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Lisa Mayo, RDH, BSDH Concorde Career College DH102: CLINIC II ULTRASONIC SCALING.

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Presentation on theme: "Lisa Mayo, RDH, BSDH Concorde Career College DH102: CLINIC II ULTRASONIC SCALING."— Presentation transcript:

1 Lisa Mayo, RDH, BSDH Concorde Career College DH102: CLINIC II ULTRASONIC SCALING

2  Nield: CH 25&26  Wilkins CH39: Nonsurgical Periodontal Instrumentation You will need to read both Nield chapters, test questions will come from power point as well as the reading! REFERENCE

3

4 1.History of Power instruments 2.Mode of action 3.Mechanism of action 4.Limitations 5.Contraindications 6.Occupational risks 7.Types 8.Controls 9.Calculus removal 10.Clinical steps TOPICS FOR TODAY

5  Rapidly vibrating tip to dislodge calculus from the tooth surface, disrupt plaque and biofilm and flush out bacteria  Technology been around since 1950s  Started as sonic scalers  Now have ultrasonic and piezo technology  Parts  Handpiece that attaches to dental unit  Interchangeable tips  Power supply POWERED INSTRUMENTS

6 HANDPIECE AND TIP

7 INTERCHANGEABLE TIP

8 TIP IN ACTION

9 OBJECTIVE #1 HISTORY OF POWER INSTRUMENTS

10 OBJECTIVE #2 MODE OF ACTION

11 Mechanical vibration  Power-driven scaling devices convert electrical energy (ultrasonic) or air pressure (sonic) into high-frequency sound waves  Sound waves produce rapid vibrations in the specially designed scaling tips  Calculus is incrementally shattered from the tooth surface when the vibrations are applied to the deposit 2. MODE OF ACTION

12 Water Irrigation/Lavage  Water is required to dissipate the heat produced at the vibrating tip  Occurs when the water meets the vibrating tip  Minute bubbles are created that collapse and release energy  Little influence on hard deposit removal  Capable of destroying surface bacteria  Remove endotoxins from the root surface  Better vision in bleeding sulcus 2. MODE OF ACTION

13 Water Irrigation: Acoustic Microstreaming of the Water  Swirling effect produced within the confined space of a periodontal pocket by the continuous stream of fluid flowing over the vibrating tip  May play a role in the disruption of sub-g plaque biofilms assoc w/ perio disease  Limited to an area immediately surrounding the instrument tip  In order to most effectively remove plaque biofilm – tip must touch every part of the root surface 2. MODE OF ACTION

14 Water Irrigation: Cavitation of the Water  Formation of tiny bubbles in water stream  Energy release that occurs when tiny bubbles in the fluid spray collapse  When bubbles collapse, they produce shock waves that alter or destroy bacteria by tearing the bacterial cell walls 2. MODE OF ACTION

15 POCKET PENETRATION OF TIP & WATER

16 The water spray in ultrasonic and sonic scaling devices penetrates to the base of the pocket to provide a continuous flushing of debris, bacteria, and endotoxin. Oscillation of the ultrasonic tip causes hydrodynamic waves to surround the tip; this acoustic turbulence is believed to have a disruptive effect on surface bacteria. A) The first statement is true and the second statement is true B) The first statement is false and the second statement is false C) The first statement is true and the second statement is false D) The first statement is false and the second statement is true REVIEW

17 A) The first statement is true and the second statement is true is the correct answer. In ultrasonic scalers, water spray acts as a lavage to flush debris from the base of the pocket; tip oscillation causes acoustic turbulence resulting in disruption of bacteria. ANSWER

18 OBJECTIVE #3 MECHANISM OF ACTION

19  How effectively instrument runs determined by: 1. Tips vibration frequency 2. Stroke length 3. Stroke motion 4. Surface of the instrument tip in contact with the tooth 3. MECHANISM OF ACTION

20  Measure of how many times the electronically powered instrument tip vibrates per second  Can be compared to windshield wipers on a car  Low Frequency: wiper setting on low, go back and forth few times in a min = tip vibrates fewer times per sec  High Frequency: wipers back and forth multiple times per min = tip vibrates more times per sec 3. MECHANISM OF ACTION FREQUENCY

