Efficacy+of+Power+Scaling

= =  In many articles, the blended approach of both manual and ultrasonic scaling works the best. They stated that by just ultrasonic scaling it can leave the tooth surface irregular, which can cause irritation to the gum tissue. In an experimental study done in 2005, they compared the effectiveness of scaling in chronic periodontitis. The results showed a more significant decrease in BOP from hand instrumentation over ultrasonic and combining the therapies was about the same as manual alone. For probing depths, the most significant results came from the combination therapy and the least effective results came from ultrasonic scaling alone.
 * Efficacy of Power Scaling **

Reina: There have been some studies that indicated non-surgical access to the base of the pocket for calculus removal was suitable for sonic and ultrasonic instruments when compared with hand instruments. But for adequate access of probing pocket depths greater or equal to 5 mm, curettes are more effective with flap surgery than the ultrasonics. The effectiveness of the ultrasonic instruments is decreased in deep pockets because those pockets restrict the movement orientation of the tip. Newer design features include a narrower tip diameter and an angulation of the tip. Ultrasonics are superior to handheld instruments in the treatment of class II and III furcations. Many of the new ultrasonic and sonic tips are 0.55 mm or lesser in diameter. Globule-ended scaler tips have been used to obtain a more effective, successful mechanical treatment. A study concluded that a diamond-coated sonic scaler insert markedly reduced the time required for root surface instrumentation of molars with furcations involvement during flap surgery and that clinical wound healing is dependent on the instrument type used. Arabaci, T., Cicek, Y., & Canakci, C. F. (2007, February). Sonic and ultrasonic scalers in periodontal treatment: A review. //International Journal of Dental Hygiene//, //5//(1), 2-12. Thirty-eight maintenance patients with moderate to advanced periodontal disease and at least two teeth with probing depths of more than 4 mm were treated either with a conventional ultrasonic device or a vector device that generates longitudinal oscillations rather than vertical ones. The observation period was 6 months in which probing pocket depths, attachment level, and bleeding upon probing were assessed at six sites on each treated tooth. Bleeding on probing, probing depth, and attachment level improved in both instrumentation groups from baseline to month 6 although there was no difference between the two instrumentation modalities. Different power-driven devices have been developed, intended to be non-aggressive in terms of substance removal due to the fact that since subgingival instrumentation is performed repeatedly during maintenance, it is crucial to prevent even minimal root damage. Kocher, T., Fanghanel, J., Schwahn, C., & Ruhling, A. (2005, April). A new ultrasonic device in maintenance therapy: Perception of pain and clinical efficacy. //Journal of Clinical Periodontology//, //32//(4), 435-429. ** Diem: Efficacy of Ultrasonic Scaling  ** Ultrasonic scaling is a procedure that remove calculus and plaque deposition by the cavitations of the cavitron tip. The purpose of using ultrasonic scaling is to eliminate inflammation of the soft tissue that hand scaling cannot achieve except gingival curettage. According to Carranza, ultrasonic scalers with advanced thin tips can be used subgingivally and effectively as hand instruments. In addition, they reduce the spirochetes and motile rods more effective than hand scaling by the heat created during cavitations. When using ultrasonic scaling properly, it causes less gingival trauma and less discomfort post-operative treatment. Power scaling is a good choice for acute inflammation or acute periodontist or gingivitis. There are some contraindication of using power scaling: these devices can interfere with the older pace maker and the aerosols can be harm to medical compromised patients.

Greenstein, G. (2000). Nonsurgical periodontal therapy in 2000: A literature review. //The Journal of American Dental Association, 131//(11), 1580-1592. Takei, N. & Carranza, K. (2006). Scaling and root planning. In J. Dolan, J. Pendill & J. Dedeke (Eds.), //Carranza's Clinical Periodontalogy// (pp.749-760). Elsevier Inc.

