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Getting the Most Out of Ultrasonic Scaling: A Guide to Maximizing EfficacyA Peer-Reviewed Publication Written by Robin Cox, BSDH, RDH, EPP

Abstract

Powered instruments have been part of dental hygiene treatment since the late 1950’s. Over time new and innovative improvements to the equipment and tip designs have made ultrasonic scaling easier and more effective. Today’s patients are in need of the highest level of therapeutic hygiene services available. With the reciprocal link between periodontal disease and several known systemic diseases, dental health care providers need to be knowledgeable about current treatment modalities and the evidence that supports it. This course is designed to aid the clinician in making instrument decisions to improve the quality of hygiene treatment provided to the patient.

Educational Objectives

At the conclusion of this educational activity participants will be able to:1. List several key benefits of powered instru-

ments over hand instruments2. Describe the specific use recommendations

for the various ultrasonic tip designs.3. Utilize correct tip to tooth adaptation of

ultrasonic instrument tips and inserts4. Explain the influence and reduced efficacy of

worn ultrasonic tips

Author Profile

Robin Cox, BSDH, RDH, EPP, is currently the course director for Periodontal Instrumentation I and II at Oregon Health and Science University, School of Dentistry. Other professional activities include; dental lead for Compassion North Portland and professional lecturer in the Pacific NW focusing on advanced instrumentation. She received her dental hygiene degrees from Oregon Institute of Technology and Eastern Washington University. Past educational experience was gained as lead clinical instructor and course director for several core dental hygiene courses with DeVry University Dental Hygiene program.

Author Disclosure

Robin Cox, BSDH, RDH, EPP has no potential conflicts of interest to disclose.

Publication date: Feb. 2015 Expiration date: Jan. 2018

This educational activity was developed by PennWell’s Dental Group with no commercial support. This course was written for dentists, dental hygienists and assistants, from novice to skilled. Educational Methods: This course is a self-instructional journal and web activity. Provider Disclosure: PennWell does not have a leadership position or a commercial interest in any products or services discussed or shared in this educational activity nor with the commercial supporter. No manufacturer or third party has had any input into the development of course content.Requirements for Successful Completion: To obtain 3 CE credits for this educational activity you must pay the required fee, review the material, complete the course evaluation and obtain a score of at least 70%.CE Planner Disclosure: Heather Hodges, CE Coordinator does not have a leadership or commercial interest with products or services discussed in this educational activity. Heather can be reached at [email protected] Disclaimer: Completing a single continuing education course does not provide enough information to result in the participant being an expert in the field related to the course topic. It is a combination of many educational courses and clinical experience that allows the participant to develop skills and expertise.Image Authenticity Statement: The images in this educational activity have not been altered.Scientific Integrity Statement: Information shared in this CE course is developed from clinical research and represents the most current information available from evidence based dentistry. Known Benefits and Limitations of the Data: The information presented in this educational activity is derived from the data and information contained in reference section. The research data is extensive and provides direct benefit to the patient and improvements in oral health. Registration: The cost of this CE course is $59.00 for 3 CE credits. Cancellation/Refund Policy: Any participant who is not 100% satisfied with this course can request a full refund by contacting PennWell in writing.

Supplement to PennWell Publications

PennWell designates this activity for 3 continuing educational credits.

Dental Board of California: Provider 4527, course registration number CA# 03-4527-14084“This course meets the Dental Board of California’s requirements for 2 units of continuing education.”

The PennWell Corporation is designated as an Approved PACE Program Provider by the

Academy of General Dentistry. The formal continuing dental education programs of this

program provider are accepted by the AGD for Fellowship, Mastership and membership

maintenance credit. Approval does not imply acceptance by a state or provincial board of

dentistry or AGD endorsement. The current term of approval extends from (11/1/2015) to

(10/31/2019) Provider ID# 320452.

Go Green, Go Online to take your course

INSTANT EXAM CODE 14084

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RDHMAG.COM | MARCH 2017 57

Educational ObjectivesAt the conclusion of this educational activity participants

will be able to:

1. List several key benefits of powered instruments over

hand instruments

2. Describe the specific use recommendations for the

various ultrasonic tip designs.

