Sonic Scalers Research Articles

Influence of motivation and a new digitized training program on undergraduate dental students during preclinical scaling training

BackgroundThe current study evaluated whether a new digitized scaling training program (DTP: n = 30; supervisor-student-ratio 1:10) improves the performance of undergraduate dental student during a preclinical course in regard to two different instruments [sonic scalers (AIR) and Gracey curettes (GRA)] compared to a conventional training program (CTP: n = 19; supervisor-student-ratio 1:4).MethodsAll the participants received a two-hour lecture on both instruments, followed by a 12-week period with a weekly training program lasting 45 min (10 sessions); one group was supported by DTP. At the end of the training phase, all the participants performed the subgingival scaling of six equivalent test teeth using GRA and AIR. Treatment time, proportion of removed simulated biofilm (relative cleaning efficacy, RCE-b) and hard deposits (RCE-d) were recorded. By using a pseudonymized questionnaire with a 5-point Likert scale, self-assessment of scaling effort, handling, root surface roughness/destruction and effectiveness were evaluated. In addition, personal data such as age, gender, handedness, regularity of playing computer games/consoles and previous dental/technical or medical education were elevated and correlated with cleaning efficacy.ResultsThe DTP participants showed higher effectiveness in RCE-b compared to those who used the CTP with GRA (71.54% vs. 67.23%, p = 0.004) and AIR (71.75% vs. 62.63%, p ≤ 0.001), and the DTP students were faster with both instruments (p ≤ 0.001). For RCE-d, there was no significant difference between the DTP and CTP groups (GRA p = 0.471; AIR p = 0.158), whereas DTP showed better RCE-d results with GRA versus AIR (84.68% vs. 77.85%, p < 0.001). According to the questionnaire, no significant differences were detected between the training groups in terms of self-assessment, handling, treatment time, root surface roughness/destruction or effectiveness of the instruments. The CTP group favored AIR compared to GRA regarding the fatigue effect. The CTP and playing computer games/consoles regularly was correlated with lower RCE-b, whereas previous education in medicine/dentistry was correlated with higher RCE-b values.ConclusionsWithin the limitations of the study, the DTP with a reduced supervision effort compared to the CTP resulted in higher effectiveness and lower instrumentation time for removing simulated biofilms.

Retrospective analysis of the long-term effect of subgingival air polishing in supportive periodontal therapy.

Glycine powder air polishing (GPAP) procedure has become popular. Aim of the analysis was to compare the clinical outcomes during supportive periodontal therapy (SPT) of subgingival application of GPAP with those using sole conventional mechanical debridement (SC). Over a median SPT period of 5.3years (re-evaluation through last observation), the GPAP cohort (n=263) received supra- and subgingival biofilm removal with GPAP. Supragingival calculus was removed using curets and sonic scalers here. Patients in the SC cohort (n=264) were treated with sonic scalers, curets and rubber cup polishing only. Changes in, that is pocket probing depth (PPD) and furcation involvement were assessed retrospectively. A bootstrapping equivalence testing method in line with the principle of the two one-sided tests (TOST) procedure was used to compare clinical outcomes. The GPAP procedure was statistically equivalent to SC regarding the number of sites with stable PPDs (83.3%; IQR 68.8%, 91.0% vs. 84.0%; IQR 77.8%, 90.0%). However, in the GPAP cohort, a trend towards deterioration in furcation status (no equivalence) was noted. In periodontal maintenance, the use of GPAP instead of mechanical plaque removal does not improve the clinical outcome. It seems to be contraindicated to treat furcation defects with GPAP only.

Suggestions for Non-Aerosol or Reduced-Aerosol Restorative Dentistry (for as Long as is Necessary)

The advent of coronavirus and the associated disease COVID-19 has led to the closure of dental practices in the UK and, indeed, in many parts of the world. In order to get dental practices operating again, it is suggested that it is necessary to adopt a new way of working. Principal among concerns has been the potential carriage of droplets (from an infected patient) into the aerosols resulting from the use of the turbine handpiece and from ultrasonic and sonic scalers, and other instruments used in restorative dentistry (current terminology being Aerosol Generating Procedures [AGPs]). It is therefore the aim of this paper to review restorative techniques and suggest those which are appropriate to aerosol-free, or reduced-aerosol restorative dentistry. CPD/Clinical Relevance: With anxieties regarding aerosol generating procedures abounding, it may be helpful to review procedures which either reduce or avoid these AGPs.

