Combining Hand Instruments with Ultrasonics for Winning Outcomes in Dental Hygiene

By Rebecca Stone September 17, 2018

When oral biofilm is allowed to run roughshod over dental surfaces, it can spread subgingivally, triggering gingivitis and periodontal disease. To eradicate subgingival plaque and calculus, clinicians, typically dental hygienists, perform nonsurgical periodontal therapy (NSPT), usually in the form of scaling and root planing (SRP). Traditionally, the armamentarium for this procedure has consisted of hand instruments such as scalers and curettes.

Featuring designs that adapt to specific portions of tooth anatomy, these hand instruments are used for cleaning supra- and subgingival surfaces, rendering them smooth to discourage biofilm buildup. Some hand instruments are specifically engineered to address large deposits of calculus.

Ultrasonics vs. Hand Instruments

The use of ultrasonic scalers has continued to grow over the past few decades. Available in piezoelectric and magnetostrictive technologies, ultrasonic instrumentation involves the use of tips, or inserts, which, like hand instruments, are designed to accommodate various tooth surfaces. Larger tips may be used to obliterate heavy calculus deposits supragingivally, while finer tips may be used in subgingival debridement without inflicting damage to root surfaces.1Shaklee R. A blended approach. Dimensions of Dental Hygiene. 2006;4(4):26–27.

Used with the correct application of vertical and horizontal overlapping strokes, and with the correct tip, ultrasonic instrumentation reportedly can significantly lower bacterial load, reaching deep into pockets that may otherwise remain untouched by hand instruments.2Mann N. The blended approach to instrumentation. Dimensions of Dental Hygiene. 2016;14(11):45–50. They can also offer clinicians more effective removal of heavy calculus buildup, while improving ergonomics and reducing the risk of operator fatigue and repetitive motion injuries.3Shaklee R. A blended approach. Dimensions of Dental Hygiene. 2006;4(4):26–27. 4Roncati M. Non-Surgical Periodontal Therapy. Available at: Accessed August 24, 2018.

Dynamic Duo

In order to ensure oral health and put the breaks on periodontal disease, all traces of biofilm and calculus must be removed. Any lingering deposits will continue to irritate tissues and will quickly re-establish a foothold.5Mann N. The blended approach to instrumentation. Dimensions of Dental Hygiene. 2016;14(11):45–50.

By using a blended approach, dental hygienists are delivering more comprehensive care to their patients and achieving more successful results than ever before. In fact, increasing evidence supports the use of both hand and ultrasonic instrumentation in annihilating plaque and calculus — and ultimately periodontal disease. Each method has its strengths and weaknesses. But the two can complement each other, with one compensating for the other’s weak points.6Mann N. The blended approach to instrumentation. Dimensions of Dental Hygiene. 2016;14(11):45–50.

For instance, although recent studies show that both hand and ultrasonic instrumentation are equally effective scaling methodologies,7Mittal A, Nichani AS, Venugopal R, Rajani V. The effect of various ultrasonic and hand instruments on the root surfaces of human single rooted teeth: a planimetric and profilometric study. J Indian Soc Periodontol. 2014;18:710–717. the latter may be more effective in deep periodontal pockets, and gentler on tooth surfaces.8 Zarandi A, Poor YM, Mehr AK. Comparing effectiveness of two scaling methods: hand and ultrasonic instruments in patients with periodontitis disease. Int J Dent Sci Res. 2016;4:76–78. 9Graetz C, Plaumann A, Wittich R. Removal of simulated biofilm: an evaluation of the effect of root surfaces roughness after scaling. Clin Oral Investig. 2017;21:1021–1028. On the other hand, a hand scaler may be the way to go for patients who are sensitive to the temperature and volume of water produced during ultrasonic scaling.10Mann N. The blended approach to instrumentation. Dimensions of Dental Hygiene. 2016;14(11):45–50.

Safety Measures

Because ultrasonics produce water, — sometimes in abundance — this is all the more reason to use isolation devices and continual suction during instrumentation to cool operating temperatures.

Because hand instrumentation can result in chips of hard calculus going airborne, oral health professionals understand the value in protecting both clinicians and their patients with eye protection, isolation and suction. While rubber dams and saliva ejectors can do the job, systems such as Isolite offer the additional benefits of an easily placed mouthpiece that offers not only isolation, but continuous suction, illumination, and even a bite block for patient comfort. Such a system can come in handy particularly for those operating solo.

The benefits offered by the blended approach are no mirage. By using these complementary modalities, along with all the appropriate protections, clinicians are giving their patients — and themselves — the best care possible.