3. Utilize correct tip to tooth adaptation of ultrasonic

instrument tips and inserts

4. Explain the influence and reduced efficacy of worn

ultrasonic tips

AbstractPowered instruments have been part of dental hygiene treatment

since the late 1950’s. Over time new and innovative improve-

ments to the equipment and tip designs have made ultrasonic

scaling easier and more effective. Today’s patients are in need

of the highest level of therapeutic hygiene services available.

With the reciprocal link between periodontal disease and several

known systemic diseases, dental health care providers need to

be knowledgeable about current treatment modalities and the

evidence that supports it. This course is designed to aid the clini-

cian in making instrument decisions to improve the quality of

hygiene treatment provided to the patient.

Ultrasonic scaling possesses certain characteristics that can-

not be achieved with hand scaling. These unique properties of

ultrasonic scalers make it the preferred method for the majority

of non-surgical treatment of periodontal disease, prevention and

maintenance. These properties include; mechanical removal of

plaque and calculus, conservation of cementum, water lavage,

bactericidal effects, improved clinician ergonomics and superior

access in furcations and deeper periodontal pockets.3,4,5

An insufficient number of in vivo studies have been complet-

ed to definitely prove the superiority of ultrasonic scaling over

hand scaling. Numerous in vitro studies clearly show the biofilm

removal properties are superior with ultrasonic instrumenta-

tion.6.7 Properties such as precise mechanical movement, cavita-

tion,8 acoustic streaming,9 acoustic turbulence,10 conservation of

cementum 11 and pocket lavage are the reasons for the superior

function of ultrasonic instrumentation. For clinicians who want

to deliver the most therapeutic treatment possible, ultrasonic

scaling should be at the forefront of treatment modalities.

Looking at each of these properties will demonstrate the ben-

efits over hand scaling and why it is important to be skilled with

ultrasonic scaling.

With hand scaling our success is based on effectiveness of

mechanical action. The ultrasonic instrument moves at a speed

of 25,000 to 50,000 cycles per second (CPS). When applying

an ultrasonic instrument to the tooth surface for scaling, the tip

of the instrument will complete its pattern of oscillation 25,000

to 42,000 times in a single second, depending on the operation

of the generator. A 30kHz insert completes 60,000 strokes per

second. 12 The mechanical movement is a precise, longitudinal

sweeping motion that cannot be replicated by hand scaling. This

extremely fast movement allows the tip to contact the calculus

and plaque in a manner that is not comparable to hand scaling.

Cavitation is a word that we are familiar with when talking

about ultrasonic instruments. As a review, cavitation is a physi-

ological property associated with ultrasonic waves. In the fluid

medium, pressure waves cause the formation and implosion of

atomized gas bubbles creating shock waves.7 This physical reac-

tion creates energy and heat at the reaction site, in turn causing

fracture of deposits and cell disruption, particularly to the gram

negative bacteria.13

The other two unique physiological properties are acoustic

microstreaming and acoustic turbulence. Imagine the forceful

flow of water over the vibrating tip of the ultrasonic scaler. The

water that passes over the oscillating tip generates a current of

water around the probe, inside the periodontal pocket. This

current, although small, has enough force to dislodge bacterial

plaque and its associated colonies.14,7 Acoustic turbulence is the

swirling effect produced by the current created from acoustic mi-

crostreaming. This swirling of fluid in the confined space of the

periodontal pockets aids in the disruption of the plaque biofilm.

(Figure 1)

In order to reap the maximum benefits of ultrasonic scaling,

one must become highly skilled in the use of the instrument and

all of the inserts or tips associated for thorough debridement.

One of the claimed benefits with the use of powered instru-

ments is that it takes less time to complete the procedure.15 This

statement may mislead the clinician into spending insufficient

time with their ultrasonic devices. Part of the skill in using this

method, is spending adequate time in the treatment area.

With hand scaling, it has been said that to thoroughly scale

a multi-rooted tooth, 10 minutes per tooth is needed.16,17 In one

study that set out to compare ultrasonic technologies, twenty

minutes per quadrant was an insufficient amount of time to

thoroughly scale using either magnetostrictive or piezoelectric

technology. The following statement referred to ultrasonic

scaling; “This study suggests that more than 20 minutes of

Figure 1. Visual image of acoustic turbulence (water current created by oscillating tip).

1703rdh_57 57 2/24/17 9:32 AM


instrumentation per quadrant is required for adequate removal

of light–moderate subgingival calculus.”18

Based on this information, maybe our thoughts of taking

less time to scale aren’t as accurate as previously thought. Cer-

tainly the time we spend using an ultrasonic scaler is less than

hand scaling, more ergonomic and less stressful on our bodies,

but spending a sufficient amount of time scaling is essential.