21  Amplitude or stroke measures how far the instrument tip moves back and forth during one stroke cycle  Ultrasonic devises have a power knob that is used to change the length of the stroke (strength)  Higher amplitude delivers a longer, more powerful stroke  Lower amplitude delivers short, less powerful stroke 3.MECHANISM OF ACTION AMPLITUDE

22  http://www.youtube.com/watch?v=iNcKT4uJZBY http://www.youtube.com/watch?v=iNcKT4uJZBY  Frequency: 0-1min  Amplitude: 2-3min FREQUENCY/AMPLITUDE

23  Combo of frequency and amplitude  Frequency = determines # vibrations  Amplitude = determines length of each stroke  Rule of thumb = use lowest setting (frequency) to achieve goal  For a Dentsply cavitron – will live in BLUE setting  Gray setting a power BOOST setting and should ONLY be used for gross/heavy calculus  If vibrates too fast = will skim over calculus on roots without removing 3. MECHANISM OF ACTION CLEANING EFFICIENCY

24  Effective calculus removal and plaque biofilm  Effective at deplaquing  Disrupt or remove sub-g plaque biofilm from root surfaces and pocket space  Pocket penetration  Can penetrate deeper than many instruments  Access to Furcations  Class II & III better access with slim line tips  Irrigation (Lavage)  Wash toxic products & free-floating bacteria from pocket  Improve vision  Shorter instrumentation time than hand instruments (shorter, not better!) 3. MECHANISM OF ACTION STRENGTH OF POWER INSTRUMENTS

25 OBJECTIVE #4 LIMITATIONS OF POWER INSTRUMENTS

26  Clinician skill level  Skill level more important than power vs hand  Very technique sensitive like hand instruments  Have to have complete understanding of root anatomy  Reduced tactile sensitivity  Occupational risks  Infection control: some components CANNOT be sterilized  Aerosol production: high levels  Muscoskeletal & Auditory Damage 4. LIMITATIONS OF POWER INSTRUMENTS

27 OBJECTIVE #5 CONTRAINDICATIONS

28

29 OBJECTIVE #6 OCCUPATIONAL RISKS

30  Dental aerosols airborne particles that are compromised of debris, microorganisms, blood which are smaller than 50μm  Aerosols stay airborne and float on office air currents moving some distance from the point of origin  Very small particles can remain suspended at the end of the procedure for many hours  Can inhale through nose and intubate in respiratory tree  The mouth contains large numbers of  Stretococci  Staphylococci  Gram (-) bacteria  Viruses 6. OCCUPATIONAL RISKS CONTAMINATED AEROSOLS

31  Power ultrasonic instrum. are the greatest produces of small- particle aerosol contamination in dentistry!!!  Can suspend blood particles!!  Preventive measures  Barrier protection  High volume suction: can reduce up to 90-98% aerosols  Saliva ejector does not substitute as HVE  Isolite: can be difficult to use, patients not always like  Pre-procedural rinse: CHX or Listerine for 1min 6. OCCUPATIONAL RISKS CONTAMINATED AEROSOLS

32 ISOLITE

33  Nerve damage from dental instruments that cause vibration  Blunt the sense of touch  Muscle weakness  Reduction strength and tactile sensitivity due to vibration 6. OCCUPATIONAL RISKS MUSCULOSKELETAL DAMAGE

34  Research ongoing!  Tinnitus: early stage of hearing loss  Hearing protection devises has been an emerging science  Custom earplugs like musicians use  Can still hear patient but drowns out high-pitch frequencies 6. OCCUPATIONAL RISKS HEARING LOSS

35 OBJECTIVE #7 TYPES OF POWER INSTRUMENTS

36 7. TYPES OF POWER INSTRUMENTS

37 1.Sonic  Low frequency  3,000-8,000 cycles per sec (Hz)  Driven by compressed air from dental unit  No heat is generated so little water used as a lavage  Not good use for heavy deposits 7. TYPES OF POWER INSTRUMENTS

