Sonic & Ultrasonic Sonic & Ultrasonic

nstrumentation nstrumentation
and instrumentation and instrumentation - - technically demanding, time technically demanding, time
consuming and tiring consuming and tiring
As a result, numerous power driven scalers have been As a result, numerous power driven scalers have been
developed over the years developed over the years
Until recently, their use was mostly limited to Until recently, their use was mostly limited to
supragingival debridement because of their bulky supragingival debridement because of their bulky
working tips working tips
The availability of slender instruments with probelike tips The availability of slender instruments with probelike tips
allow efficient instrumentation of deep periodontal allow efficient instrumentation of deep periodontal
pockets with less operator fatigue pockets with less operator fatigue
echanism of Action echanism of Action
requency requency
A frequency of 25,000 equates to the tip moving 25,000 A frequency of 25,000 equates to the tip moving 25,000
times per second times per second
requency is important because it determines the area requency is important because it determines the area
of the insert tip that is considered active of the insert tip that is considered active
A higher frequency results in a smaller active area of an A higher frequency results in a smaller active area of an
insert tip insert tip
An insert working in the frequency of 30K would have an An insert working in the frequency of 30K would have an
active tip area of 4.2 mm, and a 25K tip has a working active tip area of 4.2 mm, and a 25K tip has a working
area of 4.3 mm area of 4.3 mm
Stroke Stroke
Stroke is the maximum distance the insert tip travels Stroke is the maximum distance the insert tip travels
during one cycle or stroke path during one cycle or stroke path
The power knob on an ultrasonic unit controls the stroke The power knob on an ultrasonic unit controls the stroke
length of the insert during cycle length of the insert during cycle
igh power setting produce a longer stroke pattern, and igh power setting produce a longer stroke pattern, and
a lower power setting provide a shorter stroke pattern a lower power setting provide a shorter stroke pattern
ater low ater low
ater contributes to three physiologic effects that ater contributes to three physiologic effects that
enhance the efficacy of power driven scalers: acoustic enhance the efficacy of power driven scalers: acoustic
streaming, acoustic turbulence, and cavitation streaming, acoustic turbulence, and cavitation
Acoustic streaming is the unidirectional fluid flow caused Acoustic streaming is the unidirectional fluid flow caused
by ultrasound waves by ultrasound waves
Acoustic turbulence is created when the movement of Acoustic turbulence is created when the movement of
the tip causes the coolant to accelerate, producing an the tip causes the coolant to accelerate, producing an
intensified swirling effect intensified swirling effect
Cavitation is the formation of bubbles in water caused by Cavitation is the formation of bubbles in water caused by
the high turbulence the high turbulence
Types of Power nstruments Types of Power nstruments
Power scalers fall into two categories: sonic and Power scalers fall into two categories: sonic and
ultrasonic ultrasonic
Sonic units attach to a dental unit because they need Sonic units attach to a dental unit because they need
compressed air; they work at a frequency of 2000 to compressed air; they work at a frequency of 2000 to
6500 cycles per second 6500 cycles per second
The two main types of ultrasonic devices are The two main types of ultrasonic devices are
magnetostrictive and piezoelectric; both work in a magnetostrictive and piezoelectric; both work in a
frequency range 18,000 to 50,000 cps frequency range 18,000 to 50,000 cps
Sonic Scalers Sonic Scalers
Sonic scalers are air Sonic scalers are air- -driven scalers in which driven scalers in which
frequency produces a vibration of the insert tip frequency produces a vibration of the insert tip
They use a high They use a high- -speed or low speed or low- -speed air source speed air source
from the dental unit from the dental unit
Sonic scaler tips are large in diameter and Sonic scaler tips are large in diameter and
universal in design universal in design
A sonic scaler tip travels is elliptical to orbital in A sonic scaler tip travels is elliptical to orbital in
shape shape
This stroke pattern allows the instrument to be This stroke pattern allows the instrument to be
adapted to all tooth surfaces adapted to all tooth surfaces
Ultrasonic Scalers Ultrasonic Scalers
Piezoelectric Piezoelectric
Ceramic disks located in the handpiece Ceramic disks located in the handpiece
power piezoelectric technology power piezoelectric technology
They change in dimension as electrical They change in dimension as electrical
energy is applied to the tip energy is applied to the tip
Piezoelectric tips move in a linear pattern, Piezoelectric tips move in a linear pattern,
giving the tip two active surfaces giving the tip two active surfaces
agnetostrictive agnetostrictive
etal stacks that changes dimension when etal stacks that changes dimension when
electrical energy is applied power electrical energy is applied power
magnetostrictive technology magnetostrictive technology
Vibrations travel from the metal stack to a Vibrations travel from the metal stack to a
connecting body, causing the vibration of the connecting body, causing the vibration of the
working tip working tip
Tips move in an elliptical or orbital stroke Tips move in an elliptical or orbital stroke
pattern, this allows the tip to have four active pattern, this allows the tip to have four active
working surfaces working surfaces
fficacy And Clinical Outcomes fficacy And Clinical Outcomes
Plaque & Calculus Plaque & Calculus
Both tradition ultrasonic and microultarsonic inserts were Both tradition ultrasonic and microultarsonic inserts were