It’s difficult to say exactly how much time is needed for any one

particular treatment. The use of proper technique with a variety

of tips can achieve definitive debridement. 19, 16

The beneficial properties of ultrasonic scaling are essentially

dependent on operator application. There is a wide variety of

inserts and tips to use for comprehensive scaling. However, most

clinicians limit themselves to the use of one or two favorites.

When using ultrasonic scalers the clinician should use the same

instrument decision tree as one does for hand scaling. Just like

hand scalers, inserts and tips are designed for specific purposes

and accessibility.

The clinician is faced with the decision of which instruments

to use based on type and location of calculus, health or disease

status of the patient and root anatomy.3 This information will di-

rect the clinician to use the proper instrument to complete the job

with the least difficulty and most efficiency. The focus will be on

reviewing the recommended use of inserts for magnetostrictive

devices. However, the basic principles for selection are similar

for both magnetostrictive and piezoelectric devices.

There are two design considerations with tip selection. First,

there is the tip shape; straight or curved. Then there is a choice

of diameter; standard, slim and ultra slim. The combination of

any of these designs will dictate how it is supposed to be utilized.

The following descriptions are based on manufacturer’s recom-

mendations and research for tip application.

Standard diameter tips are designed for power or for moderate

and heavy calculus removal. Because they are meant to be used at

high power settings, they are not recommended for subgingival

scaling in narrow pockets and areas of difficult access. Utilizing

these tips in such areas, especially at high power, increase risk of

tooth structure damage.11

Standard diameter tips are considered straight tips. They

are available with a single, double and triple bend in the shank.

There is also a large flat option called the Beavertail. Each one is

designed for specific access and application.

The tips with one and two bends are very similar and are

especially useful in all areas of the mouth, supragingival and

subgingival to the cervical third of the root (≤4mm). These can

be used at high power settings making them very effective for

initial debridement of moderate to heavy calculus. In addition,

these single or double bend tips are very good for accessing

deeper pockets in single rooted teeth or line angles where tissue

distention is not a factor. The back side of the tip (magnetostric-

tive only) adapts very well to the concavities of these areas and

along line angles. The shank is rounded with a tapered end.

There is no significant difference in access or use between these

two. (Figures 2 and 3)

The standard diameter triple bend is a commonly used for

heavy calculus removal. It differs in design as it has a diamond

pattern in cross section. (Figure 4) When an insert has “bladed”

edges, the power distribution is stronger at the apex of the edge.

The triple bend has improved line angle and interproximal ad-

aptation. The beveled edge is extremely efficient at removing

moderate to heavy calculus in these areas. This tip is also effec-

tive on the buccal and lingual aspects. It is important to examine

the design of this particular insert, as it does have some limita-

tions. Because of the bends, this instrument will not adapt well

in pockets >4mm and will cause significant damage to root and

tooth structure if the point comes in direct contact at 90°. This

insert is indicated for patients with a lot of calculus but not many

deep pockets.

The pie server shaped Beavertail is a work horse for heavy

calculus bridges. This tip is meant to be used with the point or

edges directed on the ledge of calculus. Care needs to be taken

when using this tip as it is not intended to come in contact with

tooth structure. It works on extremely high amplitude and will

indeed cause damage if applied to the tooth. Clinicians should

have one available in their arsenal for special cases. (Figure 5)

Figure 2. #10 tip, single bend, standard diameter.

Figure 3. #100 tip, double bend, standard diameter.

Figure 4. #1000 tip triple bend, standard diameter; beveled edges are areas of high energy.

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Figure 5. Beavertail tip, used for heavy calculus bridges. The working area is the point of the instrument.

Slim diameter tips are generally available in the same tip designs

as the standard diameter tips. The diameter of the tip is 30% smaller

than the standard tip. This slimmer design can access deeper pockets

and furcation areas and are especially suited for root anatomy.20,21,3

In addition to the designs earlier mentioned, there is also a curved

design available in the slim inserts. These curved instruments are

intended for posterior root adaptation and have much better contact

with convexities and concavities than do the straight tips.

Slim tips have excellent adaptability and superior access over

standard diameter tips and hand instruments. They need to be used

in a manner that will maximize its effect while maintaining tissue

and tooth integrity.

