Ultrasonics

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3. 1. History
2. Insight
3. Physics behind Ultrasonics
4. Physics behind Sonics
5. Biophysical effects of Endosonics
6. Comparative Analysis
7. Ultrasonic tips for conservative Dentistry
8. Ultrasonic Tips for endodontics
 Based on Approach
 Based on Use
9. Applications Of US And Sonics in Endodontics
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4. Latin
Ultra: ‘beyond’
Sonic: ‘sound’
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Ultrasound is high frequency mechanical
vibrations or pressure waves above a
frequency the human ear can hear.
Audible 20Hz and 20 KHz.
Infra sound Below 20Hz
Ultrasound Above 20 KHz

5. Ultrasonic Instrumentation- First introduced into dentistry in the form of a
drill (Catuna, 1953; Balamuth, 1967).
Johnson and Wilson (1957) improved it and the US scaler became
established in the removal of dental plaque and calculus.
Richman(1957) reported use of barbed broach connected to an ultrasonic
delivery system for use in canal preparation and apical resection.
Martin (1976) developed a commercial system harnessing ultrasonic
energy in the preparation and cleaning of the root canal.
Endosonics term coined by Martin and Cunningham
“Microultrasonics”.
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6. • Endosonics - Imparts sinusoidal
vibration of high intensity to a root
canal instrument.
 Either above that of audible
perception, i.e. at Ultrasonic
frequencies (20-42 kHz) or operate
within the arbitrary sonic or hearing
range (i.e. below 20 kHz).
 Both similar in design, consist of a
driver, to which an endosonic file is
clamped usually at an angle of 600 –
900 to the long axis of the driver
 It is the oscillatory pattern of the
driver that determines the nature of
movement of the attached file.
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Currently, the most widely used piezoelectric material is
Lead zirconate Titanate (PZT)
Magnetostrictive
Converts
electromagnetic energy
into mechanical energy
Cycles per second
24kHz max
Generates heat
Creates a figure eight
(elliptical) motion
Peizoelectric
A crystal is used that
changes dimension
when an electrical
charge is applied
converting this into
mechanical oscillation
Cycles per second
40kHz
No heat generation
Work in a linear, back-
and-forth, “piston-like”
motion

8. • Not a particularly
effective mode of
movement for an
endodontic
procedure:
• Results in irregular
cutting of dentin or
uncontrolled filing
in the apical third
of the root canal
Transverse
oscillation :–
• Advantage-
Enables filing
action to take place
along the total
length of the root
canal.
True longitudinal
action :–
At ultrasonic frequencies –
main driver oscillates longitudinally, the file
vibrates transversely.
This sets up a characteristic pattern of nodes
(points of minimum oscillation)
and
antinodes (points of maximum oscillation).
The greatest displacement occurs when the
working tip of the file is allowed to work
without interference.
Transverse motion of the file causes filing of
the dentine when the instrument is moved
vertically within the root canal space.
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9.  Only similarity - Imparting vibrational type of
movement for the root canal instrument, which they
activate.
 Other features such as the source of power,
frequency of vibration, type of hand piece and root
canal instruments used are all different.
 Sonic system does not require special
connections, as it involves only a hand piece.
 Sonic instruments rely on the passage of
pressurized air .
 Uses compressed air line at a pressure of 0.4 Mpa.
 Frequency- 3-6 kHz.
 Produces elliptical pattern of oscillation
 File when operated in air without any physical
constraint, sets up a circular motion
 Characterized by single antinode at the tip and a
node near the driver.
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Defined as the creation of new bubbles or the expansion,
contraction / distortion of pre existing bubbles in a liquid, the
process being coupled to acoustic energy.
(Leighton 1994)

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cavitation occurs when the ultrasonic
file vibrates in a liquid to produce
alternating compressions and
rarefractions of pressure.
A negative pressure develops within
the exposed cells of the intracanal
materials.
This causes an implosion, or inward
explosion, that breaks these cells
apart inwardly and leads to their
destruction.

13. Roy et al 1994 : Two types of cavitation
can occur during passive root canal
irrigation
Transient
Stable
Transient cavitation occurs only when
the file can vibrate freely in the canal or
when the file touches lightly the canal
wall (unintentional)
(lumley et al 1993 and Roy et al 1994)
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14. •Defined as the generation of time independent,
steady unidirectional circulation of fluid in the
vicinity of a small vibrating object.
• Acoustic streaming is the rapid movement of
particles of fluid in circular or vortex like motion
around a vibrating file.
-(Walmsley1987)
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15. When a vibrating file is immersed
in a fluid, the file is observed to
generate a streaming fluid
comprising two components:
Primary field - Consisting of
rapidly moving eddies in which the
fluid element oscillates about a
mean position
 Superimposed secondary field
Consisting patterns of relatively
slow, time independent flow.
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16. The acoustic streaming generated by the file
may play a useful role in reducing the number
of bacteria in the canal removing the smear
layer and debris harboring bacteria.
The main advantage of ultrasonic files is that
they move the irrigants around the canal to
penetrate to the most apical extent of the
instrument.
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HEAT
• Increases the temperature of NaOCl in root
canal upto 10 degrees.
• Use of regular coolant advisable.
AEROSOL
• Aerosol produced, contains micro-
organisms and blood contaminants.
PACE MAKERS
• Piezoelectric devices: no interference.
• Current guidelines recommend: avoidance
of magnetostrictive devices on patients with
pacemakers.
• Stooper et al.J Can Dent Assoc
2011:77:b113

