POWERED SCALING 
 INSTRUMENTATION

PRESENTED BY :
ASEEL MAJDALAWI                         FARAH ABU AMER          
HALA SAAD                                       NERMIN MOUSA   
ISRAA ELFARAA                               GHADA ALATRASH     
                                                                
 SUPERVISED BY :
 DR.HAMOUDA SHUBLAQ
  TOPICS TO BE DISCUSSED

INTRODUCTION TO POWERED INSTRUMENTATION

TYPES OF POWERED DEVICES

TIP DESIGNS FOR POWERED INSTRUMENTATION

MECHANISM OF ACTION FOR POWERED INSTRUMENTATION

TECHNIQUES OF POWERED INSTRUMENTATION

SPEACIAL CONSIDERATIONS DURING POWERED INSTRUMENTATION

CLINICAL OUTCOMES OF POWERED INSTRUMENTATION

INTRODUCTION TO
POWERED INSTRUMENTATION 
 PERIODONTAL
DEBRIDMENT
INSTRUMENTS

HAND\MANUAL POWERED
INSTRUMENTSMAN INSTRUMENTS

ULTRASONIC
SCALERS CURETTES  SONIC DEVICES
DEVICES
Sound is a form of energy produced by vibrations and humans can hear  
 sound at frequencies up to      KHz

Ultra
Beyound \ Higher than

Sonic
Related to audiable sound or the speed of a sound wave

So, ULTRASONIC means: sound (acoustic) energy having a frequency

higher than       KHz, above the audiable range of human ear
 Because these scalers convert
ULTRASONIC\SONIC  POWER-DRIVEN SCALERS  ​ 
high frequency electrical energy(ultrasonic)
SCALERS ​
or air pressure (sonic)
 MACHINE-DRIVEN SCALERS
into high frequency sound waves 
​

Powered instruments use a rapidly vibrating instrument tip to dislodge calculus from the tooth surface,
disrupt plaque biofilm, and flush out bacteria from the periodontal pocket

Powered devices consist of  - Handpiece that attaches to the dental unit or an electronic generator
                                                 - Interchangeable instrument tips                                        
Indications for use

Removal of supragingival calculus and tenacious stains

    
Subgingival debridement

Removal of calculus, attatched biofilm amd endotoxins from the root surface

Removal of unattached biofilm from the sulcular space

Strengths of Powered Instrumentation
a. Effective Removal of Calculus Deposits and Plaque Biofilms
Powered instrumentation has been shown to be as effective as hand instrumentation. Powered instruments
are especially effective in deplaquing : the disruption or removal of the subgingival plaque biofilm from root
surfaces and the pocket space

b. Pocket Penetration
Slim-diameter instrument tips penetrate deeper into periodontal pockets than hand instruments

c. Access to Furcations 
Slim-powered instrument tips are more effective in treating class II and III furcations when used by 
experienced clinicians

d. Irrigation (Lavage) 
Water irrigation of the pocket washes toxic products and free-floating bacteria from the pocket and provides 
better vision during instrumentation by removing blood from the treatment site

 e. Shorter Instrumentation Time

Several studies have shown that instrumentation time may be reduced when using powered instruments as
compared to hand instruments
Limitations of Powered Instrumentation

a. Clinician Skill Level

 The skill level of the clinician is the best predictor of the outcome of periodontal instrumentation regardless of whether
a hand or powered instrument is used

Powered instrument is ineffective and may even be harmful if the clinician is not skilled
in the technique, Powered instrumentation is just as technique sensitive as hand instrumentation
    
 A complete understanding of root anatomy is the key to successful periodontal instrumentation
 
  
b. Reduced Tactile Sensitivity

Clinicians experience less tactile sensitivity when using powered instruments than when using hand instruments  

    
c. Occupational Risks  

Infection control
Infection control can be compromised because some electronically powered devices have components 
that cannotbe sterilized

When selecting an electronically powered device for purchase, consider whether the unit’s handpiece and fluid reserv
oir bottles can be autoclaved

Aerosol Production
Powered instruments have been shown to generate high levels of contaminated aerosols

