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Ultrasonics: types, techniques, terminology and tips

Article · September 2014

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CLINICAL
Ultrasonics: types, techniques,
terminology and tips CPD
Reena Wadia delves into the world of ultrasonics to explore
more about this popular tool for periodontal debridement
T
he term ‘ultrasonic’ refers to
anything above the frequency
of audible sound and nominally
includes frequencies more than 20,000Hz
(Figure 1). Ultrasound has a range of
popular medical uses including: imaging,
ultrasonic heat treatment for muscle strain
as well as the treatment of gallstones and
kidney stones.
The ultrasonic scaler is one of the most
popular tools used amongst all dental
professionals. Scientific evidence supports
the use of powered instruments as an
integral and important part of periodontal
debridement. Ultrasonic instrumentation
is as effective as hand scaling for plaque
and calculus removal and the successful
healing of diseased periodontal tissues
(Capulos et al, 1993; Schenk et al, 2000).
Ultrasonic scalers are available as either
magnetostrictive or piezoelectric devices.
This article will provide an overview on:
the differences between magnetostrictive
and piezoelectric devices, general
principles of ultrasonic instrumentation,
definitions of the buzzwords and a few tips
to help ensure optimal use.
Magnetostrictive vs piezoelectric –
what’s the difference?
Magnetostrictive scalers
The first magnetostrictive ultrasonic scaler
was released in 1957 by Cavitron, Dentsply
(Figure 2).
Electrical energy is applied to the
handpiece of the device and this generates
magnetic energy. The magnetic energy is
applied to the insert’s stacked metal strips,
which converts energy from the handpiece
into mechanical oscillations that activates
Figure 2: Cavitron, Dentsply
Figure 3: Satelec
18 DH&T September 2014
Figure 1: Range of ultrasonics
the tip.
Magnetostrictive scalers rely on the
elliptical movement of the insert tip.
Magnetostrictive technology results in
all surfaces of the insert being active; this
allows more flexibility in adaptation to the
tooth surface. However, the most active
area of the insert’s tip is the point and the
lateral surfaces are the least active. The
length of the active tip varies according
to the energy output and frequency at
which the ultrasonic device operates.
Magnetostrictive scalers usually operate
at 25kHz or 30kHz and this results in an
active terminal length of 4.3mm or 4.2mm
respectively.
Piezoelectric scalers
The first piezoelectric device was put on
the market in 1970 by Satelec (Figure 3).
In piezoelectric units the electrical
energy is applied to ceramic crystals.
This causes changes in the crystal lattice
shape and the alternate expansion and
compression of the ceramic discs results in
micromovement of the tip.
Piezoelectric scalers rely upon linear
movement. Given the linear fashion in
which the tip moves, it is the tip’s two
lateral surfaces that are the most active.
Piezoelectric devices generally operate at
frequencies ranging from 25-50kHz.
Figure 4: Adaptation of instrument
Techniques: general principles of
ultrasonic instrumentation
• The angulation of the insert to tooth is
much less than for hand instrumentation
– 0-15°
• Inserts should be activated prior to
insertion into the pockets
• Adapt the surface of the instrument that
best conforms to the anatomy of the
treatment site (Figure 4) (Nield-Gehrig,
2008). Particularly with magnetostrictive
technology, you are not limited to a
lateral surface
• In contrast to hand scaling, which
requires the cutting edge to be below
the deposit, the ultrasonic tip removes
deposit as it encounters it, therefore
Figure 5a: Lower power = shorter, less powerful
strokes
Low power
Figure 5b: Higher power = longer, more powerful
strokes
High power
Aims and objectives
This article aims to educate readers
on ultrasonics.
By the end of this article readers
should:
• Understand the difference between
magnetostrictive and piezoelectric
scalers
• Understand the general principles
of ultrasonic instrumentation.
Verifiable CPD hours: 1
strokes should initiate at the gingival
margin
• The tip should be used in a constant
erasing type of motion, using short,
overlapping horizontal, oblique, and
vertical strokes to completely cover the
root surface. It is important to implement
strokes that are equally distributed (ie,
