Ask the Expert: Ongoing Innovation

Anna M. Pattison, RDH, MS, is editor in chief of Dimensions of Dental Hygiene. She is associate professor and former chair of the Department of Dental Hygiene at University of Southern California, School of Dentistry, Los Angeles. She is the co-author with her husband Gordon L. Pattison, DDS, of the textbook Periodontal Instrumentation, which is used in dental and dental hygiene schools throughout the United States and the world. A 2005 recipient of the Pfizer/American Dental Hygienists’ Association Excellence in Dental Hygiene Award, she speaks on periodontal instrumentation throughout the United States and internationally.

Q: Are there any new advancements in hand instruments?

A: Yes, the most current innovations are the instruments that need less or no sharpening. The EverEdge™ technology, made by Hu-Friedy Mfg Co Inc, Chicago, uses a special treatment process to create very hard steel, which requires much less sharpening than traditional instruments. The new Hu-Friedy Ever- Edge metal is much harder and sharper than previous Hu-Friedy instruments. Gracey curets, After Five Gracey curets, Mini Five Gracey curets, universal curets, and sickles are all available in the EverEdge metal (Figure 1). Among these designs are instruments that are rigid for use on heavy calculus as well as standard shanked instruments that are more flexible for fine scaling and root planing. These instruments are designed to last longer and if you start with heavy, rigid blades, when they become sharpened down and thinner, they are still excellent for periodontal maintenance scaling. American Eagle Instruments, Missoula, Mont, makes the new XP™ instruments that require no sharpening.

Q: How can instruments require no sharpening?

A: American Eagle XP instruments are made with a specially manufactured metal that maintains a sharp cutting edge for months, so they don’t need sharpening. When the instrument becomes dull (about 3 to 4 months depending on frequency of use), it should be replaced. When the XP instruments were first introduced, the entire instrument needed replacement when the blade wore out. Now, American Eagle has just introduced its Quik Tip system, which consists of replaceable cone socket tips in many designs (Figure 2). The XP cone socket tips come with a resin or stainless steel handle and a wrench. When the tips become dull, the working ends are replaced. American Eagle XP instruments have thin blades and relatively flexible shanks. They are specifically designed for fine scaling and root planing after gross scaling with an ultrasonic scaler or heavier hand instruments.

Q: Are there any instruments with fine blades that are well-suited for periodontal maintenance therapy?

A: Clinicians are always looking for instruments with thinner, sharp, strong blades for periodontal maintenance patients who have areas of pocket depth with tighter tissue. The standard Hu-Friedy Gracey curets made with EverEdge metal and the new American Eagle XP instruments are thin and very sharp, so they are ideal for periodontal maintenance. Several other companies also make instruments with very fine blades. Paradise Dental Technologies (PDT), Missoula, Mont, makes instruments with thin blades that are tactilely sensitive and sharp (Figure 3). They have lightweight resin handles with relatively flexible shanks, making them especially well suited for periodontal maintenance scaling and for fine scaling and root planing. Suter Dental Mfg Co Inc, Chico, Calif, makes a thin bladed Barnhart 1-2 universal curet that is ideal for scaling periodontal maintenance patients (Figure 4).

A: G. Hartzell & Son, Concord, Calif, makes extremely rigid, sharp, strong instruments that are ideal for heavy or tenacious calculus removal (Figure 5). The rigid shanked Gracey curets have sharp, hard blades and come in both stainless steel and carbon steel. For more than 50 years, Hartzell has pioneered the manufacturing of cone socket replaceable tips in both carbon and stainless steel. These instruments are available with standard fixed tips or cone socket tips.

Q: Are there new developments in ultrasonic tips?

A: A new diamond calculus removal tip called the HST (Harrel Safety Tip) (Figure 6) has been introduced. Designed for both nonsurgical and surgical periodontal treatment by Dallas periodontist and Baylor College of Dentistry professor, Stephen K. Harrel, DDS, the piezo tip is made by Vista Dental Products, Racine, Wis. HST can be obtained with EMS (Electro Medical Systems), Satelec/ ACTEON North America, Brasseler NSK, or Vista threading. This is a diamond tip that is specially designed to cut through tenacious calculus while protecting the root surface. The diamond coating is placed in grooves that are cut into the smooth tip. Since the abrasive diamond is recessed, it is able to remove heavy or tenacious calculus more quickly and easily while the smooth surfaces of the tip protect the root.

Q: Are there any new ultrasonic implant tips?

A: Yes, one new magnetostrictive implant tip and one new piezoelectric implant tip are available. DENTSPLY Professional, York, PA has just introduced a new magnetostrictive implant insert called the DENTSPLY Cavitron^® SofTip™ Ultrasonic Implant Insert (Figure 7). This insert comes with 15 blue plastic SofTip™ disposable prophy tips and a TipTool wrench to attach them. Tony Riso Co, N Miami Beach, has made magnetostrictive implant inserts for many years. The Tony Riso Titanium Implant Scaler has a blue plastic tip that is permanently fixed (Figure 8) and can be obtained with two different shank angulations.

Q: Which piezoelectric ultrasonic units have implant tips?

A: Three companies make piezoelectric implant tips—EMS, Dallas; Satelec/ ACTEON North America, Mount Laurel, NJ; and Brasseler NSK, Savannah, Ga. All of these inserts are made of plastic or carbon composite. The new Brasseler NSK implant tip (Figure 9) and the EMS implant tip (Figure 10) both attach to the piezo handpiece with an endo chuck. There are three sickle-shaped Satelec carbon composite plastic implant tips (right and left posterior tips and a straighter anterior tip) (Figure 11) that screw directly into the piezo handpiece.

From Dimensions of Dental Hygiene. November 2006;4(11): 18-20.