The slim tips are meant to be used at low to medium power set-

tings. At these settings the slim tip will effectively remove bacterial

plaque 9,20 as well as light to moderate calculus. In addition, the slim

tips are less invasive of the root surface than other tips, retaining

more dental cementum during scaling. 11,3 However, the advantages

of the slim design are only afforded if the tip is used properly and

within the manufacturer’s recommendations. If one is using these

slim tips to remove heavier calculus at high power settings, root

structure may be compromised and clinical attachment loss may

occur.15,20 In addition a high power setting can cause damage to the

insert itself, resulting in ineffective oscillation.

When using slim tips, the mindset of using a single insert for the

entire mouth needs to be rethought when scaling subgingivally. The

straight, slim inserts are designed more or less like a probe. Because

they are straight they adapt well to single rooted teeth, (Figures 6

and 7) but not so well to posterior teeth. When treatment involves

pockets greater than 4mm, especially if there is furcation involve-

ment, the clinician should utilize both curved and straight tips.

Figure 6. SLIM STRAIGHT Figure 7. SLIM CURVED

In figure 6 you can see that the straight tip does not adapt to the root and is improperly positioned onto the root. In figure 7 notice how the curved insert adapts well in the concave surface of the mesial root.

New on the market is an ultrathin insert. (Figure 8) The ultrathin

insert is 47% thinner than its comparable slim insert which allows

for access in very narrow pockets and increases tactile sensitivity. It

also has an increased back bend angle of 9° making it easier to adapt

to root anatomy and access deeper pockets. While the slim tips are

fragile at high powers, this new design was developed to withstand

higher power settings, although it is designed to be used at low to

mid-power settings. This insert is highly recommended for peri-

odontal maintenance patients, for access and pocket management.

Figure 8. Thin insert. 47% thinner and 9° back bend angle for access.

Other important keys to ultrasonic technique are adaptation

of the tip to tooth, instrument stroke, grasp and lateral

pressure. Small adjustments to each of these categories can

increase your scaling effectiveness significantly. The following

recommendations are based on the technology of the ultrasonic

instrument function.

When learning the use of an ultrasonic scaler the instruc-

tor probably said, “adapt the terminal 2-3mm of the tip to the

surface being scaled.” This statement is significant, based on

the pattern of ultrasonic vibrations. Along the ultrasonic wave

there are areas or points where no vibration occurs. These areas

are referred to as nodal points. Depending on the tip design

these nodal points occur between 2.2 mm and 4.4 mm from the

point of the insert.8 When adapting for scaling, if the terminal

2-3 mm is not in contact with the treatment area a nodal point

may be reached rendering the instrument ineffective. (Figure 9)

Figure 9. Nodal points-points of no movement along insert.

1703rdh_59 59 2/24/17 9:32 AM


When using the terminal 2-3 mm of the tip, it can be

difficult to cover the entire surface area that needs to be

scaled. The instrument should be used with repeated, short,

overlapping, brush-like strokes with very light lateral pressure.

This motion allows for more complete coverage of the surface

area being scaled. This stroke is recommended for deplaquing

and removal of calculus and root surface toxins. The instrument

will perform in all directions of the stroke and is intended to

remove debris from top to bottom. Vertical, horizontal and

oblique strokes are used to cover all surfaces of the treatment

area.3

The point of the instrument should never be placed directly

on tooth structure at a 90° angle. This is the area of highest

power and will cause tooth damage. With moderate and heavy

calculus the point can be used directly on the calculus in a

repeated tapping motion to dislodge large pieces of calculus.

When accessing a periodontal pocket, one should take care that

the tip of the working end is not heavily contacting the clinical

attachment. Although it has been shown that the attachment is

penetrated by the ultrasonic tip, careful technique will mini-

mize this, preventing significant damage affecting the healing

of the pocket.11

The grasp of the ultrasonic instrument is very important

for both ergonomics and efficacy. (Figure 10) The instrument

should be balanced in your hand to reduce the need for a tight

finger grasp to hold the instrument in place. Pinching the end

of the instrument or the handle can result in efficacy reduction

of the device itself and will inhibit the natural movement of

the ultrasonic tip. To make sure you have the correct grasp and

placement, balance the handle between your thumb and index

finger in a position where little or no assistance is required. At

that point, bring thumb and index finger together and grasp

only tightly enough to keep it in place. During scaling, the

grasp should always be very light so that maximum efficiency

is achieved. Having a light grasp ensures that you are maintain-

ing light lateral pressure, which is also required for effective

debridement and stroke. The tighter the grasp, the stronger the

lateral pressure will be.

