Current Trends in Ultrasonic Therapy

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Current Trends
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Scott Benjamin, DDS and Jan Lebeau, RDH
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Current Trends in Ultrasonic Therapy
Scott Benjamin, DDS and Jan Lebeau, RDH
ABSTRACT
EDUCATIONAL OBJECTIVES
Periodontal disease is prevalent in the US population and globally. A
full periodontal examination is required to diagnose and treatment
plan this disease. Standard initial nonsurgical periodontal therapy
requires the removal of all calculus deposits, bacterial toxins, debris,
and the disruption and removal of all biofilm. Methods available for
the removal of calculus include hand scaling and piezoelectric or
magnetostrictive ultrasonic scaling. Selecting appropriate tips and
using a safe and effective technique are prerequisites for successful
nonsurgical periodontal therapy, as is lifetime re-evaluation of the
periodontal patient and regular periodontal maintenance.
The overall goal of this article is to provide the reader with information on the pathogenesis and treatment of periodontal disease. After
completing this article the reader will be able to:
1.Describe the prevalence and etiology of periodontal disease;
2.Review the components of a full mouth periodontal examination;
3.Delineate the considerations involved in the use of piezoelectric
ultrasonic scalers; and,
4.List and describe the attributes that contribute to time savings,
efficacy, safety and ergonomics when using ultrasonic scalers.
ABOUT THE AUTHORS
Scott Benjamin, DDS - Dr. Scott Benjamin is a graduate of
SUNY Buffalo, School of Dental Medicine and has been
in full-time private practice for over 25 years. He has presented internationally at major dental meetings, universities, workshops, and study clubs, and has published more
than 100 articles on dental technology in over a dozen
publications on topics ranging from computerization and the internet
to micro air abrasion, diagnostic modalities and lasers. AUTHOR DISCLOSURE: Dr. Benjamin has no conflict of interest to declare. He can
be reached at: [email protected].
Jan LeBeau, RDH - Jan LeBeau has been in the practice
and education of dental hygiene for over 30 years, joining
Pacific Dental Services in 2009 and now serves as the Chair
of Hygiene for the PDS Institute. Jan has lectured and published articles on lasers and periodontal disease, the hygienist's role in implant maintenance, and effective communication for the dental hygienist. Jan is an active member of the Academy of
Laser Dentistry and the American Dental Hygiene Association. AUTHOR
DISCLOSURE: Ms. LeBeau has no conflict of interest to declare. She can
be reached at: [email protected].
Introduction
N
ow, more than ever, dentistry and medicine have
come together in collaboration to support the
overall health of the patients we serve. Today the
profession of dentistry knows so much more about the
etiology of periodontal disease, the inflammatory process
and subsequent host response, and the link periodontal
diseases have to other serious, systemic health concerns such
as diabetes and cardiovascular disease. Dentists and dental
hygienists are embracing better technology, such as lasers
and the newer piezoelectric ultrasonic scalers with enhanced
features, to effectively and efficiently manage the periodontal infection with better results and less patient time and
discomfort. Periodontal disease is a multifactorial inflammatory disease initiated by bacterial microorganisms that, if left
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Current Trends in Ultrasonic Therapy
untreated, can result in destruction of the tissues supporting
the teeth, tooth loss, masticatory dysfunction and poor
nutrition. It is prevalent throughout the world, ranging from
reversible gingivitis to severe periodontal disease. In the
United States, it has been estimated that 75% of the population over the age of 35 experiences some form of periodontal disease, including gingivitis.1 Environmental, genetic and
acquired risk factors all play a role in periodontal disease
