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Ultrasonic Scaler review 2012 - ARCHIVED

A narrative literature review of ultrasonic scalers 2012
by

Damien Walmsley

on 25 June 2013

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Transcript of Ultrasonic Scaler review 2012 - ARCHIVED

Ultrasonic Instrumentation Literature Review: SCIENTIFIC EVIDENCE SUPPORTING
CLINICAL INSTRUCTION & PRACTICE Damien Walmsley
Professor of Restorative Dentistry Bacterial Biofilm Clinical effectiveness Ultrasonic
Technologies Finding the
Evidence Calculus and Biofilm Removal Clinical efficacy of sonic and ultrasonic scalers is primarily due to mechanical removal of subgingival plaque Effect on Disease Status Instrument on half setting as good as on full setting Introduction of Slimline tips, easy to use and offer better access Clinical
Effectiveness Implications for practice

No1
No difference in efficacy of subgingival debridement using ultrasonic/sonic and hand instruments in treatment of chronic periodontitis in singlerooted teeth No3
Subgingival debridement completed in less time with ultrasonic/sonic than with hand instruments No2
For multirooted teeth, no evidence on the efficacy of machine-driven instruments was found No4
No major difference in frequency and severity of adverse effects following 2 treatment modalities (evidence is weak) No information:-
Clinical efficacy of rotary burs or oscillating files compared with hand instrumentation
Assessed parameters for ultrasonic instruments with oscillation parallel to long axis of working tip More high quality controlled randomized clinical trials

- periodontal disease progression or tooth survival as primary outcome
- multirooted teeth
- biopsychosocial aspects - comfort, aesthetics
- adverse effects -root sensitivity, pain
- health and safety of operator.

Cost-effectiveness of different modes of subgingival debridement Relevant QuestionDoes power driven pocket/root instrumentation offer a clinical advantage over hand instrumentation? Conclusions
•Power driven similar clinical outcomes to hand instrumentation •Addition of antiseptic agents to coolants or irrigants no clinical benefits
•Newer designs of powered instruments no apparent advantage
•New in vitro research
- variation in performance of different tip designs and generators
- ? clinical relevance Walmsley AD, Laird WRE and Williams AR. Dental plaque removal by cavitational activity during ultrasonic scaling. Journal of Clinical Periodontology, 15: 539-543, 1988 Technologies Tip Motion
All ultrasonic instruments on the market (magnetostrictive and piezoelectric) tips are ELLIPTICAL Lea SC, Felver B, Landini G & Walmsley AD.
Three dimensional ultrasonic scaler probe oscillations. J Clin Periodontol 2009; 36, 44-50. Tip movement Cavitation & Streaming Lea SC, Landini G, Walmsley AD. Ultrasonic scaler tip performances under various load conditions. Journal of Clinical Periodontology 30: 876-81, 2003

Trenter S, Landini G, Walmsley AD. The Effect of Loading on the Vibration Characteristics of Thin Magnetostrictive Ultrasonic Scaler Inserts. Journal of Periodontology 2003; 74: 1308-1315

Lea SC, Landini G, Walmsley AD. Displacement amplitude of ultrasonic scaler inserts. Journal of Clinical Periodontology 2003; 30: 505–510 Forceful flow of cavitating fluid
Enhances effectiveness beyond surface actually touched by tip Mapping Cavitation Walmsley AD, Lea SC, Felver B, King DC, Price GJ. Mapping Cavitation activity around dental ultrasonic tips. Clinical Oral Investigations (In Press) http://www.dimensionsofdentalhygiene.com/ddhnoright.aspx?id=13010#.T_2LJiLzfWt http://www.dimensionsofdentalhygiene.com/ddhright.aspx?id=12318#.T_2LiiLzfWs “Staged instrumentation” efficient and effective deposit removal
minimum amount of cementum removal Aim heavier diameter inserts at higher power settings for moderate-heavy deposit removal (scaling) transition to thinner, diameter inserts for definitive debridement/light deposit removal and or biofilm removal (debridment). Impaction on tooth surface Is this dentist correct in his description of ultrasonic scaling? More evidence
for ultrasonic scaling...... Perimplantitis Which instrument to use for cleaning? Titanium Plastic Stainless
Steel Ultrasonic
Scaler Summary load/power settings - important factors in damage caused to implant surfaces by scaler probes

provision of plastic coated – minimal damage

operating at low power ensures efficiency as no visible damage to tip Implant insert Debris visible may be removal of superficial layer of titanium surface + plastic coat

At high power, plastic coat melts at tip

May create further damage to implant surface laser profilometer measured defect depth & width Defect depth Treating Peri-implantitis Ultrasonics
professional maintenance importance:
dental implants = natural teeth

ultrasonic scalers used to remove plaque and calculus from titanium implant surfaces

damage may be caused by metal probes Treating Peri-implantitis Ultrasonics relationship between surface roughness and bacterial colonization - Quiryen et al (1993)

environment allows tenacious adherence of a biofilm implant failure

damage minimised using plastic coated ultrasonic scaler probes ? Evidence Base No peri-implantitis (or periodontitis) resolution if oral hygiene remains poor and bleeding scores remain high Aerosols standard barriers
masks and gloves
use of preprocedural rinses
high-volume evacuation Do patients like ultrasonic scaling? Bottom Line Conclusions

Ultrasonic results same as hand scaling
New technologies may lead to further improvements Acknowledgements - Gareth Price, Tim Donley, Simon Lea, Malvern Mann, Dipesh Parmer, Marie George, David King, Bernhard Felver, Dentsply, EPSRC grant no EP/F020090 Thank you for listening 30kHz - Dentsply inserts outperformed others
25kHz - No superior insert. Hu-Friedy greatest amplitude but also variability

Dentsply most consistent performer at both frequencies Please contact Professor Walmsley
a.d.walmsley@bham.ac.uk
for further information on this presentation
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