Ultrasonic scalers vibrate at approximately 25,000-45,000 Hertz. [i] [ii] [iii] They are very efficient at cleaning and provide the additional benefit of creating an antibacterial effect in the coolant spray (cavitation). [iv] [v] [vi]

Ultrasonic tips have a recommended vibrational velocity (Hz) range, which should be determined and set before initiating scaling.  The power should initially be set low and adjusted upward to the minimum required power.[ix] [x] [xi] The power should always be reduced when it is used subgingivally (i.e., on the root). Also, when cleaning subgingivally, a periodontal tip is recommended as it creates a smoother root surface and can result in less sensitivity.[xii] (Figure 1)

The area of maximum vibration (i.e., efficient cleaning) is 1-3 mm from the tip.[xiii] [xiv] Do not use the very tip of the instrument as it is not effective for calculus removal and can potentially damage the tooth. [xv] [xvi]

Regularly inspect the instruments for wear.  It has been shown that damage affecting the terminal 1-mm of the tip reduces the efficiency of an ultrasonic scaler by 25% and 2-mm by 50%.[xvii] Additionally, worn instruments have been shown to increase surface roughness.[xviii]  Finally, tip wear has been shown to not only decrease efficiency but also to lead to less clean roots and increase surface roughness.[xix] [xx] [xxi] [xxii] [xxiii]  Therefore, check the instruments regularly and replace them when 2 mm is worn away. (Figure 2)

To ensure adequate coolant is delivered through the scaler’s working end, a fine but significant spray is recommended (Figure 3).[xxiv]  Utilizing mechanical scalers without sufficient coolant can cause numerous deleterious effects, including tooth death.[xxv] [xxvi]  In addition, supra gingival tips must not be used under the gingival margin.[xxvii] [xxviii]

The instrument should be gently grasped similar to holding a pen (Figure 4). [xxix] [xxx] Avoid using a whole palm grip as this tends to reduce tactile sensitivity for residual calculus, increases operator fatigue, and creates too much downward pressure on the tooth.

Next, place the side of the instrument gently in touch with the tooth surface..[xxxi] [xxxii] [xxxiii] [xxxiv] [xxxv][xxxvi](Figure 8) Excessive pressure on the instrument will not improve its efficiency.  In fact, excessive pressure dampens the vibration, making the instrument less effective,[xxxvii] and can result in damage to both the instrument and the tooth. [xxxviii] [xxxix] [xl] [xli]

The side of the terminal end of the tip is kept parallel to the tooth.  (Figure 4) This angulation has been shown to be very important in achieving the optimum clinical results.[xlii]  [xliii] [xliv] [xlv] [xlvi]  Run the instrument over the entire tooth surface using numerous overlapping strokes in different directions (crosshatching).[xlvii] [xlviii]

It has been recommended to limit the amount of time ultrasonic scalers stay in contact with a tooth usually 5-15 seconds).[xlix] [l] [li] [lii]  However, there is no evidence that a well-cooled ultrasonic instrument will overheat a tooth.[liii] [liv]  Further, the force applied against the tooth markedly affects the heat generated.[lv].

Scalers do not work when not in contact with the tooth, and they should not be removed from the tooth surface.  Keep the instrument in constant motion, running slowly over the tooth surface in overlapping, wide, sweeping motions to cover each mm² of every tooth surface. [lvi]  [lvii]  [lviii]

References

[i] Pattison AM, Pattison GL: Scaling and root planing, in Carranza’s Clinical Periodontology. St. Louis, Mo, WB Saunders, 2006, pp 749-97

[ii] Bellows J:  Equipping the Dental Practice. In: Small Animal Dental Equipment, Materials, and Techniques, a Primer. Blackwell, 2004, pp. 13-55.

[iii] Wiggs RB, Lobprise HB: Dental Equipment, in Veterinary Dentistry, Principals and Practice.  Philadelphia, PA, Lippincott – Raven, 1997, pp 1-28

[iv] Jahn CA: Sonic and ultrasonic instrumentation, in Carranza’s Clinical Periodontology. St. Louis, Mo, WB Saunders, 2006, pp 828-835

[v] Felver B, King DC, Lea SC, Price GJ, Damien Walmsley A. Cavitation occurrence around ultrasonic dental scalers. Ultrason Sonochem. 2009 Jul;16(5):692-7.

