Win the Battle Against Biofilm: Leverage the Power of Ultrasonics

Transcription

1 1301 Smile Way York, PA Department of Clinical Education Win the Battle Against Biofilm: Leverage the Power of Ultrasonics COURSE DESCRIPTION This course is based on current scientific literature and evidence based strategies to give the clinician practical guidelines regarding the use of ultrasonic instrumentation for nonsurgical periodontal therapy. Ultrasonic instrumentation techniques will be covered extensively following the dental hygiene process of care and utilizing hands-on activities. COURSE GOAL The goal of this course is to enable the clinician to identify modifying factors related to nonsurgical periodontal instrumentation, manage patient discomfort appropriately, and improve ultrasonic instrumentation skills to facilitate thorough periodontal debridement and enhance treatment outcomes. COURSE OBJECTIVES Upon completion of this course, participants will be able to: Differentiate the advantages and limitations of the various technologies which drive power scaling units Compare and contrast the three E s of hand, sonic, and ultrasonic instrumentation techniques: effectiveness, efficiency, and ergonomics Discuss current research findings which demonstrate the clinical advantages/benefits of ultrasonic instrumentation over manual instrumentation Describe the technology of ultrasonics and define key terminology, including acoustic streaming, acoustical turbulence, cavitation, lavage, frequency, power and stroke pattern Identify and assess pretreatment considerations for the use of ultrasonic instrumentation to include patient s medical history, clinical indications, and contraindications Incorporate appropriate pain management techniques to improve patient comfort and efficiency during instrumentation Identify various modifying factors which influence and/or change instrumentation protocols such as root anatomy, furcations and oral conditions. List criteria for the appropriate selection of ultrasonic inserts, both standard and modified. Demonstrate the correct technique for utilization of the ultrasonic scaler to include insert and power selection, lavage flow, grasp, fulcrum, tip adaptation, and stroke OUTLINE: I. Evolution of Instrumentation for Nonsurgical Periodontal Therapy II. Assessment a. Medical History b. Periodontal Status c. Morphology III. Diagnose and Plan Instrumentation Approach IV. Implementation of Instrumentation Strategies a. Science of Ultrasonic Technology b. Ultrasonic Tip and Insert Designs c. Clinical Application of Ultrasonic Instrumentation V. Evaluation of Therapy VI. Ultrasonic Lavage DENTSPLY Professional 1301 Smile Way York, PA

2 Ultrasonics: An Evidence Based Approach to Nonsurgical Periodontal Therapy Assess Diagnose Plan Implement Evaluate Assessment Patient Assessment assessment of the patient s chief complaint, current periodontal and dental disease status Biofilm Assessment assessment of the quality and quantity of the biofilm present Morphology Assessment - assessment of the root morphology to include furcations, challenge areas and root adaptability Cementum Assessment assessment of the cementum at the location of the biofilm Diagnose American Academy of Periodontally Periodontal Classification, 1999, Web site: Gingival diseases Plaque induced Non-plaque induced Chronic periodontitis Aggressive periodontitis Periodontitis as a manifestation of systemic diseases Necrotizing periodontal diseases Abscesses of the periodontium Periodontitis associated with endodontic lesions Developmental or acquired deformities and conditions Nonsurgical Periodontal Therapy Periodontal debridement Lavage/Irrigation Sustained-release antibiotic/antimicrobial agent Remove iatrogenic biofilm retainers Concurrent dental therapy Periodontal Debridement Therapeutic interventions Scaling Root planing Root debridement Definitive or complete treatment Preparatory or initial therapy prior to surgery Instrumentation Approach Diagnostic instrumentation Ultrasonic periodontal debridement including lavage Evaluation - hand and/or ultrasonic Ultrasonic subgingival irrigation/rinse Plan Implement DENTSPLY Professional 1301 Smile Way York, PA