Figure 10. Balance and grasp.

Several manufacturers have developed inserts with larger

grips for better ergonomics. Larger grips lessen muscle load

and pinch force. 22 Other features include natural finger rests

and ribbed design so that the user maintains a light grasp and

pinch while being able to keep it stable in a wet environment.

Newer inserts are also lightweight and comfortable and tactile

sensitivity is minimally compromised. (Figure 11)

Figure 11. Ergonomic grip for ultrasonic scaling.

All ultrasonic machines and instruments need to be main-

tained to manufacturer’s recommendations to achieve long life.

Water filters, O-rings and line flushing are essential regular

maintenance tasks to ensure safety and proper operation of these

devices. In addition, the tips for piezoelectric and inserts for

magnetostrictive need to be monitored regularly.

Monitoring the wear of the insert or tip should be done fre-

quently. When a tip wears, the non-vibrating nodal point comes

closer to the point of the instrument. This will result in the

scaling area being reduced. A single millimeter of wear reduces

efficacy by 25% and a loss of 2 mms reduces it by 50%. 23 In addi-

tion, when a tip is worn the clinician must use excessive pressure

which causes discomfort for both the patient and the clinician.

Manufacturers supply wear guides to help assess need for re-

placement. The clinician should have one available and monitor

wear carefully for replacement as needed.

To extend the life of magnetostrictive inserts always fill the

handpiece with water prior to placing the insert inside. Lubricate

the O-ring with water before gently placing the insert into the

handpiece. Use proper grasp, pressure and stroke during scaling

procedures to avoid excessive tip wear. Evaluate the stack of the

insert. Bent, spread or broken laminates in the stack cause loss

of power and can also damage the handpiece, and should be dis-

carded. Always follow manufacturer’s instructions for cleaning

and maintenance.

Another consideration is mismatching manufacturer inserts

or tips and generator or machine. It has been shown that inter-

changing manufacturer inserts and generator units can change

the system’s performance.14 Manufacturer’s inserts or tips are

designed to perform with their own generator. By utilizing the

same manufacturer, you will be optimizing the oscillation per-

formance of the instrument you are using.

In conclusion, the use of powered instruments provides

therapeutic value over hand scaling alone. The properties associ-

ated with ultrasonic scaling make this treatment modality a must

if the clinician wants to provide optimal therapy. To achieve the

maximum benefits of ultrasonic instruments, proper technique

is required. Improper grasp, pressure, adaptation and stroke

can alter the efficacy of the instrument and possibly cause tooth

1703rdh_60 60 2/24/17 9:32 AM


structure damage. For thorough debridement, an adequate

amount of time must be spent using these devices.

A wide variety of instrument tips are available. Definitive

debridement can only be achieved if access and adaptation is

achieved. Each tip is designed for specific conditions and access.

Selecting the correct ultrasonic instrument should be based on

location and type of calculus as well as patient health and disease

status. Whether using piezoelectric or magnetostrictive units,

larger diameter tips are indicated for higher power settings and

heavier calculus removal. Slim and ultra-slim tips are used on

low to mid-power settings, for light to moderate calculus in

difficult to access areas. It is recommended that for thorough

debridement, an assortment of ultrasonic tips be used during

each procedure.

Reduced effectiveness of the ultrasonic scaler will occur with

improper maintenance and operation. Utilizing worn tips, bent

or broken laminates or improper use and care, as well as inter-

changing manufacturer tips and generators all affect optimal

performance.

References1. Driscol, CL & Reserach, Science and Therapy Committee. (2000). Sonic

and Ultrasonic Scalers in Periodontics *. J Periodontol, 71, 1792-1801.2. (2013) Periodontitis and Systemic Diseases; Proceedings of a Workshop

jointly held by the European Federation of Periodontology and American American Academy of Periodontology. J Clin Periodontol, 84(4 Supp).

3. Jill S. Nield-Ghrig, (2008). Fundamental of Periodontal Instrumentation & Advanced Root Instrumentation (6th ed.). Baltimore, MD: Lippincott Williams & Wilkins

4. Ritz L, Hefti AF, Rateitschak KA (1991). An in vitro investigation on the loss of root substance in scaling with various instruments. Journal of Clinical Periodontology, 18, 643-7.

