The Effect of Dental Ultrasonic Scaler on Dental Restorations

Abstract

The ultrasonic scalers are today becoming the most chosen form of dental polishing and cleaning. With the various researchers and lab tests done on them, it is steered clear of any side effects or invasive methodologies that might harm the patient in any manner. It works both on the soft and hard oral tissues have become the most widely used cleaning instruments among dental practitioners. Ultrasonic scalers use its vibrating power to eradicate different forms of dental plague and foreign components from the teeth. Through various on-field experiments and lab tests, it was made sure that these ultrasonic scalers work much better than any other primitive method for the same task. And that’s the major reason why it is so much in demand, ultrasonic scaling has become widely used for professional tooth cleaning. The aim of the systematic review is to assess the role of ultrasonic scaling on dental restoration. A computerized literature search was performed in following database including: Pubmed, the Cochrane Library, Google Scholar and Scopus databases from 1st January 2000 till January 2022. Studies determining the impact of ultrasonic scaling on dental restorations including randomized controlled trials, prospective and retrospective studies, and cross-sectional studies were included. After an initial search a total of 570 articles were identified. Then, 44 studies which were full-text articles were critically reviewed by independently for eligibility. Finally, 10 studies which met all the inclusion criteria were included in the review. The findings showed that out of all of the elements used, we can observe that the glass ionomers have had the chances of greater impacts. Further studies should assess the method of polishing for the removal of discolorations from ceramic restorations after ultrasonic scaling procedures and the possible side effects of polishing.

Full text

Citation: Deema Kamal M Shukri et al (2022). The Effect of Dental Ultrasonic Scaler on Dental Restorations. Saudi J
Oral Dent Res, 7(8): 201-207.
201
Saudi Journal of Oral and Dental Research
Abbreviated Key Title: Saudi J Oral Dent Res
ISSN 2518-1300 (Print) | ISSN 2518-1297 (Online)
Scholars Middle East Publishers, Dubai, United Arab Emirates
Journal homepage: https://saudijournals.com
Original Research Article
Dental Research
The Effect of Dental Ultrasonic Scaler on Dental Restorations
Deema Kamal M Shukri1*, Dala Jumah Alturaif1, Laila Mohammed Alanazi1, Alwaleed Talal Alanazi1, Riyadh Ahmed
Almalki2, Dawi Hamed S Alrashidy3, Abdullah Mohammed Gusti4, Hassan Waleed S Khan5, Nadia Aqeel Alanazi5, Hani
Abdulaziz Al Qataberi6
1General Dentist, Saudi Ministry of Health
2Dental Intern, Taif University
3General Dentist, Private Clinic
4General Dentist, Saudi Ministry of Defense
5General Dentist, Ministry of Health
6Periodontist, Ministry of Health
DOI: 10.36348/sjodr.2022.v07i08.003 | Received: 12.07.2022 | Accepted: 16.08.2022 | Published: 21.08.2022
*Corresponding author: Deema Kamal M Shukri
General Dentist, Saudi Ministry of Health
Abstract
The ultrasonic scalers are today becoming the most chosen form of dental polishing and cleaning. With the various
researchers and lab tests done on them, it is steered clear of any side effects or invasive methodologies that might harm
the patient in any manner. It works both on the soft and hard oral tissues have become the most widely used cleaning
instruments among dental practitioners. Ultrasonic scalers use its vibrating power to eradicate different forms of dental
plague and foreign components from the teeth. Through various on-field experiments and lab tests, it was made sure that
these ultrasonic scalers work much better than any other primitive method for the same task. And that’s the major reason
why it is so much in demand, ultrasonic scaling has become widely used for professional tooth cleaning. The aim of the
systematic review is to assess the role of ultrasonic scaling on dental restoration. A computerized literature search was
performed in following database including: Pubmed, the Cochrane Library, Google Scholar and Scopus databases from
1st January 2000 till January 2022. Studies determining the impact of ultrasonic scaling on dental restorations including
randomized controlled trials, prospective and retrospective studies, and cross-sectional studies were included. After an
initial search a total of 570 articles were identified. Then, 44 studies which were full-text articles were critically reviewed
by independently for eligibility. Finally, 10 studies which met all the inclusion criteria were included in the review. The
findings showed that out of all of the elements used, we can observe that the glass ionomers have had the chances of
greater impacts. Further studies should assess the method of polishing for the removal of discolorations from ceramic
restorations after ultrasonic scaling procedures and the possible side effects of polishing.
