Many factors are involved in achieving successful debridement with ultrasonic dental equipment technologies. Both patient- and clinician-centered ingredients are part of the formula for positive outcomes. Patient-centered factors include periodontal status, tolerance, sensitivity, comfort, and preference. Clinician-centered aspects include education, experience, motivation, and equipment choices.
Both magnetostrictive and piezoelectric inserts/tips oscillate with an elliptical pattern, and this motion depends on power setting and probe shape/design.1 Long and thin ultrasonic inserts/tips (UITs) are prone to greater elliptical motion, particularly at high power levels.1 Thus, it is not the type of generator used that is most important in optimal debridement.
One of the key factors in ultrasonic debridement is that the UIT reaches and adapts to the plaque biofilm or calculus location on the root. In addition, choosing the right UIT for the function needed, such as tenacious, burnished, or light deposit removal, is paramount. Think about UIT designs based on appearance and patterns, as with hand-activated instruments. Each end has similar characteristics, such as a contour, shank diameter (wide, thin, thinnest), and shank length (short, long, and longest).
UIT contour can be round and smooth, round with diamond coating, flat, or bladed. Roundness allows easy application of all working sides and ease of insertion subgingivally. In contrast, flat profiles—adapted to the tooth on the flat surfaces—are ideal for gross calculus deposits, stain, and supragingival orthodontic cement removal. Likewise, the bladed silhouettes, most often associated with piezoelectric units, are indicated for supragingival use and subgingival endoscopic visualization, and require that the blade/edge be adapted to the deposit.
Tip diameter is categorized as wide, thin, and thinnest (micro). Wide UITs are indicated for supragingival debridement and stain removal, while thin UITs are used for subgingival applications (a thin UIT is shown in the cover photo). Also, wide tips are best for large or tenacious deposits, while thin tips are well suited for fine accumulates. There is concern regarding the influence of thin UITs on attachment loss. Casarin et al2 found that a thin UIT induced a greater immediate clinical attachment loss than a standard tip; however, this finding did not affect clinical outcomes. Patient comfort also is enhanced with thin UITs. A significant difference in patient preference was evident when a standard and thin UIT were compared.3 Reductions in plaque and bleeding indices were noted with both designs; however, the thin UITs produced significantly less patient discomfort.3
Shank length also is important. The longest shanks are intended to adapt in deep pockets. Typically, thin and long UITs are used at low to moderate power (amplitude), and wide, large ones are used on moderate to moderately high power. There are newly manufactured UITs, however, that are thin, long, and recommended for use with moderate to heavy calculus on moderately high power levels.
CONCLUSION
Successful debridement with ultrasonic therapy relies on many factors; however, an initial step is proper UIT selection. With a plethora of new designs available, clinicians should examine the profile prior to selection for therapy. There are many buying options, and it is best to visit manufacturers' websites to review availability.
Many advances have been made in nonsurgical dental supplies therapy, with UIT design being one. However, only one randomized controlled trial on UIT design has been conducted.11 Efforts are being made to enhance clinical results, patient-centered outcomes, and cost-effectiveness of nonsurgical periodontal therapy.11 One facet of this mission is to develop better UITs. More randomized controlled trials are needed to study UIT design, as well as ultrasonic systems. No longer are hand instruments and a single UIT the norm. Instead, multiple UITs and hand-activated instruments should be interwoven into debridement therapy.
