Clinical Uses and Benefits of Ultrasonic Scalers as Compared to Curets: A Review

Abstract

Complete cementum removal is no longer a requisite. Many studies have demonstrated that hand and power-driven instruments are equally effective in reducing the probing depth, attaining attachment level gains and reducing inflammation by removal of plaque bacteria, calculus, and endotoxin. Power-driven instruments have many advantages over the manual scalers; however, further studies are needed to improve the performance of currently available instruments. These include the development of a more effective tip and ultrasonic generator unit. Long-term randomized controlled studies are also required to examine the efficacy of the newly designed scalers. These studies would help to provide treatment based on exact information regarding the instrument and technology.
Every instrument comes with its own disadvantages and advantages but when proper protocol is followed the instrument can be put to its best use for the comfort of the patient and the operator. The use of Ultrasonic in periodontal surgery definitely has benefits but the choice to use hand instrument or ultrasonic instruments depends solely in the manual skill, expertise and preference of the clinician.

Full text

108 JOHCD  www.johcd.org  May 2013;7(2)
Clinical Uses and Benefits of
Ultrasonic Scalers as Compared to
Curets: A Review
Chatterjee A1, Baiju CS2, Bose S3, Shetty SS4
Contact Author
Dr. Anirban Chatterjee
dranirbanchatterjee@yahoo.com
J Oral Health Comm Dent 2013;7(2)108-113
1Professor
Department of Periodontology and Implantology
Oxford Dental College and Hospital
Bangalore, Karnataka, India
2Professor and Head
Department of Periodontology and Implantology
Sudha Rustagi College of Dental Sciences and
Research, Faridabad, Haryana, India
3Post Graduate Student
Department of Periodontology and Implantology
Oxford Dental College and Hospital
Bangalore, Karnataka, India
4Post Graduate Student
Department of Periodontology and Implantology
Oxford Dental College and Hospital
Bangalore, Karnataka, India
ABSTRACT
Complete cementum removal is no longer a requisite. Many studies have demonstrated that hand and power-driven
instruments are equally effective in reducing the probing depth, attaining attachment level gains and reducing inflammation
by removal of plaque bacteria, calculus, and endotoxin. Power-driven instruments have many advantages over the
manual scalers; however, further studies are needed to improve the performance of currently available instruments.
These include the development of a more effective tip and ultrasonic generator unit. Long-term randomized controlled
studies are also required to examine the efficacy of the newly designed scalers. These studies would help to provide
treatment based on exact information regarding the instrument and technology.
Every instrument comes with its own disadvantages and advantages but when proper protocol is followed the instrument
can be put to its best use for the comfort of the patient and the operator. The use of Ultrasonic in periodontal surgery
definitely has benefits but the choice to use hand instrument or ultrasonic instruments depends solely in the manual skill,
expertise and preference of the clinician.
Keywords: Ultrasonic, Scaler, Curets, Periodontal therapy
REVIEW ARTICLE
INTRODUCTION
A myriad of new products have been
introduced that have revolution
ized periodontal therapy in the past
several years. Many of the recognized brand
names have survived the test of time, of-
fering the benefit of reducing hand and
wrist fatigue as well as tissue trauma. Com-
mon in today’s hygiene and periodontal
armamentarium is the sonic or ultrasonic
handpiece. Whether used only occasionally
or on a routine basis, most dental profes-
sionals are familiar with sonic or ultrasonic
technology in some capacity. With the utility
of the products that are available today, there
is no reason why every operatory should
not be equipped with this technology.
The sonic scaler operates at a low frequency
of about 3,000 to 8,000 cycles/second
(which is how many times the tip comes in
contact with the tooth). The sonic scaler is
air-driven, and the tip moves in an ellipti-
Journal of Oral Health
Community Dentistry
&
cal motion. The ultrasonic handpiece uti-
lizes either magnetostrictive or piezo-elec-
tric technology. Magnetostrictive inserts
operate at 25,000 to 30,000 cycles/second
and, like the sonic scaler, have an elliptical
motion. A low-voltage magnetic signal
causes tip movement. Piezo-electric tech-
nology operates at 28,000 to 36,000 cycles/
second. The tip moves in a back-and-forth
motion and works along the side of the
tooth, shaving off calculus and debris. Here
the handpiece, rather than the instrument
tip, is activated.
