1301 Smile Way
York, PA 17404
800.989.8825
Department of Clinical Education
“
www.professional.dentsply.com
Win the Battle Against Biofilm: Leverage the Power of Ultrasonics”
COURSE DESCRIPTION
This course is based on current scientific literature and evidence based strategies to give the clinician practical
guidelines regarding the use of ultrasonic instrumentation for nonsurgical periodontal therapy. Ultrasonic
instrumentation techniques will be covered extensively following the dental hygiene process of care and utilizing
hands-on activities.
COURSE GOAL
The goal of this course is to enable the clinician to identify modifying factors related to nonsurgical periodontal
instrumentation, manage patient discomfort appropriately, and improve ultrasonic instrumentation skills to
facilitate thorough periodontal debridement and enhance treatment outcomes.
COURSE OBJECTIVES
Upon completion of this course, participants will be able to:
 Differentiate the advantages and limitations of the various technologies which drive power scaling units
 Compare and contrast the three E’s of hand, sonic, and ultrasonic instrumentation techniques:
effectiveness, efficiency, and ergonomics
 Discuss current research findings which demonstrate the clinical advantages/benefits of ultrasonic
instrumentation over manual instrumentation
 Describe the technology of ultrasonics and define key terminology, including acoustic streaming,
acoustical turbulence, cavitation, lavage, frequency, power and stroke pattern
 Identify and assess pretreatment considerations for the use of ultrasonic instrumentation to include
patient’s medical history, clinical indications, and contraindications
 Incorporate appropriate pain management techniques to improve patient comfort and efficiency during
instrumentation
 Identify various modifying factors which influence and/or change instrumentation protocols such as root
anatomy, furcations and oral conditions.
 List criteria for the appropriate selection of ultrasonic inserts, both standard and modified.
 Demonstrate the correct technique for utilization of the ultrasonic scaler to include insert and power
selection, lavage flow, grasp, fulcrum, tip adaptation, and stroke
OUTLINE:
I.
Evolution of Instrumentation for Nonsurgical Periodontal Therapy
II.
Assessment
a. Medical History
b. Periodontal Status
c. Morphology
III.
Diagnose and Plan Instrumentation Approach
IV.
Implementation of Instrumentation Strategies
a. Science of Ultrasonic Technology
b. Ultrasonic Tip and Insert Designs
c. Clinical Application of Ultrasonic Instrumentation
V.
Evaluation of Therapy
VI.
Ultrasonic Lavage
DENTSPLY Professional 1301 Smile Way York, PA 17404 800.989.8825
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“Ultrasonics: An Evidence Based Approach to Nonsurgical Periodontal Therapy’
Assess
Diagnose
Plan
Implement
Evaluate
Assessment
Patient Assessment – assessment of the patient’s chief complaint, current periodontal and dental disease status
Biofilm Assessment – assessment of the quality and quantity of the biofilm present
Morphology Assessment - assessment of the root morphology to include furcations, challenge areas and root adaptability
Cementum Assessment – assessment of the cementum at the location of the biofilm
Diagnose
American Academy of Periodontally Periodontal Classification, 1999, Web site: www.perio.org
•
•
•
•
•
•
•
•
Gingival diseases
– Plaque induced
– Non-plaque induced
Chronic periodontitis
Aggressive periodontitis
Periodontitis as a manifestation of systemic diseases
Necrotizing periodontal diseases
Abscesses of the periodontium
Periodontitis associated with endodontic lesions
Developmental or acquired deformities and conditions
Plan
Nonsurgical Periodontal Therapy
•
Periodontal debridement
•
Lavage/Irrigation
•
Sustained-release antibiotic/antimicrobial agent
•
Remove iatrogenic biofilm retainers
•
Concurrent dental therapy
Periodontal Debridement
•
Therapeutic interventions
– Scaling
– Root planing
– Root debridement
•
Definitive or complete treatment
•
Preparatory or initial therapy prior to surgery
Implement
Instrumentation Approach