[vi] Bellows J:  Equipping the Dental Practice. In: Small Animal Dental Equipment, Materials, and Techniques, a Primer. Blackwell, 2004, pp. 13-55.

[ix] Pattison AM, Pattison GL: Scaling and root planing, in Carranza’s Clinical Periodontology. St. Louis, Mo, WB Saunders, 2006, pp 749-97

[x] Parashar, Atul and Neeta Bhavsar. “Assessing the effect of piezoelectric ultrasonic scaler tip wear on root surface roughness under influence of various working parameters: A profilometric and atomic force microscopic study.” Journal of Indian Society of Periodontology 27 (2023): 583 – 589.

[xi] Arabaci T, Cicek Y, Dilsiz A, Erdogan İY, Kose O, Kizildağ A. Influence of tip wear of piezoelectric ultrasonic scalers on root surface roughness at different working parameters. A profilometric and atomic force microscopy study. Int J Dent Hyg. 2013 Feb;11(1):69-74. doi: 10.1111/idh.12003. Epub 2012 Oct 4. PMID: 23033943.

[xii] Abdul Hayei NA, Yahya NA, Safii SH, Saub R, Vaithilingam RD, Baharuddin NA. Influence of scaler tip design on root surface roughness, tooth substance loss and patients’ pain perception: an in vitro and a randomised clinical trial. BMC Oral Health. 2021 Mar 31;21(1):169.

[xiii] Holmstrolm SE, Frost P, Eisner ER: Dental Prophylaxis, in Veterinary Dental Techniques, (ed 2).  Philadelphia, PA, Saunders, 1998, pp 133-166

[xiv] Debowes LJ: Problems with the gingiva. In: Small Animal dental, oral and maxillofacial disease, A color handbook (Niemiec BA ed.). London, Manson, 2010, pp159 – 181.

[xv] Pattison AM, Pattison GL: Scaling and root planing, in Carranza’s Clinical Periodontology. St. Louis, Mo, WB Saunders, 2006, pp 749-97

[xvi] Bellows J:  Equipping the Dental Practice. In: Small Animal Dental Equipment, Materials, and Techniques, a Primer. Blackwell, 2004, pp. 13-55.

[xvii] Bellows J. Small animal dental equipment, materials, and techniques: a primer.Wiley-Blackwell. Ames, 2004.

[xviii] Parashar, Atul and Neeta Bhavsar. “Assessing the effect of piezoelectric ultrasonic scaler tip wear on root surface roughness under influence of various working parameters: A profilometric and atomic force microscopic study.” Journal of Indian Society of Periodontology 27 (2023): 583 – 589.

[xix] Arabaci T, Cicek Y, Dilsiz A, Erdogan İY, Kose O, Kizildağ A. Influence of tip wear of piezoelectric ultrasonic scalers on root surface roughness at different working parameters. A profilometric and atomic force microscopy study. Int J Dent Hyg. 2013 Feb;11(1):69-74.

[xx] Vengatachalapathi H, Naik R, Rao R, Venugopal R, Nichani AS. The Effect of Piezoelectric Ultrasonic Scaler Tip Wear on Root Surface Roughness at Different Working Parameters: An Atomic Force Microscopic and Profilometric Study. J Int Acad Periodontol. 2017 Jan 2;19(1):15-21.

[xxi] Arabaci T, Cicek Y, Dilsiz A, Erdogan İY, Kose O, Kizildağ A. Influence of tip wear of piezoelectric ultrasonic scalers on root surface roughness at different working parameters. A profilometric and atomic force microscopy study. Int J Dent Hyg. 2013 Feb;11(1):69-74. doi: 10.1111/idh.12003. Epub 2012 Oct 4. PMID: 23033943.

[xxii] Vengatachalapathi H, Naik R, Rao R, Venugopal R, Nichani AS. The Effect of Piezoelectric Ultrasonic Scaler Tip Wear on Root Surface Roughness at Different Working Parameters: An Atomic Force Microscopic and Profilometric Study. J Int Acad Periodontol. 2017 Jan 2;19(1):15-21. PMID: 31473708.

[xxiii] Lea SC, Landini G, Walmsley AD. The effect of wear on ultrasonic scaler tip displacement amplitude. J Clin Periodontol. 2006 Jan;33(1):37-41.