Evaluation of a systematic digitized training program on the effectivity of subgingival instrumentation with curettes and sonic scalers in vitro

ObjectivesWhereas the key role of subgingival instrumentation in periodontal therapy is well known, the influence of operators’ experience/training with different devices on treatment results is yet uncertain. Therefore, we assessed untrained undergraduate students, working on manikins, as to how effectively they learn to use curettes (GRA) and sonic scalers (AIR); hypothesizing that AIR will result in higher relative cleaning efficacy (RCE) than GRA.Material and methodsBefore baseline evaluation (T0), 30 operators (9 males, 21 females) received a 2-h theoretical lesson for both instruments, followed by a 12-week period with a weekly digitized training program for 45 min. During three sessions (T1–T3), the operators had to instrument six equivalent test teeth with GRA and AIR. At T0–T3, treatment time, proportion of removed simulated biofilm (RCE-b), and hard deposits (RCE-d) were measured.ResultsAt T0, RCE-b was in mean(SD) 64.18(25.74) % for GRA, 62.25(26.69) % for AIR; (p = 0.172) and RCE-d 85.48(12.32) %/ 65.71(15.27) % (p < 0.001). At T3, operators reached highest RCE-b in both groups (GRA/AIR 71.54(23.90) %/71.75(23.05)%; p = 0.864); RCE-d GRA/AIR: 84.68(16.84) %/77.85(13.98) %; p < 0.001). Both groups achieved shorter treatment times after training. At T3, using curettes was faster (GRA/AIR 16.67(3.31) min/19.80(4.52) min; p < 0.001).ConclusionsAfter systematic digitized training, untrained operators were able to clean 70% of the root surfaces with curettes and sonic scalers.Clinical relevanceIt can be concluded that a systematic digitized and interactive training program in manikin heads is helpful in the training of root surface debridement.

In Vitro Evaluation of Direct and Indirect Effects of Sonic and Ultrasonic Instrumentations on the Shear Bond Strength of Orthodontic Brackets.

Sonic and ultrasonic instrumentations generate vibrations that may influence debonding characteristics. The objective of this in vitro study was to assess the direct and indirect effects of sonic and ultrasonic periodontal instrumentations on the shear bond strength (SBS) and the adhesive remnant index (ARI) scores of metallic orthodontic brackets. Metallic brackets were bonded to 75 extracted mandibular central incisors that were embedded in acrylic resin. Instrumentations around the bracket base performed with ultrasonic (UltrasonicB group, n=15) and sonic (SonicB group, n=15) scalers were used to evaluate the direct effects on the SBS of brackets. Lingual surface instrumentations with ultrasonic (UltrasonicL group, n=15) and sonic (SonicL group, n=15) scalers were performed to assess the indirect effects. The control group (n=15) did not have any treatment. Instrumentations were performed for 30 s with 0° scaler tip angulations with settings recommended by manufacturers. The SBS of the brackets tested with a universal testing machine and ARI scores were recorded. Data were analyzed by Kruskal-Wallis and Mann-Whitney U tests. The mean SBS of the control group was significantly higher than that of the UltrasonicB and SonicB groups (p=0.008). The UltrasonicL and SonicL group instrumentations also decreased the SBS, although the difference was statistically insignificant. UltrasonicB instrumentations caused significantly higher frequency of ARI scores than the control group. The decrease of the SBS of metallic brackets indicates the influence of ultrasonic and sonic instrumentations on the breakage behavior at the bracket-resin interface. Instrumentations around the bracket base should be conducted with caution to decrease the bond failure risk of metallic brackets.

