What is the difference between a sonic and ultrasonic scaler

Acoustic steaming is the unidirectional fluid flow caused by ultrasound waves. Acoustic turbulence is created when the movement of the tip causes the coolant to accelerate, producing an intensified swirling effect. This turbulence continues until cavitation occurs. Cavitation is the formation of bubbles in water caused by the high turbulence.

The bubbles implode and produce shock waves in the liquid, creating further shock waves throughout the water. In vitro, the combination of acoustic streaming, acoustic turbulence, and cavitation has been shown to disrupt microflora.

Sonic units work at a frequency of to cycles per second and use a high- or low-speed air source from the dental unit. Water is delivered via the same tubing used to deliver water to a dental handpiece. Sonic scaler tips are large in diameter and universal in design. A sonic scaler tip travels in an elliptical or orbital stroke pattern. This stroke pattern allows the instrument to be adapted to all tooth surfaces.

Box outlines the advantages and disadvantages of mechanized instruments as compared to manual instruments. Magnetostrictive ultrasonic devices work in a frequency range of 18, to 50, cycles per second Figures and Metal stacks that change dimension when electrical energy is applied power magnetostrictive technology. Vibrations travel from the metal stack to a connecting body that causes the vibration of the working tip.

Tips move in an elliptical or orbital stroke pattern. This allows the tip four active working surfaces Figure Piezoelectric ultrasonic units work in a frequency range of 18, to 50, cycles per second Figure They have ceramic discs that are located in the handpiece power piezoelectric technology. They change in dimension as electrical energy is applied to the tip. Piezoelectric tips move in a linear pattern, giving the tip two active surfaces Figure A variety of insert tip designs and shapes are available for use.

Power instrumentation has the potential to make scaling less demanding, more time efficient, and more ergonomically friendly. Modified tip designs allow for improved access in many areas, including furcations. Newer, slimmer designs operate effectively at lower power settings, thus improving patient comfort. Sonic and ultrasonic tips can reduce the time needed for scaling. There are tips designed to remove heavy supragingival calculus or to definitively debride periodontal pockets.

Large diameter tips are created in a universal design and are indicated for the removal of large, tenacious deposits. A high power setting is generally recommended. Thinner diameter tips may be site specific in design.

The straight tip design is ideal for use in treating patients with gingivitis and deplaquing maintenance patients Figure The right and left contra-angled instruments allow for greater access and adaptation to root morphology. These inserts are designed to work in a low power setting. They can be used for exploration. The amount of water delivered for lavage can be controlled through the selection of either traditional flow or a focused tip delivery flow.

For exclusive biofilm removal, especially during the maintenance phase the force applied to the scaler tip should be as low as 1 N feather touch with the instrument aligned parallel to the tooth surface While using the scaler, firstly, the tip of the insert should be used in a probe-like manner to evaluate the morphology and dimensions of the periodontal pocket.

Then the tip is moved in a systematic way performing serpentine-like overlapping tractions. After completion of scaling and root planing, the root surface is evaluated with the help of a fine explorer. If any …….. Several studies have evaluated the scaling efficiency and amount of tooth structure removed mechanically by hand instruments and ultrasonic scalers 16, Many studies have suggested that hand instruments produce a significantly smoother root surface than ultrasonic scalers, whereas other studies 21 suggested that an ultrasonic scaler produced a smoother root surface than hand instruments.

These studies may have contradictory results, but one common finding is that one of the important factors determining the surface smoothness is the efficiency and appropriate technique of scaling used by the operator. One study compared the scaling efficiencies and root surface roughness after scaling by hand instruments, sonic scalers, and ultrasonic scalers. It was found that all three were effective in disrupting biofilm and in removing biofilm and calculus deposits. Use of the magnetostrictive ultrasonic scaler resulted in the least tooth substance loss Some studies evaluated the efficacy of hand scalers, sonic and ultrasonic scalers in calculus removal from the furcation of multi-rooted teeth.

It was found that sonic and ultrasonic scalers allow more efficient cleaning of furcation as compared to hand scalers 23, Comparison of calculus removal with sonic Titan-S sonic scaler and ultrasonic scaler Dentsply Cavitron ultrasonic scaler was done on extracted teeth in one study. Using scanning electron microscopy, the results indicated that the Titan-S sonic scaler was as effective at calculus removal as the Dentsply Cavitron ultrasonic scaler and surface roughness was found to be less with sonic scaler Initially, it was believed that complete cementum removal was necessary in order to remove the disease-causing agents, but later on, research showed that extensive removal of cementum is not necessary to render the root free of bacterial endotoxins The objective of scaling and root planing is the complete removal of plaque, calculus and the endotoxin adherent to the root surface.

