Dentaltown November 2017 - 116

continuing
education
angle (Fig. 8e), while maintaining vertical
orientation, start to direct the ultrasonic
instrument into the mesial subgingival space
(Fig. 8f). Note: Ideal access of interproximal
areas may require a slight oblique instrument
position (Fig. 8g) but this change from
vertical orientation should not be used
until well past line angles. Failure to do
so increases risk for poor access below the
gingival margin interproximally.

Fig. 8d

Fig. 8e

Fig. 8f

Fig. 8g

Accessing a furctation
using a curved instrument
The buccal furcation of the upper right
maxillary molar is best done with a curved
-left instrument. Unless the technology
being used restricts clinicians to using the
lateral surfaces only, there is an advantage
to leading or contacting the tooth or root
with the convex back when possible, because
it conforms to the concave anatomy of the
tooth or root. Depending on classification of
furcation, tooth position and client-operator
position, many combinations of the back
and lateral surfaces may be options.
This series of images shows the back
(Fig. 9a) and the lateral side (Fig. 9b) of the
curved instrument leading into the dome of
the furcation. During treatment, the clinician
should keep the active 2-3 millimeters of
the tip adapted and use a combination of
suitable stroke types to debride as much of
the dome that is exposed (Fig. 9c). Once the
dome has been fully accessed, shift to the
mesial surface of the distal root, adapting
either the back or lateral surface of the curved
instrument (Fig. 9d). The fi nal required
step is placement of the lateral surface of
the curved insert on the distal surface of
mesial root (Fig. 9e).

Conclusion
Modern debridement strategies have
advanced beyond using ultrasonics only
for the removal of calculus, and it is not
enough to know our ultrasonic instruments
by color. Clinicians must possess a solid
understanding of USI design characteristics
and strive to achieve confidence with curved
-left/right ultrasonic instruments if they
want to maximize ultrasonic technology for

116

NOVEMBER 2017 // dentaltown.com

Fig. 9a

Fig. 9b

Fig. 9c

Fig. 9d

the disruption and removal of subgingival
biofilm, conservation of the tooth structure,
resolution of inflammation and efficiency.
The effects of long-term, chronic inflammation stretch far beyond the oral cavity, and
our patients can only benefit from the best
technology has to offer when it is combined
with the best clinical technique. ■
References
1.
Asadoorian J, Botbyl D, Goulding M. Dental hygienists'
perception of preparation and use for ultrasonic instrumentation. Int J Dent Hygiene 2015;13(1):30-41.
2.
Holbrook T, Low S. Clark's Clinical Dentistry. In: J. H,
editor. 3. Philadelphia J.B. Lipincott; 1991. p. 1-24.
3.
Dragoo M. A clinical evaluation of hand and ultrasonic
instruments on subgingival debridement. Part 1. With
unmodified and modified ultrasonic inserts. Int J Periodontol
and Rest Dent 1992;12(4):310-23.
4.
Drisko C. Scaling and root planning without over instrumentation: hand versus power-driven scalers. Curr Opin
Perio. 1993:78-88.
5.
Walmsley A, Laird W, Williams A. Dental plaque removal
by cavitational activity during ultrsonic scaling. J Clin
Periodontol. 1988;15:539-43.
6.
Thurnheer T, Rohrer E, Belibasakis GN, Attin T, Schmidlin
PR. Statis biofilm removal around ultrasonic tips in vitro.
Clin Oral Invest. 2014;18:1779-17841.
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Gartenmann SJ, Thurnheer T, Attin T, Schmidlin PR.

Fig. 9e

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Infl uence of ultrasonic tip distance and orientation on biofilm
removal. Clin Oral Invest. 2017;21:1029-36.
Sliva L, Hodges K, Calley K, Seikel J. A comparison of dental
ultrasonic technologies on subgingival calculus removal: a
pilot study. J Dent Hyg. 2012;86(2):150-8.
Drisko C. Nonsurgical periodontal therapy. Periodontal
2000. 2001;25:77-88.
Khorsravi M, Bahrami Z, Atabaki M, Shorkrgozar M,
Shokri F. Comparative effectiveness of hand and ultrasonic
instruments in root surface planning in vitro. J Clin
Periodontol. 2004;31(3):160-5.
Tunkel J, Heinecke A, Flemming T. A systematic review
of efficacy of machine-driven and manual subgingival
debridement in the treatment of chronic periodontitis. J Clin
Periodontol. 2002;29(Suppl 3):72-81.
Kinane D, Papageorgakopoulos G. Full mouth disinfection
versus quadrant debridement: the clinician's choice. J Int
Acad Periodontol. 2008;10(1):6-9.
Asadoorian J, Botbyl D, Goulding M. Ultrasonic
instrumentation instruction in Canadian dental hygiene
programs: Perspectives of program directors on curricular
elements. Can J Dent Hyg. 2017;51(1):7-15.
Stemple Hinchman S, Funk A, DeBiase C, Frere C.
Ultrasonic instrumentation instruction in dental hygiene
programs in the United States J Dent Hyg 2016;90(2):
135-42.
Jepsen S, Ayna M, Hedderich J, Eberhard J. Significant
infl uence of slcaer tip design on root substance loss resulting
from ultrasonic scaling: a laser profilometric in vitro study.
J Clin Periodontol. 2004;31:1003-6.
SC. L, B. F, G. L, Walmsley A. Ultrasonic scaler oscillations
and tooth-surface defects. J Dent Rest. 2009;88:229-34.
George MD, Donley TG, Preshaw PM. Ultrasonic
Peridontal Debridement: Theory and Technique.
USA: Wiley Blackwell 2014.


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Table of Contents for the Digital Edition of Dentaltown November 2017

Dentaltown November 2017 - Intro
Dentaltown November 2017 - Cover1
Dentaltown November 2017 - Cover2
Dentaltown November 2017 - 1
Dentaltown November 2017 - 2
Dentaltown November 2017 - 3
Dentaltown November 2017 - 4
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