5. Sugaya T, Kawanami M, Kato H (2002, Oct.). Effects of debridement with an ultrasonic furcation tip in degree II furcation involvement of mandibular molars. Journal of the International Academy of Periodontology, 4(4), 138-42.

6. Sanz M, Tenghelow. (2008). Innovations in non-surgical periodontal therapy: Consensus Report of the Sixth European Workshop on Periodontology. J Clin Periodontol, (Supp 8), 3-7.

7. O’Leary R, Sved AM, Davies EH, Leighton TG, Wilson M, Kieser JB. (1997). The bactericidal effects of dental ultrasound on Actinobacillus actinomycetemcomitans and Porphyromonas gingivaiis An in vitro investigation. Journal of Clinical Periodontology, 24, 432-439.

8. Walmsley AD, Lea SC, Felver B, King DC, Price GJ. (2013). Mapping cavitation activity around dental ultrasonic tips. Clin Oral Invest, 17, 1227-1234.

9. Khambay BS, Walmsley AD,. (1999, June). Acoustic Microstreaming: Detection and Measurement Around Ultrasonic Scalers*. J Clin Periodontology, 70(6), 626-631.

10. Medical Dictionary for the Dental Professions. (2012). (Farlex) Retrieved 8 1, 2014, from the free dictionary: http://medical-dictionary.thefreedictionary.com/acoustic+turbulence

11. Jensen S, Ayna M, Hedderich J, Eberhard J. (2004). Significant influence on scaler tip design on root substance loss resulting from ultrasonic scaling: a laserprofilometric in vitro study. J Clin Periodontol, 31, 1003-1006.

12. Lea SC, Walmsley AD. (2011). Do ultrasonic scaler inserts and generators from the same manufacturer optimize performance? Annual Clinical Journal of Dental Health, 1, 22-27.

13. Donley T. April 2011. ineedce; Instrumentation for the Treatment of Periodontal Disease. Pennwell. 25 July 2013.

14. Walmsley AD. (2012). The Possibility of Pulsation. Dimensions of Dental Hygiene, 10(1), 42,44.

15. Sanz I, Alonso B, Carasol M, Herrera D, Sanz M. (2012). NONSURGICAL TREATMENT OF PERIODONTITIS. Jounal of Evidence Based Dental Practice, 12(S1), 76-86.

16. Greenstein, G. (2000, Nov). Nonsurgical periodontal therapy in 2000: a literature review. Journal of the American Dental Association, 131(11), 1580-92.

17. Sweeting LA, Davis K, Cobb CM. (2008). Periodontal Treatment Protocol (PTP) for the General Dental Practice. The Journal of Dental Hygiene, 83(6), 16-28.

18. Silva LB, Hodges KO, Calley KH, Seikel JA. (2012, Spring). A Comparison of Dental Ultrasonic Technologies on Subgingival Calculus Removal: A Pilot Study. Journal of Dental Hygiene, 86(2), 150-8

19. Hallmon W, Rees T. (2003, Dec). Local Anti-Infective Therapy: Mechanical and Physical Approaches. A Systematic Review. Ann Periodont, 8(1), 99-114.

20. Casarin, R., Bittencourt, S., Del Peloso Ribeiro, E., Humberto Nociti, F., Sallum, A., & Casati, M. (2010, March). Influence of immediate attachment loss during instrumentation employing thin ultrasonic tips on clinical response to nonsurgical periodontal therapy. Quintessence International, 41(3), 249-256.

21. Clifford LR, Needleman IG, Chan YK. (1999). Comparison of periodontal pocket penetration by conventional and microultrasonic inserts. J Clin Periodontol, 26, 124-130.

22. Murphy DC. (1998). Ergonomics and the Dental Care Worker. American Public Health Association; Washington DC, 1434, 176.

23. Lea SC, Landini G, Walmsley AD. (2006). The effect of wear on ultrasonic sclaer tip displacement amplitude. J Clin Periodontol, 33, 37-41.

