As a dental hygienist, these three statements are likely to relate to you: 1. You practice in a clinical setting. 2. You spend most patient appointments fighting calculus, biofilm and stain. and 3. Your treatment room is equipped with ultrasound technology. There’s also a good chance that ultrasound technology and your smartphone have something in common. Many of us do not optimize the capabilities of our smartphones and many dental hygienists do not optimize the capabilities of their ultrasound systems.
More Chairside Impact:
Optimizing ultrasound in op
For decades, the use of a Cavitron was synonymous with the abstraction of calculus. In fact, when I graduated in the 1990s, hand instruments were the gold standard for scaling and root planing, hygienists had a choice of ultrasonic instruments, ultrasonic instruments could not be used subgingivally, and stain removal was not generally considered a function of ultrasound instruments. However, since I graduated, manufacturers have provided a greater selection of ultrasound instruments, and the evidence for the use of ultrasound has evolved beyond calculus removal. Today, ultrasound technology provides greater subgingival utility, including the use of thin, ultrathin, straight, and curved ultrasound instruments to remove and disrupt biofilm. In fact, a recent systematic review reported the benefits of manual subgingival instruments and ultrasound, reporting that both methods were effective in reducing oral inflammation and pocket depth.1 Other randomized clinical trials have also concluded that clinical outcomes using ultrasound instruments are equal to hand scaling, but add that ultrasound technology achieves these outcomes more quickly.2-4 A group of researchers also found that when equal scaling motions were applied, ultrasonic instruments removed an average of 50% more active biofilm compared to hand instruments.2
Basic variables
Dental hygienists should be excited about the possibilities of ultrasound, but these instruments are not magic wands. As expectations for ultrasound technology rise, consider these three things: one insert/tip cannot do it all. not all ultrasound units are created equal. and technique matters. Digital scanners vary in complexity and ultrasound units should be treated the same way. Dental burs have distinct characteristics and indications—ultrasound instruments do, too. Analyzing the diameter, length, shape and cross-section of the active tip of ultrasonic instruments will guide dentists in selecting an ideal option for each cleaning need. An experienced ultrasound technician, combined with the ultrasound system most appropriate for your practice, will improve the likelihood of rapid, effective biofilm, calculus, and stain removal while providing your patients with a positive experience.
Author’s Note: To learn how to optimize your ultrasound systems, please join me in a virtual seminar titled “Say Goodbye to Biofilm, Calculus, and Staining: Leveraging Ultrasound as a Triple Threat.” This virtual seminar will be held live on November 14, 2023, 7:30-8:45 PM EST. Click here to register.
Editor’s Note: This article appeared in the September 2023 print edition RDH magazine. Dental hygienists in North America are eligible for a free print subscription. Register here.
bibliographical references
- Suvan J, Leira Y, Moreno Sancho FM, Graziani F, Derks J, Tomasi C. Subgingival appliances for the treatment of periodontitis. A systematic review. J Clin Periodontol. 2020;47(Suppl 22):155-175. doi:10.1111/jcpe.13245
- Johnston W, Rosier BT, Carda-Deiguez M, Al-Hebshi N, Chen T, Mira A, Culshaw S. Evaluating the microbial effect of hand and ultrasonic instruments in vitro and in vivo effect of instrumentation on in vitro periodontitis biofilm. University of Glasgow, Glasgow, United Kingdom. FISABIO, Valencia, Spain. Komber School of Dentistry, Pennsylvania. Forsyth Institute, Massachusetts. Presented at: IADR/AADR/CADR General Assembly. 2020. Washington, DC.
- Johnston W, Paterson M, Piela K, et al. The systemic inflammatory response after hand versus ultrasound instrumentation – a randomized controlled trial. J Clin Periodontol. 2020;47(9):1087-1097. doi:10.1111/jcpe.13342
- Hamm C, Dakin L, Lavoie D, Longo AB, Fritz P, Ward PE, editors. Timing of instrumentation for nonsurgical debridement using ultrasound alone versus ultrasound alone and hand tools in generalized advanced periodontitis. Poster. Presented at: The Ninth Conference of European Federation of Periodontology EuroPerio. June 2018. Amsterdam, Netherlands.
