Once clinicians have a full complement of UITs, the interpretation of assessment data is vital. Sulcus, shallow or deep pocket depth, taut or elastic tissue tone, and type and location of deposits should all be considered.
The most commonly used UITs are those with rounded contours, and they are available in both piezoelectric and magnetostrictive dental equipment technologies. These universal round UITs with straight shanks are for gross supragingival or subgingival debridement in all intraoral locations. The shank width and length aid in determining if straight shanks are applied above or below the gingival margin. A thin shank microultrasonic rounded silhouette UIT with a straight shank is suitable for light deposit and plaque biofilm on all surfaces in anterior segments and any narrow periodontal pockets. This UIT is indicated for prophylaxis, periodontal maintenance, and initial periodontal therapy after gross deposit removal.
The addition of round and thin right and left contours is for light deposits and adaptation to proximal surfaces, root contour, and furcations. The option of a ball-ended design might assist in light debridement of furcation areas, particularly in the concave surface adjacent to the roof of the furcation entrance.
Diamond-coated UITs also have a round profile; however, they are saved for removing calculus in deep pockets and furcations. They were initially manufactured for residual deposits best identified and treated with an endoscope or direct vision during surgery. Unfortunately, endoscopic technology is not currently available to all clinicians. These UIT ends are coated with fine-diamond grit; therefore, they are very abrasive. Their adaptation and activation should be gentle and precise, with frequent evaluation of the site with direct vision or an explorer. Straight, right, and left shanks are available. The diamond surface is moved over the deposit and removal occurs from the outer to the inner layer. As such, this UIT is not most active at the terminal end as with other UITs.4 Significant root structure removal within a limited time has been demonstrated, so these UITs should be used with the utmost caution.4
Flat contours originally were designed only for heavy supragingival deposits. The standard universal flat design may include a long shank for moderate to heavy subgingival deposits. The 100 series is a universal design with a flat end and is indicated for all pocket depth and large deposits. Flat designs are intended for large deposits in supragingival or subgingival environments, but not for fine deposit and biofilm debridement. The flat UIT could be used for debridement in prophylaxis or periodontal maintenance and in the beginning stages of instrumentation for nonsurgical periodontal therapy.
Using bladed or edged profiles with piezoelectric units is reserved for heavy and/or burnished residual deposits. Anterior and posterior segments can be treated with the curved design (4 right shank/4 left shank or similar) for proximal surfaces.
The use of ultrasonic therapy for implant maintenance is increasing as more products are developed. Options include varying metal substances, plastic UITs, and soft UITs. Mann et al5 found that metal tips produced defects in titanium implants; however, the amplitude and load used affected this damage. Plastic-coated tips cause minimal damage and polish well, but leave plastic deposits on the surface. The development of less problematic materials for use on implants is needed.5
Braun et al6 found that a novel copper alloy UIT minimally influenced the titanium implant, making this a viable alternative that may provide improved durability and wear. Other researchers also concluded that copper alloy may be used in the maintenance of implant prostheses.7–9 Until these UITs are readily available, a special magnetostrictive insert with a disposable soft tip placed with a wrench device may be helpful. Many piezoelectric tip options for implants are also available.
Another concern with UIT selection is debridement of restorations. Arabaci et al10 found that applying piezoelectric tips to amalgam, porcelain, and composite restorations created roughness, scratches, and nicks. Studies show that roughness influences the establishment of plaque biofilm; therefore, achieving smoothness is important for enamel, root, and restorative surfaces.10 How much this residual roughness contributes to clinical outcomes is undetermined. In general, restorations are contraindicated for ultrasonic dental instruments; however, some UITs designed for implants may be used to debride restorations, such as the insert with a soft tip.
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