-
All tips oscillate in an elliptical manner
(with varying degrees of ellipticity)

32.  Tip motion-
- Power settings of generator
- Shape of the probe
 Lea SC et al (2009) – probes under
load show a reduction in the lateral
component of oscillation.
Both classes exhibit elliptical motion

34. EFFECTIVENESS OF ELECTRONICALLY POWERED
INSTRUMENTATION
1)Plaque and calculus removal
2)Bacterial reduction endotoxin removal
3) Root surface conservation
4) Pocket penetration
5) Required time and clinical outcome
7) Irrigation ( lavage)
8) Bactericidal effect

35.  Powered instrumentation have been shown to
be as effective as hand instrumentation
 They are especially effective in deplaquing
Plaque and calculus removal

36.  Cavitational activity of the ultrasonic scaler is considered
effective for removal of plaque and endotoxin. ( Walmsley et
al, 1990).
 Studies suggested that ultrasonic scalers are capable of
removing endotoxin located on the root surface without
excessive removal of cementum or dentin. ( Checchi et al, 1988)
( Chiew et al, 1991)
Bacterial reduction and endotoxin and
cementum removal

37. Root Surface Removal
 Rosenberg (1979), Von Vokinberg et al (1976)
- Manual instruments remove more root surface
 Pattison et al (1996):
- Ultrasonics  better
 Ritz et al (1991):
 Sonic  1.72 µm
 Ultrasonic  4.3 – 7.8 µm
 Diamond bur  7.9 – 15.5 µm
 Fine curette  5 – 22 µm

38. Required time and clinical outcome
 Badersten et al (1984):
 Compared clinical effects  no difference
 Manual instrumentation  longer time
 Copulos et al (1993):
 ultrasonic and curette  equally effective in all clinical
parameters measured
 time spent  3.6 min (US), 5.8 min (manual)

39. Busslinger et al (2001)
 time needed , calculus removal and root roughness
 in -vitro model
 curette  126.1 ± 38.2 s
 piezoelectric  74.1 ± 27.6 s (> efficient but
rougher surface)
 magnetostrictive  104.9 ± 25.4 s
It may be concluded that manual scalers require more
time in scaling and root planing than power-driven
scalers.

40.  Slim diameter tips penetrate deeper into
periodontal pockets
 Reach the base of the pocket better than hand
instruments.
 Water lavage reaches a depth that is equal to
the depth reached by a powered instrument tip
Pocket penetration

41.  Constant stream of water exits near the point of the
instrument tip
 Water stream within the periodontal pocket is termed as
the fluid lavage.
 Washes toxic products and free floating bacteria from the
pocket
 Better vision during instrumentation
Irrigation ( lavage)

43. Bactericidal effect
Cavitation and Acoustic streaming
Distruption of cell walls and biofilms even beyond
reach
Destroy from a distance
Just the act of holding an activated ultrasonic tip in
the periodontal pocket is destructive

44. Recent developments of
power driven scalers

45. Limitations of electronically
powered instrumentation

46. AEROSOL PRODUCTION
CARDIAC PACEMAKERS
REDUCED TACTILE SENSATION INFECTION CONTROL

47. Ultrasonic instruments
Advantages-
 Less time
 Stain removal
 Flushing of debris, blood, necrotic
tissue
 Less force
 Antimicrobial effect
 Less fatigue
 Patient comfort
Disadvantages-
 Less tactile sensitivity
 Hampers visibility by constant
water spray
 Hazard by contaminated aerosol
 Damage to hearing in many pts
 Magnetostrictive  not used in
pacemakers

48.  Scaling and root planing play a pivotal role in the elimination of
causative factors of periodontal disease.
 In the past, it had been generally agreed that excessive root surface
removal by hand instruments was necessary to remove the tenacious
calculus deposits.
 However, research over the past years has shown that definitive root
surface detoxification can be achieved without excessive cementum
removal or aggressive instrumentation. Complete cementum removal
is no longer a requisite.
 Many studies have demonstrated that hand and power-driven
instruments are equally effective in reducing the probing depth,
attaining attachment level gains and reducing inflammation by
removal of plaque bacteria, calculus, and endotoxin.
Conclusion

49. Power-driven instruments have many advantages over the manual
scalers; however, further studies are needed to improve the
performance of currently available instruments. These studies
would help to provide treatment based on exact information
regarding the instrument and technology

50. Electrocautery

51. The term electrosurgery or radiosurgery is currently used to
identify surgical techniques performed on soft tissue using
controlled high-frequency electrical currents in the range of
1.5 to 7.5 million cycles per second or megahertz

52. 3 classes of active electrodes
Incising or excising planing tissue coagulation procedures
Single -
wire
electrodes
Loop
electrodes
Heavy
electrodes

53. 4 basic types of electrosurgical techniques
Electrosection
Electrocoagulation
Electrofulguration
Electrodessication

54.  Electrosection is used for incisions, excisions and tissue planing
 They are performed with single-wire active electrodes that can be
bent or adapted to accomplish any type of cutting procedure
 Electrocoagulation provides a wide range of coagulation or
haemorrhage control obtained by using the electrocoagulation
current
 Electrofulguration and Electrodessication are not in general use in
dentistry

55.  The most important basic rule of electrosurgery is always
keep the tip moving
 Electrosurgery is not intended to destroy tissue
 It is a controllable means of sculpturing or modifying oral
soft tissue with little discomfort and hemorrhage for the
patient

56. ADVANTAGES:
 Electrosurgery permits adequate contouring of the tissue and
controls hemorrhage
DISADVANTAGES:
 It cannot be used in patients who have a noncompatible or a
poorly shielded cardiac pacemaker
 The treatment causes an unpleasant odour If the tip contacts
the bone, irreparable damage can be done

57. HEALING AFTER ELECTROSURGERY
 When used for deep resections close to the bone, electrosurgery can
produce
 gingival recession
 bone necrosis
 Sequestration
 loss of bone height
 furcation exposure
 tooth mobility