38 2.Ultrasonic: 18,000-50,000 cycles per sec 1)Piezoelectric  Use electric energy to activate crystals within the handpiece to vibrate the tip 2)Magnetostrictive  Transfer electrical energy to metal stacks made of nickel-iron alloy or to a ferrous rod 7. TYPES OF POWER INSTRUMENTS

39 7. Types of power instruments

40 Handpiece that attached to dental unit high-speed handpiece and interchangeable tips 7. TYPES OF POWER INSTRUMENTS SONIC

41  Tip activation  Tip motion: Driven by compressed air from the dental unit rather than electrical energy. Moves in an elliptical pattern. All surfaces of the tip are active.  Amplitude. Less powerful than ultrasonic scalers  Frequency. Producing vibrations at the tip; range between 2,500 and 7,000 cps. Because of fewer vibrations produced, calculus removal is more difficult.  Water source. Water is required to cool the friction between the instrument tip and the tooth surface. Heat is not generated by the scaling tip. 7. TYPES OF POWER INSTRUMENTS SONIC SCALING DEVICES

42  Portable electronic generator  Handpiece  Instrument tips 7. TYPES OF POWER INSTRUMENTS ULTRASONIC PIEZO

43  Composition  Ceramic rod in handpiece  Activation  Dimensional changes in quartz or metal alloy crystal transducers housed in handpiece  Tip motion  Moves in a linear pattern, forward and backward  Only the lateral surfaces of the tip are active  Handpiece position will adjust at each line angle to maintain adaptation of the lateral surface of the tip to the tooth 7. TYPES OF POWER INSTRUMENTS PIEZOELECTRIC ULTRASONIC SCALERS

44  Technique  Placement and movement of the tip is specific  Position the lateral surface of the tip in contact with the tooth  Use only the terminal 2-4 mm of the tip’s lateral surface  Keep terminal lateral surface adapted at all times around curvatures and line angles using wrist pivot  Tip shape  Cross section of tip varies from trapezoidal with angular edges to round or bladed  Frequency  Varies according to manufacturer  # of times per second a tip moves back and forth during one cycle  Ranges from 25,000 to 50,000 cps 7. TYPES OF POWER INSTRUMENTS PIEZOELECTRIC ULTRASONIC SCALERS

45  Portable unit  Electronic generator  Handpiece  Interchangeable tips/inserts  Available in 25-kHz or 30-kHz 7. TYPES OF POWER INSTRUMENTS MAGNETOSTRICTIVE ULTRASONIC

46 7. TYPES OF POWER INSTRUMENTS 25K: INSERTS LONGER AND THICKER

47 Metal Stack: converts electrical power into mechanical O-Ring: seal that keeps water flowing through the insert rather than flowing out of the handpiece Handle grip: portion of the insert grasped by the clinician during instrumentation Water outlet: provides water to the instrument Working-End: used for calculus removal 7. TYPES OF POWER INSTRUMENTS MAGNETOSTRICTIVE INSERTS You will need to be able to list all 5 parts of insert for Quiz!

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49  Variety of designs and functions  Different tips from different manufacturers not always interchangeable  2 Basic Types 1.Standard-Diameter  Larger in size  Shorter shank lengths  Similar to sickle scalers or universal Columbia 13/14 2.Slim-Diameter  40% smaller diameter  Longer, more complex shanks  Similar to area-specific curets 7. TYPES OF POWER INSTRUMENTS TIPS

50 7. TYPES OF POWER INSTRUMENTS STANDARD DIAMETER

51 7. TYPES OF POWER INSTRUMENTS SLIM DIAMETER

52  Rule of thumb = 1mm of wear results in 25% loss of efficiency  2mm wear = 50% loss of efficiency  Inspect for signs of wear frequently  Prevent from bending or will not work correctly  Bag correctly: always place insert “BUTT-FIRST” into a bag  Tips fragile, esp slim and ultra-slim designs  Can easy bend/break  If insert into unit while tip still hot – will bend as well 7. TYPES OF POWER INSTRUMENTS TIP WEAR & REPLACEMENT