Diagnostic instrumentation

Ultrasonic periodontal debridement including lavage

Evaluation - hand and/or ultrasonic

Ultrasonic subgingival irrigation/rinse
DENTSPLY Professional 1301 Smile Way York, PA 17404 800.989.8825
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Hand Instrumentation
Choices in Hand Instrument Selection
•
Area specific designs
•
Terminal shank and working end length
•
Variety of handle diameters
•
Stainless steel, carbon steel, and hybrid steel
Technique
•
Terminal shank
•
Work to base of pocket
•
Engage 1/3
•
Apply lateral pressure
Ultrasonic Instrumentation
Acoustic streaming
 Forceful fluid flow
Acoustic turbulence
 Fluid moves in a swirling manner
Cavitation
 Bubbles implode creating a shock wave
Sonic technology
 Compressed air runs handpiece to
activate tip
 2,500 to 7,000 cps
 Circular/elliptical movement
 All sides are active
Piezoelectric technology
• Electrical energy activates piezo-ceramic
disks in handpiece
• 25,000 to 50,000 cps
• Linear movement
• Two active sides
Magnetostrictive technology
• Electrical energy is applied to coils in the
handpiece
• 25,000 to 30,000 cps
• Elliptical movement
• All sides are active
Frequency
 Number of cycles (one complete stroke
path) per second
 Frequency correlates to the active tip
area
 Example: 30k = 4.2mm of active tip area
Power
 Size of the stroke path
 As the power increases, the stroke
becomes larger
Ultrasonic Technology
DENTSPLY Professional 1301 Smile Way York, PA 17404 800.989.8825
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Ultrasonic Guidelines
Magnetostrictive
Inserts
Standard Design
Power – Low to High
Slim-diameter Design
Power – Low to Medium
Perio Specialty Design
Beavertail
Heavy stain or calculus
Straight
Light calculus and/or deplaquing in
pockets less than 4mm
Furcation
Furcation access
Power – Low to Medium
Single bend
Light to moderate calculus
Modified / Curved
Light calculus and/or deplaquing in
pockets greater than 4mm
Implant
Implant care
Power - Low
Double bend
Light to moderate calculus
Dental Specialty Inserts
1. Endodontic – canal debridement, cleansing, irrigation; for
dental use only
2. Diamond Coat – removal of tenacious calculus and soft tissue
in surgical treatment settings; for dental use only
Triple bend
Moderate to heavy tenacious
calculus
Piezoelectric
Standard Design
Thin Design
Large scaling tips and bladed
tips - tenacious calculus –
medium to high power
light to moderate calculus –
medium power
Furcation and deep periodontal pockets – utilize on high power to
remove calculus deposites from root surface and to prevent
burnishing
Tips
Specialty Tips
1. Thin Diamond Coated Tips
~ fine scaling and root planing in narrow furcations
~ can be utilized with Dental Endoscope for
subgingival areas
~ low power
2. Furcation ball tips – furcation areas
~ low power
3. Implant Carbon Composite Tip/ Restorative Margins
Positioning
 Modified pen grasp and fulcrum
Stroke Patterns
 Vertical or tapping motion for moderate
to heavy calculus
 Horizontal or sweeping motion for light
calculus and/or deplaquing
 Oblique for interproximal and contact
areas
Clinical Application
Vertical Technique
 Positioned like a probe
 Vertical or horizontal strokes
Oblique Technique
 Positioned like a hand instrument
 Oblique strokes
Modified / Curved Design Technique
 Subgingival application in pockets
greater than 4mm
Hand Instrument Evaluation
 Assess with probe, explorer, and/or
inactivated tip
Ultrasonic Lavage/Rinse




Water
Chlorhexidine
Povidone-iodine
Other
DENTSPLY Professional 1301 Smile Way York, PA 17404 800.989.8825
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