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The use of ultrasonics in periodontal treatment
THE
USE OF ULTRASONICS
IN PERIODONTAL
TREATMENT
JOHN R. WILSON, D.D.S.’
The Ohio State University,
College of Dentistry,
T in the field of periodontics.article will HE DISCUSSION IN THIS
Columbus, Ohio
be limited to the possible use of ultrasonics
Because of the newness of the use of ultrasonic devices in dentistry, and the even more recent use of this equipment as applied to periodontics, literature relating it to the practice of periodontics is extremely meager. Zinnerl included the application of the ultrasonic instrument to removal of calculus in his studies. He “planed off” calculus from teeth with water alone, instead of using a slurry. Necrotic cementum was also removed by this procedure. His report indicated that there was very little bleeding encountered in the subgingival procedures. He also indicated a lower degree of root sensitivity His patients showed no adverse as compared to standard scaling techniques. clinical symptoms. Roth2 reported a lack of gingival injury during use of the ultrasonic instruments. He concluded that this was a significant contribution to the practice of dentistry. Valldauras reported favorable bacteriostatic properties when ultrasonic irThe report indiradiation was used in combination with antibiotic treatment. cated general, as well as local, improvement when this method of treatment of periodontal disease was used. In an unpublished Master’s thesis, Leonard4 reported the use of scaling tips adapted to ultrasonic application. Water alone was used in conjunction with the scaling procedures. It was noted that all calculus was removed from the teeth that were scaled. File tips that were adapted to this use produced apparent grooving and scratching of the enamel. Less bleeding of the gingival tissue was noted when the ultrasonically adapted tips were used than when conventional hand scalers were used. Johnson and Wilson5 have made a study covering both in vitro and in vivo application of the ultrasonic unit to scaling procedures. They designed seven scaling tips with which all surfaces of all the teeth could be reached. Scaling procedures were accomplished in the same mouth using conventional scalers on some teeth and the specially devised ultrasonic tips on other teeth. The teeth scaled by these two methods were then extracted to provide an investigative Read before the Symposium on Ultrasonic Dentistry, Miami Beach, Fla., Nov. 3, 1957. Received for publication Oct. 16, 1957. *Chairman, Department of Periodontics. 161
162
Fig. I.--The
Fig. 2.
ultrasonic
instrument
Pig. 3. Fig. 2.-An ultrasonic handpiece. Fig. 3.-The handpiece and inserts.
Volun1e 8 Sumber 1
ULTRASONICS
IN
PERIODONTAL
TREATMENT
163
comparison. A qualitative comparison was made and a time study was accomplished also. They report the adequate removal of calculus more rapidly with the ultrasonic tips than with conventional scaling methods. They also state that cementum under the calculus is virtually unharmed. The most recent development in the ultrasonic field relating to periodontal therapy has been the production of an ultrasonic unit* designed primarily for use in scaling procedures (Fig. 1). Fig. 4.
Fig. 3.
Fig. 6. Fig. Fig. Fig. Fig.
4.-Tip 5.-Tip B.-Tip ‘I.-Tip
A A B B
is is is is
Fig. 7. used used used used
for small crevices and fossae. interproximally. on the labial surfaces of lower anterior teeth. on the lingual surfaces of upper anterior teeth.
The new instrument is much smaller than the one originally designed for making cavity preparations. Important improvements noted in the new instrument are : 1. A water temperature regulator built into the machine. “Cavitron.
164
Fig. S.-Tip
13 is 11sec1on the distal surfaces of
Fig. 10.
Fig. 9.
Fig. 12.
Fig. 11. Fig. 9.-Tip Fig. lO.- Tip Fig. Il.-Tip Flg. l2.-Tip
molars.
C is used C is used D is used E is used
on on on on
the the the the
bucca1 surfaces of molars. lingual surfaces of molars. lin&#d surfaces of lower anterior interproximal surfaces.
teeth.