It is now clear that cementum removal is unnecessary. Various studies have compared the removal of endotoxin from the root surface by using hand instruments 27, 28 and ultrasonic devices Most of them have found …….. Immediately after scaling and root planing, root surface smoothness can be evaluated, but soft tissue evaluation should not be done immediately after scaling. It has been shown that the re-epithelialization of the injured area during scaling takes place within 1 to 2 weeks 30, Junctional epithelium can be expected to take approximately one week to heal following the debridement whereas underlying connective tissue can take weeks During this period of healing gingival bleeding can be expected during probing.

If the patient is maintaining a good oral hygiene and regularly following advised brushing technique, complete healing takes place during this time period, after which patient can be re-evaluated. This device generates ultrasonic vibrations which are converted by a resonating ring in such a way that horizontal oscillations are deflected vertically because of which the tip of the scaler moves parallel to the root surface.

Hence, damage to the root surface is minimal. This system is recommended for use in conjunction with irrigation fluids containing hydroxylapatite or silicon carbide These spraying agents disrupt the plaque during the scaling procedure to increase the efficiency and achieve better clinical results. The hydrodynamic forces such as cavitation or acoustic microstreaming are supposed to be responsible for cleaning of tooth surface rather than chipping action of the instrument tip 9.

The major advantage of this system is, patient comfort. By avoiding vibrations applied horizontally to the root surface, treatment with this system has been shown to be less painful than treatment with conventional systems Studies have compared the VectorTM system with the conventional ultrasonic scalers and hand instrumentation for its efficacy. One study demonstrated complete removal of calculus from the root surface, however, the efficiency was dependent on the fluid used In another study, it was shown that the calculus removal efficiency of the Vector system was lower than that of hand instrumentation and the conventional ultrasonic system, however; the root surfaces scaled by the Vector system were less traumatized and it was emphasized that Vector system was more promising to use in a regular maintenance therapy to avoid the high loss of cementum and dentine One more study done on this system demonstrated the root surface roughness comparable to hand instruments Centers for Disease Control and Prevention recommends that all sources of blood-contaminated splatter and aerosols should be minimized during dental treatment.

One of the major sources of potential aerosol and splatter contamination in the dental setting is the ultrasonic scaler.

Micik and colleagues 40 have defined dental aerosols and splatter. It has been demonstrated that these particles behave in a ballistic manner, i. There are two types of infectious aerosols: dust born and droplet nuclei. The dust born aerosols are larger in diameter and they can be easily removed from the air by sedimentation or filtration.

They are less likely to cause infection. On the other hand, the droplet aerosols are smaller in size and settle out of the air slowly. Being smaller and lighter, these droplet nuclei particles can remain in the environment for a longer period of time.

These can easily spread in the dental operatory with air currents and can contaminate open surfaces and equipment. So, droplet aerosols pose a greater risk to the patients and health care providers as compared to dust born aerosols.

Viral particles, such as Human immunodeficiency virus and Hepatitis B virus are easily carried by these particles. According to the American Dental Association ADA , aerosol contamination is to be minimized: 1 by the use of a rubber dam whenever possible; 2 by the use of a high-volume evacuator HVE ; and 3 by proper patient positioning The frequency at which ultrasonic scalers work range from 20, to 50, vibrations per second with a 68 to 75 average decibel range of noise level 45, One study has proposed that ultrasonic scaling units produce high-frequency vibrations, which have the potential to cause occupational hearing loss A study demonstrated levels of annoyance and discomfort from high-frequency noise produced by ultrasonic cleaners ranging from 72 to 96 decibels Excessive heat may be produced during scaling which is mainly due to functional heating due to contact between scaler and tooth and acoustic energy absorption of ultrasound transmitted into the tooth.

It has been shown that absorption of acoustic energy by the tooth surface can result in the elevation of tooth temperature, causing heat injury Performing ultrasonic scaling without irrigation leads to increase in temperature, and may completely damage the pulp tissue. Proprioceptive dysfunction can often be caused by noise exposure. Dental considerations in pregnant women. Advanced periodontal diagnostic techniques mine.

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