Dentaltown November 2017 - 112

Introduction

Learning objectives
After reading this article,
participants should be able to:
1. List four aspects of ultrasonic
instrumentation design that
affect the removal of deposit
and the preservation of tooth
structure.
2. Discuss how ultrasonic
instrument characteristics-
length, diameter, cross section
and shape-can improve the
removal and disruption of
biofilm and light calculus.
3. Define and state the clinical
significance of vertical
orientation and transverse
orientation of ultrasonic
instruments.
4. Discuss how instrument
selection can be a cost-savings
strategy for practices.
5. State the benefit of adapting
the back of a curved
ultrasonic instrument to
furcations and concavities.
6. Discuss how the back and
lateral surfaces of a curved
ultrasonic instrument can be
adapted for successful removal
and disruption of biofilm and
light calculus.

Over the past several decades, ultrasonic
technology and the evidence for its use have
evolved beyond just the removal of calculus.
Today, it provides greater utility subgingivally,
including the use of thin, ultrathin, straight
and curved ultrasonic instruments for removal
and disruption of biofilm.
Essentially, ultrasonic instrumentation
can now be categorized into traditional
and contemporary approaches (Table 1).1
Holbrook and Low ignited this more contemporary use of ultrasonics in the 1990s
when they examined thin, straight and
curved ultrasonic inserts for the negotiation
of deep periodontal pockets.2
Soon after, Dragoo further explored
this concept using left- and right-curved
designs, and showed their superiority with
better access to deep periodontal pockets.3
These thin, curved inserts produced more
effective removal of calculus and plaque,
with the least amount of root surface damage
when compared with hand instruments and
traditional thick ultrasonic inserts.3 Drisko's
benchmark review article on ultrasonic
technology for nonsurgical periodontal
therapy further confirmed these findings.4
The research has also looked more
closely at ultrasonic tip movement and
there is compelling evidence showing how
elements such as noise, water movement
and bubbles have effects beyond mechanical
removal of biofilm.5-7 (Obviously, this

Table 1: Comparison of traditional and contemporary ultrasonic approaches

TRADITIONAL
* Thick diameter inserts
* Subgingival access limited
* Moderate to heavy calculus removal
* Instrument contacts calculus
* Medium to high power settings typical
* Basic level of knowledge/skill
and short "time on task" to
achieve competence
* Complete debridement requires
the use of hand instruments
* Client/patient comfort challenging

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NOVEMBER 2017 // dentaltown.com

"therapeutic" Jacuzzi cannot be created by
hand instrumentation.) The development
of thin, straight and curved ultrasonic
instruments, along with "bubble" research,
has perpetuated a shift toward ultrasonics
as a first choice for periodontal debridement
because of its perceived advantages1,8-12 but
most of today's clinicians aren't maximizing
the contemporary ultrasonic approach.
Recent research suggests that dental
hygiene programs within Canada and
the United States are not keeping pace
with the scientific evidence and continue
to teach students how to use ultrasonics
in the traditional manner-with a focus
on calculus removal.1,13,14 It appears that
specifically thin and ultrathin straight
ultrasonic instruments (USIs) and thin,
curved USIs are underutilized or incorrectly
used in clinical practice. Despite the benefits
of curved USIs, a 2015 Canadian study
suggests that approximately 85 percent
of recent dental hygiene graduates do not
use curved ultrasonic instruments after
graduating.1
Admittedly, curved designs are less
intuitive compared with straight designs, so
many clinicians report a lack of knowledge
and confidence with their use. This article
is intended to help clinicians improve the
implementation of USIs beyond the removal
of moderate to heavy deposit, with an
emphasis on the use of left- and right-curved
instruments for enhancing the removal and
disruption of biofilm.

CONTEMPORARY
* Thin or ultrathin diameter inserts;
straight and curved designs
* Subgingival access is superior
* Light calculus removal;
focus on biofilm removal
* Instrument contacts cementum/dentin
* Low-medium power settings typical
* Higher level of knowledge/skill
and a longer "time on task"
to achieve competence
* Complete debridement possible
with ultrasonics
* Client/patient comfort most usual
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Table of Contents for the Digital Edition of Dentaltown November 2017