Marcia- There advantages of using the ultrasonic scaler compared to hand scaling in periodontal involved patients is that hand scaling can cause excessive removal of cementum. When we use the ultrasonic instead, there is less destruction to roots and cementum. For really good removal of calculus with minimal removal of root structure is the use of micro ultrasonic scalers tips in conjunction with the use of periodontal endoscopy which allows for subgingival visualization with a fiber optic light which is seen on a screen at chair side to get right to the calculus.

Merjohn, G. K., (2001). The biofilm problem and a few simple solutions. Journal of the California Dental Association Received on April 10, 2009 from http://www.cda.org/library/cda_member/pubs/journal/jour0901/comment.html

Kwan, J. Y., (2005). Enhanced periodontal debridement with the use of micro ultrasonic periodontal endoscopy. Journal of the California Dental Association 33:3 241- 248. Received on April 10, 2009 from http://www.cda.org/library/cda_member/pubs/journal/jour0305/kwan.pdf

Shari- Twenty years ago when clinicians used powered instruments they were looked down upon in a negative way do to: -cheating -not getting the job done effectively or safely Today the use of powered instruments are accepted today and some feel that it has better results for the patient and the clinician. The benefits of powered instruments are: -safer -more efficient -time saver -equal or more efficient than manual instrumentation for better results -more comfort for the patient The research focus on biofilm removal. the main goal is to remove biofilm and calculus. To remove all cementum is no longer needed on the root to produce a smooth glassy surface. To debride root surface in a minimally invasive way is by ultrasonic to conserve more cementum. Ultra sonic does not need sharpening, it reduces the amount of repetitive stress injury. When used appropriately powered instruments cause less root damage which reduces hypersensitivity. It provides better access to base of pockets and furcations areas. over all it also promotes healing.

Maria- Periodontally involved pockets can present a challenge to a clinician attempting to remove calculus. Ultrasonic scaling is one method that can be utilized to treat periodontal disease. According to Carr (2004), ultrasonic scaling is effective in periodontally involved patients, however the correct tip must be used. The most appropriate tip is one that is thin, rigid and extended enough to reach the pocket. There are a wide variety of magnetostrictive and piezoelectric inserts and it is crucial that the correct tip is utilized. The same principle of proper instrument selection is considered for manual scaling. The instrument, when utilized correctly, must have the ability to reach the depth of the pocket. The problem often arises with operator technique. However, in a study conducted by Rupf et al. (2005) found that ultrasonic devices are clinically acceptable in removal of calculus, but microscopic remnants of calculus is often seen. The authors attributed the remnants to poor selection of the insert and operator error. Therefore, it is important that we select the right insert when utilizing ultrasonic scalers to treat periodontally involved patients. It is also important the use proper technique, otherwise leaving calculus behind can cause a periodontally involved pocket to progress.

Carr, M. P. (2004, May). Update on ultrasonics. Dimensions of Dental Hygiene, 2(5), 22, 24, 26, 28-29.

Rupf, S., Brader, I., Vonderlind, D., Kannengiesser, S., Eschrich, K., et al. (2005, Novemeber). Clinical and microbiological evaluation of a linear oscillating device for scaling and root planning. Journal of Periodontology, 76(11), 1942-1949.

__Ferris__ Many tests have been run to determine which is better manual scaling or power scaling and in most reports they are equally as effective but best used in conjunction with the other. One interesting fact I found was that ultrasonic scalers are more effective if Class II and III furcations especially with thinner tips. This is so true because many times gracey's cannot get into these crevices. Other benefits to ultrasonic scaling is there is no need for sharpening, are quicker and easier to use with universal tips, which is probably why RDA's are beginning to be licensed with them. In my person opinion none are better than the other when used in conjunction and both are responsible for causing damage when used improperly.