The use of ultrasonic devices has dramati-
cally improved the practice of supragingival
scaling and periodontal debridement. Al-
though ultrasonic technology has been
around for decades, improvements in re-
cent years have allowed its use to become
mainstream (1-4).
Ultrasonic technology in general, whether

JOHCD  www.johcd.org  May 2013;7(2) 109
magnetostrictive (long inserts with metal
rods that flex) or piezo-electric (small tips
that screw onto the handpiece), and sonic
scalers to a lesser degree, offer several ad-
vantages over hand scaling:
Less hand and wrist fatigue due to the
light touch necessary to merely guide
the scaler tip along the tooth surface
Decreased treatment time, especially
with heavy deposits, leaving more time
for patient education or procedures
such as placement of chemotherapeu-
tic agents (ie, arestin [orapharma],
atridox [collagenex pharmaceuticals], or
periochip [dexcel pharma]).
More efficient removal of dental plaque
and calculi with ultrasonic instrumen-
tation
Ultrasonic tip spray promotes elimina-
tion of dental plaque
Ultrasonic instruments rid the radicu-
lar surfaces of bacterial endotoxins
while preserving the cementum
Less tissue trauma due to no sharp cut-
ting edges
Water provides continuous tissue lav-
age, thereby reducing the need for rins-
ing during scaling, since the water flow
allows for high visibility throughout
the procedure; this lavage also increases
tissue comfort for the patient during
and after the procedure
Antiseptic solution can be substituted
for the water to provide simultaneous
irrigation/disinfection of the region be-
ing treated
Excellent for stain removal that may
otherwise be tedious to scale by hand
Gritty, pumice-based polish may no
longer be necessary or indicated follow-
ing scaling with ultrasonic; due to the
efficient stain removal during scaling, a
milder, minimally invasive paste or
polish can be used, preserving the glaze
on composite and porcelain restora-
tions; less abrasive polish enhances
patient acceptance and lowers post-scal-
ing sensitivity
less chance of operator injury:
Ultrasonic scaler inserts are not
sharp—there are no cutting edges
Seldom need to place tips in an ul-
trasonic bath prior to sterilization,
eliminating a step in the handling
process
Rarely need to scrub ultrasonic tips,
as is often necessary for conven-
tional hand scalers, further reduc-
ing the risk of operator injury
Hand instrument sharpening
greatly minimized due to minimal
usage
Patients experience a higher level of
comfort; the entire procedure is en-
dured more easily.
PIEZO-ELECTRIC TECHNOLOGY
With piezo-electric technology, achieving
ultrasonic mechanical vibration requires the
application of an electrical voltage to piezo-
electric ceramics. The ultrasonic energy thus
generated is transmitted via a transducer
contained in the handpiece and is pro-
longed by an amplifier. The resulting ad-
vantages of this mechanism include en-
hanced power control, greater patient con-
venience, and high transducer efficiency.
The axial transmission mode of mechani-
cal waves allows a more accurate approach
to fragile tissues. Furthermore, there is no
cumbersome cooling system necessary.
Piezo-electric scalers in particular have some
distinct advantages over many other con-
ventional ultrasonic units. In addition to
the previously mentioned benefits of ul-
trasonics in general, piezo-electric technol-
ogy offers the following:
Quiet operation
Less water is necessary during the pro-
cedure, adding to patient comfort and
operator convenience; less need for
management of excessive water accu-
mulation; less water is required because
the unit’s efficiency is greater than
90%—there is no delivered energy or
mechanical friction, hence, little second-
ary temperature rise; since there is very
little temperature rise, the handpiece can
be used without water. (However, use
of light water spray may be desirable,
as this will produce a cavitation or
physico-chemical effect.)