(Fig. 1).2 Tobacco use is a strong risk factor for the development, progression and severity of periodontal disease, as
well as impacting the success of managing the disease long
term.3 Genetic factors are increasingly being investigated.4
Periodontal Disease Progression
Gingivitis occurs due to an inflammatory process associated initially with the accumulation of gram-positive
supragingival plaque, and can occur within 2 to 3 days of
the start of dental biofilm formation. By day 7, gram-negative bacteria migrate and form a subgingival biofilm that
by 12 weeks is well-established, well-differentiated with a
diverse gram-negative flora, and well-structured (Fig. 2).5 As
biofilm travels deep down the root surface, oral hygiene has
minimal influence on the disruption of subgingival plaque
ENVIRONMENTAL
Poor oral hygiene
SES
quantity or its composition, due to an inability to reach the
biofilm with brushing and flossing.6
Periodontal Examination and Diagnosis
A diagnosis of periodontal disease is based on the
patient’s medical history, dental history, clinical and radiographic findings. A comprehensive periodontal examination
includes full mouth pocket charting with 6 sites probed
and recorded per tooth and documentation of bleeding on
probing (BOP), suppuration, gingival recession, mobility,
furcation involvement and other contributing factors such
as overhangs and poor margins (Fig. 3). Radiographs are
essential and permit the assessment of the quantity and pattern of alveolar bone loss, root form, length and proximity,
and the presence of periapical lesions (Fig. 4).7
Adjunctive testing may be performed and can be beneficial in establishing the diagnosis and etiology of the patient’s
condition. These adjunctive tests and techniques include but
are not limited to DNA, enzyme and bacterial testing for specific pathogens and the bacterial load, as well as assessments
of the levels of prostaglandins, cytokines, tissue-destruction
agents and host-derived enzymes.7 Once a diagnosis has been
made, appropriate periodontal therapy can be instituted.
GENETIC
Familial
Gender
Ethnicity
ACQUIRED
Smoking tobacco
Alcohol use
Systemic disease
Medication use
Low Ca, Vit D
Obesity
Figure 1. Risk Factors for Periodontal Disease
Figure 2. Image of localized gingivitis
DENTAL LEARNING
Periodontal Therapy
Nonsurgical periodontal therapy is the standard of
care for the initial treatment of periodontal disease.
During instrumentation, the goal of nonsurgical periodontal therapy is to disrupt and effectively remove
plaque as well as to remove calculus, bacterial toxins
and other debris supra- and subgingivally, while minimizing iatrogenic damage to the tooth structure.8 All
root surfaces must be thoroughly debrided to the base
of the pocket where periodontal pathogens are most
concentrated, and furcation areas and other periodontal
niches must be properly-accessed and debrided.9
Thorough debridement is essential to control periodontal disease and achieve a satisfactory outcome, and
ultrasonic scaling is most frequently the method selected
for nonsurgical periodontal therapy. The evidence supports the use of piezoelectric or magnetostrictive ultrasonic scaling which is at the very least as efficacious as
manual scalers or a combination of manual and ultrasonic scalers,8 and in the case of difficult-to-access sites
provides for superior instrumentation.
Ultrasonic Scaling
Ultrasonic scaling can be performed using piezoelectric
or magnetostrictive scaler units, which are both effective
Figure 3. Image of use of perio probe
4
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and offer advantages over manual scaling. Piezoelectric
ultrasonic scalers provide linear micromovements of the
scaler insert, created by current-activated ceramic discs. All
surfaces of the insert may be used, with the lateral surfaces
being the most active. Magnetostrictive ultrasonic scaler
inserts move elliptically; again, all surfaces of the insert may
be used. In the case of magnetostrictive units, the tips of the
inserts are the most active area and the lateral surfaces the
least active.