53  Select based on size, shape, diameter, length, curvature – just like hand instruments  Calculus size and location 7. TYPES OF POWER INSTRUMENTS TIP SELECTION

54 7. TYPES OF POWER INSTRUMENTS TIP SELECTION & SEQUENCE OF USE 1.Standard Diameter Tips  Supra deposits  Mod to heavy sub-g  Extrinsic stain  Medium power 2.Straight Slim Diameter Tips  Lt to mod deposits anterior teeth and post deposits sub-g  Deep pockets  Root scaling  Low to medium power 3.Curved Slim Diameter Tips  Lt to mod calculus deposits on post roots  Deeper pockets  Root scaling  Low power

55 7. TYPES OF POWER INSTRUMENTS CURVED INSERT

56 7. TYPES OF POWER INSTRUMENTS STANDARD TIP

57 7. TYPES OF POWER INSTRUMENTS TIPS

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59  Set of Slim-Diameter Tips  Straight  Rt-Curved  Lf-Curved  Straight: similar to perio probe  Curved: similar to Naber’s probe 7. TYPES OF POWER INSTRUMENTS TIPS

60

61 OBJECTIVE #8 CONTROLS

62  Controls to adjust water and power  Some allow to control frequency: Manually Tunes Ultrasonic 8. CONTROLS

63  Power  Determine length of stroke  Distance instrument travels back and forth in one cycle  Higher = longer, more forceful stroke  More uncomfortable for patient  More likely to damage tooth surface  Lower = shorter, less powerful stroke  Recommended  SLOWER IS BETTER!!!  Most slim and ultra slim CANNOT be used on higher power settings = risk of breakage 8. CONTROLS

64 8. CONTROLS TIPS THAT CAN BE USED ON HIGH POWER SETTINGS

65  Frequency 1.Automatic: We have in clinic  2 control knobs: power and water  Clinician can adjust length stroke and water flow  LOW to MED for patient comfort  Water dissipates heat by vibrating tip  Auto = allows the tip to vibrate at a frequency that produces the most effective calculus removal for the selected power setting 8. CONTROLS

66  Frequency 2.Manual  3 knows: power, water, tuning  Clinician adjusts length of stroke (strength), tip frequency of vibration (#) and water flow  Can set vibration frequency of the tips at a level above or below the resonant frequency  Disadv: incorrectly tuned = ineffective calculus removal  OLD SCHOOL! 8. CONTROLS

67  Water Flow  Cools by fluid to prevent overheating of vibrating tip  Water is the coolant  Continuous flow  Disperses in a fine spray at or near the tip  Clinicians can adjust the volume of water supplied to tip  Lower rates of water flow increase heating changes = warmer water at the tip  Too little = heat damage to pulp  More water flow recommended for calculus removal and less water slow for deplaquing 8. CONTROLS FREQUENCY, AMPLITUDE & WATER FLOW

68 8. CONTROLS WATER FLOW A: fine mist B: slow drip

69  Water Flow  One of most common mistakes by beginning clinicians = using too little water  If handpiece warms up in your hand = water too low  Tip have external or internal flow 8. CONTROLS FREQUENCY, AMPLITUDE & WATER FLOW

70 8. CONTROLS INTERNAL WATER FLOW (OUR CLINIC USES)

71 8. CONTROLS EXTERNAL WATER FLOW

72  Fluid Reservoirs  Some have  Distilled water, sterile saline, stannous fluoride, antimicrobials (CHX)  Not been shown to enhance pocket depth resolve than regular instrumentation  Pathogenic biofilms are highly resistant to antimicrobial agents and systemic antibiotics  Only way to disrupt biofilm = mechanical removal 8. CONTROLS FREQUENCY, AMPLITUDE & WATER FLOW

73  Vibrations from ea surface of working end  Have to adapt correct tip surface to control energy dispersion and patient sensitivity  Dependent on 3 factors (next slides) 1.Energy output 2.Pattern of Tip Movement 3.Adaptation of Powered Tips 8. CONTROLS ENERGY DISPERSION BY WORKING-END