Kanay, B. (2004). The comparison of manuel scaling and ultrasonic scaling in treatment of tartar in dogs. Veteriner Cerrahi Dergisi. Retrieved April 27, 2009, from http://www.cababstractplus.org/abstracts/Abstract.aspx?AcNo=20043046810

Dental ultrasonic scaling. Retreived April 27, 2009, from http://www.softdentl.com/houston_dentist/Dental_Ultrasonic_Scaling.html

Jennifer I read a few articles which greatly support the power scaling. One article compared the difference between the newer power scalers and found there is not a great difference in outcome, however the newer tips are showing a verration in performance. In some cases the tips access furcations better the hand scalers, as some of you have already found. Another article I read found that the power scaler if used right of course can do less damage to the root surface than hand instruments. I am not saying that the power scaling is better but through this research I have began to respect the cavatron more, it can really benefit our pt by removing the bulk calculus with little removal of the tooth. So when we do hand scale we will remove less tooth structure. The Position paper although seemed to be pro power scaling in most ways, really stressed the aerosols, and I agree that the power scaling could be a breech into infection control. Watmsel, A., Lea, S., Landini,G., Moses, A., Advances in power driven pocket/root instrumentation. Journal of Clinical Periodontology. 2008, 35(22-28).

Drisko, S., Cochlam, D., Blieden, T., Bouwsma, O., Cohen, R., Damoulis, P., et al. Position Paper: Sonic and ultrasonic scalers in periodontal research, science and therapy committee of the American academy of periodontology. Journal of Periodontology. 2000, 71(11):1792-1801.

Natalie: Through my research I have discovered that the clinical results of hand scaling and ultrasonic scaling on periodontal disease are similar. A combined approach seems to be most effective in removing deposits and allowing for an environment where healing can occur. Non-surgical therapy has its limitations for severe periodontal disease with pocket depths over 6mm. Sometimes surgical intervention is necessary if non-surgical therapy is unsuccessful in localized areas. Systemic conditions and the use of tobacco also affect periodontal disease and their response to non-surgical therapy.

Utilizing both power and hand scaling provides the best clinical results. One study with 20 individuals who had moderate to severe periodontal disease compared manual and power scaling. Their quads were randomly assigned into hand scaling and ultrasonic scaling groups, and also a combination group. Assessments were gathered including probing depths, BOP, and PI at 3 and 6 mos. All of the groups experienced an improvement in their periodontal disease in comparison with their original findings; however, there was not a statistical difference between the quads that were scaled. Both techniques were effective. The operator technique and systemic factors also influence the outcome and healing response. It is important that the dental hygienist is competent with hand scaling and ultrasonic scaling so that we can provide the best non-surgical treatment for our patients.

Arabaci, T., Cicek, Y., & Canakci, C. (2007). Sonic and ultrasonic scalers in periodontal treatment: a review. International Journal of Dental Hygiene. 5(1):2-12.

Dental Ultrasonic Scaling. Retrieved on April 24, 2009 from http://www.softdental.com/houston_dentist/Dental_Ultrasonic_Scaling.html

Obeid, P., D’Hoore, W., & Bercy, P. (2004). Comparative clinical responses related to the use of various periodontal instrumentation. Journal of Clinical Periodontology. 31(3):193-199.

__Tawnya__

As dental hygienists one of our goals is to prevent periodontal disease and progression with our patients. We must be aware of the best possible treatment we can provide to our patients and what research indicates the most appropriate treatment options are. Through the research I evaluated I have learned hand scaling and ultrasonic scaling are equally effective but the combination of the two is most favorable. Damage can result with either method if the clinician is not practicing the correct techniques so it is critical that the clinician is properly trained in the use. For patients with periodontal disease the use of the slimmer ultrasonic tips can provide the clinician better access to CII and III furcations when providing non surgical treatment. Arabaci, T., Cicek, Y., & Canakci, C. (2007). Sonic and ultrasonic scalers in periodontal treatment: a review. International Journal of Dental Hygiene. 5(1):2-12. Bonner, B., Young, L., Smith, P., McCombes, W., and Clarkson, J. (2005). A randomized controlled trial to explore attitudes to routine scale and polish and compare manual versus ultrasonic scaling in the general dental service in Scotland. BioMed Central Oral Health. (5): 1186/1472-6831-5-3. Chapper, A., Catao, V., and Oppermann, R. (2005). Hand and ultrasonic instrumentation in the treatment of chronic periodontitis after supragingival plaque control. Brazilian Oral Research. 19 (1): 41-6.