Efficacy, Efficiency and Patient Comfort
Selecting an ultrasonic unit and appropriate use of inserts leads to greater efficacy, efficiency, patient comfort and
safety than the use of manual scalers. Considerably less time
is required to perform ultrasonic scaling than manual scaling, which improves the efficiency of instrumentation.10,11
Time savings for ultrasonic scaling versus manual scaling
can be up to one-third, a significant increase in efficiency.10
From the patient’s perspective, increased efficiency improves
patient comfort since less time is required per sextant or
quadrant, and may enable more treatment to occur in fewer
visits, providing convenience without compromising treatment outcomes. It is worth noting that the completion of
full-mouth periodontal debridement in one visit has been
advocated to reduce recolonization of periodontal sites
Figure 4. Radiograph showing extent of bone loss and
furcational involvement
VOLUME 3 | ISSUE 1
Current Trends in Ultrasonic Therapy
through migration from as-yet-to-be-treated quadrants,
although the results of several studies have shown the same
outcome whether periodontal therapy is conducted in one
or more visits.12,13
For both piezoelectric and magnetostrictive ultrasonic
inserts, instrumentation from the coronal rather than the
apical aspect of calculus deposits enables their removal efficiently and with less tissue distension than with a manual
scaler which is applied from the apical aspect of the deposit.
This, together with the application of less force, further contributes to improved patient comfort. In addition, the incorporation of an air polishing option into ultrasonic units may
aid the clinician in debriding deep pockets at interdental
sites, compared to curettes.14 Air polishing is also perceived
by patients to cause less discomfort than hand scaling and
requires less time and, in one study, no differences were
found for microbiological parameters.15
A well-directed flow of lavage improves cooling, and
improves patient comfort since the lavage is more easily
suctioned away. Nonetheless, since piezoelectric ultrasonic
units generate less heat, they require less lavage/coolant in
comparison to magnetostrictive units. This further helps to
improve visibility and reduces the need for breaks to suction
more than the saliva ejector can handle. Moderate requirement for lavage further improves patient comfort by reducing
the uncomfortable feeling of a need to swallow or patient
gagging. This is very beneficial to the dental hygienist who
often works without the aid of an assistant. In the absence
of local anesthesia, patients may also experience thermal discomfort from a cool or cold lavage stimulating any exposed
dentin and eliciting dentinal hypersensitivity. The ability to
use an irrigating solution that can be temperature-controlled,
in addition to reducing the volume of irrigating solution, may
reduce the potential for sensitivity and discomfort during
treatment. Using a chemotherapeutic as the lavage/cooling
agent can help reduce bacterial loads in the depths of pockets
and periodontal niches that are the most difficult to access.
Therefore, a device with the ability to introduce a chemotherapeutic lavage during instrumentation offers antibacterial
benefits not available during manual scaling, which would
OCTOBER 2014
require a separate step for the application of chemotherapeutics. An ultrasonic unit that enables the clinician to easily
change between solutions used for irrigation to select the appropriate agents for the patient or even site-specific situation
is therefore also beneficial (Table 1).16
Selecting a unit that offers a well-directed flow of the
solution being used with bright illumination from an LED
light incorporated into it results in improved visibility of
the site (Fig. 5). Using optimal illumination, the tissue can
be gently retracted and the light positioned to illuminate
deep into the pocket. This has the potential to reduce
the time required for instrumentation and to improve
outcomes by enhancing accuracy of instrumentation.
Bright and properly-aimed illumination can enhance the
clinician’s ability to visualize the treatment site to assist in
TABLE 1. Partial list of the benefits of piezoelectric
ultrasonic instrumentation
Slimmer tips result in less tissue distension
Reduced force required
Calculus can be instrumented from the coronal aspect
Coronal insert application reduces tissue distension
Less potential for gagging due to limited lavage
requirements
Limited coolant requirements reduces stimuli reaching
exposed dentin
Reduced chairside time
Ability to control the temperature of the solutions irrigating
and lavaging the treatment area
Ability to deliver appropriate antimicrobial agents while
debriding the root/tooth structure
Enhanced visualization with the ability to illuminate the area
being treated
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DENTAL LEARNING
enabling the appropriate amount of scaling of the treatment area and reduce the chances of either over- or
under-instrumenting the root surface. Enabling the correct
amount of instrumentation will enhance the patient’s comfort both during the procedure and postoperatively, and
help ensure improved outcomes.