Less vibration
Small inserts—less cum-bersome to
operate, more accurate placement dur-
ing treatment, increasing patient com-
fort
Versatile ultrasonic units have numer-
ous clinical applications due to a com-
prehensive range of accessories; in ad-
dition to inserts for use in scaling and
debridement, many other inserts are
available for procedures such as peri-
odontics, apical surgery, and prostho-
dontics; dozens of various inserts are
offered that all fit on the same hand-
piece
LED curing light is available with some
units—much more convenient to as-
semble and operate than conventional
curing lights, saving time, money, and
space; the light simply attaches to the
unit in place of the piezo-electric hand-
piece; perfect for sealant curing in the
hygiene room as well as for restorative
materials
Lightweight handpiece and hose; easy
on the wrist
Can be used for virtually any class of
patient; great for routine prophylactic
procedures as well as periodontal scal-
ing and root planing; a wide range of
convenient, thin insert designs for all
possible scenarios
Small unit sits on counter; small foot-
print
Convenient, color-coded power dial on
some units—coordinates with colored
rings on inserts; no guessing at the ideal
power setting for each insert, as is some-
times the case with other ultrasonic
handpieces
Inserts for piezo-electric units are of-
ten interchangeable with other manu-
facturers
Easy, convenient barrier protection—
intraoral camera sheaths intimately fit
many piezo-electric handpieces; barrier
protection for the unit itself is provided
by simply placing a sheet of plastic wrap
loosely over the entire unit; with this
in place, the operator can adjust the
water and power setting and place the
handpiece in its holder without con-
taminating the unit, which minimizes
the use of surface disinfectant, which
would add time following the proce-
dure and risk damaging the unit
Handpiece and inserts are easily remov-
able and autoclavable
Piezo-electric inserts take up much less
space to store than hand scalers and
other dental instruments
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110 JOHCD  www.johcd.org  May 2013;7(2)
The use of state-of-the-art technology
helps to strengthen patient relations;
communicating with patients and edu-
cating them about the advantages of
the piezo-electric scaler is a practice
builder; patients feel more comfortable
throughout the procedure and confi-
dent that they are receiving the best
possible care.
The piezo-electric scaler is a staple in our
hygiene rooms. Hygienists in our office rave
about our new piezo-electric scalers and,
more importantly, patients are very com-
plimentary about how their mouths feel
after their maintenance visits. If you have
the desire to move into the world of elec-
tric scalers, or are ready to upgrade, give
considerable thought to the purchase of a
piezo-electric scaler. This technology will
stand the test of time. It is the ultimate in
ultrasonic scalers.
SONIC VS ULTRASONIC
Ultrasonic and sonic scalers appear to at-
tain similar results as hand instruments
for removing plaque, calculus, and endo-
toxin. Ultrasonic scalers used at medium
power seem to produce less root surface
damage than hand or sonic scalers. Due to
instrument width, furcations may be more
accessible using ultrasonic or sonic scalers
than manual scalers. It is not clear whether
root surface roughness is more or less pro-
nounced following power-driven scalers or
manual scalers. It is also unclear if root
surface roughness affects long-term wound
healing. Periodontal scaling and root plan-
ing includes thorough calculus removal,
but complete cementum removal should
not be a goal of periodontal therapy. Stud-
ies have established that endotoxin is
weakly adsorbed to the root surface, and
can be easily removed with light, overlap-
ping strokes with an ultrasonic scaler. A
significant disadvantage of power-driven
scalers is the production of contaminated
aerosols. Because ultrasonics and sonics
produce aerosols, additional care is required
to achieve and maintain good infection
control when incorporating these instru-
mentation techniques into dental practice.
Preliminary evidence suggests that the ad-
dition of certain antimicrobials to the lav-
age during ultrasonic instrumentation may
be of minimal clinical benefit. However,
more randomized controlled clinical trials
need to be conducted over longer periods
of time to better understand the long-term
benefits of ultrasonic and sonic debride-
ment (5).
Another review was presented by Baehni P
et al (1) where he suggested that sonic and
ultrasonic scalers should mainly be used
during initial therapy and their use is often
limited to the supragingival area. Subgin-
gival instrumentation is usually performed
with hand curettes. Recent literature shows
that clinical and bacteriological results ob-
tained after treatment of periodontal le-
sions with sonic or ultrasonic scalers are
similar to those observed following hand
curettage. In addition, recent ultrasonic scal-
ers allow irrigation with sterile or antiseptic
solutions. Finally, new inserts are better
designed for subgingival instrumentation.
