4/5/2020

Ultrasonic and Sonic Scaling

Dr. MahMouD MuDalal

B.Sc. Dental surgery

M.Sc. Periodontology
Ph.D. Periodontology and Implantology
Asst. Professor at Arab American university
Member of ADEE.
Research fellow at Jilin Provincial Experimental School.
Google scholar. Mahmoud MUDALAL 22 citations.

Instruments
• Ultrasonic scalers may be used for removing
plaque and stain, scaling, root planing,
curetting, and surgical debridement. The two
types of ultrasonic units are magneto-strictive
and piezoelectric.
• In both types, alternating electrical current
generates oscillations in materials in the
handpiece that cause the scaler tip to vibrate.

1
 4/5/2020

• Sonic units consist of a handpiece that

attaches to a compressed-air line and uses a
variety of specially designed tips. Vibrations at
the sonic tip range from 2500 to 7000 cps,
which provides less power for calculus
removal than ultrasonic units.
• Larger tips are used for removal of heavy
supragingival calculus and heavy subgingival
calculus where tissue is inflamed and
retractable. Thinner tips are designed for
more definitive subgingival debridement.

Ultrasonic Instruments
• Ultrasonic instruments have been used as a
valuable adjunct to conventional hand
instrumentation for many years.
• Ultrasonic scaling, most tips were large and bulky,
making them generally suitable only for
supragingival scaling
• Currently, many thinner ultrasonic tips allow
better access to subgingival areas that were
previously accessible only with hand instruments.

2
 4/5/2020

• Ultrasonic instruments have been shown to be more

effective than hand instruments at reducing
spirochetes and motile rods in class II and III furcation.
• The use of ultrasonic and sonic scaling devices has
some contraindications.
• Magneto-strictive devices have been reported to
interfere with the function of older cardiac
pacemakers.
• Piezoelectric dental scaler produced no
electromagnetic interference with defibrillators.
• Patients with newer pacemakers can be treated safely;
however, a risk may exist if the patient is medically
fragile or if electronically defective ultrasonic devices
are used.
• Medical consultation is advised when treating patients
with such conditions.

Technique
• Ultrasonic instrumentation is accomplished with
a light-to-moderate grasp and varying pressure
depending on the amount and tenacity of the
deposit.
• Excessive pressure is not recommended because
it can cause dampening of the vibration of the
tip.
• The ultrasonic tip must come in direct physical
contact with calculus to fracture and remove it.
The tip must also contact all aspects of the root
surface to remove biofilm and toxins thoroughly.
• A series of focused, overlapping strokes must be
activated to keep this small active portion of the
tip adapted to the root surface at all times.
6

3
 4/5/2020

• Aerosols from ultrasonic instrumentation

always contain blood, potentially infectious
blood-borne and airborne pathogens, and
linger in the air for 30 minutes or longer.

Points in Mind
1. Thoroughly wipe the ultrasonic unit with a
disinfectant.
2. Direct the patient to rinse for 1 minute with an
antimicrobial oral rinse such as 0.12% chlorhexidine
to reduce the contaminated aerosol.
3. The clinician and the assistant should wear protective
eyewear or face shields and masks.
4. Turn on the unit, select an insert, place it into the
handpiece, and then adjust the water control knob to
produce a light mist of water at the working tip.
5. The instrument is grasped with a light to moderate
pen or modified pen grasp, and a finger rest or
extraoral fulcrum should be established to allow a
light touch.

4
 4/5/2020

6. Use short, light, vertical, horizontal, or oblique

overlapping strokes.
7. The working end should be kept in constant
motion, and the tip should be kept parallel to
the tooth surface or at no mor than a 15-degree
angle to avoid etching or grooving the toot
surface.
8. The instrument should be switched off
periodically to allow for aspiration of water, and
the tooth surface should be examined
frequently with an explorer.
9. Any remaining irregularities of the root
surface may be removed with sharp standard or
mini-bladed curettes if necessary.
9

Evaluation
• Although smoothness is the criterion by which
scaling and root planning are immediately
evaluated, the ultimate evaluation is based on
tissue response.
• Positive clinical changes after instrumentation
often continue for weeks or months. Therefore a
longer period of evaluation may be indicated
before deciding whether to intervene with
further instrumentation or surgery.