Additionally, the ability to control and adjust the power
and irrigation flow during the procedure without interruption improves the practitioner’s efficiency and augments
his/her ability to stay focused on the patient’s care and
treatment, rather than on the instrument. This control can
easily be obtained in utilizing quality piezoelectric ultrasonic
units with foot pedals that control the power and water vs.
devices that require the clinician to stop and turn to adjust
knobs which interrupts the treatment process workflow.
Ergonomic Considerations
Ultrasonic scaling minimizes the need for the clinician
to place his/her fingers and thumb in positions that cause
strain and fatigue.17 Given the prevalence of musculoskeletal
occupational injuries (including carpal tunnel syndrome)
that are related to dental and dental hygiene procedures,
attention to ergonomics is essential. By having and utilizing
appropriate tips and techniques, pivoting of the wrist can
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be minimized with ultrasonic scaling. Less force, movement
and muscle activity are also required than with manual
scalers, further reducing the risk of occupational injury. An
appropriate posture with use of loupes further improves
ergonomics and reduces the risk of occupational injury
(Fig. 6). Carefully assessing the anatomy and access when
selecting the most appropriate tips optimizes the number
required, by ensuring that the inserts offering the easiest
safe and effective access at a given clinical site are used. This
reduces the time required since fewer stops are necessary to
change out tip designs, reducing fatigue. Typically, at least
three different tips are required when treating a quadrant or
more. Ultrasonic inserts with silicone grips or dimpled grips
that are placed over the handpiece area are available for
magnetostrictive and piezoelectric ultrasonic inserts – these
make holding the scaler insert more comfortable and reduce
pinch force and vibration, resulting in less fatigue. As mentioned before, having LED lights incorporated into ultrasonic scaling also improve ergonomics by providing excellent
visualization where it is needed – the clinician is less likely
to bend in awkward positions in an effort to adequately see
the site. Using a foot pedal to vary the power as well as the
Table 2. Attributes of ultrasonic scaling contributing
to improved ergonomics
Less time required than hand scaling
Less force required than hand scaling
Built-in LED lighting
Foot controls
Insert selection
Removes need for awkward thumb/finger grips
Figure 5. LED illumination of periodontal pockets
6
Silicone and dimpled grips
VOLUME 3 | ISSUE 1
Current Trends in Ultrasonic Therapy
lavage used lets the clinician focus, again without the need
for the clinician to change his/her body position to adjust
knobs or dials as would be the case with the device having
the controls on the countertop (Table 2). Since considerably
less time is required with ultrasonic scaling,10 this results
in ergonomic benefits for the clinician. A more ergonomic
procedure is also likely to result in less fatigue and reduced
treatment time (a benefit to the practice and the patient).
Selecting and Using Ultrasonic Tips
Selecting multiple ultrasonic insert tips improves instrumentation and efficacy – units with more choice give
the clinician the ability to customize insert use for a given
site. Typically, wider diameter inserts are used first for the
removal of gross calculus deposits, followed by instrumentation with narrower inserts. Narrow, slim ultrasonic inserts
enable access to furcations and other periodontal regions
that would otherwise be difficult or impossible to access.
Deep pockets harbor the highest load of periodontal pathogens yet, paradoxically, manual scalers are wider than the
base of many periodontal pockets and the slimmest Gracey
curette is still wider than the access to some furcation sites
and therefore not able to adequately instrument the site.18
Narrow ultrasonic inserts enable deeper instrumentation,
Figure 6. Ergonomic posture and use of loupes
OCTOBER 2014
more consistently access to the base of deep pockets, and
improve debridement of deep pockets which can be expected to improve treatment outcomes.9,19,20 Slimmer ultrasonic
inserts minimize tissue distension and associated patient
discomfort.