Altogether, these observations give a new
dimension to these instruments.
POWER-DRIVEN VERSUS MANUAL
SCALERS
The literature is clear that periodontal thera-
pies aimed at altering the progression of
inflammatory periodontal diseases must
include meticulous subgingival mechani-
cal débridement during both the nonsur-
gical and the surgical phases of treatment
as the basis of most anti-infective therapy.
In the past, infection control was achieved
by the mechanical removal of subgingival
deposits of plaque, calculus, and endo-
toxin with curets, files, and hoes. Histori-
cally, it was also generally agreed that ag-
gressive scaling and root planing with hand
instruments was necessary to remove te-
nacious calculus deposits to produce roots
as smooth as possible for removal of the
endotoxins previously thought to be
deeply embedded into the root surfaces.
Based on current evidence in the literature,
it is now known that endotoxin is a weakly
adherent surface phenomenon and that
sonic and ultrasonic (power-driven) instru-
ments can be used to accomplish defini-
tive root detoxification and maximal
wound healing without overinstrumen-
tation of root and without extensive ce-
mentum removal. Power-driven scalers
may have unique advantages because of
the cavitational activity associated with ul-
trasonics thought to supplement removal
of root surface plaques. In addition, the
constant flushing activity of the lavage used
to cool the tips results in disruption of the
unattached and weakly attached subgingi-
val plaques. The ability to flush the pocket
during subgingival instrumentation with
water or other chemical irrigating solutions
is unique to ultrasonic and sonic scalers
and has been shown to enhance pocket
depth reduction and gain in clinical attach-
ment beyond that achieved with hand scal-
ing. The added benefit of chemical lavage
during ultrasonic instrumentation shows
great promise and may enhance the overall
effect of nonsurgical anti-infective peri-
odontal therapy. Other major advantages
of power-driven scalers may include better
access to difficult areas, such as deep nar-
row defects, root grooves, and furcations,
using newly designed microultrasonic tips,
which are smaller in diameter and able to
penetrate the pocket approximately 1 mm
farther than hand instruments. Taken to-
gether, it appears that use of ultrasonic or
sonic scalers for periodontal débridement
will result in improvements in clinical and
microbial parameters at a level equal to or
superior to hand scalers (6).
The working mechanism and the correct
use of ultrasonic devices is discussed in
another review. Comparative efficiency of
ultrasonic and hand instrumentation is
evaluated for the removal of subgingival
plaque and calculus, for the effect on root
surfaces and for the ability in removing
endotoxins. Possible side effects of the
ultrasonic vibrations on the tooth struc-
tures and periodontal tissues, the incidence
of bacteremias and the spreading of oral
infections via aerosols are stated. Particular
attention is given to the clinical results of
both instrumentation technics and the ne-
cessity of root planing. One can conclude,
that ultrasonics present an alternative and/
or a supply for hand instruments, provided
that a selective and careful use is taken into
account (7).
A systematic review of efficacy of machine-
CLINICAL USES AND BENEFITS OF ULTRASONIC SCALERS AS COMPARED TO CURETS: A REVIEW

JOHCD  www.johcd.org  May 2013;7(2) 111
driven and manual subgingival debride-
ment in the treatment of chronic
periodontitis.The purpose of this system-
atic review was to determine the efficacy of
machine-driven compared with manual
subgingival debridement in the treatment
of periodontitis.A literature search for con-
trolled clinical trials with at least 6 months’
follow-up comparing machine-driven in-
struments with hand instruments for the
treatment of chronic periodontitis was
performed up to April 2001. Screening of
titles and abstracts as well as data extrac-
tion was conducted independently by two
reviewers (J.T. and T.F.F.). As primary out-
come variable, the prevention of tooth loss
was used; secondary outcome variables
were the prevention of disease progres-
sion, the resolution of anatomical defects
and the resolution of gingival inflamma-
tion. Efficiency was assessed by mean time
needed to treat one tooth.From a total of
419 abstracts, 27 articles were included for
the review. The weighted kappa score for
agreement between the two reviewers was
0.77, 95% CI: 0.65-0.89, indicating sub-
stantial agreement. No study reported on
the selected primary outcome variables.
