Ultrasonic scaling (US) Flashcards by PIPER KING

POWERED SCALERS

Powered instrumentation uses
_________ inserts to remove _____
and ________ deposits, disrupt plaque
biofilm, and flush ______ products and free–
floating ______ from pockets

Powered instrumentation uses ________
pressure with ________ strokes to
remove deposits.

powered instrumentation uses INTERCHANGEABLE inserts to remove SUPRA and SUBGINGIVAL deposits, disrupt plaque and biofilm, and flush toxic products and FREE FLOATING BACTERIA out of pockets

powered instrumentation uses GENTLE pressure with OVERLAPPING strokes to remove deposits

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powered ultrasonic scalers

power driven units that convert _______ to __________ by flowing electricity over _______ or _________ in form of rapid vibrations to the instrument tip

these rapid vibrations fracture and shatter ______, ______, and _______ from teeth

ultrasonic scalers are power-driven units that convert ELECTRICAL ENERGY to MECHANICAL ENERGY by flowing electricity over QUARTZ CRYSTALS or FERROMAGNETIC METALS in the form of rapid vibrations

these rapid vibrations fracture and shatter CALCULUS, PLAQUE, AND STAIN from teeth

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what are the benefits to ultrasonic scaling

takes less times (20-60% less depending on skill)
less operator fatigue
ergonomics; less repetitive movements, larger handle size, no need to wrist motion
sulcular irrigation
no need to sharpen tip, just replace overtime

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what are the 3 types of positive tissue response

ACOUSTIC TURBULENCE/MICROSTREAMING: intensified swirling and pressure effect that disrupts biofilm (loss of fimbriae)

CAVITATION: imploding bubbles that produce shock waves in the water that kill bacteria

LAVAGE/IRRIGATION: constant subgingival flushing

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what are the contraindications to US (7)

primary teeth
severe respiratory diseases
dysphagia
active communicable diseases
demineralized teeth
immunosuppressed individuals (medical consult)
pacemaker (medical consult)

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aside from contraindication, what other obstacles come with using US (3)

hearing impacts
musculoskeletal issues
aerosol generation

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POWERED DEVICE CLASSIFICATION - sonic (3)

2500-7000 cycles per second (cps)
elliptical motion
all sides are active

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POWERED DEVICE CLASSIFICATION - ultrasonic magnetostrictive (3)

18000-45000 cps
elliptical motion
all sides active

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POWERED DEVICE CLASSFICATION - ultrasonic piezoelectric (3)

25000-50000 cps
linear motion
only lateral sides active

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MAGNETORESTRICTIVE US (in our kits)

driven by _________

___________ inserts use stacks of _______ strips in the handpiece

ferromagnetic units use a _____ rod to do the same thing with less ____ byproduct

magnetic field created by ______ and ________ of metal pieces

driven by ELECTRICAL CURRENTS

CONVENTIONAL inserts use stacks of METAL strips in the handpiece

ferromagnetic units use a FERRIC rod to do the same thing with less HEAT byproduct

magnetic field created by the EXPANSION and CONTRACTION of metal pieces

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MAGNETORESTRICTIVE US

-power source
-movement pattern
-power
-amplitude
-active sides

POWER SOURCE: electricity over magnetic field when ultrasonic sound waves are dissipated in form of heat and cooled by water

MOVEMENT PATTERN: elliptical

POWER: oscillating frequencies of 25000-45000 cps

AMPLITUDE: more powerful than sonic scalers

ACTIVE SIDES: all sides are active (lateral sides are stronger and preferred)

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what determines the range of cps

brand, age of the device, etc.

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PIEZOELECTRIC SCALERS

tip coupled to _________ subjected to ________ voltages which causes them to expand and contract

_________ transducer converts __________ into ___________

amplitude:

power:

tip coupled to CERAMIC CRYSTALS subjected to PULSATING voltages which causes them to expand and contract

QUARTZ CRYSTAL TRANSDUCERS converts ELECTRICAL ENERGY into US VIBRATIONS

AMPLITUDE: more powerful than sonic scalers

POWER: oscillating frequencies of 25000-50000 cps

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PIEZOELECTRIC SCALERS

no interference with _________

tip movement is ______ (windshield wiper)

active sides:

generates less _____; _____ cools

no interference with PACEMAKERS

tip movement is LINEAR (windshield wiper)

active sides: ONLY LATERAL

generates less HEAT; WATER cools

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SONIC SCALERS

driven by:

amplitude:

power:

attaches directly to _______; activated by _______

mostly _______ shape

active surface:

no ________

DRIVEN BY: compressed air by dental unit

AMPLITUDE: least powerful

POWER: 3000-8000 cps

attaches directly to the DENTAL UNIT; activated by CONVENTIONAL HANDPIECE FOOT CONTROL

mostly ELLIPTICAL shape

ALL SURFACES ACTIVE

NO HEAT GENERATION

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quick comparison of US: magnetostrictive vs piezoelectric

frequency
stroke pattern
energy conversion
power dispersion

FREQUENCY: m=20-40kHz; p=29-50kHZ

STROKE PATTERN: m=elliptical; p=linear

ENERGY CONVERSION: m=metal rod/stack of metal sheets; p=crystals activated by ceramic handpiece

POWER DISPERSION: m=all surfaces active; p=only lateral sides active

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the powerline 100 AND powerline 1000 are used for: (5)

medium-heavy tenacious calculus and stain deposits

necrotic root tissue

overhanging restorations

cement removal

supra and subgingival

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what is the Hu Friedly equivalent of the powerline 100 and 1000

P10 and Triplebend

what are 3 additional indications for powerline 100 and 1000 use

ANUG (acute necrotizing ulcerative gingivitis) debridement
pre-scaling for oral surgery
clearing abscesses/acute periodontal infections

powerline 1000 or triple bend design:

Gross removal of _____________

____ and ____

what are the bends for

more useful at removing tenacious calc compared to ________

Gross removal of MOD-HEAVY TENACIOUS CALC

SUPRA and SUB

bends facilitate access to line angles and interproximal surfaces

more useful at removing tenacious calc compared to the powerline 100/p10

what considerations regard the powerline 1000 or triple bend

narrow pockets
restorative materials: laminate veneers, composites, porcelain jacket crowns

BEAVER TAIL TIP (not in our kits)

__________ calc removal on _____ teeth

best for ____ deposits and _________

________ strokes on proximal surfaces

________ strokes on facial/lingual surfaces

SUPRAGINGIVAL calculus removal on ALL teeth

best for HEAVY deposits and CALCULUS BRIDGES

HORIZONTAL strokes on proximal surfaces

VERTICAL strokes on facial/lingual surfaces

MODIFIED/SLIMLINE TIPS

includes _______, ________, and ________ inserts

indicated for: (5)

typically includes: straight, left, and right inserts

indicated for: deep pockets, bone loss, removal of plaque/biofilm/endotoxins/and light-moderate calc and stain

what questions to ask when deciding which tip to use in a treatment area

what size of calc? small, medium, large deposits

where is it located? above FGM, 4mm or less below FGM, more than 4mm below FGM

integrated vs portable

integrated US are fixed to the unit portable US must be obtained from sterilization

how to set up to use the US (5)

1. Disinfect, place barriers 2. bleed the lines for 3 minutes 3. install and lubricate the O ring 4. Check the water flow and adjust as needed 5. prepare the patient

US instrumentation ____ grasp and stroke pressure _____ or ________ fulcrum with ____ grasp ______ for water control ________ power to remove deposits higher calc class = ________ power ____ to control ________

LIGHT grasp and stroke pressure; let the oscillations do the work for you INTRA or EXTRAORAL fulcrum with PEN grasp; opposite arch, cross arch, etc. SUCTION for water control LOWEST power to remove deposits Higher calculus class = HIGHER power HVE to control AEROSOL GENERATION

how to adapt the US what part of the tip is active how to scale a tooth

roll the insert between your fingertips (same as hand instrumentation) last 3mm work from the most coronal part of the deposit and work apically (channeling)

what are the two basic types of stroke motions used with ultrasonic scaling

sweeping strokes against the tooth surface tapping strokes against the calculus deposit

describe the sweeping US motion (5)

- short, small, controlled strokes - multiple overlapping strokes - heavier deposits need more strokes - tip should CONSTANTLY be moving to avoid heat - eraser motion

describe the tapping motion

- used for large calculus deposits - lateral surface against the tooth - slower, repetitive strokes

what is the correct technique when using the magnetostrictive US

- adapted with the lateral surface or back surface against the tooth - slow, repetitive strokes - channeling (coronal > apical)

how to adapt to the interproximal how to adapt to the buccal/lingual

- lateral surface adapted like a curet; active lateral edges - lateral surface adapted to the facial surface like a probe; active lateral edges

describe the back of an US tip

- check manufacturers recommendations to see if the instruments allows adaption of the back; most MR tips do - less powerful than lateral sides

what is one of the most common technique mistakes

using too much pressure (moderate-heavy); we need to use light pressure

DESCRIBE THE PROCESS/TECHNUE!

1. adapt the lateral surface in a VERTICAL position at the DB LINE ANGLE of the most distal tooth 2. move distally keeping the lateral surface adapted; use horizontal and oblique strokes to scale the distal surface of mod-heavy deposits 3. transition below the distal contact like you're using a curet 4. return to vertical strokes adapting the lateral surface to the DB line angle; move mesially and subging using horizontal and oblique stroke to debride the buccal 5. move mesially and adapt the lateral surface using horizontal and oblique strokes on the mesial surface of mod-heavy deposits 6. go below the mesial contact like using a curet *repeat on lingual

CAUTION the point of an electronically powered instrument tip should NEVER be adapted to the __________ __________ dispersed by the point could damage the _______

the point of an electronically powered instrument tip should NEVER be adapted to the DIRECT TOOTH SURFACE the HIGH ENERGY dispersed by the point could damage the TOOTH

what is burnished calculus

when a clinician uses LOW POWERED ultrasonics to try to remove TENACIOUS calculus, deposits can be rapidly SMOOTHED over, making them difficult/impossible to DETECT and REMOVE

how to reduce patient sensitivity (5)

1. lighten your pressure 2. decrease the power to prevent root sensitivity 3. change the tip motion 4. increase the water compared to powder 5. increase the speed of your movement

usage tips: prevent _________ with lower power minimize _______ by cupping not retracting use _____ when not in use, lay __________; do not __________ _________ movement is critical keep _______ filled with integrated units:_________ before polishing tips are ________

prevent ROOT SENSITIVITY with lower power minimize WATER BUILD UP by cupping not retracting use HVE when not in use, lay FLAT ON THE BRACKET TABLE; do not PLACE IN THE HANDPIECE HOLDER CONSTANT movement is critical keep WATER filled with integrated units: REMOVE THE INSERT before polishing tips are STERILIZED

TREATMENT PLANNING no ________ only work on ________ always follow with __________

- no gross scaling - only work on the TEETH TO BE COMPLETED IN THAT SESSION - always follow with hand instrumentation

does powered scaling replace hand instrumentation

NO, they compliment each other

HANDPIECE CORD MANAGEMENT reduce the pull of the cord by: (3)

1. wrapping it around your forearm 2. running it between the little and ring finger 3. rest the cord on your palm around the thumb