The Blended Approach

Can ultrasound machines eliminate periodontal pathogens?
It is impossible to completely eliminate the oral pathogen from the mouth, at this point. Ultrasound or Ultrasonic Scaler is designed for the mechanical destruction of biofilm and the washing of bacteria.
The main question is whether we can eradicate or eliminate pathogens. In addition to the actinomycetemcomitans, studies have shown that the most common of local aggressive periodontitis is that the eradication of predictable oral pathogens in the mouth seems impossible
Does cavitation have a profound effect on pathogens?
A cavitation caused by a sonic or sonic scaler is not enough to kill bacteria. In 2000, Schenk et al2 published an article, research a lot of pathogens, and exposure to the magnetostrictive ultrasonic scalar, scalar sound velocity, and an ultrasonic cell division (used in laboratory for decomposing bacteria cells). On different ultrasound machines, periodontal pathogens are exposed to 150 seconds. This does not show a decrease in the number of bacteria counts in either the ultrasound or the ultrasonic scalar. Only effective cellular distractors can significantly reduce the number of bacteria. The findings support the idea that neither ultrasound nor sound instruments can be used in the mouth, killing bacteria. Their main function is to remove the biofilm and the tooth from the surface of the tooth.
Does acoustic microflow enhance biofilm interference?
One Khambay and Walmsley3 studied the efficacy of an ultrasonic scaler in the absence of water. They found that larger areas of water were cleaned when water was present than the ultrasonic scald that operated under dry conditions. The results show that the flow of acoustic microfluies-the flow of water at the tip of the instrument-may play an important role in the destruction of subgingivium biofilm. However, its role is limited to the perimeter of the instrument. In order to effectively remove the biofilm in clinical practice, the tip of the instrument must be exposed to every part of the root surface.
Reduce colonization
How fast is the recoloring of the biofilm under the subgingivium after the ultrasonic wave?
An older study focused on recolonization, focusing on the organic weight of bacteria. They found that after four to eight days, the number of bacteria (weight) increased again. Recent studies have shown that the pathogens of periodontal disease seem to be slow, so they are later colonized.
Early settlers, such as streptococcus and actinomyces, entered first, and then the periodontal pathogen entered. There are a number of bacteria that are beneficial to non-pathogenic bacteria. Teles et al6 shows that the risk of disease progression and adhesion loss is related to the number of gingival porphyrins and a. actinomycetemcomitans. Reducing the number of bacteria and slower recolonization of certain bacteria are the main clinical methods available now.
Q: in the debate between ultrasound and manual devices, do you believe that one is more effective than the other?
There are two systematic reviews, 8 for direct comparison. They all concluded that there was no difference between the effectiveness of hand and ultrasound machines in reducing the detection depth and signs of gum inflammation. A machine driven instrument is more efficient than a manual instrument and requires about a third of the time.
The skill level of the doctor who performed the debridement should have more influence on the result than the method used. Calculus is about creating a good baseline for a smooth root surface and creating maintainable clinical conditions. If it leaves roughness on the root surface, it may be harder to maintain the periodontal health rather than starting with a smooth root surface. The key part of the effective instrument is the biofilm removal.
Under gingiva, it can be reduced by as much as 90% to 99% of the bacteria under the gum. However, if the skill level of practitioners is substandard, this may be different.
Q: how about biofilm removal if residual stones or roughness are found on the root?
In fact, it’s impossible to completely eliminate calculus, which makes it a grey matter, not black and white. There is a clear correlation between the number of pathogens under the gum and the risk of periodontal disease. The risk of disease progression increases when the level of gingivitis or actinomycetes exceeds a certain threshold. As long as the number of bacteria is still below that level, it may be affected by various endogenous and exogenous risk factors, and in most cases periodontal conditions are stable.
Hybrid approach
Do you think ultrasonic dental supplies are most effective when combined with manual devices?
I think it depends on the preferences of the practitioners. These studies compared the machine-driven individual instruments with the manual instruments, and showed no difference. I think it’s a clinical judgment. Do you need one device to reach the end of the clinic or do you need another instrument? To achieve efficiency, I prefer to use a musical instrument throughout the mouth and then add a second instrument, only where I can’t get to the original instrument. I don’t think we have the data to support the manual instrumentation that is necessary for ultrasound or ultrasound in all cases.
Some clinical doctors think, if you can let the patient every 3 months to accept a low-energy ultrasound debridement, can keep germs, so in polished stone spikes are not harmful. Do you think it’s enough to control periodontal disease?
I think it’s a good clinical practice to remove all the calculus that can be touched, not just to polish it. The clinical outcome is important tissue healing and arrest of disease progression; Qingchuang is the means to achieve this end.