Author profileRobin Cox, BSDH, RDH, EPP, is currently the course director for Periodon-

tal Instrumentation I and II at Oregon Health and Science University, School

of Dentistry. Other professional activities include; dental lead for Compassion

North Portland and professional lecturer in the Pacific NW focusing on ad-

vanced instrumentation. She received her dental hygiene degrees from Oregon

Institute of Technology and Eastern Washington University. Past educational

experience was gained as lead clinical instructor and course director for several

core dental hygiene courses with DeVry University Dental Hygiene program.

Author DisclosureRobin Cox, BSDH, RDH, EPP has no potential conflicts of interest to disclose.

Notes

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http://medical-dictionary.thefreedictionary.com/acoustic+turbulence

http://medical-dictionary.thefreedictionary.com/acoustic+turbulence


Questions

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1. An ultrasonic tip will complete

a pattern of oscillation 25,000 to

42,000 times per second. This state-

ment is describing which property

of the ultrasonic scaler?a. Cavitationb. Mechanicalc. Acoustic turbulenced. Bactericidal

2. The formation and implosion of

atomized gas bubbles caused by

pressure waves in a fluid medium is

referred to as:a. Cavitationb. Mechanicalc. Acoustic turbulenced. Bactericidal

3. Water passing over the oscillat-

ing tip generates a current of

water around the probe, inside the

periodontal pocket. This statement

is describing which property of

ultrasonic scalers?a. Cavitation b. Mechanicalc. Acoustic turbulenced. Acoustic microstreaming

4. The swirling effect produced by

the current created from acoustic

microstreaming that aids in the

disruption of plaque biofilm is

called:a. Cavitationb. Mechanicalc. Acoustic turbulenced. Acoustic microstreaming

5. It has been said that in order to ad-

equately remove light to moderate

subgingival calculus in a quadrant

one must instrument for more than

how many minutes?a. 40 minutes b. 30 minutes c. 20 minutesd. 50 minutes

6. The beneficial properties of

ultrasonic scalers are essentially

dependent on which of the following

factors?a. Tip selectionb. Ultrasonic technologyc. Manufacturer brandsd. Operator application

7. Just like hand scalers ultrasonic

inserts and tips are designed for:a. Specific purpose and accessibility

b. Universal application

c. All areas of application

d. Area specific application only

8. When deciding on which ultrasonic

instrument tip to use, the clinician

will consider which of the following? a. Operator position

b. Length of procedure

c. Patient preference

d. Type and location of calculus

9. What are the two design consider-

ations with ultrasonic tip selection?a. Straight and curved

b. Diameter and shape

c. Standard and slim

d. Slim and ultra slim

10. The standard diameter tip design

is meant to be used in which of the

following conditions?a. High power for moderate to heavy calculus

removal

b. Low power for light calculus removal

c. Narrow pockets and difficult to access areas

d. Furcation involvement

11. Utilizing standard diameter tips in

narrow pockets and difficult access

areas may increase the chance of:a. Perforated root

b. Tooth structure damage

c. Epithelial attachment loss

d. Reduced tactile sensitivity

12. Standard diameter tips with a

single or double bend are especially

suited for which of the following

conditions?a. Furcation involved posterior teeth

b. Anterior teeth and roots only

c. All areas of the mouth to the cervical third of the

root

d. Narrow pockets and difficult to access areas

13. The standard diameter tip with

a triple bend design has improved

adaptation for which of the follow-

ing areas? a. Furcation involved posterior teeth

b. Interproximal and line angle surfaces

c. Narrow pockets and difficult to access areas

d. Deep pockets on single rooted teeth

14. The standard diameter tip with a triple bend has design limitations. Which of the following is a limita-tion of this design?a. Pockets greater than 4 mmb. Interproximal surfacesc. Line anglesd. Facial and lingual surfaces

15. The triple bend tip has which of the following shapes viewed in a cross section?a. Octagonb. Diamondc. Squared. Oval

16. Instruments with “bladed” edges have increased power distribution in which areas of the tip?a. On the heal of the tip b. On the back of the tip c. On the face of the tipd. At the apex of the bladed edge

17. The specially designed Beavertail insert is recommended for which of the following conditions?a. Plaque and biofilm disruptionb. Heavy calculus ledgesc. Deep, narrow pocketsd. Furcation involvement

18. Slim diameter tips are smaller in diameter than standard tips by what percentage?a. 20 percent b. 30 percentc. 40 percent d. 50 percent

19. In addition to the standard straight shapes, the slim design also is available in which of the following shapes?a. Single bendb. Double bendc. Triple bendd. Curved

