Many busy clinicians, regardless of specialty, are reaching for ultrasonic technology to improve their level of care. Today, dental practitioners need more than an explorer and a drill to provide patients with high-quality, efficient, minimally invasive, safe — not to mention comfortable — oral health care. So, it’s no wonder that ultrasonic instrumentation continues to gain traction in dental practices of all stripes.
Long a reliable tool of the dental hygienist’s trade for periodontal therapy, the efficacy of ultrasonic technology in removing dental plaque and calculus from tooth structure is no secret. But, increasingly, the technology is proving its mettle in other kinds of applications.11. van der Sluis LW, Versluis M, Wu MK, Wesselink PR. Passive ultrasonic irrigation of the root canal: a review of the literature. Int Endod J. 2007;40:415–426.22. Pullen RV. Innovations in endodontic cleaning and disinfection. Decisions in Dentistry. April 2018;4(4):37-42.33. Mozo S, Llena C, Forner L. Review of ultrasonic irrigation in endodontics: increasing action of irrigating solutions. Med Oral Patol Oral Cir Bucal. 2011;17:5512–e516.
Ultrasonic Technology and Endodontics
Endodontists, for instance, may use ultrasonics in the creation of access cavities, for canal location, removal of intracanal obstructions or posts, in root-end cavity preparation, to aid in the condensation of obturation material, and to agitate irrigants inside the canal through passive ultrasonic irrigation. While there is some evidence that sonic technology may be a safer alternative for use in canals, when performed with care, passive ultrasonic irrigation has been shown to clinically enhance cleaning and debris removal from the most obscure reaches of canal structure via cavitation and acoustic streaming.
Ultrasonic Technology and Oral Surgery
Oral surgeons appreciate the enhanced control and precise cutting offered by ultrasonic technology, which are also said to promote wound healing and bone tissue formation. These devices are beneficial in the course of implant placement, and may also benefit orthognathic procedures while reducing the risk of nerve damage. 44. Iwanabe Y, et al. The effect of low-intensity pulsed ultrasound on wound healing using scratch assay in epithelial cells. J Prosthodont Res. 2016;60:308–314. 55. Kokuryo S, et al. Comparison of the effects of ultrasonic and conventional surgery on the neurosensory disturbance after bilateral sagittal split osteotomy. J Oral Maxillofac Surg. 2018;76:1539–1545.
Selecting the Right Ultrasonic Technology
Ultrasonic technology is available in two iterations: magnetostrictive units, which operate via a magnetic signal, which causes their tips to move in an elliptical pattern at 18,000 to 45,000 cycles per second; and piezoelectric units, which operate via an electrically charged crystal, in a linear motion at a clip of 25,000 to 50,000 cycles per second.
Because they generate heat during operation, magnetostrictive units require the use of more water to keep temperatures in check than do piezoelectric units, which tend to run cooler. But all ultrasonics utilize water lavage, so during operation a significant amount of spatter and aerosolized contaminants can result. This may raise a red flag in contemporary dental practice, when the concern for cross contamination is at an all-time high.
Creating Patient Comfort
To help protect both patients and clinicians from any airborne debris or pathogens, solid protective measures are recommended. In addition to face masks and protective eyewear, isolation strategies accompanied by continuous fluid evacuation make a whole lot of sense. These aid not only safety but also patient comfort.
Indeed, the significant water output generated by ultrasonic technology may cause some patients to feel that they are about to drown. But by utilizing sound isolation techniques and devices, such as rubber dams or more comprehensive systems such as the Isolite 3, which offers a soft, comfortable mouthpiece that can provide isolation, as well as suction, illumination and continuous evacuation, clinicians can throw their patients — and themselves — a life preserver.
There is little doubt that ultrasonics have become valued players in oral health care. In ergonomics alone, the technology is worth its weight in gold. Operators enjoy far less hand and wrist fatigue, even during repetitive procedures such as scaling. And because ultrasonics do not involve cutting edges, both patient and operator injuries are minimized, as is tooth trauma. It all adds up to a technology that has become a boon to the concept of minimally invasive dentistry. And that’s no small feat.