Dorinda Manual vs. power scaling to expand to use for different severities of periodontitis. Manual and power scaling are not more significant over one or the other. Both accomplish the same goal of removing the calculus and benefiting the area to be removed of disease as much as possible depending on the severity. It is important to note that on more severe perio cases may not benefit from these options as much as we hope as clinicians, some patients may need a more invasive procedure such as surgery. Although some other cases may benefit from manual and power scaling alone. There are also other inserts that can be used on the power scaler that will help with deep pockets as well as furcations areas, these may really be beneficial for use when hand instruments alone are not getting the area 100% the power scaler can really get in there with certain tips and irrigate as well as loosen the calculus. It is important that we keep in mind as clinicians every patient is different and one person who has sever perio may benefit differently from another case when using manual and power scaling as treatment. Scaling and root planning: hand versus power-driven instruments. (April, 1998). Pub Med. Retreived on April 9, 2009 from http://www.ncbi.nlm.nih.gov/pubmed/9594465 Scaling and root planning without over instrumentation: hand versus power-driven scalers. (1993). Pub Med. Retreived on April 9, 2009 from http://www.ncbi.nlm.nih.gov/pubmed/8401851

Noo:

Periodontally involved pockets can present a challenge to a clinician attempting to remove calculus. Manual scaling and ultrasonic scaling are two methods that can be utilized to treat periodontal disease. According to Carr (2004), ultrasonic scaling is effective in periodontally involved patients, however the correct tip must be used. The most appropriate tip is one that is thin, rigid and extended enough to reach the pocket. There are a wide variety of magnetostrictive and piezoelectric inserts and it is crucial that the correct tip is utilized. The same principle of proper instrument selection is considered for manual scaling. The instrument, when utilized correctly, must have the ability to reach the depth of the pocket. The problem often arises with operator technique. However, in a study conducted by Kwan(2005) found that ultrasonic devices are clinically acceptable in removal of calculus, but microscopic remnants of calculus is often seen. The authors attributed the remnants to poor selection of the insert and operator error. Therefore, it is important that we select the right insert when utilizing ultrasonic scalers and to select the appropriate manual scalers to treat periodontally involved patients. It is also important the use proper technique, otherwise leaving calculus behind can cause a periodontally involved pocket to progress.

Carr, M. P. (2004, May). Update on ultrasonics. Dimensions of Dental Hygiene, 2(5), 22, 24, 26, 28-29. Kwan JY. Enhanced periodontal debridement with the use of micro ultrasonic, periodontal endoscopy. J Calif Dent Assoc. 2005;33:241-248.

Ceri:

One of the studies researched root planning/manual scaling and ultrasonic scaling and the effect on periodontal disease. This study researched others studies, and from the information gathered there have not been significant differences in manual scaling compared to power scaling. One finding about using the power scaler was that it has a great ability to decrease inflammation, but hand scaling also can accomplish this task. One study stated that microscopically the root appears smoother from manual scaling, but with ultrasonic scaling there may be less chair time and less operator fatigue. As far as comparing the resulting periodontal disease it appears that both have a significant effect in the treatment, but it has not been proven that one is necessarily better than the other. This study did state however that manual scaling is most effective in case of slight to moderately involved periodontal patients. Patients with more severe periodontal disease definitely would benefit from the use of a power scaler in conjunction with manual scaling.

Obeid, P., D’Hoore, W., & Bercy, P. (2004). Comparative clinical responses related to the use of various periodontal instrumentation. Journal of Clinical Periodontology. 31(3):193-199.

Greenstein, G. (2000). Nonsurgical periodontal therapy in 2000: A Literature Review. The Journal of the American Dental Association. 131(11). 1580-1592

Chapper, A., Catao, V. V., Oppermann, R. V. (2005). Hand and ultrasonic instrumentation in the treatment of chronic periodontitis after supragingival plaque control. Brazil Oral Resource, 19(1), 41-46.