Keywords: Ultrasonic scaler, dental restoration, scaling, composite, ceramic, glass ionomer cement.
Copyright © 2022 The Author(s): This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International
License (CC BY-NC 4.0) which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use provided the original
author and source are credited.
INTRODUCTION
The surgical procedure used to remove any
foreign particles or plaque from our teeth and gums
includes a variety of processes like use of ultrasonic
waves, polishing the teeth surface with air-powder
polishes, and many other such systems [1]. The
common problems of stains or the yellowness of our
teeth can be managed through procedures like polishing
which is immensely effective. It can close tiny gaps
between our teeth and also work on making a more
beautiful smile [2]. To conduct procedures like
polishing various systems have been used. All these
systems have similar end results but what majorly
differs is the amount of time each one takes [3]. It is
observed that the system of ultrasonic scaler takes less
time that other methods and is also supported for being
the favourite method of most dentists because of its
simple use [4]. It works just fine as the other systems
and reduces the yellowness and stains on the teeth [5].
This system called the ultrasonic scaling system has
been a latest invention in the dental world and is now
considered an additional to the other previously used
conventional systems. This method is much preferred
nowadays because of 3 major reasons:
 These are very simple to use and easy to
execute.

Deema Kamal M Shukri et al; Saudi J Oral Dent Res, Aug 2022; 7(8): 201-207
© 2022 |Published by Scholars Middle East Publishers, Dubai, United Arab Emirates 202
 They cause minimum damage to the teeth
structure of the patient and also cause the least
pain.
 They work the best for cleaning the yellowness
of the teeth [6].
The ultrasonic scalers are today becoming the
most chosen form of dental polishing and cleaning.
With the various researchers and lab tests done on them,
it is steered clear of any side effects or invasive
methodologies that might harm the patient in any
manner. It works both on the soft and hard oral tissues
have become the most widely used cleaning instruments
among dental practitioners [7, 8]. Sadly, there is one
drawback of this system as it loses its competition to
piezoelectric scalers. They later have proven better in
the removal of tartar or hardened plague and also
working on sticky film bacteria that causes the gum on
the tooth to go loose. This is majorly the result of
unhealthy oral habits [8, 9]. Along with that, more
information about the ultrasonic procedure suggests not
to go for it if dentists believe that we need some sort of
refurbishments for our teeth. As this system has also
had negative feedbacks about increasing teeth surface
roughness after polishing [4, 5]. But blaming only the
system for its nature is not the absolutely right thing to
do. Other factors should also be considered before
forming a belief that ultrasonic waves do not give
satisfactory results. The other factors might include:
 The bonding or adherent system the dentist
uses.
 The location of the teeth.
 The closeness of the affected part to the root of
the teeth.
 Severity of the periodontal status [10].
If the severity of the issue is too high or if the
affected area of the teeth is too close to the root of the
teeth, using ultrasonic sounds can result in bigger, life-
staying issues like sensitivity, permanent discoloration,
or adverse change in the shape of the teeth. It is highly
important for the patient to note all these factors before
choosing to go for any sort of treatment.
Even with its numerous benefits and capacities, the
ultrasonic system also has a few negative sides. These
include:
 The ultrasonic vibrations may cause wear and
tear of the hard tissues of the teeth.
 It can roughen the already problematic surface
of the teeth [2].
 Tooth gaps may increase creating pain and
problems in the set of the teeth [13].
 Accumulation of hardened plague may
increase.
 May cause severe gum problems and gum
loosening.
 There are chances of teeth fall-out because of
the loosening of the gum [11].
 The teeth set might start looking worse [14].