Using clinical attachment gain, probing
pocket depth reduction or bleeding on
probing reduction as outcome variables,
there appeared to be no differences between
ultrasonic/sonic and manual debridement.
No major differences in the frequency or
severity of adverse effects were found.
However no meta-analysis could be per-
formed on any of the previously men-
tioned parameters. Ultrasonic/sonic deb-
ridement was found to take significantly
less time, i.e. 36.6%, than debridement
using hand instruments (P = 0.0002, 95%
CI of the standardized effect estimate:
0.39-1.37, heterogeneity P = 0.77).With
respect to clinical outcome measures, the
available data do not indicate a difference
between ultrasonic/sonic and manual de-
bridement in the treatment of chronic peri-
odontitis for single-rooted teeth; however,
the evidence for this is not very strong. In
addition, ultrasonic/sonic subgingival de-
bridement requires less time than hand
instrumentation. Further research is needed
to assess the efficacy of machine-driven
debridement on multirooted teeth and
clinical outcome variables having tangible
benefit to the patients should be ad-
dressed(8).
PATIENT BENEFITS: WHY ULTRA-
SONICS?
The evidence is clear. Today’s clinician
knows how ultrasonic scaling advances
patient care. Since the landmark Drisko re-
view article of 1993, non-surgical periodon-
tal therapy has advanced beyond basic cal-
culus removal. Ultrasonic therapy in peri-
odontics now focuses on the etiology of
periodontal disease by disruption of bac-
terial biofilms and stimulation of the host
immune response (9).
In the American Association of Periodon-
tology position paper on ultrasonic scalers
(2000), the following statements were made
(10):
In general, the evidence suggests that
the disruption and removal of sub-
gingival biofilms (plaque) can be accom-
plished with powerdriven scalers at a
level comparable to manual scalers.
The lavage effect produced by the wa-
ter coolant used with power-driven
scalers provides a constant flushing ac-
tivity during instrumentation that ap-
pears to have some therapeutic effects
(11).
Ultrasonics are clearly superior in the
treatment of Class II and Class III
furcations when used by experienced
dental professionals. Based on these
observations and published studies,
sonics and ultrasonics may be the in-
strument of choice for scaling and root
planning furcations.
The bottom line: an ultrasonic scaler is one
of the single most important instruments
you have for improving the periodontal
hygiene and health of your patients.
CLINICAL BENEFITS
As a dental health care professional, you’re
concerned for your patients’ health and
comfort. Providing them the best care is
foremost on your mind. The Cavitron Plus
and Jet Plus systems provide a high level
of clinical efficacy. Our dynamic auto-tune
technology allows you to switch inserts as
often and efficiently as you do your hand
instruments. The handpiece attachment
enables unsurpassed oral access and tooth
adaptability enabling you to effectively uti-
lize curved inserts for superior debridement
in deep pockets and furcations.
As a clinician you’re also concerned with
repetitive motion disorders, and how they
can impact your career. Hand scaling is typi-
cal of the type of repetitive motion that
experts agree may lead to painful carpal-
tunnel syndrome. Our ultrasonic units re-
place the stress of hand scaling with a low-
amplitude high-frequency energy that’s ca-
pable of powering off even the most te-
nacious calculus with a “feather touch.”
PRACTICE BENEFITS
The newer set of ultrasonic instruments
offer several advanced features to improve
the ergonomics for the clinician. Good er-
gonomics in a dental practice are critical to
ensuring a healthy team and bottom line.
The new ergonomically-contoured 360°
foot control as well as the swivel cable at-
tachment on the handpiece reduce the po-
tential for work induced injuries.
Unique time-saving features help keep your
office working efficiently. The 30kHz is a
proven operating frequency for preventive
care ultrasonic scalers. The autoclavable Steri-
Mate handpiece and purge mode expedite
patient set-ups while offering a high level
of water quality and protection from cross-
contamination.