[xxiv] Pattison AM, Pattison GL: Scaling and root planing, in Carranza’s Clinical Periodontology. St. Louis, Mo, WB Saunders, 2006, pp 749-97

[xxv] Nicoll BK, Peters RJ. Heat generation during ultrasonic instrumentation of dentin as affected by different irrigation methods. J Periodontol. 69(8):884-8, 1998.

[xxvi] Holmstrolm SE, Frost P, Eisner ER: Dental Prophylaxis and periodontal disease stages, in Veterinary Dental Techniques, (ed 3).  Philadelphia, PA, Saunders, 2002, pp 175-232.

[xxvii] Jahn CA: Sonic and ultrasonic instrumentation, in Carranza’s Clinical Periodontology. St. Louis, Mo, WB Saunders, 2006, pp 828-835

[xxviii] Wiggs RB, Lobprise HB: Dental Equipment, in Veterinary Dentistry, Principals and Practice.  Philadelphia, PA, Lippincott – Raven, 1997, pp 1-28

[xxix] Pattison AM, Pattison GL: Scaling and root planing, in Carranza’s Clinical Periodontology. St. Louis, Mo, WB Saunders, 2006, pp 749-97

[xxx] Holmstrolm SE, Frost P, Eisner ER: Periodontal Therapy and Surgery. in Veterinary Dental Techniques, (ed 2).  Philadelphia, PA, Saunders, 1998, pp 167-213.

[xxxi] Holmstrolm SE, Frost P, Eisner ER: Dental Prophylaxis and periodontal disease stages, in Veterinary Dental Techniques, (ed 3).  Philadelphia, PA, Saunders, 2002, pp 175-232.

[xxxii] Pattison AM, Pattison GL: Scaling and root planing, in Carranza’s Clinical Periodontology. St. Louis, Mo, WB Saunders, 2006, pp 749-97

[xxxiii] Wiggs RB, Lobprise HB: Periodontology, in Veterinary Dentistry, Principals and Practice.  Philadelphia, PA, Lippincott – Raven, 1997, pp 186-231

[xxxiv] Debowes LJ: Problems with the gingiva. In: Small Animal dental, oral and maxillofacial disease, A color handbook (Niemiec BA ed.). London, Manson, 2010, pp159 – 181.

[xxxv] Drisko CL, Cochran DL, Blieden T, Bouwsma OJ, Cohen RE, Damoulis P, Fine JB, Greenstein G, Hinrichs J, Somerman MJ, Iacono V, Genco RJ; Research, Science and Therapy Committee of the American Accademy of Periodontology. Position paper: sonic and ultrasonic scalers in periodontics. Research, Science and Therapy Committee of the American Academy of Periodontology. J Periodontol. 2000 Nov;71(11):1792-801.

[xxxvi] Stutzer D, Hofmann M, Eick S, Scharp N, Burger J, Niederhauser T. In-Vitro Measurement of Forces During Debridement with a Piezoelectric Ultrasonic Periodontal Scaler. Oral Health Prev Dent. 2024 Jun 12;22:223-230.

[xxxvii] Trenter SC, Landini G, Walmsley AD. Effect of loading on the vibration characteristics of thin magnetostrictive ultrasonic scaler inserts. J Periodontol. 2003 Sep;74(9):1308-15

[xxxviii] Holmstrolm SE, Frost P, Eisner ER: Dental Prophylaxis and periodontal disease stages, in Veterinary Dental Techniques, (ed 3).  Philadelphia, PA, Saunders, 2002, pp 175-232.

[xxxix] Brine EJ, Marretta SM, Pijanowski GJ, Siegel AM. Comparison of the effects of four different power scalers on enamel tooth surfacein the dog. J Vet Dent. 2000 Mar;17(1):17-21.

[xl] Parashar, Atul and Neeta Bhavsar. “Assessing the effect of piezoelectric ultrasonic scaler tip wear on root surface roughness under influence of various working parameters: A profilometric and atomic force microscopic study.” Journal of Indian Society of Periodontology 27 (2023): 583 – 589.

[xli] Vengatachalapathi H, Naik R, Rao R, Venugopal R, Nichani AS. The Effect of Piezoelectric Ultrasonic Scaler Tip Wear on Root Surface Roughness at Different Working Parameters: An Atomic Force Microscopic and Profilometric Study. J Int Acad Periodontol. 2017 Jan 2;19(1):15-21. PMID: 31473708.