Dental materials are used to fill teeth gaps,
unevenness and cavities. While there are different sizes
of particles used in these composites, it is common
sense to say that larger the particles, more the roughness
it causes. With smaller particles, also known as nano
composites, the roughness levels are reduced
accordingly [15]. Nano composites are reputed majorly
for their:
 Amazing cleaning abilities.
 Makes the teeth set look natural and white [16]
 Less pain to the patient.
 Particles ranging from 5.0- 120 nanometres.
 Makes the surface look glossy.
 Retains the smooth surface of the teeth for
longer times [16].
 Fills the teeth space without leaving any
micro-cavities [17].
The only negative feature of this procedure is
that it might cause degradation or can stain teeth after
about 6 months after completion. So whatever
procedure is used, it is necessary to make sure that we
maintain good oral hygiene in order to sustain its effect
for longer periods of time [2]. Ultrasonic scalers use its
vibrating power to eradicate different forms of dental
plague and foreign components from the teeth. Through
various on-field experiments and lab tests, it was made
sure that these ultrasonic scalers work much better than
any other primitive method for the same task. And
that’s the major reason why it is so much in demand
[18], ultrasonic scaling has become widely used for
professional tooth cleaning. Another negative claim
held upon this method is its possibility to
defunctionalize prosthetics used for oral care. Dentists
use prosthetic methodologies to improve the dental
structure, restore different missing parts or cavities of
our teeth. These prosthetics are generally made of
stainless metal or fibres. Now, if these sonic waves are
longitudinally used on teeth, there is a high chance of it
causing toxic reactions with the prosthetics, eventually
affecting the health. Zirconia, which is a ceramic
element also, used in diamonds, is one of the elements
used as teeth prosthetics. Ultrasonic vibrations can have
a comparatively worse impact on dental restorations
[18].
Therefore, the aim of the study is to determine
the impact of ultrasonic vibrations on the structural
integrity of dental restorations. This will help to provide
an effective understanding regarding the procedures for
future research.
Aim and Objectives
The aim of the systematic review is:
 To assess the role of ultrasonic scaling on
dental restoration.

Deema Kamal M Shukri et al; Saudi J Oral Dent Res, Aug 2022; 7(8): 201-207
© 2022 |Published by Scholars Middle East Publishers, Dubai, United Arab Emirates 203
 To understand the influence on the surface
roughness of the dental restoration
METHODS
The present review was prepared according to
the Preferred Reporting Items for Systematic Reviews
and Meta- Analyses statement [PRISMA Checklist
2009]
Literature Search
A computerized literature search was
performed in following database including: Pubmed,
the Cochrane Library, Google Scholar and Scopus
databases from 1st January 2000 till January 2022. The
keywords used to determine the relevant articles
included: ((((dental restoration) AND (ultrasonic
scaling)) AND (scale)) AND (restoration)) AND
(effect)
Eligibility Criteria
Inclusion and Exclusion Criteria
The full-text articles of the relevant studies
were obtained and reviewed by the reviewer
independently to ensure that the studies met the
inclusion criteria. The inclusion criteria were as
follows:
 Studies determining the impact of ultrasonic
scaling on dental restorations.
 Randomized controlled trials, prospective and
retrospective studies, and cross-sectional
studies.
 Full-text research studies that determined the
surface roughness on the dental restoration.
 In-vitro studies and in-vivo studies.
 Studies published in English language only.
The exclusion criteria were as follows:
 Review articles, commentaries, abstracts and
summary.
 Studies that included other prevention
modalities for periodontal maintenance except
ultrasonic scaling.
 Studies published in languages other than
English languages in order to prevent
translator bias.
Study Selection
References for textbook and selected articles
were screened to identify any relevant studies. The
author was independently involved in the process of this
study and extracted the necessary information. All
available titles and abstracts were identified and
scanned and their relevance to the study was
determined. When information from the title and
abstract was unclear in determining the paper's
relevance, full-text articles were thoroughly
investigated by the reviewer. Additionally, papers that
had cited these articles were identified through Science
Citation Index (http://www.isinet.com) to identify
potentially relevant subsequent primary research.
