ULTRASONIC SCALING TECHNIQUE

Ultrasonic scaling is done in the following manner:

‰ Patient preparation: Direct the patient to rinse for 1 minute with an antimicrobial mouthrinse, such
as 0.12% chlorhexidine, to reduce the contaminated aerosol.
‰ Preparation of ultrasonic unit: Thoroughly wipe the ultrasonic unit with a disinfectant and cover the
ultrasonic unit or control knobs with plastic or latex barriers. Use a sterile, autoclavable ultrasonic
handpiece. Flush the waterlines and handpiece for approximately 2 minutes to decrease the number of
microorganisms in the lines. Whenever possible, use waterline filters or sterile water.
‰ Operator preparation: The operator and the assistant should wear protective eyewear and masks and
use high-speed evacuation to minimize inhalation of the contaminated aerosol produced
duringinstrumentation.
‰ Patient and operator positioning: Slightly raise the back of the patient’s chair as it allows easy
pooling of water and provides better and direct visibility of certain areas.
‰ Power setting: Depending on the unit used, power setting and water need to be adjusted with each tip
application. The sturdier tips can accommodate higher power setting, whereas finer tips require less
power. Medium-to-high power settings are recommended for heavy debris removal and low-to-medium
settings are recommended for removing light debris. But, the power setting should begin on low and be
adjusted not higher than necessary to remove calculus. Medium-to-high power settings have been
shown to cause damage to roots when the tip is not parallel to the root surface.
‰ Turn on the unit, select tip and place it into the handpiece: Magnetostrictive device is inserted by
pushing downward with a slight twist until the O-ring is within the handpiece and the tip securely in
place. For piezoelectric system, wrench is used to screw the tip into the handpiece. Adjust the water
control knob to produce a light mist of water at the working tip.
‰ Pen grasp and finger rest: The instrument is grasped with a light pen or modified pen grasp. Light
grasp increases tactile sensitivity and patient’s comfort and reduces clinician’s fatigue. The bulk of the
powered instrument’s handpiece and attached cord sometimes requires the use of an extraoral fulcrum
to maintain control of the instruments. An extraoral fulcrum provides balance rather than strength. A
finger rest or extraoral fulcrum should be established to allow a very light, feather-like touch. For
maxillary teeth, extraoral hand rests should be used and for mandibular teeth, either intraoral or
extraoral fulcrums may be used Powered handpieces are heavier than manual
instruments and moreover weight from the cord drags which require adjustments in the cord placement.
To reduce tension from cord and for correct adaptation of the instrument, the cord is wrapped around
the forearm.
‰ Adaptation and angulation: Like manual instrumentation, adaptation of the anterior 2–3 mm of the
tip is appropriate. Keep the working tip adapted to the tooth surface as it is passed over the deposit.
Heavy lateral pressure is unnecessary because the vibrational energy of the instrument dislodges the
calculus. However, the working end must touch the deposit for this to occur. The working end should be
kept in constant motion, and the tip should be kept parallel to the tooth surface or at not more than a 15 °
angle to avoid grooving of the tooth surface.
‰ Strokes: Use short, light, vertical, horizontal, or oblique overlapping strokes.
‰ The instrument should be switched off periodically to allow for aspiration of water, and the tooth
surface should be examined frequently with an explorer.
‰ Any remaining irregularities of the root surface should be removed thereafter with sharp curettes.
Aerosol Production Hazards
Micik and colleagues defined dental aerosols as being particles smaller than 50 μm, with any particles
larger than 50 μm being described as splatter. These particles behaved in a ballistic manner, means that
these particles are ejected forcibly from the operating site and they arch in a trajectory similar to that of
a bullet until they contact a surface or fall to the floor.The aerosol produced by sonic and ultrasonic
instrumentation may contain potentially infectious bloodand airborne pathogens. Pneumococci,
Staphylococci,alpha-hemolytic streptococci and Mycobacterium tuberculosis are among the bacteria
that have been found in dental aerosols. Both large and small aerosol particles may contain blood
elements with attached viral particles, such as herpes simplex virus, influenza virus, common
coldviruses, Epstein-Barr virus, cytomegalovirus, human immunodeficiency virus and hepatitis B virus.
Of additional concern are pathogens that do not originate from patients but are from the contaminated
waterlines of the dental unit or the ultrasonic device. Putative pathogens, such as Pseudomonas sp. And
Legionella pneumophila, have been isolated from dental unit water and can become
aerosolized by an ultrasonic scaler. Aerosol from ultrasonic instrumentation always contains blood and
lingers in the air for 30 minutes or longer in the entire operatory and in areas of the dental office outside
the operatory.10-13 Following are the ways that can reduce hazards of aerosols production:14,15 ‰
Protective barriers: Unprotected patients may be more susceptible to infection from the aerosol than
dental personnel who are wearing protective barriers, such as masks, gloves, eyewear and clinical
clothing. A wellfitting surgical facemask, i.e. theatre or dome-type facemask, is preferable to the paper
type, which rapidly becomes permeable and inefficient. Masks should have at least 95% filtration
efficiency for particles 3.0–5.0 µm in diameter. Ideally, mask should be changed for each patient. It
should be changed after 20 minutes in aerosol or 60 minutes in non-aerosol environments. Protective
glasses with top and side shields must be worn while treating patients. ‰
Position of the patient: The position of a patient during dental treatment is also significant. A patient
should be treated in the supine position which, apart from other advantages, makes it possible for a
doctor to avoid work in the breath way of a patient.
High-volume evacuator (HVE): HVE removes a large volume of air within a short period. It usually has
opening of 8 mm or more and evacuates up to 100 cubic feet of air per minute. It can reduce the
contamination arising from the operative site by more than 90%
Preprocedural rinsing: Rinse the oral cavity of a patient with an antiseptic, e.g. chlorhexidine, before
the procedure.
Flushing of the handpiece and waterlines or a selfcontained sterile water source, thorough disinfection
of environmental surfaces: The first flushing assures elimination of microflora whose presence is due to
the night stagnation. The second rinsing for 20–30 second is recommended, to help reduce the risk of
retraction of the oral cavity fluids, and aims at elimination of potential cross infection. Adequate
ventilation and air filtration units with highefficiency particulate air (HEPA) filters effectively reduce
the bacterial load in the environment of operatory. A dental unit should be rinsed at the beginning of a
working day, and between patients

CONTRAINDICATIONS
‰ Pacemakers: Patients with a pacemaker poses electromagnetic interference, especially to
magnetostrictive, but newer models of pacemakers are insulated and bipolar so electromagnetic
interference is unlikely
Patients with contagious and communicable diseases: Hepatitis, tuberculosis, throat and respiratory
infections wherein transmission via aerosols is possible
Composite resin and porcelain inlays or crown: For demineralized tooth structure, hypersensitive
areas, veneers, cast crowns and implants, ultrasonic instrumentation may harm the surfaces.

‰Children: Primary and newly erupted teeth have larger pulp areas and are more susceptible to heat.
‰ Immunocompromised patient: Creation of aerosols may increase patient’s risk for infection