[xlii] Flemmig TF, Petersilka GJ, Mehl A, Hickel R, Klaiber B. The effect of working parameters on root substance removal using a piezoelectric ultrasonic scaler in vitro. J Clin Periodontol. 1998 Feb;25(2):158-63. doi: 10.1111/j.1600-051x.1998.tb02422.x. PMID: 9495615.

[xliii] Arabaci T, Cicek Y, Dilsiz A, Erdogan İY, Kose O, Kizildağ A. Influence of tip wear of piezoelectric ultrasonic scalers on root surface roughness at different working parameters. A profilometric and atomic force microscopy study. Int J Dent Hyg. 2013 Feb;11(1):69-74.

[xliv] Vengatachalapathi H, Naik R, Rao R, Venugopal R, Nichani AS. The Effect of Piezoelectric Ultrasonic Scaler Tip Wear on Root Surface Roughness at Different Working Parameters: An Atomic Force Microscopic and Profilometric Study. J Int Acad Periodontol. 2017 Jan 2;19(1):15-21.

[xlv] Arabaci T, Cicek Y, Dilsiz A, Erdogan İY, Kose O, Kizildağ A. Influence of tip wear of piezoelectric ultrasonic scalers on root surface roughness at different working parameters. A profilometric and atomic force microscopy study. Int J Dent Hyg. 2013 Feb;11(1):69-74. doi: 10.1111/idh.12003. Epub 2012 Oct 4. PMID: 23033943.

[xlvi] Vengatachalapathi H, Naik R, Rao R, Venugopal R, Nichani AS. The Effect of Piezoelectric Ultrasonic Scaler Tip Wear on Root Surface Roughness at Different Working Parameters: An Atomic Force Microscopic and Profilometric Study. J Int Acad Periodontol. 2017 Jan 2;19(1):15-21. PMID: 31473708.

[xlvii] Holmstrolm SE, Frost P, Eisner ER: Dental Prophylaxis, in Veterinary Dental Techniques, (ed 2).  Philadelphia, PA, Saunders, 1998, pp 133-166

[xlviii] Pattison AM, Pattison GL: Scaling and root planing, in Carranza’s Clinical Periodontology. St. Louis, Mo, WB Saunders, 2006, pp 749-97

[xlix] Holmstrolm SE, Frost P, Eisner ER: Dental Prophylaxis, in Veterinary Dental Techniques, (ed 2).  Philadelphia, PA, Saunders, 1998, pp 133-166

[l] Pattison AM, Pattison GL: Scaling and root planing, in Carranza’s Clinical Periodontology. St. Louis, Mo, WB Saunders, 2006, pp 749-97

[li] Wiggs RB, Lobprise HB: Periodontology, in Veterinary Dentistry, Principals and Practice.  Philadelphia, PA, Lippincott – Raven, 1997, pp 186-231

[lii] Debowes LJ: Problems with the gingiva. In: Small Animal dental, oral and maxillofacial disease, A color handbook (Niemiec BA ed.). London, Manson, 2010, pp159 – 181.

[liii] Vérez-Fraguela JL, Vives Vallés MA, Ezquerra Calvo LJ. Effects of ultrasonic dental scaling on pulp vitality in dogs: an experimental study. J Vet Dent. 2000 Jun;17(2):75-9.

[liv] Van der Velden U, Koster TJ, Feilzer AJ, Timmerman MF, Van der Weijden GA. In vitro evaluation of temperature changes in the root canal induced by ultrasonic scalers. Int J Dent Hyg. 2015 May;13(2):132-7.

[lv] Kocher T, Plagmann HC. Heat propagation in dentin during instrumentation with different sonic scaler tips. Quintessence Int. 1996 Apr;27(4):259-64. PMID: 8941844.

[lvi] Pattison AM, Pattison GL: Scaling and root planing, in Carranza’s Clinical Periodontology. St. Louis, Mo, WB Saunders, 2006, pp 749-97

[lvii] Holmstrolm SE, Frost P, Eisner ER: Dental Prophylaxis, in Veterinary Dental Techniques, (ed 2).  Philadelphia, PA, Saunders, 1998, pp 133-166

[lviii] Niemiec BA: Periodontal therapy. Top Companion Anim Med. 23(2):81-90, 2008.