74  Face, back, lateral surfaces and point produce different amts of energy  Point of Tip  Produced greatest amt of energy vibrations  NEVER adapt directly on a tooth surface due to potential discomfort for the patient and damage of root surface  Face of Tip (concave surface)  2 nd greatest amt of energy vibrations  NOT adapted – would be difficult to do 8. CONTROLS 1.) ENERGY OUTPUT

75  Back of Tip (convex surface)  Produces less energy than the face or the point  3 rd greatest amt  Lateral surfaces of tip  Produces less energy than the face or the point  Least amt  To be used against tooth surface 8. CONTROLS 1.) ENERGY OUTPUT

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78  Tip motion varies from lateral motion to an elliptical motion  Motion is really more dependent on power setting and shape of instrument tip  Elliptical motions appears to be better at efficient calculus removal 8. CONTROLS 2.) PATTERN OF TIP MOVEMENT

79  Follow manufacturer directions for instrument tip-to-tooth surface adaptation  The point of tip and face of the tip should never be directly adapted to a tooth surface  Backs of most ultrasonic and sonic instrument tips can be adapted to the tooth surface, following the recommendations of the tip manufacturer 8. CONTROLS 3.) ADAPTATION OF POWERED TIPS

80  Angle of adaptation: an angle of between 0-15 degrees is recommended for direct adaptation to tooth surfaces  Lateral surfaces of the working end is recommended with sonic, piezoelectric, magnetostrictive ultrasonic  Piezo: tip does not do as much vibration as magnetostrictive, it’s the lateral surfaces that are more effective 8. CONTROLS 3.) ADAPTATION OF POWERED TIPSTIPS

81  Active tip area: portion of the instruments that is capable of doing work  Power to remove calculus is concentrated in the last 2-4mm of the length of a tip 8. CONTROLS 3.) ADAPTATION OF POWERED TIPS Test Alert!

82  Tip HAS to be made of a material that is softer than titanium because titanium is a soft metal that can easily be damaged by metal instruments  If scratch titanium implant = increase potential for biofilm adhesion by creating a roughened surface  Power tip with nonmetal plastic or carbon tips are appropriate  Some studies show they are more effective than hand- activated plastic instruments 8. CONTROLS 3.) ADAPTATION OF POWERED TIPS & IMPLANTS

83 1.Adaptation of tip surfaces to the tooth surface 1)Point and face of a power tip 2)Back and Lateral surface of a power tip 2.Orientation of the powered tip to the tooth surface 1)Transverse tip orientation (Curet Position) 2)Vertical tip orientation (Probe Position) 8. CONTROLS 3.) ADAPTATION OF POWERED TIPS

84 1.Adaptation of tip surfaces to the tooth surface 1)Point and face of a power tip a)NEVER be directly adapted to a tooth surface b)Great caution must be taken with the point of power tip = highest motion and vibration, surface area small = concentrated energy 8. CONTROLS 3.) ADAPTATION OF POWERED TIPS

85 1.Adaptation of tip surfaces to the tooth surface 2)Back and Lateral surface of a power tip a)Magnetostrictive =BACK SURFACE most effective in breaking calculus deposits and LATERAL SURFACES most effective in breaking tenacious calculus deposits b)Both can be used for calculus removal=sonic, piezo, magnetostrictive c)Last 2-4mm of back and lateral surface=active portion–must be in contact w/tooth at all times and be adapted so that the point is not directed toward the root or against the soft tissue 8. CONTROLS 3.) ADAPTATION OF POWERED TIPS

86 2.Orientation of the powered tip to the tooth surface 1)Transverse tip orientation (Curet Position)  Length of the tip is positioned with the back or lateral surface in a transverse orientation or at a right angle to the long axis of the tooth  Tip is placed in a similar fashion to a universal curet  Zero degree angulation maintained between back or lateral surface of the tip to tooth  Can be used when removing calculus above or slightly below gingival margin 8. CONTROLS 3.) ADAPTATION OF POWERED TIPS