Safe Use
When used incorrectly, manual and ultrasonic scalers can cause iatrogenic root damage including gouging,
riffeling and rough surfaces that then provide rough sites
encouraging recolonization and growth of biofilm following periodontal therapy. Choosing appropriate ultrasonic
inserts and using the correct technique minimizes the
potential for root damage – care should be taken to avoid
using excess force, and slimmer inserts are gentler on root
surfaces than wider inserts.21,22 Inserts must also be aligned
correctly against the tooth surface to avoid damage to the
root surface (Fig. 7); piezoelectric units will sound different if they are incorrectly aligned, alerting the clinician to adjust the tip’s angulation. Care should always be
taken to avoid using the tip of inserts pointed at the tooth
surface, and inserts should be replaced when they show
signs of wear as their efficacy then decreases and there is
an increased risk of root surface damage. Adequate lavage
Figure 7. Correct placement of ultrasonic tip
7
DENTAL LEARNING
TABLE 3. Attributes of ultrasonic scaling benefitting
instrumentation and safety
Narrow, slim inserts aid access to pocket depths and
furcations
Slimmer tips preserve tooth tissue
All surfaces of ultrasonic inserts may be used
More efficient than hand scaling
Inserts provide for cavitation and lavage
Require for less coolant with piezoelectric increases visibility
and reduces the potential for bacterial aerosol
Timely replacement of worn tips
Piezoelectric units alert the user to incorrect insert alignment
for cooling and irrigation is essential to avoid heat-related
pulpal and periodontal damage – piezoelectric units result
in less temperature change and therefore require less coolant than magnetostrictive scalers, thereby also reducing the
potential amount of bacterial aerosol produced during the
procedure (Table 3).
Response to Treatment and Periodontal
Maintenance
Following standard nonsurgical periodontal therapy,
the patient must return for re-evaluation and life-long
periodontal maintenance visits which are typically every
3 to 4 months. Just as the host response and host factors
influence the onset and progression of periodontal disease, they also influence an individual patient’s response
to treatment.23 Recurrent periodontitis varies depending
upon risk factors, the level of home care (oral hygiene)
and professional maintenance following initial therapy. In
moderate to severe cases of periodontal disease, adjunctive
8
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therapy may be required and surgical intervention may be
indicated.
Summary
The need for efficiency and improved treatment outcomes is paramount for practice success, as well as the
patients we serve. Incorporating the appropriate treatment modalities, such as piezoelectric ultrasonic scalers,
into a clinician’s armamentarium enables the practitioners
to be highly effective in the initial phase of treatment in
the management of periodontal disease. By incorporating
minimally invasive and effective procedures with minimal
discomfort into the practice should lead to higher case acceptance and enhanced care, but more importantly better
overall health for patients with this extremely common
oral health condition.
References
1. Genco R, Offenbacher S, Beck J. Periodontal disease
and cardiovascular disease: Epidemiology and possible
mechanisms. J Am Dent Assoc. 2002;133(Suppl):14S-22S.
2. Genco RJ, Borgnakke WS. Risk factors for periodontal
disease. Periodontol 2000. 2013;62(1):59-94.
3. Albandar JM , Streckfus CF, Adesanya MR, Winn
DM. Cigar, pipe, and cigarette smoking as risk factors
for periodontal disease and tooth loss. J Periodontol.
2000;71(12):1874-81.
4. American Academy of Periodontology. Position Paper.
Epidemiology of Periodontal Diseases. J Periodontol.
2005;76:1406-19.
5. Lovegrove JM. Dental plaque revisited: bacteria associated with periodontal disease. J NZ Soc Periodontol.
2004;87:7-21.
6. Westfelt E. Rationale of mechanical plaque control. J
Periodontol. 1996;23(3 Pt. 2):263-7.
7. American Academy of Periodontology. Position Paper. Diagnosis of Periodontal Diseases. J Periodontol.
2003;74:1237-47.
8. Drisko CL, Cochran DL, Blieden T, Bouwsma OJ, Cohen
VOLUME 3 | ISSUE 1
Current Trends in Ultrasonic Therapy
RE, Damoulis P, et al. Position paper: sonic and ultrasonic
scalers in periodontics. Research, Science and Therapy
Committee of the American Academy of Periodontology. J
Periodontol. 2000;71:1792-801.
9. Socransky SS, Haffajee AD, Cignin MA, et al. Microbial
complexes in subgingival plaque. J Clin Periodontol.