3 Choices in Hand Instrument Selection Area specific designs Terminal shank and working end length Variety of handle diameters Stainless steel, carbon steel, and hybrid steel Technique Terminal shank Work to base of pocket Engage 1/3 Apply lateral pressure Hand Instrumentation Ultrasonic Instrumentation Ultrasonic Technology Acoustic streaming Acoustic turbulence Cavitation Sonic technology Piezoelectric technology Magnetostrictive technology Frequency Power Forceful fluid flow Fluid moves in a swirling manner Bubbles implode creating a shock wave Compressed air runs handpiece to activate tip 2,500 to 7,000 cps Circular/elliptical movement All sides are active Electrical energy activates piezo-ceramic disks in handpiece 25,000 to 50,000 cps Linear movement Two active sides Electrical energy is applied to coils in the handpiece 25,000 to 30,000 cps Elliptical movement All sides are active Number of cycles (one complete stroke path) per second Frequency correlates to the active tip area Example: 30k = 4.2mm of active tip area Size of the stroke path As the power increases, the stroke becomes larger DENTSPLY Professional 1301 Smile Way York, PA

4 Ultrasonic Guidelines Magnetostrictive Standard Design Power Low to High Slim-diameter Design Power Low to Medium Perio Specialty Design Beavertail Heavy stain or calculus Straight Light calculus and/or deplaquing in pockets less than 4mm Furcation Furcation access Power Low to Medium Inserts Single bend Light to moderate calculus Modified / Curved Light calculus and/or deplaquing in pockets greater than 4mm Implant Implant care Power - Low Double bend Light to moderate calculus Triple bend Moderate to heavy tenacious calculus Dental Specialty Inserts 1. Endodontic canal debridement, cleansing, irrigation; for dental use only 2. Diamond Coat removal of tenacious calculus and soft tissue in surgical treatment settings; for dental use only Piezoelectric Standard Design Thin Design Tips Large scaling tips and bladed tips - tenacious calculus medium to high power light to moderate calculus medium power Furcation and deep periodontal pockets utilize on high power to remove calculus deposites from root surface and to prevent burnishing Specialty Tips 1. Thin Diamond Coated Tips ~ fine scaling and root planing in narrow furcations ~ can be utilized with Dental Endoscope for subgingival areas ~ low power 2. Furcation ball tips furcation areas ~ low power 3. Implant Carbon Composite Tip/ Restorative Margins Positioning Stroke Patterns Modified pen grasp and fulcrum Vertical or tapping motion for moderate to heavy calculus Horizontal or sweeping motion for light calculus and/or deplaquing Clinical Application Vertical Technique Oblique Technique Modified / Curved Design Technique Hand Instrument Evaluation Ultrasonic Lavage/Rinse Oblique for interproximal and contact areas Positioned like a probe Vertical or horizontal strokes Positioned like a hand instrument Oblique strokes Subgingival application in pockets greater than 4mm Assess with probe, explorer, and/or inactivated tip Water Chlorhexidine Povidone-iodine Other DENTSPLY Professional 1301 Smile Way York, PA