USE OF ULTRASONIC SCALERS
DURING PERIODONTAL SURGERY
Originally hand instruments were used for
debridement of supragingival and subgin-
gival plaque and calculus. During the sec-
ond half of the last century, electric and air
operated instruments were introduced,
which proved to be of great value to the
operator for obtaining optimal treatment
results. These mechanical scalers are now
available in sonic and ultrasonic versions.
The vibrations of the sonic tip that are
transmitted to the tooth surface are respon-
sible for the clearing effect. The term ultra-
sonic describes a range of acoustic vibra-
tions with a frequency above 20,000 vibra-
CLINICAL USES AND BENEFITS OF ULTRASONIC SCALERS AS COMPARED TO CURETS: A REVIEW

112 JOHCD  www.johcd.org  May 2013;7(2)
tions per second. Most of these instru-
ments work according to the
magnetostrictive or piezoelectric principle.
In many studies the effectiveness of pro-
fessional debridement is related to the abil-
ity to remove plaque, calculus and
endotoxins and to the degree of smooth-
ness of the treated tooth surfaces. After
reviewing the various studies, the limita-
tions of every analysis method should be
taken into account. Additionally, the type
of instrument, the tooth type, the anatomy
of root, the initial pocket depth, the pa-
tient’s cooperation and in particular the
manual skills. This hampers the compara-
bility of the results between the studies.
Advantages of Ultrasonics in periodontal
surgery:
Sonic and ultrasonic instrumentation
has the potential to make scaling and
root planning less demanding.
More time efficient.(3.9 minutes for
ultrasonic, 5.9 minutes for manual scal-
ing)
More ergonomically friendly.
Modified tip designs allow for im-
proved access in many areas, including
furcations.
New, slimmer, designs operate effec-
tively at lower power setting thus im-
proving patient comfort.
Absence of need to sharpen the tips
of power driven instruments.
 Better visibility due to lavage and con-
stant flushing mediated by acoustic
micro-streaming.
Easy to distinguish blood clots from
granulation tissue and loosens granu-
lation tissue.
Reduced root surface alterations and
dentin removal.
In 1984 Hunter and Kepic et al in 1990
showed that ultrasonic instruments are
not significantly different in removing
calculus with or without flap access.
Both studies showed ultrasonic instru-
ments to have slightly less residual cal-
culus than hand scaled specimens when
examined microscopically (12).
Recent studies have found ultrasonic
instruments more effective in remov-
ing endotoxins adhering to the root
surfaces (13,14).
Cavitation and acoustic microstreaming
phenomenon associated with ultra-
sonic are thought to have an adjunc-
tive effect on plaque and endotoxin re-
moval. (15,16).
Light strokes using ultrasonic instru-
ments rather than intentional cemen-
tum removal results in fibroblast reat-
tachment to previously diseased roots.
Wound healing studies have confirmed
that attachment gain and reduction of
gingival inflammation and pocket
depths can be achieved by thoroughly
removing, subgingival deposits with
meticulous light overlapping,stokes
with an ultrasonic scaler.
Cavitational activity supplements re-
moval of root surface plaques. Con-
stant flushing activity of lavage to cool
tips results in disruption of unattached
and weakly attached subgingival
plaques and granulation tissue.
Constant irrigation resulting in flush-
ing the pocket during instrumentation
with water or other chemical irrigating
solutions, is unique to ultrasonic scaler
and have been shown to enhance
pocket reduction to gain in clinical at-
tachment level beyond that achieved by
hand scaling.
Better access to difficult areas, such as
deep narrow defects, root grooves and
furcations, using newly designed mi-
cro ultrasonic tips,smaller in diameter
and able to penetrate 1mm father than
hand instruments.
Ultrasonic instrument are an unam-
biguous choice in scaling and root plan-
ning of mobile teeth.
Root planning with hand scalers pre-
dispose to many linear injuries and the
entire root surface is covered with a
smear layer.
Study by Guentech et al 2006 in Modi-
fied Widman Flap procedure when
compared with manual instrumenta-
tion resulted in less recession follow-
ing treatment and less trauma to soft
tissue during therapy.