Data Extraction and Quality Assessment
Studies that fulfilled the inclusion criteria were
processed for data extraction. The main aim of the
systematic review is to determine the role of ultrasonic
scaling on the dental restoration. Therefore, the studies
were investigated for data extraction. The following
information was gathered to understand the role of
scaling: author, year, aim, results, summary and
conclusion.
RESULTS
Search and Study Selection
The process of retrieving and screening the
studies which were included for in this systematic
review. After an initial search a total of 570 articles
were identified. After screening the titles and abstracts,
only 210 were found to be relevant. The remaining
studies were excluded as some of them were duplicated,
irrelevant and others did not justify the inclusion
criteria. Then, 44 studies which were full-text articles
were critically reviewed by independently for
eligibility. Finally, 10 studies which met all the
inclusion criteria were included in the review.
Characteristics of Studies Included in the Review
The included studies were assessed on several
factors as mentioned in Table 1. The following
parameters were included: the author and year,
objectives, aim, results, summary and conclusion.
Table 1: The results of the study conducted
Author, year
Aim of the experiment
Findings
Conclusion
Reference
Erdilek, 2015
The effects of various levels and
variants of ultrasonic waves were
tested on different elements. These
included some like: nano-hybrid,
polyacid composites, regular glass,
ionomer cements. After testing the
effect of the waves on various
surfaces with diverse levels of
smoothness, it was seen that on
each of these elements, these waves
worked with the same effectiveness
thus making it clear that whatever
the type of roughness offered in the
Although both sonic and USS
exacerbated the tribological
properties of all gingiva material,
USS corrugated the substrates of all
control samples far beyond SS. As a
consequence, USS might have had a
serious effect on molar biomaterials,
particularly conventional ionomers.
According to this
experiment, the originator
highly recommends the
ultrasonic treatment and ends
his clause on the positive
note on this.
19

Deema Kamal M Shukri et al; Saudi J Oral Dent Res, Aug 2022; 7(8): 201-207
© 2022 |Published by Scholars Middle East Publishers, Dubai, United Arab Emirates 204
Author, year
Aim of the experiment
Findings
Conclusion
Reference
tooth structure, these waves would
function highly in each such
variety.
Shenoi et al.,
2014
Role of ultrasonic scaling and its
impact on the roughness of tooth-
colored restoration. This includes
Filtek Z 250 XT, GC 2, GC LC, and
GC 9
Surface roughness during pre-
instrumentation and post-
instrumentation was the greatest with
GC 2, and lowest with the Filtek Z
250 XT.
GC 2 LC restoration was
affected with the ultrasonic
scaling the most, while the
least susceptible restoration
was Filtek Z 250 XT
20
Babina et al.,
2021
To understand and analyze the
effects of ultrasounds and polishing
treatments on the rough the enamel.
The major components used are:
Premise, Herculite Ultra, and
Harmonize.
Substrate degradation to composite
materials varied depending on the
substance. Ultrasonic scaling had no
substantial effect on the premise
surface. Surface morphology of
frameworks that help and repair
margins was increased more by air-
powder buffing with both powders
than by supersonic scales.
Thoracic tooth hygiene
should be approached with
prudence. In the case of
restorations, laser scalability
and air-powder buffing
should be avoided if feasible.
21
Filho, 2008
After ultrasonic instrumentation, the
tensile fracture toughness of crowns
bonded with inorganic mineral
cement to natural teeth changed
The tensile bond strength was
significantly reduced after 15
minutes of heating and cooling and
ultrasonic instrumentation (p.05).
Recommendations such as
using ultrasonic instruments
sparingly, particularly in the
case of molars with metallic
restorations.
22
Eid, 2013
On four distinct types of regularly
used laminate ceramic restorations
for class V cavities, the impact of
ultrasonic scaling on machining
parameters and quantitative
bacterial count.
In compared to other varieties,
silicone caulk and segmentation
divides buyers composites had
significantly smoother surfaces and a
lower bacterial count, demonstrating
that microbial stickiness is directly
related to substrate ruggedness.