effective in disrupting the apical plaque border effective in disrupting the apical plaque border
Ultrasonic mini inserts are more effective in the apical Ultrasonic mini inserts are more effective in the apical
plaque zone than curettes plaque zone than curettes
Both hand and ultrasonic instruments remove plaque Both hand and ultrasonic instruments remove plaque
equally well equally well
Both sonic and ultrasonic instruments have been shown Both sonic and ultrasonic instruments have been shown
to be effective in removing calculus similar to hand to be effective in removing calculus similar to hand
instrumentation instrumentation
Bacterial Reduction And ndotoxin/Cementum Bacterial Reduction And ndotoxin/Cementum
Removal Removal
Cavitational activity and acoustic microstreaming may Cavitational activity and acoustic microstreaming may
enhance cleaning efficacy and increase plaque reduction enhance cleaning efficacy and increase plaque reduction
Up to 5 minutes of ultrasonic activation resulted in Up to 5 minutes of ultrasonic activation resulted in
significant killing of Actinobacillus significant killing of Actinobacillus
actinomycetemcomitans and P. gingivalis actinomycetemcomitans and P. gingivalis
Conversely, few others found that neither sonic nor Conversely, few others found that neither sonic nor
ultrasonic scaling is capable of killing Actinobacillus ultrasonic scaling is capable of killing Actinobacillus
actinomycetemcomitans or P. gingivalis actinomycetemcomitans or P. gingivalis
Ultrasonic instrumentation in r and class furcation is Ultrasonic instrumentation in r and class furcation is
more effective in reducing bacteria and keeping bacterial more effective in reducing bacteria and keeping bacterial
at a healthy level longer than hand instrumentation at a healthy level longer than hand instrumentation
ater, chlorhexidine and povidone ater, chlorhexidine and povidone- -iodine all produce iodine all produce
similar results similar results
Ultrasonic instruments are effective in reducing root Ultrasonic instruments are effective in reducing root
surface endotoxin surface endotoxin
and instruments are more effective than an ultrasonic and instruments are more effective than an ultrasonic
scaler in reducing root endotoxin scaler in reducing root endotoxin
Studies on which type of instrumentation leaves the Studies on which type of instrumentation leaves the
smoothest root surface have reported mixed results smoothest root surface have reported mixed results
Bleeding on Probing, Probing Depth, and Clinical Bleeding on Probing, Probing Depth, and Clinical
Attachment Attachment
Both hand scalers and power scalers demonstrate Both hand scalers and power scalers demonstrate
similar outcomes for reductions in bleeding on probing similar outcomes for reductions in bleeding on probing
and probing depth and gains in clinical attachment and probing depth and gains in clinical attachment
Sonic scalers have been shown to be as effective as Sonic scalers have been shown to be as effective as
hand instruments hand instruments
urcation Access urcation Access
Ultrasonic scalers equal to hand scalers in reducing the Ultrasonic scalers equal to hand scalers in reducing the
bacteria in class furcations but more effective in class bacteria in class furcations but more effective in class
and furcations and furcations
Both sonic and ultrasonic tips are similar in their ability to Both sonic and ultrasonic tips are similar in their ability to
remove calculus in furcations remove calculus in furcations
fficiency fficiency
Tip designs Tip designs
Large Large- -diameter tips are indicated for the removal of diameter tips are indicated for the removal of
large, tenacious deposits large, tenacious deposits
Thinner Thinner- -diameter tips have a site diameter tips have a site- -specific design specific design
The straight The straight- -tip design is ideal for treating patients with tip design is ideal for treating patients with
gingivitis and for deplaquing maintenance patients gingivitis and for deplaquing maintenance patients
The right and left contra The right and left contra- -angled instruments allow for angled instruments allow for
greater access and adaptation to root morphology greater access and adaptation to root morphology
Time Time
Sonic and ultrasonic scalers require less time than hand Sonic and ultrasonic scalers require less time than hand
scaling scaling
nstrumentation time per tooth with an ultrasonic scaler is nstrumentation time per tooth with an ultrasonic scaler is
3.9 minutes versus to 5.9 minutes for hand instruments 3.9 minutes versus to 5.9 minutes for hand instruments
Sonic scaler require less time than an ultrasonic scaler Sonic scaler require less time than an ultrasonic scaler
(Jotikasthira et al.) (Jotikasthira et al.)
Ultrasonic scaler is faster (Loos et al.) Ultrasonic scaler is faster (Loos et al.)
Special Considerations Special Considerations
Aerosol Production Aerosol Production
No significant differences in amount of aerosol produced No significant differences in amount of aerosol produced
between sonic, magnetostrictive and piezoelectric scalers between sonic, magnetostrictive and piezoelectric scalers
3 levels of defense in the reduction of dental aerosols: 3 levels of defense in the reduction of dental aerosols:
1. 1. Personal protective barriers such as mask, gloves Personal protective barriers such as mask, gloves
2. 2. Preprocedural antiseptic rinse Preprocedural antiseptic rinse
3. 3. Use of high speed evacuation device Use of high speed evacuation device
Cardiac Pacemakers Cardiac Pacemakers
Atrial and ventricular pacing are inhibited by Atrial and ventricular pacing are inhibited by
electromagnetic interference produced by a electromagnetic interference produced by a
magnetostrictive ultrasonic scaler magnetostrictive ultrasonic scaler
Sonic scaler does not produce the same effect Sonic scaler does not produce the same effect