Volume 8 Number 1
ULTRASONICS
IN
PERIODONTAL
TREATMENT
165
2. A newly designed handpiece which is much lighter than others and which will allow the dentist a much better “feel” of root surfaces (Fig. 2). 3. An insert of new design which directs the flow of water more efficiently than the original handpiece. The new insert is advantageous in that the tip is a permanent part of the insert and can be changed quickly by simply removing the entire insert from the handpiece and replacing it with another insert to which is attached a different tip (Fig. 3). Five tips have been designed for use in scaling procedures. The various tips which are now in experimental use, and the areas for which they were designed, are shown in Figs. 4 through 1’2. Since this ultrasonic instrument has been in use but a short time, only its clinically observable use can be reported at this time. The new unit appears to be very efficient for removing hard deposits. It is possible to use the instrument to remove thin stains on the crowns of teeth, but it seems to be inefficient in this regard, except in certain areas such as in crevices with very small dimensions where the energy released by cavitation apparently removes the stain. In accord with Crawford’s findings,6 only slight contact was necessary to remove the hard deposits, and increasing the pressure merely dampened the vibration and reduced the effectiveness. The water temperature control on the new instrument has proved to eliminate the previous difficulty encountered by Johnson and Wilson.5 No macroscopic gouging of the surface has been evidenced with the tips presently in use. Some difficulty is encountered when indirect vision is attempted, since the use of water is essential. Sca1’mg can be done with more ease if direct vision is used. The patient reaction to the use of the ultrasonic instrument for scaling has been favorable. This was noted especially in patients where heavy deposits were to be removed and in patients with necrotizing ulcerative gingivitis where the tissue is extremely sensitive. Both conventional and ultrasonic methods were used in the same mouths, and patients have expressed a preference for the ultrasonic method. Patients have also expressed the feeling that their teeth felt smoother to the touch of the tongue when the ultrasonic unit was used than when con;entional procedures were used. This dental instrument is probably best suited for the removal of subgingival and supragingival gross calculus. Therefore, it is an effective adjunct to the equipment used by the dentist for the scaling procedures. As an instrument for removing thin stain on the crowns of the teeth, it is not nearly as effective as the rubber cup, brush, or Porte polisher. In its present state of development, it is probably not the complete answer to the problems of calculus removal, but it can be used to relieve much of the burden of removing heavy calculus, thus saving valuable time for other procedures. Its versatility and effectiveness are now undergoing complete studies, and it is hoped that much more valuable information will soon be available in addition to these opinions which are based mainly on clinical research.
WILSON
166
J. I’m%
Dell.
Ja~~uary, 1958
REFERENCES
1. Zinner, Doran, D.: Ultrasonic Studies in Dentistry : American Institute of Ultrasonics in Medicine; Proceedings of the Fourth Annual Conference on Ultrasonic Therapy, Library of Congress Number 5.5-12257,Aug. 27, 1955, pp. 6-16. 2. Roth, Lester H.: Application of the Ultrasonic Dental Handpiece, Preliminary Report, MT. Virginia D. J. 30:9, 1956. 3. Valldaura, A. : Ultrasonics in Dentistry, D. Abs. 1:207, 1956. (From Zahnirztl. Rundschau 64:602, 1955.) 4. Leonard, Wilmore B.: The Effect of Various Scaling Instruments on Tooth Root Surfaces, Unpublished Master’s Thesis, The Ohio State University, 1956. 5. Johnson, Walter N., and Wilson, John R.: The Application of the Ultrasonic Dental Unit to Scaling Procedures, J. Periodont. 28:264, 1957. 6. Crawford, Alan E.: Ultrasonic Engineering, London, 1955, Butterworths Scientific Publications, p. 246. THE OHIO STATE UNIVERSITY COLLEGE OF DENTISTRY COLUMBUS 10, 01110
USE OF ULTRASONICS
IN PERIODONTAL
TREATMENT
JOHN R. WILSON, D.D.S.’
The Ohio State University,
College of Dentistry,
T in the field of periodontics.article will HE DISCUSSION IN THIS
Columbus, Ohio
be limited to the possible use of ultrasonics
Because of the newness of the use of ultrasonic devices in dentistry, and the even more recent use of this equipment as applied to periodontics, literature relating it to the practice of periodontics is extremely meager. Zinnerl included the application of the ultrasonic instrument to removal of calculus in his studies. He “planed off” calculus from teeth with water alone, instead of using a slurry. Necrotic cementum was also removed by this procedure. His report indicated that there was very little bleeding encountered in the subgingival procedures. He also indicated a lower degree of root sensitivity His patients showed no adverse as compared to standard scaling techniques. clinical symptoms. Roth2 reported a lack of gingival injury during use of the ultrasonic instruments. He concluded that this was a significant contribution to the practice of dentistry. Valldauras reported favorable bacteriostatic properties when ultrasonic irThe report indiradiation was used in combination with antibiotic treatment. cated general, as well as local, improvement when this method of treatment of periodontal disease was used. In an unpublished Master’s thesis, Leonard4 reported the use of scaling tips adapted to ultrasonic application. Water alone was used in conjunction with the scaling procedures. It was noted that all calculus was removed from the teeth that were scaled. File tips that were adapted to this use produced apparent grooving and scratching of the enamel. Less bleeding of the gingival tissue was noted when the ultrasonically adapted tips were used than when conventional hand scalers were used. Johnson and Wilson5 have made a study covering both in vitro and in vivo application of the ultrasonic unit to scaling procedures. They designed seven scaling tips with which all surfaces of all the teeth could be reached. Scaling procedures were accomplished in the same mouth using conventional scalers on some teeth and the specially devised ultrasonic tips on other teeth. The teeth scaled by these two methods were then extracted to provide an investigative Read before the Symposium on Ultrasonic Dentistry, Miami Beach, Fla., Nov. 3, 1957. Received for publication Oct. 16, 1957. *Chairman, Department of Periodontics. 161
162
Fig. I.--The
Fig. 2.
ultrasonic
instrument
Pig. 3. Fig. 2.-An ultrasonic handpiece. Fig. 3.-The handpiece and inserts.