The interfaces of compound
ceramic restorations are
affected by the application of
ultrasonic scalers.
23
Sharon, 2021
Temporary cement remains are
commonly removed from tooth
structure using an ultrasonic down
sampling. The ultrasonic scaler's
impact on the sturdiness of the
foundation end of the race is a key
problem.
Following ultrasonic scaling, the
average change at the finish line area
was 71.5 24.6 m. Enamel and
chamfer finish lines had higher
modifications than tantalum and
scalpel blade.
The roughness value of the
majority of materials was
found to be more than 0.2
µm.
24
Lai, 2007
the effects of sonic and ultrasonic
scaling on the surface roughness of
five different types of restorative
materials commonly used in
cervical lesions
had disastrous effects on the surface
roughness of all test materials.
The roughness value of the
majority of materials was
found to be more than 0.2
µm.
4
Lee et al.,
2019
to analyze the potential of
ultrasonic waves on translucent
surfaces such as ones made of
ceramics. Some the elements used
were:
Lava Ultimate, Vita Enamic and
others.
This case showed critical differences
as it showed ways in which the
translucent elements lost their
properties.
The findings can aid
restorative dentists in the
selection of appropriate
materials and motivate
periodontists for performing
scaling procedures with due
consideration of restorations
in esthetically demanding
areas.
25
Nakazawa K,
2018
to access the impact of ultrasonic
scaling along with low-temperature
degradation on Zirconia.
At the end of the test, the
results showed that even
though the ultrasonic waves
do not impact the upper
strata or enamel formed with
Zirconia, it might not be
similarly beneficial to tackle
the virus as well.
26
Elmagd, 2019
Lithium disilicate glass ceramics
are used in this operation with the
same purpose of checking its
prominence to sonic waves.
The preservation of dilithium silicon
resins is affected by ultrasonic
scaling using a piezoelectric
ultrasound down sampling for one
minute under standard settings (the
angle here between tip and linoleum
substrate surface was 15°, at
maximum energy. and acceptable
cooling with distilled water).
It was majorly affected by
the waves. Also sustained as
unusable and definitely not a
substitute.
27

Deema Kamal M Shukri et al; Saudi J Oral Dent Res, Aug 2022; 7(8): 201-207
© 2022 |Published by Scholars Middle East Publishers, Dubai, United Arab Emirates 205
DISCUSSION
Scaling is a common oral treatment technique,
and thermoelectric instruments have become popular
for cleaning alveolar and central tooth regions [8]. On
enamel biomaterials, however, these procedures may
generate rough regions like as scuffs, and fractures [4].
Ultrasonic scalers used throughout the cervical margin,
in particular, can readily damage restorative surfaces
and margins, causing tooth enamel hypersensitivity and
consequent oral and dental complications. Plaque,
calcification, and microbial toxic metabolites are
removed from the dental and uncovered tooth structure
by ultrasonic scaling. Endodontists advise sonic scaling
every 6-12 months [28], however different molar
implants have a longer lifetime. Plaque and sediments
accumulate excessively in the anterior areas of the
teeth, uncovering the restorations to gingival treatment
[11]. Ripple effects of these scrubbing treatments
include an increase in the overall harshness of tooth
fibrous tissue and wound dressings. Exterior
discrepancies significantly raise available surface area
by 3 to 4 times, having provided an area of interest for
pathogens to adhere and expand, leading to a faster
hardened dental plaque and so more. Clarified that
bacterial adherence is approximately equal to surface
quality of the implants [11, 29].
Tensile modulus was not diminished by
ultrasound equipment for less than 10 mins; however, it
was reduced dramatically after 20 minutes. The
obtained consistent patterns, nevertheless the scientists
used shorter instrumentation durations in absolute terms
since such samples seemed to be much lesser [30].
Thermal cycling has also been associated to
deterioration in compressive interfacial adhesion in
specimens [31]. However, it appears that the majority of
iterations used are indeed a major consideration [31].
The discrepancy in the characteristic of temperature
dependence between dental, cement, and metallic base
generates discrete motions of these components, which
leads to breakdown of both the overlapping components
and, as a result, a loss in compressive interfacial
adhesion.