Comparison of nonsurgical periodontal therapy with hand scaler, conventional ultrasonic scaler, and vector™ ultrasonic system in patients with generalized chronic periodontitis

Background: The purpose of the study was to compare clinical efficacy of nonsurgical periodontal therapy with hand scaler, conventional ultrasonic scaler, and Vector™ ultrasonic system in patients with generalized chronic periodontitis. Materials and Methods: Sixty patients with generalized chronic periodontitis fitting the inclusion and exclusion criteria were assigned to one of the three treatment groups (n = 20 in each group). Group I – hand scalers, Group II – conventional ultrasonic scalers, and Group III – Vector™ ultrasonic system. Before oral prophylaxis, clinical parameters (gingival index [GI], plaque index [PI], calculus index [CI], periodontal probing depth [PPD], clinical attachment loss [CAL], and hypersensitivity) were recorded. GI, PI, CI, and hypersensitivity were reevaluated at 1, 3, 6 and 12 weeks. PPD and CAL were reevaluated at 6 and 12 weeks. Results and Conclusion: The results showed that nonsurgical therapy with Vector™ ultrasonic system is clinically comparable in all the parameters, to hand and conventional ultrasonic scalers, suggesting that it can be used as a gentle root debridement device for supportive periodontal therapy, as an alternative to other ultrasonic or sonic scalers.

Nonsurgical periodontal therapy: A review

Nonsurgical therapy aims to eliminate both living bacteria in the microbial biofilm and calcified biofilm microorganisms from the tooth surface and adjacent soft tissues. Complete elimination of such pathogenic microorganisms is perhaps over-ambitious. However, a reduction in inflammation of the periodontium due to a lesser bacterial load leads to beneficial clinical changes. In addition, nonsurgical therapy aims to create an environment in which the host can more effectively prevent pathogenic microbial recolonization using personal oral hygiene methods. The concept of critical probing depth was consistently found to be greater for the surgical approach than for the nonsurgical treatment. The various methods used in nonsurgical therapy, such as hand instrumentation, ultrasonic and sonic scalers, and ablative laser therapy.

The effects of mechanical instruments on contaminated titanium dental implant surfaces: a systematic review

The objective of this systematic review was to evaluate the ability of mechanical instruments to clean contaminated implant titanium surfaces. MEDLINE, Cochrane-CENTRAL and EMBASE databases were searched up to May 2013 to identify controlled studies on the cleaning efficacy of mechanical instruments on contaminated titanium surfaces. A comprehensive search identified 1893 unique potential papers. Fourteen studies met the inclusion criteria and were selected for this systematic review. Most of the studies were in vitro studies. Different surfaces and different contamination methods were used. Most studies used titanium discs, strips and cylinders. The air abrasive was the treatment mostly evaluated. The available studies had a high heterogeneity that precluded any statistical analysis of the data. Therefore, the conclusions are not based on quantitative data. Non-metal curettes and rubber cups were found to be ineffective. Positive results were reported for (ultra)sonic scalers with a metal tip on polished surfaces, (ultra)sonic scalers with a non-metal tip on smooth and sand-blasted and acid-etched (SLA) surfaces, metal curettes and rotating titanium brushes on SLA surfaces. The air abrasive was found to be effective in cleaning machined, SLA and titanium plasma-sprayed (TPS) surfaces. The available data suggest that the air abrasive may remove plaque effectively from machined, SLA and TPS titanium surfaces. Positive results were also observed for rotating titanium brushes on SLA surfaces and ultrasonic scalers with non-metal tip on polished and SLA surfaces. However, the clinical impact of these findings requires further clarification.

Position Paper Update

In May 2007, the Board of Trustees of the American Academy of Periodontology rescinded the following position papers: "Periodontal Considerations in the HIV Positive Patient" (1994). "Periodontal Considerations in the Management of the Cancer Patient" (1997). "Periodontal Management of Patients With Cardiovascular Diseases" (2002). "The Potential Role of Growth and Differentiation Factors in Periodontal Regeneration" (1996). "Sonic and Ultrasonic Scalers in Periodontics" (2000). These papers have been removed from the AAP Web and online Journal sites. Readers are encouraged to consult the literature for the most current information on these topics.