don’t use a hand scaling stroke that is
predominant in one direction)
• A tapping stroke with the point of the
tip can be used to remove tenacious
supragingival deposits
• Only a light grasp is required. A light
grasp increases tactile sense of deposits,
allows the tip to move freely over the
tooth surface, enhances patient comfort
and reduces operator fatigue
• It is important to keep the tip moving
and maintain the integrity of the contact
between the active area of the tip and the
tooth surface for optimal results
• The fulcrum is needed only to stabilise
the instrument rather than provide
leverage for force and therefore a number
of alternative fulcrums can be utilised.
Terminology: buzzwords
Frequency and amplitude: the frequency
is the number of times the tip travels back
and forth per second. The amplitude is the
distance the tip travels with each stroke.
Frequency and amplitude determine
power. Power determines stroke length:
lower power = shorter, less powerful
strokes; higher power = longer, more
powerful strokes (Figures 5a and 5b)
(Nield-Gehrig, 2008).
Cavitation: this is the formation of
pulsating bubbles that are powered by an
ultrasonic field (Figure 6) (Nield-Gehrig,
2008). The bubbles collapse inwards,
releasing energy. It enhances biofilm
removal and potentially disrupts bacterial
cell walls.
Acoustic microstreaming: this describes
the fluid flow generated by ultrasonic
oscillations. The forceful flow of the
 Walmsley AD, Lea SC, Landini G, Moses
Tips for using ultrasonics AJ (2008) Advances in power driven
pocket/root instrumentation. J Clin
• Always use the lowest effective power setting and increase as required. Periodontol 35 (Suppl 8):22–28
Optimal function of the tip and a well maintained tip should reduce the need
for increased power settings
• Scaling efficiency is significantly diminished with worn, damaged or bent
tip inserts. Two millimetre of wear can result in 50% efficiency loss.
Therefore, tips should be checked regularly for wear with the help of a wear
guide that comes with the instrument
• As ultrasonics have evolved, new designs in straight and curved tips have
included designs that reflect the site-specific benefits of Gracey curettes Figure 6: Cavitation
(Walmsley et al, 2008). Pick the most appropriate tip for the tooth surface in
question
• Ultrasonic scalers are considered superior to hand instruments for the one? Dent Clin North Am Apr;42(2):229-
treatment of teeth with furcation involvement (Drisko, 1998). When entering 44
the furcation, rotating the insert enables the tip to reach the roof of the Nield-Gehrig J (2008). Fundamentals of
furcation Periodontal Instrumentation & Advanced
• There are benefits to both hand and ultrasonic instrumentation. Therefore, Root Instrumentation. First edition.
the use of both with a blended approach is ideal for non-surgical periodontal Lippincott Williams & Wilkins. USA
therapy (Cobb, 1996). Schenk G, Flemmig TF, Lob S,
Ruckdeschel G, Hickel R (2000) Lack of
cavitating fluid enhances the effectiveness References antimicrobial effect on periodontopathic
of biofilm removal beyond the surface Capulos TA, Low SB, Walker CB, bacteria by ultrasonic and sonic scalers in
directly in contact with the tip. Trebilcock YY, Hefti AF (1993) vitro. J Clin Periodontol 27:116-119.
Fluid lavage: flushing ability created Comparative analysis between a modified
by a continuous fluid stream within the ultrasonic tip and hand instruments on
Reena Wadia
pocket. The flushing action washes debris, clinical parameters of periodontal disease.
Dr Reena Wadia BDS Hons (Lond) MJDF RCS (Eng) qualified from Barts and
bacteria and unattached plaque from the J Periodontol 64:694-700
The London with the prestigious Gold Medal. Following general practice,
periodontal pocket. The fluid also cools the Cobb CM (1996) Non-surgical pocket
Reena worked as a senior house officer in both restorative dentistry and
handpiece and tip. An adjustable flow rate therapy: mechanical. Ann Periodontol oral surgery. Currently, she is completing her part-time specialty training in
allows the operator to select the optimal 1:443-490 periodontology at Guy’s Hospital. She is also working in general practice at
flow. DH&T Drisko CH (1998) Root instrumentation. Harley Street Dental Group and Woodford Dental Care.
Power-driven versus manual scalers, which

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