The substrates of laminate biomaterials are
affected by the application of ultrasound. With terms of
enamel in mind, it is always advocated that frequent
dental scraping be done with great caution, and that
polishing the scaled surfaces can help to overcome the
changes in roughness, minimizing additional cavities,
upper strata discoloration, hardening of the plague, and
consequent gum aggravation [23]. There is nothing to
hide when saying that all these lab experiments had
revealed a lot about how each of these composite’s
work. Out of all of the elements used, we can observe
that the glass ionomers have had the chances of greater
impacts [4]. They have major chances of increasing-
rough texture, definitely more than any other element,
so far tested. There are 2 basic reasons these could be
blamed upon. They are:
 It’s heterogeneous nature
 The fact that it is also biphasic.
 The compound has poly-salts which are
usually removed before using them and hence
what remains is the particles majorly of glass,
which do not react as expected [24, 25].
Now comparing this performance to the other
elements, it is seen that their performance is
comparatively better. These elements which have one or
two similar elements to ionomers, did not seem to react
like it. The level of roughness was quite low, thus
making these elements more suitable to sonic waves.
The modified ones were far better off than the
conventional ones in every aspect. Thus, it can be
claimed that the modified glass ionomers function
better in this respect [32]. The in vitro design is the
major limitation of this study. The effects of saliva,
accumulated mastication, and aging of the ceramic
materials may influence the results in actual clinical
conditions. Additional clinical studies are needed to
confirm the results of this study. In addition, further
studies should assess the method of polishing for the
removal of discolorations from ceramic restorations
after ultrasonic scaling procedures and the possible side
effects of polishing.
CONCLUSION
The conclusion to this discussion should be
more on a relative note. We believe that usage of
ultrasonic waves cannot be stopped or discarded. When
people today with more obese hygiene habits, are in
need of such rescue methods, dentists are left with only
one option. They need to take resort to some different
kind of composites for teeth filling and other such
procedures. Using these same composites will make this
argument even tougher and so, research must be done
on the same. When our oral beauty and hygiene
becomes a priority, we should keep no stone unturned
to make this a better experience for the users all
together.
REFERENCES
1. Yildirim, T. T., Oztekin, F., Keklik, E., & Tozum,
M. D. (2021). Surface roughness of enamel and
root surface after scaling, root planning and
polishing procedures: An in-vitro study. Journal of
Oral Biology and Craniofacial Research, 11(2),
287-290.
2. Gomes, I. A., Mendes, H. G., de C, R. C., Nina, M.
G., Turssi, C. P., Vasconcelos, A. J., ... & de Jesus
Tavarez, R. R. (2018). Effect of Dental Prophylaxis
Techniques on the Surface Roughness of Resin
Composites. The journal of contemporary dental
practice, 19(1), 37-41.
3. Mahiroglu, M. B., Kahramanoglu, E., Ay, M.,
Kuru, L., & Agrali, O. B. (2020, March).
Comparison of Root Surface Wear and Roughness
Resulted from Different Ultrasonic Scalers and

Deema Kamal M Shukri et al; Saudi J Oral Dent Res, Aug 2022; 7(8): 201-207
© 2022 |Published by Scholars Middle East Publishers, Dubai, United Arab Emirates 206
Polishing Devices Applied on Human Teeth: An
In-Vitro Study. In Healthcare (Vol. 8, No. 1, p.
55). MDPI.
4. Lai, Y. L., Lin, Y. C., Chang, C. S., & Lee, S. Y.
(2007). Effects of sonic and ultrasonic scaling on
the surface roughness of tooth-colored restorative
materials for cervical lesions. Operative
dentistry, 32(3), 273-278.
5. Mourouzis, P., Koulaouzidou, E. A., Vassiliadis,
L., & Helvatjoglu-Antoniades, M. (2009). Effects
of sonic scaling on the surface roughness of
restorative materials. Journal of Oral
Science, 51(4), 607-614.