Ultrasonic instrumentation is definitely
more patient friendly with less discom-
fort and pain.
DISADVANTAGES OF ULTRASONIC
It may produce thermal damage to
tissues(pulp and dentin)
Ultrasonic scaler is applied lightly to the
tooth surface to remove plaque and
calculus which may alter the topogra-
phy of tooth surface. Whether the sur-
face finish produced after ultrasonic use
is biologically acceptable for reattach-
ment of the periodontal tissues is still
in discussion.
Studies by Rischer and Eastm in 1992
point that cavitation may cause trauma
to blood vessels and accelerate the
blood coagulation system thus result-
ing in unwanted blood clots in the sys-
tem.
Vibrations of a wire at an ultrasonic
frequency will potentially damage eryth-
rocytes, leucocytes and platelets. It was
shown that hemolysis of heparinised
blood occurred with a wire vibrating at
20 KHz and the level of platelet dam-
age was dependent on the wire diam-
eter.
Ultrasound produce acoustic micro-
streaming fields around the scaling tip
.These shear forces produced are pow-
erful enough to damage the platelets.
Neurologic disturbances of hand
caused by vibrations, hearing loss and
interferences with cardiac pacemakers
(17).
“White Finger” is produced by large
amplitudes produced by pneumatics.
Aerosol produced by the in vivo use
of an ultrasonic scaler on periodontally
involved teeth was contaminated with
blood and that contamination occurred
regardless of inflammation.
This Aerosol production contaminated
with blood are of concern lately. Huntley
et al found a greater amount of aero-
sol contamination on the sleeves and
chest of scrub jackets with sonic and
ultrasonic scalers than with hand scal-
ers (18).
Miller et al found atrial and ventricular
pacing was inhibited by electromagnetic
interference produced by a
magnetostrictive ultrasonic scaler (19).
· Studies by Osteocagide FJ and Long
BA 1997 found that gracey curette were
more effective in debribing root
trunks,furcation entrance and furcation
areas of mandibular molars.
Ultrasonic instrumentation is accom-
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JOHCD  www.johcd.org  May 2013;7(2) 113
plished with light touch and light pres-
sure. However light stokes with a blunt
vibrating end may impair tactile sensi-
tivity and constant water spray ham-
pers visibility.
The usage of ultrasonics is contraindi-
cated in patients with respiratory dis-
eases.
Metal ultrasonic instruments are con-
traindicated in titanium implant pa-
tients which can be etched.
CONSENSUS
The ill effects /disadvantages of an ultra-
sonic instrument could be overcome by
proper use of the device during surgery.
To eliminate the problem of heating
effects,ultrasonic scalers should not be
used if the irrigate water flow below
20ml/min.
Cavitation can cause damage to platelet
which have the potential to cause pulp
death, although in vivo experiments
have shown no significant danger of
thrombosis.
Prolonged operation of an ultrasonic
scaler may cause disruption of blood
and nerve supplies to the operator fin-
gers, although the work is uncon-
firmed.
In order to reduce the hazards of aero-
sols, the equipment should be used in
conjuction with a pre-procedural anti-
septic mouth rinse and a high volume
evacuator and any high risk infective
patient should be treated by hand in-
struments.
The ultrasonic scaler may produce tem-
porary hearing shifts in the patient and
clinician, although there is no evidence
of permanent damage.
Magneto-strictive ultrasonic scalers
should not be used by clinician or pa-
tient with a pacemaker.
SUMMARY AND CONCLUSION
It is clear from the literature that scaling
and root planing play a pivotal role in the
elimination ofcausative factors of peri-
odontal disease throughout periodontal
therapy, including the nonsurgical, surgical
and maintenance phases. In the past, it had
been generally agreed that excessive root
surface removal by hand instruments was
necessary to remove the tenacious calculus
deposits. However, research over the past
years has shown that definitive root sur-
face detoxification can be achieved without
excessive cementum removal or aggressive
instrumentation.
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CLINICAL USES AND BENEFITS OF ULTRASONIC SCALERS AS COMPARED TO CURETS: A REVIEW