20. The curved design available in the slim diameter is indicated specifi-cally for which areas of access?a. Anterior root adaptationb. Line anglesc. Posterior root adaptation d. Facial and lingual surfaces

21. Slim diameter tips are recom-mended to be used at which of the following power settings?a. Low to medium power b. High powerc. Any power settingd. Low power only


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22. A slim diameter tip used at the

recommended power setting is

effective for which of the following

conditions?a. Heavy calculus removal

b. Light to moderate calculus removal

c. Only for deplaquing

d. Is not recommended for calculus removal

23. Which tip design is least invasive to

root surface and retains more dental

cementum during scaling with

recommended use and settings?a. Beavertail tips

b. Standard diameter tips

c. Slim diameter tips

d. There is no difference between tip designs

24. Additional benefits of the newer

ultra-slim tip include:a. When used, no other tip needs to be considered

b. Access to very narrow pockets and increased tactile

sensitivity

c. Removes tenacious calculus from all surfaces

d. Has twice the power on lower power settings

25. Which of the following instrument

tips adapts best to the concavities in

furcations?a. Standard straight tips

b. Slim straight tips

c. Slim curved tips

d. Triple bend tips

26. Along the ultrasonic wave there are

areas or points where no vibration

occurs. These areas are referred to as:a. Functional points

b. End points

c. Terminal points

d. Nodal points

27. The clinician must adapt which

portion of the instrument to the

treatment area in order to avoid

reaching the inactive nodal point?a. The entire length of the tip

b. The terminal 2-3 mm of the tip

c. Only the back side of the tip

d. Only the face of the tip

28. The instrument stroke used should be repeated short, overlapping, brush-like strokes with very light lateral pressure. Why is this stroke recommended?a. For more complete coverage of the surface area

being scaledb. To ensure less clinician fatiguec. To complete the scaling procedure fasterd. To maintain complete visibility

29. Having a light grasp on the instrument ensures that you are maintaining which of the following?a. Good operator positionb. Heavy calculus removal strokesc. A light lateral pressured. Adaptation of the terminal 2-3 mm

of the tip

30. Monitoring tip wear is essential in the maintenance of your instru-ments. If a tip is worn by 2 mm, how much efficacy will be lost?a. 10 Percentb. 35 Percent c. 40 Percent d. 50 Percent

Questions (Continued)

Notes

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Getting the Most Out of Ultrasonic Scaling: A Guide to Maximizing Efficacy

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Educational Objectives

1. List several, key benefits of powered instruments over hand instruments

2. Describe the specific use recommendations for the various ultrasonic tip designs.

3. Utilize correct tip to tooth adaptation of ultrasonic instrument tips and inserts

4. Explain the influence and reduced efficacy of worn tips in terms of mm to percentage ratio

Course Evaluation1. Were the individual course objectives met?

Objective #1: Yes No Objective #2: Yes No

Objective #3: Yes No Objective #4: Yes No

Please evaluate this course by responding to the following statements, using a scale of Excellent = 5 to Poor = 0.

2. To what extent were the course objectives accomplished overall? 5 4 3 2 1 0

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8. Please rate the usefulness and clinical applicability of this course. 5 4 3 2 1 0

9. Please rate the usefulness of the supplemental webliography. 5 4 3 2 1 0

10. Do you feel that the references were adequate? Yes No

11. Would you participate in a similar program on a different topic? Yes No

12. If any of the continuing education questions were unclear or ambiguous, please list them.

________________________________________________________________

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_________________________________________________________________

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For IMMEDIATE results, go to www.DentalAcademyOfCE.com to take tests online.

INSTANT EXAM CODE 14084 Answer sheets can be faxed with credit card payment to

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AGD Code 495

PLEASE PHOTOCOPY ANSWER SHEET FOR ADDITIONAL PARTICIPANTS.

CAV0317RDH

COURSE EVALUATION and PARTICIPANT FEEDBACKWe encourage participant feedback pertaining to all courses. Please be sure to complete the survey included with the course. Please e-mail all questions to: [email protected].

INSTRUCTIONSAll questions should have only one answer. Grading of this examination is done manually. Participants will receive confirmation of passing by receipt of a verification form. Verification of Participation forms will be mailed within two weeks after taking an examination.

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PROVIDER INFORMATIONPennWell is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, not does it imply acceptance of credit hours by boards of dentistry.

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