6. Erdilek, D., Sişmanoglu, S., Gumustas, B. U. R. A.
K., & Efes, B. G. (2015). Effects of ultrasonic and
sonic scaling on surfaces of tooth-colored
restorative materials: An in vitro study. Nigerian
journal of clinical practice, 18(4), 467-471.
7. Apatzidou, D. A. (2012). Modern approaches to
non-surgical biofilm management. Periodontal
Disease, 15, 99-116.
8. Kawashima, H., Sato, S., Kishida, M., & Ito, K.
(2007). A comparison of root surface
instrumentation using two piezoelectric ultrasonic
scalers and a hand scaler in vivo. Journal of
periodontal research, 42(1), 90-95.
9. Ota-Tsuzuki, C., Martins, F. L., Giorgetti, A. P. O.,
de Freitas, P. M., & Duarte, P. M. (2009). In vitro
adhesion of Streptococcus sanguinis to dentine root
surface after treatment with Er: YAG laser,
ultrasonic system, or manual
curette. Photomedicine and Laser Surgery, 27(5),
735-741.
10. Tsurumaki, J. D. N., Souto, B. H. M., Oliveira, G.
J. P. L. D., Sampaio, J. E. C., Marcantonio Júnior,
E., & Marcantonio, R. A. C. (2011). Effect of
instrumentation using curettes, piezoelectric
ultrasonic scaler and Er, Cr: YSGG laser on the
morphology and adhesion of blood components on
root surfaces: a SEM study. Brazilian Dental
Journal, 22, 185-192.
11. Hossam, A. E., Rafi, A. T., Ahmed, A. S., &
Sumanth, P. C. (2013). Surface topography of
composite restorative materials following
ultrasonic scaling and its Impact on bacterial
plaque accumulation. An in-vitro SEM
study. Journal of international oral health:
JIOH, 5(3), 13-19.
12. Casselli, D. S. M., CASSELLI, H., & MARTINS,
L. R. M. (2013). Marginal adaptation of class V
composite restorations submitted to thermal and
mechanical cycling. Journal of Applied Oral
Science, 21, 68-73.
13. Kimyai, S., Pournaghi-Azar, F., Daneshpooy, M.,
Kahnamoii, M. A., & Davoodi, F. (2016). Effect of
two prophylaxis methods on marginal gap of Cl
Vresin-modified glass-ionomer
restorations. Journal of Dental Research, Dental
Clinics, Dental Prospects, 10(1), 23-29.
14. Freitas, F., Pinheiro de Melo, T., Delgado, A. H.,
Monteiro, P., Rua, J., Proença, L., ... & Mendes, J.
J. (2020). Varying the Polishing Protocol
Influences the Color Stability and Surface
Roughness of Bulk-Fill Resin-Based
Composites. Journal of Functional
Biomaterials, 12(1), 1.
15. Janiszewska-Olszowska, J., Drozdzik, A.,
Tandecka, K., & Grocholewicz, K. (2020). Effect
of air-polishing on surface roughness of composite
dental restorative material–comparison of three
different air-polishing powders. BMC Oral
Health, 20(1), 1-7.
16. Jandt, K. D., & Watts, D. C. (2020).
Nanotechnology in dentistry: Present and future
perspectives on dental nanomaterials. Dental
Materials, 36(11), 1365-1378.
17. Tunkel, J., Heinecke, A., & Flemmig, T. F. (2002).
A systematic review of efficacy of machine‐driven
and manual subgingival debridement in the
treatment of chronic periodontitis. Journal of
clinical periodontology, 29, 72-81.
18. Rezaei, N. M., Hasegawa, M., Ishijima, M.,
Nakhaei, K., Okubo, T., Taniyama, T., ... &
Ogawa, T. (2018). Biological and osseointegration
capabilities of hierarchically (meso-/micro-/nano-
scale) roughened zirconia. International Journal of
Nanomedicine, 13, 3381-3395.
19. Erdilek, D., Sişmanoglu, S., Gumustas, B. U. R. A.
K., & Efes, B. G. (2015). Effects of ultrasonic and
sonic scaling on surfaces of tooth-colored
restorative materials: An in vitro study. Nigerian
journal of clinical practice, 18(4), 467-471.