Musculoskeletal and Auditory Damage

Research is needed to establish the effect of powered instrumentation on musculoskeletal function and hearing 

d. Contraindications for Powered Instrumentation

Powered instrumentation is contraindicated for certain dental and medical conditions,will be discussed later 

TYPES OF
 POWERED DEVICES
Magnetostrictive Inserts

Most magnetostrictive devices have removable instrument inserts that fit into a 
tubular handpiece. The components of a magnetostrictive insert are
TIP GEOMETRY
ULTRASONIC INSERTS ULTRASONIC INSERTS
WITH ROUND CROSS WITH EDGES OR
SECTION BEVELS TI
Tips that are round in cross-
section allow energy to
spread more equally around
the tip surface and are better
suited for light to moderate
deposits, new calculus, and
biofilm removal since those
deposits can be removed
without the power boost
provided by an edge or bevel
These bevels concentrate the
ultrasonic energy, resulting
in additional power along
that edge.Tips with an edge
rely on this concentrated
energy to create micro-
fractures in the calculus,
resulting in more efficient
removal of even the most
tenacious deposits
WATER DELIVERY METHOD

Water is a critical element of any ultrasonic tip, operating

as a coolant to prevent the handpiece from overheating and
acting as a lavage to flush debris from the treatment site. As
insert design has progressed over the years, you now have a
choice of water delivery options

All three water delivery styles remain available.

Since each allows for effective tip cooling and
lavage of the treatment site, selection is a matter
of personal preference
 As ultrasonic technology and design continue
,In the original design
 ,d to advance

water was delivered through an external tube running parallel to the tip, positionin  water delivery methods were modified again resulting in the ability to have the wa
g water flow over the tip to the treatment site. However, these inserts require delica ter flow through the grip and through the tip, exiting very close to the working en
te handling as any bending or misalignment of the external water tube causes the  d of the insert. This Direct Flow water delivery method minimizes excess spray, th
water flow to be misdirected us improving visibility to the treatment site

The preferred water flow delivery 

method for most clinicians today

A reengineered design eliminated the external
 tube and allowed water to flow through the gr
ip and exit at the base of the tip
Delivery of cooling water to the tip is either internal (magnetostrictive only) or external (piezoelectric or
magnetostrictive) to the tip. External delivery may allow the diameter of the tip to be slightly narrower
than a comparable tip with internal water delivery. An advantage of internal tubing is that the water is
delivered closer in proximity to the active area of the tip. While this more focused delivery probably
allows the clinician to better manage the spray of water emitted, it does not reduce the amount of aerosol
contamination produced during ultrasonic scaling
FREQUENCY
HANDLE STYLE

Choosing the right insert is both an art and a science and

takes time. However, thoughtful consideration of procedure
type, anatomy, debris characteristics, ergonomics, and your
own personal preferences can allow selection of inserts that
aid in optimizing your clinical outcomes while at the same
time providing superior ergonomic comfort
  TIP DESIGNS FOR
 POWERED INSTRUMENTATION
TIP DIAMETER
standard diameter,slim diameter and ultraslim diameter 

TIP GEOMETRY
Straight and curved
INSTRUMENT TIP SELECTION

Instrument tips vary in tip shape, diameter, length, and curvature. Factors to be  
considered when selecting an instrument tip for a particular task include
 Also, REMEMBER THAT
INSTRUMENT TIP WEAR AND REPLACEMENT
SEQUENCE FOR USE OF TIPS
MECHANISM OF ACTION
     FOR POWERED INSTRUMENTATION
 MOST 
IMPORTANT
FACTORS ARE

AMPLITUDE
FREQUENCY WATER FLOW
(STROKE)

Is the measure of how Is the measure of how far the

In addition to rate of flow,
many times the electronically  instrument tip moves back
the physiologic effects of
powered instrument tip  and forth during one cycle
water may play a
vibrates per second
contributing role in the
efficacy of power
The instrument tip to
move a shorter distance instruments

The instrument tip The instrument tip

vibrates fewer times vibrates more times The instrument tip
per second  per second moves a longer distance 
Water contributes to three physiologic effects that play a role in the efficacy

