PERIODONTAL THERAPY Ultra sonic scaling

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1 PERIODONTAL THERAPY Ultra sonic scaling Dr.Erry Mochamad Arief USM School of Dentistry 1 july 2007 ultrasonic scaling yr dr erry 1

2 PERIODONTAL THERAPY Phase I therapy Started after diagnosis and treatment planning Removal all irritants that may contribute to gingival inflammation, Instructing and motivating patients in the performance of plaque control Maintenance phase All patients that undergo periodontal therapy should be place on maintenance phase. During maintenance phase patients return to dental clinic on scheduled basis for evaluation, periodontal instrumentation, and reinforcement of plaque control techniques performed at home. Phase II therapy This is surgical phase 1 july 2007 ultrasonic scaling yr dr erry 2

3 Principles and phases of treatment 1 july 2007 ultrasonic scaling yr dr erry 3

4 Neutral position 1 july 2007 ultrasonic scaling yr dr erry 4

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16 Patient position 1 july 2007 ultrasonic scaling yr dr erry 16

17 The patient s heels should be slightly higher than the tip of his or her nose 1 july 2007 ultrasonic scaling yr dr erry 17

18 Patient head: Chin up for maxillary area. Chin down for mandibular area 1 july 2007 ultrasonic scaling yr dr erry 18

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22 Ultrasonic scaling 1 july 2007 ultrasonic scaling yr dr erry 22

23 Possible burn by scaler tip movement on patient s oral tissue The rapid motion of all ultrasonic and sonic scaler tips can burn patient's tissue, some faster than others, even though the tip itself may not be hot. The majority of scalers tested (17 of 23, or 74%) can burn tissues within 3 seconds of touching the tip to the tissue. This serves as a warning to clinicians to constantly be moving the tip during scaling, especially when treating subgingival areas. Clinical Research Associates, july 2007 ultrasonic scaling yr dr erry 23

24 Sterilize before use As non-sterile handpieces, instruments may cause bacterial or viral infections, you must always clean, disinfect, sterilize the handpiece, instruments, file holders and inserts before or after treatment. 1 july 2007 ultrasonic scaling yr dr erry 24

25 Do not use dry Never use the instruments dry. If used dry, the tips of the instruments will heat instantly. This may cause thermal injury to the tooth. Ensure that adequate water is always available. 1 july 2007 ultrasonic scaling yr dr erry 25

26 EMS Electro Medical Systems Ultrasonic Piezon Systems 1 july 2007 ultrasonic scaling yr dr erry 26

27 Scaler tip A for supragingival P for supra and subgingival PS for interdental/interproximal and subgingival 1 july 2007 ultrasonic scaling yr dr erry 27

28 cleaning action Four different mechanisms acting in parallel: Mechanical stroke, Irrigation, Ultrasonification and Adjunctive antimicrobial therapy Ultrasonic lavage is combined therapeutic value of irrigation. ultrasonification, and antimicrobials. Ultrasonic treatment is effective for reducing pocket formation, took less time 1 july 2007 ultrasonic scaling yr dr erry 28

29 Contraindication Cardiac pacemaker Communicable diseases: HIV, hepatitis Pt at risk of respiratory disease, include, Immunosuppressed, Chronic pulmonary disease Porcelain or bonded restorations 1 july 2007 ultrasonic scaling yr dr erry 29

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40 Ultrasonic hazard The ultrasonic dental scaler is a useful instrument in the field of periodontology, but considerations need to be made when utilising it in the clinical situation. To eliminate the problems of heating effects, ultrasonic scalers should not be used if the irrigant water flow is below 20 ml/min. Cavitation can cause damage to platelets, which have the potential to cause pulp death, although in vivo experiments have shown no signifycant danger of thrombosis. Prolonged operation of an ultrasonic scaler may cause disruption of blood and nerve supplies to the operator fingers, although this work is unconfirmed.. 1 july 2007 ultrasonic scaling yr dr erry 40

41 Ultrasonic hazard To reduce the hazards of aerosols, the equipment should be used in conjunction with a pre-procedural antiseptic mouthrinse and a high-volume evacuator, and any highrisk infective patients should be treated with hand instruments. The ultrasonic scaler may produce temporary hearing shifts in the patient and clinician, although there is no evidence of permanent damage. Magnetostrictive ultrasonic scalers should not be used by clinicians or on patients with a pacemaker 1 july 2007 ultrasonic scaling yr dr erry 41

42 Suggested reading Fundamentals of Periodontal Instrumentation & Advanced Root Instrumentation, 5th Edition Jill S. Nield-Gehrig RDH, MS Position paper: Sonic and Ultrasonic Scalers in Periodontics, Journal Periodontology 2000:71; july 2007 ultrasonic scaling yr dr erry 42

43 Thank you 1 july 2007 ultrasonic scaling yr dr erry 43

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45 PL 1 and PL 2 instruments Are precisely formed for unparalleled, gently cleaning of root surfaces 1 july 2007 ultrasonic scaling yr dr erry 45

46 PL 3 instrument Is straight linear with a smooth, rounded surface on the tip. Perfect for deep pocket irrigation and root cleaning 1 july 2007 ultrasonic scaling yr dr erry 46

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