ULTRASONIC SCALING

DISADVANTAGES:
According to the study in reference, following are some pitfalls of ultrasonic scaling:

Aerosol contamination along with vibrational hazards [1]

Contraindications with electromagnetic devices. [1][5]
Hearing impairment: a protracted exposure to low intensity sound irritant can induce
Chronic acoustic trauma. The damage is irreversible as cochlear hair cells cannot
regenerate.[1]
According to Kilpatrick a number of sounds in the dental office that may be
hazardous to dentists hearing: [1]
High-speed turbine
High-volume aspirator
Ultrasonic scaler
Mixing devices for stone, amalgam, etc..5

Dental unit waterline contamination [1]

There are evidences that not only the patients are at risk but that the large
amplitudes generated by the pneumatic drills cause white finger or acrocyanosis
as the continuous vibrations cause a disruption in the blood flow to the fingers of
the operator. [4]
There is a reduced tactile sensitivity and performance .
Damage to the tooth surface as a result of frictional heat produced
There are proved thermal effects on the pulp with modifications in the vascular flow
due to the rise in temperature. An increase above 11C was shown to invariably
destroy the pulp and a 17C increase produced pulp death. [1]
The oscillating tip of ultrasonic scaler which is in contact with the tooth carries a
possibility that the tooth may act as a waveguide conducting the vibrational energy
from the scaler toward the apex of the root and If sufficient energy reaches the root,
then it can provoke a thrombogenic risk to the blood vessels passing through the
apical foramen into the pulp which inturn may sacrifice the vitality of
tooth . [1]
Studies also reveal that as instruments contact time, tip to tooth angle and
instrument pressure is increased, the likelihood of root surface damage is also
increased [1]
The electromagnetic field produced by magnetostrictive ultrasonic scalers may
interfere with the pacemaker discharge rate, resulting in a serious life-threatening
hazard to the patient.[7]

the authors concluded that ultrasonic instrumentation at high power settings

produces rougher root surfaces than ultrasonic instrumentation at lower power; and
that manual instrumentation with curettes produces lower roughness than ultrasonic
instrumentation independent of power setting. [11]
Biofilms have been shown to be a primary source of contaminated water delivered
by dental units.[ The medical risk from the microbial contamination of water is the
most significant to immunosuppressed individuals [1]

ADVANTAGES:

Ultrasonic and sonic instruments are referred to as power driven scalers which are
employed to remove bacterial deposits, plaque and calculus from teeth and to
cleanse the periodontal pockets with the help of water-cooled tip vibrating at high
frequency.[3] [4]
They also mention that thin ultrasonic tips can access deep pockets and fucations
but should be used on low power and to use a higher power tip for heavy calculus to
prevent burnishing of the calculus. They belive that ultrasonic scaling shold be
followed by exporing and then hand scaling using the area specific instruments and
correct angulation and adaptation to remove subinival calculus. [8] [9]
The ability to flush the pocket during subgingival instrumentation with water or other
chemical irrigating solutions is unique to ultrasonic and sonic scalers and has been
shown to enhance pocket depth reduction and gain in clinical attachment beyond
that achieved with hand scaling.[9]
Taken together, it appears that use of ultrasonic or sonic scalers for periodontal
dbridement will result in improvements in clinical and microbial parameters at a
level equal to or superior to hand scalers. [9]

less hand and wrist fatigue due to the light touch necessary to merely guide the
scaler tip along the tooth surface [11]

decreased treatment time, especially with heavy deposits, leaving more time for
patient education or procedures such as placement of chemotherapeutic [9]

more efficient removal of dental plaque and calculi with ultrasonic instrumentation

ultrasonic instruments rid the radicular surfaces of bacterial endotoxins while

preserving the cementum[13]

less tissue trauma due to no sharp cutting edges[13]

water provides continuous tissue lavage, thereby reducing the need for rinsing
during scaling, since the water flow allows for high visibility throughout the
procedure; this lavage also increases tissue comfort for the patient during and after
the procedure[8][9]

[10]

antiseptic solution can be substituted for the water to provide simultaneous

irrigation/disinfection of the region being treated [8]

excellent for stain removal that may otherwise be tedious to scale by hand [11]

gritty, pumice-based polish may no longer be necessary or indicated following

scaling with ultrasonic; due to the efficient stain removal during scaling, a milder,
minimally invasive paste or polish can be used, preserving the glaze on composite
and porcelain restorations; less abrasive polish enhances patient acceptance and
lowers post-scaling sensitivity[8]

less chance of operator injury:[8]

seldom need to place tips in an ultrasonic bath prior to sterilization, eliminating a step
in the handling process[8]

patients experience a higher level of comfort; the entire procedure is endured more
easily.[11]

