Dentaltown November 2017 - 113

continuing
education

QUESTION

Once the moderate to heavy hard deposit has
been removed or a maintenance patient presents
with no moderate to heavy calculus, what is the best
ultrasonic instrumentation strategy?

When treatment-planning best USI
options, consider the following, in order:
* deposit type
* gingival condition
* root surface anatomy
For more details, see Fig. 1.
Evaluating the diameter, length, shape
and cross section of a USI will help lead
clinicians to think critically as they decide
which USI is the best option for the debridement task at hand.

Diameter
When moderate-to-heavy calculus is
not present, standard- or thick-diameter
instruments can leave the game. When the
USI active tip will directly touch root surfaces
(and not moderate-to-heavy deposit), the
best diameter choices are thin or ultrathin.
Standard or thick instruments should be
considered when the USI active tip is going
to directly contact moderate-to-heavy hard
Fig. 1: Considerations for ultrasonic
instrument selection

deposit. Thin instruments directly touching
root surfaces have a greater potential of
preserving more root structure.15
In the presence of light calculus and
biofilm, clinicians are often faced with
deciding between thin and ultrathin USI
diameters. If an instrument with a thin
diameter design can be used, use it! Save
ultrathin USIs for situations where thin
USIs are too thick, such as: contact points,
the CEJ or use in shallow pockets. The
consistent unnecessary use of a USI with
an ultrathin diameter will result in quicker
instrument wear.
Although the removal of moderateto-heavy calculus is not the focus of this
article, it's worthwhile mentioning that the
consistent use of thin- or ultrathin-diameter
USIs on this category of hard deposit is an
inappropriate use of the technology, yielding
longer debridement times and quicker wear
rates of the USI. Preservation of both the

tooth structure and the active tip of an
ultrasonic instrument should be objectives
in modern periodontal therapy.
A USI active tip that's worn beyond
acceptable levels may lead to poor debridement efforts and patient sensitivity. The
general rule concludes that a USI should
be discarded or recycled once 50 percent
of its original active tip has been worn. To
ensure safe, effective, efficient performance
of USIs, check your instruments routinely
using the efficiency indicator cards provided
by manufacturers (Fig 2).

Length
Marrying the length of a USI with the
depth of the pocket or the apical plaque
border (APB) is likely as simple as it sounds.
However, the orientation of the USI selected
is a more complex concept. For improved
subgingival access, including biofilm removal
and cavitational activity, consider vertical

Fig. 2: Ultrasonic wear indicator guide

30K FSI-SLI-10L-FG
Deposit Type
* Moderate-Heavy Calculus
* Light Calculus
* Biofilm

30K FSI-SLI-10S-FG

Gingival Condition
* Tight/Firm
* Loose/Flabby
* Thick
* Thin

30K FSI-SLI-1000-FG

Root Anatomy
* Flat
* Contoured/Concave

30K THINSERT-FG

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