Power Driven Scalers GN PDF

53 Periodontal guidelines. DO NOT USE TIP -NO Pressure req...

53 Periodontal guidelines. DO NOT USE TIP -NO Pressure req Power Driven Scalers Magnetostrictive Pocket irrigation + visability · Optimum appointment time. Ultrasonic tips generally Smaller-ACCESS · Foundations of Clinical Skills and Practice Advantages: Disadvantages: Factors to consider: Calibrated and repaired Hearing damage due to high frequencies Patient selection - disabilities, medical histories; pacemaker, respiratory, immunocompromised. Lavage can clear treatment sight (with nurse support) Aerosols with microorganisms. Gag reflex due to water. Lavage can penetrate pockets. Patient sensitivity. Mouth breathers - find it more traumatic and choking risk. Reduction of repetitive strain injury. Reduced tactile sensation. Check water supply before appointment. Access improved - different tips and furcations. Unable to use with some pacemakers. Optimal equipment maintenance including tip wear. Cavitation (water bubbles) De skill in hand instrumentation. Implants - unable to use standards tips. Mechanical Unable to use on immature enamel/newly erupted teeth. Prosthetic devices and restorations - porcelain/implants - metal scratch on composite. Acoustic Thermal effects. Local aesthetic - comfort. No sharpening of tips Lost/blunt tips Clinician skill/technique/knowledge. Time management - quicker appointment time. More likely to conserve cementum with PDS - (attaches PDL) Reduced tissue distension. Contra-indications: Pacemaker - magenetic field. Sensitivity. Respiratory conditions. Spread or cause infections in immunocompromised patients. Diabetes type 2; uncontrolled. Difficulty swallowing. Damage to implants/restorations. Untreated cleft palate/drug user - nasal and oral communications. Decalcified areas more susceptible to damage. Newly erupted inmate enamel. GDC Learning Outcomes 1.1.1 1.1.5 1.5.3 1.8.1 1.11.3 8.2 9.6 10.8 Intended Learning Outcomes By the end of the session, you will be able to: Explain the rationale for using a Power Driven Scaler (PDS) as a part of periodontal treatment. Explain the modes of action of a PDS Discuss the advantages and disadvantages of PDS Explain the difference on frequency and amplitude in PDS and their impact on delivery of care Explain the anatomy of the PDS tip and impact of clinical adaptation Explain the key differences between sonic, piezo and magnetostrictive scalers Discuss key safety checks to be undertaken prior to and during PDS use 3 History Instrumentation/debridement (manual) was the only method available for the safe removal of supra and sub gingival calculus until ultrasonic devices were introduced in about 1950 4 Bookjamvermont.com Power Driven Scalers This is the umbrella term for all power driven scalers. Power driven scalers Piezoelectric Sonic Ultrasonic Magnetostrictive Sonic Piezo Magnetostrictive These are the types of scaler most routinely seen in general practice 5 What is a Power Driven Scaler? A power driven scaler accomplishes the task of removing plaque and calculus from the tooth surface by means of a mechanical action. Power driven scalers convert high frequency electrical energy (ultrasonic) or air pressure (sonic) into high frequency sound waves. The energy at their tips fracture calculus from the tooth surface Assists in cleansing pathogens from within the periodontal pocket 6 Why do we use them? Optimal treatment outcomes Better access to complex areas Disturbance of plaque biofilm Reduce operator fatigue Make optimum use of appointment time Reduced patient discomfort * Can you think of any other reasons? 7 Modes of Action of Power Driven Scalers Modes of Action of PDS Cavitation effect Microstreaming Acoustic turbulence Lavage Mechanical Cavitational Affect Cavitation is the formation of pulsating bubbles that are powered by an ultrasonic field. When an ultrasound wave passes through water, molecules are pushed closer together and pulled apart in a split second. If the movement of these sound waves is high, the micromillimeter-sized bubbles expand and collapse violently. The subsequent energy is released as a shock wave, heat, and/or abrupt changes in nearby hydraulic pressures. Though a single bubble’s energy is quickly dissipated, within the coolant there will be thousands, if not millions, of other bubbles produced that will then collapse, creating the appearance of pulsation. 