Volun1e 8 Sumber 1
ULTRASONICS
IN
PERIODONTAL
TREATMENT
163
comparison. A qualitative comparison was made and a time study was accomplished also. They report the adequate removal of calculus more rapidly with the ultrasonic tips than with conventional scaling methods. They also state that cementum under the calculus is virtually unharmed. The most recent development in the ultrasonic field relating to periodontal therapy has been the production of an ultrasonic unit* designed primarily for use in scaling procedures (Fig. 1). Fig. 4.
Fig. 3.
Fig. 6. Fig. Fig. Fig. Fig.
4.-Tip 5.-Tip B.-Tip ‘I.-Tip
A A B B
is is is is
Fig. 7. used used used used
for small crevices and fossae. interproximally. on the labial surfaces of lower anterior teeth. on the lingual surfaces of upper anterior teeth.
The new instrument is much smaller than the one originally designed for making cavity preparations. Important improvements noted in the new instrument are : 1. A water temperature regulator built into the machine. “Cavitron.
164
Fig. S.-Tip
13 is 11sec1on the distal surfaces of
Fig. 10.
Fig. 9.
Fig. 12.
Fig. 11. Fig. 9.-Tip Fig. lO.- Tip Fig. Il.-Tip Flg. l2.-Tip
molars.
C is used C is used D is used E is used
on on on on
the the the the
bucca1 surfaces of molars. lingual surfaces of molars. lin&#d surfaces of lower anterior interproximal surfaces.
teeth.
Volume 8 Number 1
ULTRASONICS
IN
PERIODONTAL
TREATMENT
165
2. A newly designed handpiece which is much lighter than others and which will allow the dentist a much better “feel” of root surfaces (Fig. 2). 3. An insert of new design which directs the flow of water more efficiently than the original handpiece. The new insert is advantageous in that the tip is a permanent part of the insert and can be changed quickly by simply removing the entire insert from the handpiece and replacing it with another insert to which is attached a different tip (Fig. 3). Five tips have been designed for use in scaling procedures. The various tips which are now in experimental use, and the areas for which they were designed, are shown in Figs. 4 through 1’2. Since this ultrasonic instrument has been in use but a short time, only its clinically observable use can be reported at this time. The new unit appears to be very efficient for removing hard deposits. It is possible to use the instrument to remove thin stains on the crowns of teeth, but it seems to be inefficient in this regard, except in certain areas such as in crevices with very small dimensions where the energy released by cavitation apparently removes the stain. In accord with Crawford’s findings,6 only slight contact was necessary to remove the hard deposits, and increasing the pressure merely dampened the vibration and reduced the effectiveness. The water temperature control on the new instrument has proved to eliminate the previous difficulty encountered by Johnson and Wilson.5 No macroscopic gouging of the surface has been evidenced with the tips presently in use. Some difficulty is encountered when indirect vision is attempted, since the use of water is essential. Sca1’mg can be done with more ease if direct vision is used. The patient reaction to the use of the ultrasonic instrument for scaling has been favorable. This was noted especially in patients where heavy deposits were to be removed and in patients with necrotizing ulcerative gingivitis where the tissue is extremely sensitive. Both conventional and ultrasonic methods were used in the same mouths, and patients have expressed a preference for the ultrasonic method. Patients have also expressed the feeling that their teeth felt smoother to the touch of the tongue when the ultrasonic unit was used than when con;entional procedures were used. This dental instrument is probably best suited for the removal of subgingival and supragingival gross calculus. Therefore, it is an effective adjunct to the equipment used by the dentist for the scaling procedures. As an instrument for removing thin stain on the crowns of the teeth, it is not nearly as effective as the rubber cup, brush, or Porte polisher. In its present state of development, it is probably not the complete answer to the problems of calculus removal, but it can be used to relieve much of the burden of removing heavy calculus, thus saving valuable time for other procedures. Its versatility and effectiveness are now undergoing complete studies, and it is hoped that much more valuable information will soon be available in addition to these opinions which are based mainly on clinical research.
WILSON
166
J. I’m%
Dell.
Ja~~uary, 1958
REFERENCES
1. Zinner, Doran, D.: Ultrasonic Studies in Dentistry : American Institute of Ultrasonics in Medicine; Proceedings of the Fourth Annual Conference on Ultrasonic Therapy, Library of Congress Number 5.5-12257,Aug. 27, 1955, pp. 6-16. 2. Roth, Lester H.: Application of the Ultrasonic Dental Handpiece, Preliminary Report, MT. Virginia D. J. 30:9, 1956. 3. Valldaura, A. : Ultrasonics in Dentistry, D. Abs. 1:207, 1956. (From Zahnirztl. Rundschau 64:602, 1955.) 4. Leonard, Wilmore B.: The Effect of Various Scaling Instruments on Tooth Root Surfaces, Unpublished Master’s Thesis, The Ohio State University, 1956. 5. Johnson, Walter N., and Wilson, John R.: The Application of the Ultrasonic Dental Unit to Scaling Procedures, J. Periodont. 28:264, 1957. 6. Crawford, Alan E.: Ultrasonic Engineering, London, 1955, Butterworths Scientific Publications, p. 246. THE OHIO STATE UNIVERSITY COLLEGE OF DENTISTRY COLUMBUS 10, 01110