Pain during prophylaxis treatment elicited by two power‐driven instruments

Sonic scalers have an elliptical and piezoceramic ultrasonic scalers a linear oscillation pattern. Thus, a sonic scaler "hammers" the tooth surface, irrespective of its alignment to the tooth, whereas a piezoceramic ultrasonic scaler may oscillate parallel to the tooth surface and gently remove calculus if the alignment is correct. The aim of this study was to measure pain on a visual analogue scale (VAS) during removal of supragingival calculus on mandibular incisors with a sonic or an ultrasonic scaler. Seventy-four periodontally healthy subjects with supragingival calculus on the mandibular incisors were treated with both a sonic and a piezoceramic ultrasonic scaler in a split-mouth design. The sequence of instrument application and allocation of instruments to jaw side were randomized. Patient comfort was assessed with a VAS after treatment. The VAS results did not show any difference between the two instrumentation modalities. For calculus removal during prophylaxis the type of power-driven instrument does not seem to have an impact on perceived pain. This means that the oscillation pattern does not influence the pain experience.

ROOT INSTRUMENTATION: Power-Driven Versus Manual Scalers, Which One?

The literature is clear that periodontal therapies aimed at altering the progression of inflammatory periodontal diseases must include meticulous subgingival mechanical débridement during both the nonsurgical and the surgical phases of treatment as the basis of most anti-infective therapy. In the past, infection control was achieved by the mechanical removal of subgingival deposits of plaque, calculus, and endotoxin with curets, files, and hoes. Historically, it was also generally agreed that aggressive scaling and root planing with hand instruments was necessary to remove tenacious calculus deposits to produce roots as smooth as possible for removal of the endotoxins previously thought to be deeply embedded into the root surfaces. Based on current evidence in the literature, it is now known that endotoxin is a weakly adherent surface phenomenon and that sonic and ultrasonic (power-driven) instruments can be used to accomplish definitive root detoxification and maximal wound healing without overinstrumentation of root and without extensive cementum removal. Power-driven scalers may have unique advantages because of the cavitational activity associated with ultrasonics thought to supplement removal of root surface plaques. In addition, the constant flushing activity of the lavage used to cool the tips results in disruption of the unattached and weakly attached subgingival plaques. 58, 59 The ability to flush the pocket during subgingival instrumentation with water or other chemical irrigating solutions is unique to ultrasonic and sonic scalers and has been shown to enhance pocket depth reduction and gain in clinical attachment beyond that achieved with hand scaling. 10, 24, 45 The added benefit of chemical lavage during ultrasonic instrumentation shows great promise and may enhance the overall effect of nonsurgical anti-infective periodontal therapy. Other major advantages of power-driven scalers may include better access to difficult areas, such as deep narrow defects, root grooves, and furcations, using newly designed microultrasonic tips, which are smaller in diameter and able to penetrate the pocket approximately 1 mm farther than hand instruments. 16, 53 Taken together, it appears that use of ultrasonic or sonic scalers for periodontal debridement will result in improvements in clinical and microbial parameters at a level equal to or superior to hand scalers.

Preliminary investigation into the performance of a sonic scaler.

Recently a number of mechanical scalers, known as air or sonic scalers, have been developed. Preliminary investigations were undertaken to observe the operating characteristics of such a sonic scaler including its oscillatory pattern, and how this was affected by changing the design of the scaling tip, the air pressure, and the application load. The oscillatory pattern exhibited an open elliptical movement that was dependent upon the air pressure input to the instrument. Application of a load to the scaling tip resulted in oscillatory damping that increased with the magnitude of the load. The oscillatory performance of the sonic scaler differed from that observed previously with ultrasonic scalers. Investigators using the sonic scaler should indicate the type of scaling tip, the air pressure input, and the application load used to enable meaningful comparisons to be made between the results of different workers. Clinicians should be aware of its operating characteristics to avoid potential damage to the tooth surface.