MANUAL SCALING
ADVANTAGES:

manual scaling left the root surfaces smother which is beneficial hence bacterial
adhesion to rough surfaces.[15]
Manual or hand activated cleaning pertains to the hand instruments like scalers and
curettes. When it comes to fine deposits attached on teeth, manual scaling is
superior. A hygienist or dentist can put more energy in manual cleaning. [15]
They are equally effective for plaque and calculus removal from shallow gum
pockets. They do not interfere with electronic equipment like heart pacemakers. They
can be used more easily on teeth in which there are areas of demineralization (areas
where minerals have been removed from the tooth's enamel, making it more
vulnerable to decay). They are easier on the tooth's surface and are thus better for
use with porcelain or composite restoration, or sensitive teeth. [14]

DISADVANTAGES:

. Sometimes they cause more discomfort than ultrasonic scalers.Root surface

instrumentation with hand instruments is often difficult and time consuming, besides
requiring a substantial amount of physical effort[13][17]
The roots treated with the hand curette had many linear injuries, which were thought
to have been caused by the instrumentation.[16]Most specimens showed only slight

loss of tooth substance, and most of the cementum was intact. roots treated with
Desmo-Clean bur showed relatively more roughness and loss of tooth substance

[13]

Conclusion:
Considering the pros and cons both these instruments offer and taking in account the
suggestions and recommendations of the professional dental experts it is deduced that the
best results for non-surgical periodontal therapy are achieved by blended approach;
combined use of power ultrasonic scalers and hand instruments. Better outcomes have
been reported when both these instruments were used in dental clinics. [15]
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REFERENCES:

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Trenter SC, Walmsley AD. Ultrasonic dental scaler: Associated hazards. J Clin
Periodontol. 2013;30:95101.
Nield-Gehrig JG. 4th ed. Baltimore: Lippincott Williams and Wilkins; 2014. Basic
concepts of ultrasonic instrumentation. Fundamentals of Periodontal
Instrumentation.
Drisko CL, Cochran DL, Blieden T, Bouwsma OJ, Cohen RE, Damoulis P, et al. Position
paper: Sonic and ultrasonic scalers in periodontics. Research, Science and Therapy
Committee of the American Academy of Periodontology. J Periodontol.
2010;71:1792801.
Walmsley AD, Laird WR, Williams AR. Intra-vascular thrombosis associated with
dental ultrasound. J Oral Pathol. 2011;16:2569
Harrel SK, Molinari J. Aerosols and splatter in dentistry: A brief review of the
literature and infection control implications. J Am Dent Assoc. 2014;135:42937.
Adams D, Fulford N, Beechy J, MacCarthy J, Stephens M. The cardiac pacemaker and
ultrasonic scalers. Br Dent J. 1982;152:1713.
Drisko CL, Cochran DL, Blieden T, Bouwsma OJ, Cohen RE, Damoulis P, et al. Position
paper: sonic and ultrasonic scalers in periodontics. Research, Science and Therapy
Committee of the American Academy of Periodontology. J Periodontol.
2000;71:17921801
Drisko CH. Root instrumentation. Power-driven versus manual scalers, which one?
Dent Clin North Am. 1998;42:229244.
Breininger DR, O'Leary TJ, Blumenshine RVH. Comparative effectiveness of
ultrasonic and hand scaling for the removal of subgingival plaque and calculus. J
Periodontol. 1987;58:918.

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Sumita Singh; ashita Upoor ; Dilip Nayak;A comparative evaluation of the efficacy of
manual, magnetostrictive and piezoelectric ultrasonic instruments - an in vitro
profilometric and SEM study; 2012
Preeti Marda, Shobha Prakash, Devaraj CG, Vastardis S;A comparison of root surface
instrumentation using manual, ultrasonic and rotary instruments: An in vitrostudy
using scanning electron;2012 microscopy
Preeti Marda1, Shobha Prakash1, CG Devaraj1, S Vastardis2;A comparison of root
surface instrumentation using manual, ultrasonic and rotary instruments: An in vitro
study using scanning electron microscopy;2012
Magnum Opus Dental; Which is Better for Cleaning Your Teeth: Ultrasonic or Hand
Tools? ;2014
aner, A., Yasin, C., & Cenk, C. F. (2007, September 14). Sonic and ultrasonic scalers
in periodontal treatment: a review. International Journal of Dental Hygiene.
Retrieved March 9, 2012
A., Krause, F., Frentzen, M., & Jepsen, S. (2005). Efficiency of subgingival calculus
removal with the Vector-system compared to ultrasonic scaling and hand
instrumentation in vitro. Journal Of Periodontal Research, 40(1), 48-52. Retrieved
march 9, 2012 from: