Advances in Ultrasonics

Ultrasonic instrumentation is a valuable component of the dental hygienist’s armamentarium and its efficacy is supported by a body of evidence.^1-9 When used in collaboration with hand instrumentation, ultrasonic instrumentation can provide effective calculus and biofilm removal.^10,11 Ultrasonic instrumentation also offers subgingival irrigation, which may help disrupt bacteria and reduce the level of periodontal pathogens, thus diminishing the total subgingival bacterial load.^7,9,11 Ergonomically, ultrasonic instrumentation can reduce muscle strain, fatigue, and pain in practitioners.¹² As the use of ultrasonic scalers continues to grow, new advancements have been introduced in both tips and units to boost performance and make instrumentation easier on the clinician.

INCREASED VISIBILITY

One of the latest advances in ultrasonic design is the addition of a light source to the tip or handpiece. Lighted tips and handpieces provide superior visibility in difficult-to-access areas, eliminating the need to continuously adjust the overhead dental light. A light-emitting diode (LED) produces a strong light without generating heat, increasing both patient and operator comfort.

Discus Dental offers the Insight™ LED magnetostrictive ultrasonic insert (Figure 1), which combines a 360° swivel handle, a comfortable silicone grip, and an LED light that is activated when the rheostat is depressed. These features are designed to improve clinical visibility, provide the ability to roll the handle easily when changing operator positions, and reduce hand stress with a more comfortable grip.

DENTSPLY makes the Cavitron^® Steri-Mate Light for 30K handpieces (Figure 2). The sleeve slides onto the Cavitron handpiece and provides illumination. It includes a flexible light tube that allows the clinician to direct the illumination. The Cavitron Steri-Mate Light does not require a battery or external power source and the sleeve attachment is autoclavable.

Some ultrasonic units incorporate lighting directly into the handpiece design. The Pro-Select^® Platinum piezoelectric ultrasonic scaler and irrigator from Zila, a division of TOLMAR, is designed for increased comfort and includes an LED to increase the clinician’s field of vision (Figure 3). Hu-Friedy makes the Symmetry IQ piezoelectric scaling unit that incorporates fiber-optic lighting within the handpiece (Figure 4). The Satelec SP Newtron LED piezoelectric ultrasonic unit includes a built-in LED in the handpiece (Figure 5). Brasseler USA/NSK makes the Varios 350 multi-functional piezoelectric ultrasonic unit that features 360° optic lighting designed to provide superior illumination for all intraoral areas (Figure 6). EMS, Electro Medical Systems Corp, has introduced an LED handpiece that is available on its newest devices: the Piezon^® Master 700 and the miniMaster^® LED. The removable light guide is sterilizable and has six encapsulated LEDs for excellent visibility (Figure 7).

INSTRUMENTING IMPLANTS AND RESTORATIONS

Ultrasonic tip design has undergone much innovation. There are numerous designs currently available, from the standard (figures 8 and 9) to new designs, including tips for instrumenting implants and tips with a very thin diameter.

Ultrasonic implant tips are designed for the debridement of implants and cosmetic restorations. They work by attaching a carbon composite or plastic tip over the ultrasonic insert. There are several types of implant tips available. DENTSPLY Professional makes Cavitron SofTip™ specifically designed for use around titanium implants and abutments (Figure 10). Parkell offers the GentleCLEAN magnetostrictive ultrasonic insert that uses replaceable tips made of Ultem™ 1000 polyetherimide resin (Figure 11). The Varios Ultrasonic Implant Tip from Brasseler USA/NSK is a plastic tip that inserts into a v-shaped tip holder for use in piezoelectric handpieces. It is safe to use on titanium implants and restorative materials (Figure 12). ACTEON North America (Satelec) offers PerioSoft™ piezoelectric tips, which are made from carbon composite and attach to any piezoelectric handpiece with a wrench (Figure 13). Tony Riso Co makes Titanium Implant Scaler (TIS) ultrasonic inserts, which are plastic tips that screw onto insert tips (Figure 14). G. Hartzell & Son manufactures blue silicone tips (#UP125k and #UP130k) that screw onto the end of an insert for both magnetostrictive and piezoelectric ultrasonic scalers (Figure 15). The Perio Implant Tip from EMS, Electro Medical Systems Corp, is a piezoelectric plastic tip that is designed for the gentle cleaning of implants and corresponding restorations (Figure 16). The tip is applied to the endo chuck and tightened with a flat wrench.

DIAMETER AND MATERIAL

The introduction of thin tips for the ultrasonic scaler has increased the dental hygienist’s ability to access root surfaces in periodontal pockets. Microthin tips are now available to provide better accessibility into periodontal pockets, interproximal areas, and furcations. DENTSPLY Professional makes the THINsert^® tip (Figure 17) that allows the clinician to debride at low to medium power in deep pockets and in areas with fibrotic gingival tissues. The THINsert magnetostrictive ultrasonic insert is 47% thinner than DENTSPLY’s FSI Slimline^® insert and includes a 9° backbend for improved access into subgingival areas. Vista Dental Products makes Mini Curette piezoelectric tips with extra thin blades and short shanks that are available in six designs and compatible with any piezoelectric unit (Figure 18). Other new tips available in a thinner design include Hu-Friedy Symmetry IQ^® piezoelectric scaling tips (Figure 19), Hu-Friedy Swivel Direct Flow^® ultrasonic inserts (Figure 20), Discus Dental Insight LED Inserts (Figure 1), and Parkell’s Burnett Power-Tip™ (Figure 21) which was redesigned to feature a longer, slimmer tip.

Two lines of tips have been introduced that are made from different materials to offer specific features. The Scorpion piezoelectric tips from Paradise Dental Technologies (PDT) are coated with titanium nitride that appears gold so dental hygienists can easily note when the tips are worn and need replacement. They are also very thin and intended to provide easy access to interproximal areas (Figure 22). American Eagle’s Infinitips are made with the company’s XP technology, which is designed to produce and retain a very sharp edge. The Infinitips are engineered to keep their shape, which aids in ultrasonic tuning (Figure 23).

NEW ULTRASONIC UNIT TECHNOLOGIES

In addition to tip design, many manufacturers have improved the design of their ultrasonic scaler units to facilitate operator ergonomics, visibility, and treatment. The Zila Pro-Select Platinum^® piezoelectric ultrasonic scaler and irrigator features a closed, multi-fluid system that offers three choices for irrigation, hands-free foot pedal control, a lightweight handpiece, and a universal tip that may be used on all patients (Figure 24). The unit includes Advanced Comfort Technology™ that is designed to require less pressure for adequate deposit removal without increasing the discomfort to the patient, and possibly reducing the need for local anesthesia during debridement procedures. The handpiece includes an LED that is designed to improve the clinician’s field of vision without causing an increase in heat production.

Satelec Suprasson^® P Max Newtron XS piezoelectric unit is a multi-function scaler that can be used for periodontal and endodontic procedures (Figure 25). The unit incorporates SP Newtron™ technology that recognizes tip frequency and can automatically adapt the current to the resistance detected during instrumentation. It includes a multi-function rheostat that can initiate irrigation and select one of four power modes. The unit design includes a handpiece equipped with Peek^® casing and a light system, in addition to an optional irrigation kit with two separate containers. The unit also incorporates a color coding system to select the required setting and ensure that power is automatically controlled.

The NSK/Brasseler USA Varios 750 Lux Multi-function piezoelectric ultrasonic system is also multi-functional and includes to change the source to tap water during instrumentation. The system also allows the clinician to save preferred settings using a memory key.

Hu-Friedy has two new ultrasonic units including the Symmetry IQ (Figure 27) and the SWERV3 (Figure 28). The Symmetry IQ is a multi-functional piezoelectric device that is offered in a 2000 series, 3000 series, and 4000 series. The 3000 series features touchpad controls with three color-coded power modes and a memory feature. The 4000 series includes a stand-alone large capacity irrigation supply and a switch that allows the clinician to change the source to tap water. The unit also features fiber-optic lighting and a large diameter, lightweight handpiece. The new SWERV3 magnetostrictive ultrasonic unit features an ergonomic design that includes a comfort zone grip to ensure a relaxed grip for the clinician. It has a wide range of power settings from very low to high power. It can be used at high power with a standard large insert for fast and efficacious calculus removal, which reduces the risk of burnishing calculus onto the tooth.¹³

The Co-Pilot™ piezoelectric dual reservoir scaling system was introduced this year by Vista Dental (Figure 29). It combines a piezoelectric scaler with two 350 ml reservoir tanks in a compact and portable design. The unit accepts a wide variety of piezoelectric tips.

EMS, Electro Medical Systems Corp, introduces two new units in October. The Piezon Master 700 piezoelectric ultrasonic unit is a two-bottle system with the company’s new iPiezon technology with intelligent feedback control (Figure 30). The unit offers an LED handpiece and a new hygienic touchpanel. The miniMaster LED unit is a smaller, portable one-bottle system that also includes an LED handpiece (Figure 31).

IN SUMMARY

As more and more dental hygienists incorporate ultrasonic instrumentation into their routines, advances in unit and tip design will continue. Clinicians must decide which type of power scaler system is appropriate for their use and their patient population.

REFERENCES

1. Trenter SC, Walmsley AD, Landini G, Shippen JM. Assessment of the ultrasonic dental scaler insert. Med Eng Phys. 2002;24:139-144.
2. Wilkins EM. Clinical Practice of the Dental Hygienist. 10th Ed. Philadelphia: Lippincott Williams & Williams; 2009.
3. Badersten A, Nilveus R, Egelberg J. Effect of nonsurgical periodontal therapy I. Moderately advanced periodontitis. J Clin Periodontol. 1981;8:57-72.
4. Badersten A, Nilveus R, Egelberg J. Effect of nonsurgical periodontal therapy II. Severely advanced periodontitis. J Clin Periodontol. 1984;11:63-76.
5. Torfason T. Kiger R. Selvig KA, Egelberg J. Clinical Improvement of gingival conditions following ultrasonic versus hand instrumentation of periodontal pockets. J Clin Periodontol. 1979;6:165-176.
6. Breininger DR, O’Leary TJ, Blumenshine RV. Comparative effectiveness of ultrasonic and hand D scaling for the removal of subgingival plaque and calculus. J Periodontol. 1987;58:9-18.
7. Oosterwaal PJ, Matee MI, Mikx FH, van’t Hof MA, Renggli HH. The effect of subgingival debridement with hand and ultrasonic instruments on the subgingival microflora. J Clin Periodontol. 1987;14:528-533.
8. Drisko CH. Root instrumentation: power-driven versus manual scalers, which one? Dent Clin North Am. 1998;42:229-244.
9. Arabaci T, Cicek Y, Canakci CF. Sonic and ultrasonic scalers in periodontal treatment: a review. Int J Dent Hygiene. 2007;5:2-12.
10. Copulos TA, Low SB, Walker CB, Trebilcock Y, Hefti AF. Comparative analysis between a modified ultrasonic tip and hand instruments on clinical parameters of periodontal disease. J Periodontol. 1993;64:694-699.
11. Baehni P, Thilo B, Chapuis B, Pernet D. Effects of ultrasonic and sonic scalers on dental plaque microflora in vitro and in vivo. J Clin Periodontol. 1992;19:455-459.
12. Ryan DL, Darby M, Bauman D, Toll&e SL, Naik D. Effects of ultrasonic scaling and hand-activated scaling on tactile sensitivity in dental hygiene students. J Dent Hyg. 2005;79:9.
13. Pattison AM. Ultrasonics unveiled. Dimensions of Dental Hygiene. 2010;9(4):36-45.

From Dimensions of Dental Hygiene. October 2010; 8(10): 48, 50, 52, 54, 56-57.