5 Bibliography Armitage, G. C. (1999, Dec). Development of a classification system for periodontal diseases and conditions. Ann Periodontol, 4(1), 1-6. Bower, R. C. (1979). Furcation morphology relative to periodontal treatment: Furcation entrance architecture. Journal of Periodontology, 50(1), Busslinger, A., Lampe, K., Beuchat, M., & Lehmann, B. (2001). A comparative in vitro study of a magnetostrictive and a piezoelectric ultrasonic scaling instrument. J Clin Periodontol, 28, Centers for Disease Control and Prevention. Guidelines for Infection Control in Dental Health-Care Settings MMWR 2003; 52(No. RR-17):[inclusive page numbers]. Daniel, S. J. & Harfst, S. A. (2002). Mosby s dental hygiene concepts, cases, and competencies. St. Louis, Missouri: Mosby, Inc. Darby, M. L. (2002). Mosby s comprehensive review of dental hygiene (5th ed.). St. Louis, Missouri: Mosby, Inc. Darby, M. (2003, February). Can we successfully maintain risk patients? International Journal of Dental Hygiene, 1(1), Drisko, C. L., Cochran, D. L., Blieden, T., Bouwsma, O. J., Cohen, R. E., Damoulis, P., Fine, J. B., Greenstein, G., Hinrichs, J., Somerman, M. J., Iacono, V., Genco R. J. (2000, November). Research, Science and Therapy Committee of the American Academy of Periodontology. Position paper: Sonic and ultrasonic scalers in periodontics. Journal of Periodontology, 71(11), Drisko, C. L. (1993). Scaling and root planing without over instrumentation: hand versus power-driven scalers. Current Opinion in Periodontology, Forrest, J. & Miller, J. (2004, Spring). The anatomy of evidence-based publications: article summaries and systematic reviews. Part 1. Journal of Dental Hygiene, 78(2), Hoang, T., Jorgensen, M. G., Keim, R. G, Pattison, A. M., & Slots, J. (2003, June). Povidone-iodine as a periodontal pocket disinfectant. J Periodontal Res, 38(3), Hodges, K. (1997). Concepts in nonsurgical periodontal therapy. Thomson Delmar Learning. Khatiblou, F. & Ghodssi, A. (1983). Root surface smoothness or roughness in periodontal treatment. Journal of Periodontology, 54(6), Lea, S. C., Landini, G., & Walmsley, A. D. (2006). The effect of wear on ultrasonic scaler tip displacement amplitude. Journal of Clinical Periodontology, 33, McInnes, C., Engel, D., & Martin, R. W. (1993, October). Fimbria damage and removal of adherent bacteria after exposure to acoustic energy. Oral Microbiology and Immunology, 8, McInnes, C., Engel, D., Moncla, B. J., and Martin, R. W. (1992, June). Reduction in adherence of actinomyces viscosus after exposure to low frequency acoustic energy. Oral Microbiology and Immunology, 7, Nield-Gehrig, J. S. (2004). Fundamentals of periodontal instrumentation & advanced root instrumentation (5th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. Nosal, G., Scheidt, M. J., O Neal, R., & Van Dyke, T. E. (1991, September). Penetration of lavage solution into the periodontal pocket during ultrasonic instrumentation. Journal of Periodontology, 62, Parameter on comprehensive periodontal examination. (2000, May). Journal of Periodontology, 71(Suppl.), Parameter on periodontitis associated with systemic conditions. (2000, May). Journal of Periodontology, 71(Suppl.), Parini, M. R., Eggett, D. L., & Pitt, W. G. (2005, November). Removal of streptococcus mutans biofilm by bubbles. Journal of Clinical Periodontology, 32(11), Parini, M. R. & Pitt, W. G. (2005, December). Removal of oral biofilms by bubbles: The effect of bubble impingement angle and sonic waves. Journal of the American Dental Association, 136(12), Pitt, W. G. (2005, October). Removal of oral biofilm by sonic phenomena. American Journal of Dentistry,18(5), Position paper: Diagnosis of periodontal diseases. (2003, August). Journal of Periodontology, 74(8), Position paper: Guidelines for periodontal therapy. (2001, November). Journal of Periodontology, 72(11), Reynolds, MA, Lavigne, CK, Minah, GE, & Suzuki, JB. (1992, Sept). Clinical effects of simultaneous ultrasonic scaling and subgingival irrigation with chlorhexidine. Mediating influence of periodontal probing depth. J Clin Periodontol, 19(8), Slots, J. & Jorgenson, M. (2002). Effective, safe, practical and affordable periodontal antimicrobial therapy: Where are we going, and are we there yet? Periodontol 2000, 28, Wilkins, E. M. (2005). Clinical practice of the dental hygienist (9th ed.). Baltimore, MD: Lippincott Williams & Wilkins. DENTSPLY Professional 1301 Smile Way York, PA