1998;25:134-44.
10. Copulos TA, Low SB, Walker CB, et al. Comparative
analysis between a modified ultrasonic tip and hand instruments on clinical parameters of periodontal disease. J Clin
Periodontol. 1993;64:694-700.
11. Busslinger A, Lampe K, Beuchat M, Lehmann B. A comparative in vitro study of a magnetostrictive and a piezoelectric ultrasonic scaling instrument. J Clin Periodontol.
2001;28(7):642-9.
12. Jervøe-Storm PM, Semaan E, Al Ahdab H, et al. Clinical
outcomes of quadrant root planing versus full-mouth root
planing. J Clin Periodontol. 2006;33(3):209-15.
13. Apatzidou DA, Kinane DF. Quadrant root planing versus same day full-mouth root planing. I. Clinical findings.
J Clin Periodontol. 2004;31(2):132-40.
14. Petersilka GJ, Tunkel J, Barakos K, Heinecke A,
Häberlein I, Flemmig T. Subgingival plaque removal at
interdental sites using a low-abrasive air polishing powder.
J Periodontol. 2003;74(3):307-11.
15. Moëne R, Décaillet F, Andersen E, Mombelli A. Subgingival plaque removal using a new air-polishing device.
J Periodontol. 2010;81(1):79-88.
16. Reynolds MA, Lavigne CK, Minah GE, Suzuki JB.
Clinical effects of simultaneous ultrasonic scaling and
subgingival irrigation with chlorhexidine. Mediating influence of periodontal probing depth. J Clin Periodontol.
1992;19(8):595-600.
17. Sartorio F, Vercelli S, Ferriero G, D’Angelo F, Migliario
M, Franchignoni M. Work-related musculoskeletal diseases
in dental professionals. 1. Prevalence and risk factors. G
Ital Med Lav Ergon. 2005;27(2):165-9.
OCTOBER 2014
18. Bower, RC. Furcation morphology relative to periodontal treatment. Furcation entrance architecture. J Periodontol. 1979;50(1):23-7.
19. Shiloah J, Hovius LA. The role of subgingival irrigations
in the treatment of periodontitis. J Periodontol. 1993;64
(9):835-43.
20. Rateitschak-Pluss EM, Scahwarz JP, Guggenheim R,
Düggelin M, Rateitschek KH. Non-surgical periodontal
treatment: where are the limits? An SEM study. J Clin Periodontol. 1992;19(4):240-4.
21. Flemmig TF, Petersilka GJ, Mehl A, Hickel R, Klaiber
B. The effect of working parameters on root substance removal using a piezoelectric ultrasonic scaler in vitro. J Clin
Periodontol. 1998;25(2):158-63.
22. Jepsen S, Ayna M, Hedderich J, Eberhard J. Significant
influence of scaler tip design on root substance loss resulting from ultrasonic scaling: a laserprofilometric in vitro
study. J Clin Periodontol. 2004;31(11):1003-6.
23. Van Dyke TE, Sheilesh D. Risk factors for periodontitis.
J Int Acad Periodontol. 2005;7:3-7.
Webliography
American Academy of Periodontology. Position
Paper. Epidemiology of Periodontal Diseases.
J Periodontol. 2005;76:1406-19. Available at: http://
Accessed March 2014.
The Periodontal Disease Classification System of the
American Academy of Periodontology — An Update.
Available at:
http://www.cda-adc.ca/jcda/vol-66/issue-11/594.html.
Accessed March 2014.
Acknowledgement
The authors would like to acknowledge and thank Dr. Chris
Salierno for the images in Figures 2-4, and Elizabeth Nies,
RDH for the images in Figures 5-7.