10

5
 4/5/2020

Instrument Sharpening
• to avoid wasting time and operating
haphazardly, clinicians must be thoroughly
familiar with the principles of sharpening and
able to apply them to produce a keen cutting
edge on the instruments they are using.
• It is impossible to carry out periodontal
procedures efficiently with dull instruments.

11

Evaluation of Sharpness
• The cutting edge of an instrument is formed
by the angular junction of two surfaces of its
blade.

12

6
 4/5/2020

13

Objective of Sharpening
• The objective of sharpening is to restore the fine,
thin, linear cutting edge of the instrument.
• This is done by grinding the surfaces of the blade
until their junction is once again sharply angular
rather than rounded.
• For any given instrument, several sharpening
techniques may produce this result.
• A technique is acceptable if it produces a sharp
cutting edge without unduly wearing down the
instrument or altering its original design.

14

7
 4/5/2020

Sharpening Stones

1. Mounted Rotary Stones

2. Unmounted Stones or Sharpening Cards

3. Diamond Sharpening Cards

15

16

8
 4/5/2020

Principles of Sharpening
1. Choose a stone or sharpening card suitable for the
instrument to be sharpened.
2. Use a sterilized sharpening stone or card if the
instrument to be sharpened will not be re-
sterilized before it is used on a patient.
3. Maintain a stable, firm grasp of both the
instrument and the sharpening stone.
4. Avoid excessive pressure.
5. Avoid the formation of a “wire edge,”
characterized by minute filamentous projections of
metal extending as a roughened ledge from the
sharpened cutting edge.
6. When using a stone, lubricate it during sharpening.
7. Sharpen instruments at the irst sign of dullness.
17

Sharpening Individual Instruments

18

9
 4/5/2020

Universal Curettes
• Several techniques will produce a properly
sharpened curette. Regardless of the
technique used, the clinician must keep in
mind that the angle between the face of the
blade and the lateral surface of any curette is
70 to 80 degrees

19

20

10
 4/5/2020

Area-Specific (Gracey) Curettes

• As with a universal curette, a Gracey curette
has an angle of 70 to 80 degrees between the
face and lateral surface of its blade. Therefore
the technique described for sharpening a
universal curette can be used to sharpen a
Gracey curette.

21

Sickle Scalers
• The two types of sickle scalers are the straight
sickle and curved sickle. On a straight sickle
the face of the blade is flat from shank to tip,
whereas on a curved sickle the face of the
blade forms a gentle curve. However, straight
and curved sickles have similar cross-sectional
designs. As in the curette, the angle between
the face of the blade and the lateral surface of
a sickle is 70 to 80 degrees.

22

11
 4/5/2020

23

Chisels and Hoes

• To sharpen a chisel, stabilize a flat sharpening stone on
a flat surface.
• Grasp the instrument with a modified pen grasp.
• Establish a finger rest with the pads of the third and
fourth fingers against the straight edge of the
sharpening stone.
• Apply the flat beveled surface of the chisel to the
surface of the stone.
• If the entire surface of the bevel is contacting the
stone, the 45-degree angle between the beveled
surface and the face of the blade will be maintained,
and the design of the instrument will not be altered.

24

12
 4/5/2020

25

• Back-action surgical chisels and hoe scalers

are sharpened with exactly the same
technique described for chisels, except that a
pull stroke is used rather than a push stroke

26

13
 4/5/2020

27

Periodontal Knives
• Two general types of periodontal knives are
available. The first type includes disposable
scalpel blades that come prepackaged and are
pre-sharpened and sterilized by the
manufacturer. These knives are not re-
sharpened when they become dull but are
discarded and replaced.

28

14
 4/5/2020

• The second type of periodontal knife is

reusable and must be sharpened when it
becomes dull. The most common knives in this
group are the flat-bladed gingivectomy knives
(e.g., Kirkland knives #15K and #16K) and the
narrow, pointed interproximal knives.

29

A gingivectomy knife may be sharpened on a stationary

flat stone. The instrument is held with a modified pen
grasp. The fourth finger guides the sharpening stroke as
the instrument is rolled between the fingers so that all
sections of the blade are sharpened.

30

15
 4/5/2020

An interproximal knife may be sharpened

on a flat stationary stone. The blade is
drawn toward the operator.

31

An interproximal knife may also be

sharpened with a handheld stone. The
instrument is held with a palm grasp, and the
stone is applied to the entire cutting edge.

32

16
 4/5/2020

Thank you

33

17