Dental supplies selection can have negative consequences. Incomplete debridement or burnished residual deposits are just a few of the adverse outcomes. Incomplete debridement occurs when, due to its size and contour, the UIT is unable reach the deposit location. A wide tip intended to reach a deposit located 5 mm subgingivally is not a wise choice. Likewise, a thin tip that is straight instead of curved is not a logical choice for proximal surfaces with deposits at the midline. A micro-thin UIT on low power used to remove tenacious deposits will result in burnishing. The UIT’s surface area and power are not sufficient to fracture the dense accumulation; therefore, undetected smooth, flat deposits remain.
Using the incorrect UIT can also cause discomfort or pain due to lack of adaptability or the need to increase power settings to obtain results. Also, using a wide UIT for subgingival applications vs a thin UIT could result in more root surface removal than necessary. This unintended removal could lead to post-operative sensitivity and/or interfere with long-term healing because the roughness and defects will attract further biofilm accumulation. Choosing the incorrect UIT can also encourage poor working posture when clinicians try to adapt a UIT to the anatomy. Inefficiency and compromised outcomes may also result.
The use of more than one UIT during debridement is desirable because, in most situations, many needs are present. For example, the use of multiple UITs is necessary to remove heavy tenacious localized supragingival and generalized fine subgingival deposits. For patients with light supragingival deposits who need moderate localized subgingival removal in the posterior sextants, large supragingival designs, large subgingival types, and thin subgingival UITs of varying shapes might be incorporated. For periodontal maintenance, subgingival UITs are indicated with straight, right, and left designs. Depending on pocket depth and tissue tone, straight, right, and left UITs with thin diameter shanks are appropriate. The shank length can be short, long, or longer to reach the epithelial attachment.
Case Study 1. A patient presents with generally healthy gingiva, localized bleeding on probing, and gingival inflammation and 4 mm pocket depth on first molars. Bone loss is not detectable; therefore, gingivitis is present. Deposits are light to moderate and not dense. In addition, the maxillary laterals have been replaced with titanium implants. For prophylaxis, precision thin right, left, and straight UITs will adapt to anterior and posterior teeth, as well as meet the needs of deposit removal and shallow pocket depth. A UIT with a soft tip could be used to debride the implants. Therefore, four UITs are needed for debridement. If the patient had dense moderate to large supragingival deposits in the mandibular anteriors, a standard UIT with a bladed or flat profile would be indicated. Neither a long shank nor a thin diameter UIT is appropriate for the anterior because of the tenacious nature of the deposits.
Case Study 2. A patient presents for initial periodontal therapy with generalized marginal and diffuse inflammation, bleeding on probing, generalized 4 mm to 6 mm pocket depth with mostly normal gingival contour, Class II molar furcations with a few adjacent to recession, and moderate to heavy tenacious deposits located marginally and subgingivally. Severe and moderate bone loss is revealed on radiographs. Initial debridement could be accomplished with a standard universal UIT. A precision thin UIT could easily cause burnishing at this stage of the debridement process. Next, a thin universal UIT indicated for moderate to heavy deposits used on moderately high power, not low power, could follow. Right, left, and straight UITs indicated for heavy deposits are another option, instead of a single universal. After determining the deposits have been fractured to small, fine pieces, micro-thin, long-shank UITs are indicated. Therefore, the right, left, and straight profiles are needed to meet the generalized needs of deposit removal, as well as the root anatomy. Ball-ended UITs could be added to finish the furcation areas—particularly where recession is present. At the reevaluation visit, diamond-coated UITs could be used for flat residual deposits discovered through endoscopy.
In both cases, hand dental equipment should be incorporated intermittently. With the first case, a sickle could be used if calculus is located below the contact area. In the second case, periodontal files might be incorporated at the beginning of the process and/or after initial debridement to fracture deposits and prevent burnishing. Hand-activated curets would also be appropriate for definitive calculus removal in the root contours where ultrasonic instrumentation is not as effective as the use of curved, bladed instruments.