87 2.Orientation of the powered tip to the tooth surface 2)Vertical tip orientation (Probe Position)  Length of tip is positioned w/ back or lateral surface in a manner similar to probing  Back or lateral surface of tip at zero degree angulation to root surface  Used for calculus removal and deplaquing shallow to deep pockets 8. CONTROLS 3.) ADAPTATION OF POWERED TIPS

88 For a transverse orientation, the power tip is positioned in a similar manner to a curet with the length of the back surface, or lateral surface, at a right angle to the long axis of the tooth

89 8. CONTROLS 3.) ADAPTATION OF POWERED TIPS For a vertical orientation, the powered tip is positioned so the length of the back surface, or lateral surface, is positioned in a manner similar to that of a periodontal probe

90 8. CONTROLS 3.) ADAPTATION OF POWERED TIPS Incorrect adaptation: the point of a power instrument tip should NOT be adapted against a tooth surface. Using a power tip in the manner can gouge cementum and dentin!!

91 8. CONTROLS 3.) ADAPTATION OF POWERED TIPS Correct Adaptation of Lateral Surface in a Transverse Orientation

92 8. CONTROLS 3.) ADAPTATION OF POWERED TIPS Correct adaptation of a lateral surface in a vertical orientation

93 8. CONTROLS 3.) ADAPTATION OF POWERED TIPS Correct adaptation of the back surface in a vertical tip orientation. Use the convex side Will prevent injury to the root surface with the tip

94  Tip-to-tooth angulation should be as close to 0°as possible and should never exceed 15°  Root surface will be gouged 8. CONTROLS 3.) ADAPTATION OF POWERED TIPS

95 OBJECTIVE #9 CALCULUS REMOVAL WITH POWER INSTRUMENTS

96  Calculus removal technique with Curet  Gracey positioned apical to or below the calculus deposit then vertical stroke coronally or up and away from the tissue  Calculus removal with power tip  Work top of the deposit downward  Start at CEJ and work downward  No need to position the tip beneath the deposit  Great advantage when working in very deep pockets 9. CALCULUS REMOVAL WITH POWER TIPS

97  Different techniques w/ power instrument tip and a hand-activated instrument  A= power  B=scaler 9. CALCULUS REMOVAL WITH POWER TIPS

98  Tips break up heavy deposits by putting little microfractures in the deposit  Power tip needs to be moved over the surface of a deposit some time in order to allow the microfractures to develop  Slower, repetitive controlled strokes are more effective in removing large tenacious calculus deposits  Keep tip moving at all times for patient comfort  Oblique, overlapping, vertical most effective  Light pressure  Avoid Horizontal = tendency to burnish calculus into tooth and create a smooth veneer than remove it completely. Why we always follow up cavitron w/hand instruments 9. STROKES FOR CALCULUS REMOVAL

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100  2-4mm of tip actively remove biofilm  Gentle, light sweeping strokes in the pocket over the root surface  Short, overlapping strokes will cover every mm of the root  Vertical, oblique or horizontal direction ok  Move tip at all times for patient comfort  Can be a little faster than hand instruments  Must hand instrument after to smooth back the surface ultrasonic roughs up  LOW power setting to avoid removing cementum 9. STROKES FOR PLAQUE BIOFILM REMOVAL

101 9. SWEEPING MOTION

102 9. CALCULUS REMOVAL

103 CURVED TIPS LATERAL SURFACE ADAPTED TO FACIAL

104

105 CURVED TIPS LATERAL SURFACE ADAPTED TO PROXIMAL

106 STRAIGHT TIPS BACK SURFACE, VERTICAL

107 STRAIGHT TIPS LATERAL SURFACE, VERTICAL

108 STRAIGHT TIPS BACK SURFACE, VERTICAL

109 STRAIGHT TIPS BACK SURFACE, TRANSVERSE

110  Common mistake with beginners is that the power tips will snap the calculus off with one quick swipe  Power tips are not magic wands!!  Take many overlapping strokes just like hand instruments 9. REMOVING TENACIOUS CALCULUS