20. Shenoi, P. R., Badole, G. P., Khode, R. T., Morey,
E. S., & Singare, P. G. (2014). Evaluation of effect
of ultrasonic scaling on surface roughness of four
different tooth-colored class V restorations: An in-
vitro study. Journal of conservative dentistry:
JCD, 17(5), 471-475. doi:10.4103/0972-
0707.139845
21. Babina, K., Polyakova, M., Sokhova, I., Doroshina,
V., Arakelyan, M., Zaytsev, A., & Novozhilova, N.
(2021). The effect of ultrasonic scaling and air-
powder polishing on the roughness of the enamel,
three different nanocomposites, and
composite/enamel and composite/cementum
interfaces. Nanomaterials, 11(11), 3072.
22. Melo Filho, A. B. D., Mori, M., Jardini, M. A. N.,
Landim, K. T., & Solis, A. C. D. O. (2008). Effect
of ultrasonic instrumentation on the bond strength
of crowns cemented with zinc phosphate cement to
natural teeth. An in vitro study. Brazilian oral
research, 22(3), 270-274.
23. Hossam, A. E., Rafi, A. T., Ahmed, A. S., &
Sumanth, P. C. (2013). Surface topography of
composite restorative materials following
ultrasonic scaling and its Impact on bacterial
plaque accumulation. An in-vitro SEM
study. Journal of international oral health:
JIOH, 5(3), 13-19.

Deema Kamal M Shukri et al; Saudi J Oral Dent Res, Aug 2022; 7(8): 201-207
© 2022 |Published by Scholars Middle East Publishers, Dubai, United Arab Emirates 207
24. Sher, I., Sharon, E., Hendler, A., Ben-Gal, G., &
Beytha, N. (2021). The Effect of Ultrasonic
Instrumentation on Finish Line Integrity. J. Dent.
App, 7(1), 467-471.
25. Lee, J. H., Kim, S. H., Han, J. S., Yeo, I. S. L.,
Yoon, H. I., & Lee, J. (2019). Effects of ultrasonic
scaling on the optical properties and surface
characteristics of highly translucent CAD/CAM
ceramic restorative materials: An in vitro
study. Ceramics International, 45(12), 14594-
14601.
26. Nakazawa, K., Nakamura, K., Harada, A., Shirato,
M., Inagaki, R., Örtengren, U., ... & Egusa, H.
(2018). Surface properties of dental zirconia
ceramics affected by ultrasonic scaling and low-
temperature degradation. PloS one, 13(9),
e0203849.
27. Abo-Elmagd, A. A. A., & Mohammed, E. (2019).
Effect of Ultrasonic Scaling on Debonding of
Lithium Disilicate Glass Ceramic Laminate Veneer
Restorations Cemented to Tooth Structures: in
Vitro Study. International Journal of Dental
Sciences and Research, 7(2), 49-53.
28. Merin, R. L. (2007). Supportive periodontal
treatment. In: Newman MG, Takei HH,
Klokkevold PR, Carranza FA, (eds.). Carranza's
Clinical Periodontology. 10th ed. New Delhi
(India): Elsevier, 1194–205.
29. Ikeda, M., Matin, K., Nikaido, T., Foxton, R. M., &
Tagami, J. (2007). Effect of surface characteristics
on adherence of S. mutans biofilms to indirect resin
composites. Dental Materials Journal, 26(6), 915-
923.
30. Matsumura, H., Salonga, J. P., Taira, Y., & Atsuta,
M. (1996). Effect of ultrasonic instrumentation on
bond strength of three dental cements bonded to
nickel-chromium alloy. The Journal of prosthetic
dentistry, 75(3), 309-313.
31. Brown, W. S., Jacobs, H. R., & Thompson, R. E.
(1972). Thermal fatigue in teeth. Journal of dental
research, 51(2), 461-467.
32. McCabe, J. F. (1998). Resin-modified glass-
ionomers. Biomaterials, 19(6), 521-527.