10  Small sound waves Acoustic Micro Streaming Acoustic micro streaming is another energy released around ultrasonic devices. This phenomenon is characterized by the movement of small currents in the water. Micro streaming commonly occurs around oscillating objects, such as cavitation bubbles or the scaler tip. These currents produce shear forces that are strong enough to break up clumps of bacteria but not powerful enough to break down bacterial cell walls. These forces have been shown to break up colonies of bacteria and disrupt biofilm. 11 Washing out or irrigation of the periodontal pocket with useage of water Repeated physical touching of ultrasonic tip on calculus Lavage Mechanical Pros & Cons of PDS Advantages of Power Driven Scalers Heavy cigarette stain Cavitational Effect Reduces effects of Furcation tip removal Carpal Tunnel Syndrome reduces damage 14 Advantages of power driven scalers Easier removal of heavy deposits/stain Reduction of tissue trauma Lavage Cavitational effect Acoustic disturbances Furcation tip access causes less damage Less tissue distension Conservation of cementum Time management No sharpening needed Reduces operator fatigue and therefore reduces likelihood of carpel tunnel syndrome/repetitive strain Patient prefers it 15 Disadvantages of Power Driven Scalers Tooth High Pitched Reduced Patient Dislikes Running out of Sensitivity Noise Visibility It water 16 Disadvantages of power driven scalers Reduced visibility due to water accumulation Patients who cannot breath through their nose Tooth sensitivity during procedure Reduced tactile sense Mirror use limited due to water spray Aerosol formation Noise Compromised procedure without nursing assistance Running out of water in the bottle Patients wearing hearing aids may have to remove them Patient dislikes it 17 Clinical Considerations of PDS Clinician considerations of PDS use Contraindications Oral Control How it works of use Adaptation – Tip Recognising a failing tip Maintenance anatomy 19 Oral control Contraindications to Use Pacemaker* High susceptibility to infections Respiratory risk Difficulty in swallowing Prone to gagging Sensitivity Untreated cleft palate Areas of demineralisation Around crowns/implants?* Speechbuddy.com  Distance scaler moved during 1 vibration Turn amplitude down on machine (makes circles bigger or smaller) depending on type of deposit removing Number of times a scaler tip vibrates per second Biofilm = low amplitude Measured in Hz Calculus = higher amplitude 25K OR 30K Frequency Amplitude VIBRATION STROKE LENGTH Active tip area and long is it What sides a can be used Frequency 23  Movement Motion M H E I D G L I O U H M W Frequency Ultrasonic powered devices Sonic powered devices Operate at 18,000 to 45,000 Operate at lower frequency of cycles per second 3,000 to 8,000 cycles per second Water 26 Tip Anatomy Active tip area Points of energy dispersion 29 Active Tip Area  Tip Geometry Defined by number of planes that the shank of the tip crosses. Tip Selection Furcation Entrances on a Maxillary First Molar Furcation Entrances on a Mandibular First Molar 34 Stroke Directions 35 Lateral Pressure Lateral Pressure Light grip Guide into pocket NO tip use Tip Wear Tip Wear Bent or re-shaped tips Maintenance of Magnetostrictive PDS Maintenance Checks Ensure all equipment Ensure you have is working correctly enough water Check tips for wear, before EVERY use Ensure inserts are not bent Piezon Maintenance Checks Beware, Piezo tips will Ensure tip is tightened disappear down the correctly drain, in a flash! Bent, broken or separated stacks  Where did that PDS tip go? A fractured tip within the mouth is a serious cause of concern. It could be wedged in a periodontal pocket It could have been swallowed It could have been spat out OR, It could have been inhaled If you cannot find it, the patient will have to undergo a chest x ray Bsdht.org.uk Insert Parts Insert and handpiece piece care Insert cleaning Insert malfunctions Clogged water Leaking water Worn R ring Comparison of Piezon vs Magnetostrictive Rdhmag.com Sonics Sonic scalers are air-turbine units that operate at low frequencies ranging between 3000 and 8000 cycles per second In general, tip movement is orbital Sonic scalers have a high intensity noise level because of the release of air pressure needed for movement of the tip of the sonic hand-piece. Final Safety Check Always remove /make safe the Power Driven Scaler between use. Even if you are going to use it again in a minutes time! Never leave the tip pointing upwards. Never leave it uncovered. A needle stick accident waiting to happen! Physicsworld.com En.wikipedia.org