111 1.Select proper tip for your task: standard, slim, curved, etc.. 2.Use a tip that can withstand medium pressure  Low power may not remove heavy tenacious deposits 3.Select appropriate water level: water should create a halo effects or light mist with no excessive dripping 4.Maintain proper control and adaptation  Keep 2-4mm of tip in contact with tooth 9. REMOVING TENACIOUS CALCULUS

112 5.Attack deposit from all directions w/ different strokes 6.Use correct surface of the powered tip: magnetostrictive vs piezo 7.Change to a different tip 8.Begin with a periodontal file first then switch to power 9.Increase the power if all the above have been utilized first, last resort and make sure select a tip that can withstand higher powers!! 9. REMOVING TENACIOUS CALCULUS

113  Slim tips can be more effective than hand instruments many times in treating Class II and III furcations  Standard gracey’s too wide to enter the furcation areas of over 50% of all maxillary and mand molars  Avg facial furcation entrance of maxillary and mand first molars is from 0.63 – 1.04mm in width  Width of standard Gracey curets ranges from 0.76 – 1mm  Diameter of a modified slim-diameter instrument tip is 0.55mm or less 9. CALCULUS REMOVAL FURCATION ACCESS

114

115

116 OBJECTIVE #10 CLINICAL STEPS

117

118  Position  Clinician same as for hand instruments  Neutral seated  Patient supine  Patient head to one side so water does not choke them  Grasp  Modified pen grasp of handpiece  Light and relaxed grasp – if have increased lateral pressure, tip will not work as effectively 10. CLINICAL STEPS FUNDAMENTALS

119  Finger Rests  Intraoral or advanced finger rest is CRITICAL!!  Lateral Pressure  Light  Moderate or firm – decrease effectiveness of tip or can even stop vibration of the tip  With proper technique, patients will not feel the tip  Motion Activation  Digital activation is recommended because the tip removes the calculus and not the clinician 10. CLINICAL STEPS FUNDAMENTALS

120  Just like hand scaling, use explorer to feel for residual calculus deposit  If have an endoscope – helpful for detecting residual calculus 10. CLINICAL STEPS

121  Dental hygiene care plan  Review medical hx for contraindications  Assess calculus deposits and location  Infection control measures  Personal protective equipment: PPE’s  Face shield to protect from aerosols  Surgical cap to prevent contamination of hair  Change mask every 20min or if it gets moist from aerosols  Flush water lines just like A/W syringe  2min at beginning of day  20-30 sec in between patients 10. CLINICAL STEPS PREPARATION

122  Plug in power cord to wall  Connect water hose  Fill handpiece with water  Then insert the tip twisting gently until it snaps into place  Select correct power setting  Select correct water setting  Pre-procedural rinse: Listerine or CHX for 2min 10. CLINICAL STEPS PREPARATION

123  Point-of-Use Filter  Some ultrasonic devises have preinstalled  Reduced # microorganisms in the water flowing over instrument tip 10. CLINICAL STEPS PREPARATION

124  Fluid control in anterior sections  Lower and upper lips can be cupped to contain the water spray  Allows the lip to act as a barrier to deflect the water back into the mouth and a “cup” to collect the water 10. CLINICAL STEPS WATER CONTAINMENT TECHNIQUES

125  Fluid control in posterior sections  Hold cheek between thumb and index finger and pull out and up, or down, to form a cup  Creates a “cheek cup” to catch water spray 10. CLINICAL STEPS WATER CONTAINMENT TECHNIQUES

126  Decrease fatigue of hands  Several techniques to reduce pull of cord 10. CLINICAL STEPS HANDPIECE CORD MANAGEMENT

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128

129  Overhang removal is a recontouring procedure used to correct defective margins of restorations to provide a smooth surface that will deter bacterial accumulation  Overhangs act as a biofilm trap  Power tips can be used to remove such as Burnett or Dentsply blue insert 10. CLINICAL STEPS SMOOTHING AMALGAM OVERHANGS

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131  Both inserts are designed to withstand higher power settings and more lateral pressure than a conventional slim-line  Uses: heavy deposits, overhangs, removing ortho cement 10. CLINICAL STEPS SMOOTHING AMALGAM OVERHANGS

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