9
DENTAL LEARNING
CEQuiz
1.The overall goal of initial nonsurgical periodontal therapy
is to __________.
a. disrupt and remove biofilm
b. remove calculus
c. remove debris and bacterial toxins
d. all of the above
2.__________ risk factors play a role in periodontal disease.
a.Environmental
b.Acquired
c.Genetic
d. all of the above
3.As biofilm travels deep down the root surface, __________ has
minimal influence on the disruption of subgingival plaque
quantity or its composition.
a. oral hygiene
b. nonsurgical periodontal therapy
c. the use of curettes
d. all of the above
4.During full mouth pocket charting as part of a comprehensive
periodontal examination, __________ must be probed and recorded.
a. 2 sites per tooth
b. 4 sites per tooth
c. 6 sites per tooth
d. any of the above
5. Radiographs __________.
a. are an essential component of the periodontal examination
b. enable assessment of alveolar bone loss
c. permit assessment of roots and the periapical region
d. all of the above
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Current Trends in Ultrasonic Therapy
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6. If incorrectly aligned, piezoelectric scalers will __________.
a.stall
b. sound different
c. cause a beeping sound from the unit
d. all of the above
7.In the United States, it has been estimated that __________ of
the population over the age of 35 experiences some form of
periodontal disease.
a.55%
b.65%
c.75%
d.85%
8.All __________ must be thoroughly debrided during nonsurgical
periodontal therapy.
a. root surfaces, including to the base of the pocket
b. furcation areas
c. periodontal niches
d. all of the above
9.Piezoelectric ultrasonic scalers provide for __________
movement of the scaler insert.
a.elliptical
b.circular
c.linear
d. directionally random
10.The results of several studies have shown __________ outcomes
when periodontal therapy is conducted in one versus more visits.
a.poorer
b. the same
c.improved
d. none of the above
VOLUME 3 | ISSUE 1
Current Trends in Ultrasonic Therapy
CEQuiz
11.Patient comfort may be improved using a piezoelectric
scaler due to _________.
a. reduced chairside time compared to manual scaling
b. the use of narrow, slim tips, which result in less tissue distension
c. lower requirements for lavage, which may reduce gagging
d. all of the above
16.After standard nonsurgical periodontal therapy, patients must
return for re-evaluation and life-long periodontal maintenance
visits, which are typically every __________.
a. 2 to 3 months
b. 3 to 4 months
c. 4 to 6 months
d.year
12.Incorrect use of manual and ultrasonic scalers can cause
__________.
a. gouging of the root surface
b.riffeling
c. a rough surface
d. all of the above
17.With piezoelectric scalers, __________ of the tips may be used.
a. all surfaces
b. only the lateral surfaces
c. only the middle area
d. none of the above
13.Silicone grips that fit over the handpiece portion of
ultrasonic scalers __________.
a. reduce vibration
b. provide a fat grip for the clinician
c. are ergonomically friendly
d. all of the above
18.Moderate requirement for lavage/coolant __________.
a. helps to improve visibility
b.reduces the need for breaks to suction more than the saliva
ejector can handle
c.improves patient comfort
d. all of the above
14.The availability of __________ helps the clinician reach
difficult-to-access areas.
a. ultrasonic scaler slim tips
b. periodontal curettes
c. universal hand scalers
d. all of the above
19.Time savings for ultrasonic scaling versus manual scaling can
be up to __________.
a.one-half
b.one-third
c.three-quarters
d. none of the above
15.Air polishing __________.
a.may aid the clinician in debriding deep pockets at interdental sites
b.is perceived by patients to cause less discomfort than hand
scaling
c. requires less time than hand scaling
d. all of the above
20.The ergonomics of ultrasonic scaler units is improved by
__________.
a. foot pedals rather than manually adjusted knobs
b. the incorporation of LED lighting
c. the ability to scale without awkward thumb and finger grips
d. all of the above
OCTOBER 2014
11
Current Trends in Ultrasonic Therapy
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QUIZ ANSWERS
1.Describe the prevalence and etiology of periodontal disease;
2.Review the components of a full mouth periodontal examination;
3.Delineate the considerations involved in the use of piezoelectric ultrasonic scalers; and
4.List and describe the attributes that contribute to time savings, efficacy, safety and ergonomics.
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VOLUME 3 | ISSUE 1