A Blended Approach

Q: based on your experience, how many clinicians do you think are using power-driven devices, such as ultrasonic and Ultrasonic Scalers?
When I talk about the ultrasonic scaler, I usually ask the audience how many operators are using the ultrasonic scaler. Interestingly, when I started teaching in the early 1990s, the audience was about 50 percent, and now it’s almost 100 percent. Since the mid-1980s, the inclusion of ultrasound machines in dental hygiene has become part of the oral health curriculum. I estimate that the average number of clinicians using a power-driven instrument is 75 percent. In the future, it will be 100%. The late adopters were dentists and dental hygienists who were thought to be short cuts when using ultrasound, not as effective as using hand tools. Late adopters may not be aware of the new research and innovation in ultrasound insertion, allowing the gingivius to go under the gum without a root surface injury.
Do most clinicians use a combination of manual and power-driven scalars?
Mixing tool selection is the most popular option for dental programs, oral health programs, and periodontal programs.
This trend is moving towards a more power-driven scaler. In fact, several authors suggest using ultrasound machines to perform all the invasive procedures, such as Holbrook,1 Kwan,2 and Mooney. Drisko’s review article discusses the plight of hand and power-driven scalds. Using hand tools can lead to greater operator fatigue and greater bone removal, which can lead to a surface sensitivity and damage to the root surface.
Is there any research showing that the power driven scalars are more effective than the manual ones?
The 2003 Periodontology 2003 symposium cited three studies comparing manual and machine-driven instruments. There was no significant difference to detect bleeding, increase in clinical attachment level or decrease in depth. One of the studies comparing acoustic instruments with manual instruments found that manual instruments were slightly better at detecting depths of 6 mm or more. In the evidence-based workshop, the conclusion was that both manual and mechanical instruments were “effective in improving the clinical parameters associated with periodontal health.”
Q: what is the effect of the subgingivil lavage in combination with the dynamical calibration device?
Unfortunately, the evidence-based workshop did not cite any research linking subgingival irrigation with dynamic scaling. In 2003, the annals of periodontal disease studied the use of subgingiva as an aid to artificial instruments. This combination has no advantage in improving periodontal health.
Q has a power driven scaler, for example, the speed of sound, magnetostriction, piezoelectric, which is proven to be more effective than the other. Okay?
No research has shown that a power driven scaler is superior to the other. Recently, Busslinger et al., in a study in the journal of clinical periodontal disease, compared the magnetostrictive ultrasonic scaler, the piezoelectric ultrasonic scaler and curette. The conclusion is that all three instruments can be tested for a non-calculi root surface.
Based on current research, what recommendations you make to clinician when deciding whether to use a hand or power instrument.
Based on the research I am familiar with, I strongly recommend using ultrasonic knife with hand instrumentation. The order of the instrument for scaling and planing includes the insertion of a standard size of ultrasound into the gross weight. This eliminates the accumulation of gingiva and under the total gingival and provides water lavage. Washing water can improve your eyesight and reduce bleeding. After a thorough debridement of the standard size, the root surface should be explored using the curettes in a specific area, with a deep, tortuous pocket anatomy. The manual instrument produces a smear layer. Debris is moved to the lower surface of the gum, so after using the curette, ultrasound should be used on thinner inserts. This will provide a final smooth stroke and remove the smear layer. A study in Dragoo shows the benefits of improved ultrasound insertion, including the removal of the most calculus, leaving the smoothest root surface and deep into the pocket. This study compared the size of ultrasonic standard needle-tip size and ultrasonic modification of tip size and hand dental equipment.