Is the formation of bubbles

Is created when the in water caused by the high
Is the unidirectional fluid movement of the tip causes turbulence. The bubbles
ACOUSTIC ACOUSTIC
flow
STREAMING caused by ultrasound the coolant to accelerate,
 TURBULANCE implode and produce shock
CAVITATION
waves producing an intensified waves in the liquid, creating
swirling effect further shock waves
throughout the water
 FLUID RESERVIORS
ENERGY DISPERSION BY THE WORKING END SURFACES
ACTIVE TIP AREA
TECHNIQUES OF
 POWERED INSTRUMENTATION
FUNDEMENTAL SKILLS OF POWERED INSTRUMENTATION

As with hand-activated instrumentation, powered instrumentation relies on

basic fundamental skills that are essential for success

POSITION

GRASP

FINGER RESTS

LATERAL PRESSURE

ASSESSMENT/END POINT OF INSTRUMENTATION

ADAPTATION OF THE POWERED INSTRUMENT TIP

ANGULATION OF A POWERED TIP

APPROACH TO CALCULUS REMOVAL

MOVING THE INSTRUMENT TIP

POSITION

As instrumentation of anterior and posterior teeth predictably require

changes in regard to tip design and operator position, working by
sextant reduces the frequency of changing these variables, resulting
in a more efficient execution of instrumentation
ADVANCE TOWARD OPERATOR

The sequence of instrumentation always

advances towards the operator from posterior R
to anterior or, in anterior sextants, from the
tooth furthest from operator, which will differ
for Right handed and Left handed

L
GRASP
FINGER RESTS

LATERAL PRESSURE
ASSESSMENT/END POINT OF INSTRUMENTATION

ADAPTATION OF THE POWERED INSTRUMENT TIP

 ANGULATION OF A POWERED TIP

ANGULATION ANGULATION
NEEDED FOR NEEDED FOR
ULTRASONIC HAND
APPROACH TO CALCULUS REMOVAL
SPECIAL
CONSIDERATIONS
 BEFORE USE OF
 POWERED INSTRUMENTATION
 DENTAL AEROSOLS
are airborne particles that are composed of debris, microorganisms, and blood propelled into the air
from the oral cavities of individuals treated throughout the day in a denal unit

Aerosols stay airborne and float on office air currents moving some distance from the point of origin
Very small particles can remain suspended at the end of the procedure for many hours. Therefore, the
risk of contamination continues long after the procedure is over
Small aerosolized particles remain airborne and enter the nasal passage and are capable of penetrating  
deep into the respiratory tract
The use of prophy angles, air-water syringes, and even hand
instruments produces some splatter in the form of relatively large
droplets

Powered instruments and air polishers are the greatest producers 

of small-particle aerosol contamination in dentistry

Several studies show that blood is found routinely in the aerosols 

produced by powered instrumentation
Preventive Measures for Powered Instrumentation

Barrier protection 

High-volume evacuation  

Preprocedural rinsing  

Each of these adds a layer of protection for the clinician and others
in the dental office. However, aerosols stay airborne after the
procedure; therefore, the risk of contamination continues long after
the procedure is over
The American Academy of Periodontology recommends that
dental healthcare workers avoid exposing patients with cardiac
pacemakers to magnetostrictive devices

Piezoelectric ultrasonic devices 

do not interfere with pacemaker function
CLINICAL OUTCOMES
 OF POWERED INSTRUMENTATION 
REFERRENCES

https://pocketdentistry.com/3-what-is-ultrasonic-ins
trumentation

https://dentistry.co.uk/2021/06/15/covid-19-ultrasonic-scaling-could-be-lower-risk-than-it-currently-is

https://www.dentalproductsreport.com/view/approaches-to-aerosol-reduction

https://www.hufriedygroup.com/blog/selecting-ultrasonic-inserts

https://pocketdentistry.com/4-ultrasonic-tip-design-and-selection/

Newman Carranzas Clinical Periodontology 11th.Edition

Fundamentals of periodontal-instrumentation.Advanced Root Instrumentation;7th Edition