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19. Excavus is a kit of five ultrasonic tips for minimally invasive
excavation that allows you to achieve small-volume proximal cavities
while preserving the integrity of adjacent teeth and healthy structures.
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20. The Perfect Margin kit of four tips enables delicate penetration of the
sulcus to finish the sub-gingival limits without harming the free gum
margin and the biological width.
The surfaces of the Perfect Margin tips have been specially
designed for each sequence of the procedure, so that the dentinal
tissue can be quickly and safely prepared in areas where it would be
delicate to use a diamond bur.
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21. 1. BASED ON APPROACH:
There are two types of ultra sonic tips in the
market
• NON SURGICAL TIPS:
 BUC TIPS
 Spartan Tips CPR Tips
 CPR TIPS Titanium Series
 Start-X TIPS
• SURGICAL TIPS:
 CT TIPS
 KIS TIPS
 BK-3 TIPS
2. BASED ON USE:
• Access refinement tips
• Vibratory tips
• Bulk removal tips
• Troughing tips
- DCNA 2004
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23. BUC-1 Fine Grit: The Cutter - Rounded tip eliminates clefts
and ditches in the pulp chamber floor. Cutting and refinement
of line angles, smoothing access walls, and cutting MB
troughs.
BUC 1A Is 6.3mm longer and has a rounded tip size of
0.3mm against 0.6mm.
BUC-2 Medium Grit: The Planer - Disk-like radiused tip
allows you to horizontally smooth pulp chamber floors and
safely plane out attached pulp stones without cutting the
chamber floor.
BUC 2A Has a tip size of 1.0mm against 1.4mm.
BUC-3 Fine Grit: The Digger - Extremely active tip for cutting
apically into calcified canals and around posts.
BUC 3A Is 4mm longer and has a pointed tip size of 0.3mm
against 0.5mm
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24.  Diamond coated – increases cutting
efficiency and creates a micro-rough
surface.
 New water port technology for wet or
dry cutting
 Trough and chase for hidden and
calcified canals
 Dislodge posts and broken
instruments
 Remove intra-canal obturation
materials
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25.  A special titanium alloy is used allowing
instrument flexibility for even greater
treatment possibilities. The titanium alloy
will retain a placed bend for access
around curved canals and obstructions.
 Access depth 20mm - CPR-6
Access depth 24mm - CPR-7
Access depth 27mm - CPR-8
Available singly or in a set of 3.
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26. Each tip has been
designed for a specific
indication and has the
following main
characteristics:micro milled
active part.
Minimized risk of potential
diamond grit loss in the
patient’s mouth
Cools down the tips and
avoids overheating of the
treated tooth. This is
particularly important when
removing metal posts
which usually require high
energy
The intermittent use of
irrigation enables the
clinician to alternate
between dry precision
work and debris
evacuation
Excellent resistance to
fracture
 START-X 1
Application - Access cavity wall refinement
Non active tip - Avoids accidentally
damaging the pulp chamber floor
Active lateral part - Creates a straight
access to the canal
 START-X 2
Application - MB2 canal scouter
Active tip - Removes the dentine that often
conceals the MB2 access in upper molars
Active lateral part - Creates a straight
access to the canal
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27.  START-X 3
Application - Canal openings scouter
Active tip - Removes the obstructions that prevent a
straight access to the canal
 START-X 4
Application - Metal post removal
Specific design - Suitable for working efficiently both
on the top and the sides of the metal post
Water port - Avoids over heating
 START-X 5
Application - Reveals the original pulp chamber floor
anatomy
Active tip - Canal orifice location made easier thanks
to the removal of calcifications and filling materials
that hide the original pulp chamber floor anatomy
Thin and cylindrical tip - Good visibility
File Holders
 Spartan File Holder
 File Holder for EMS
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28.  Irrisafe designed for safe removal of the
smear layer, dentine debris and bacteria
from the root canal.
 The instruments are used during Passive
Ultrasonic Irrigation (PUI) with sodium
hypochlorite.
 The instruments are ISO colour coded,
and available in sizes 20 and 25.
 Available in lengths of 21mm and25mm, in
packets of individual sizes.
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29.  The first ultrasonic tips for endodontic
surgery were first available in early
1990
 Designed by Dr. Gary Carr, hence
known as Carr tips or CTs. ¼ mm in
diameter,3mm in length and about 1/10
the size of a conventional microhead
handpiece.
 The original CTs (1-3).
 CTs are made of stainless steel.
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6 TIPS-
1D,2D,3D,4D,5D,6
Coated with zirconium nitride,
• provides strength
• surface roughness.
• cut significantly faster and more smoothly
• leave a slightly rougher dentin surface
• provides a more adherent surface for the
filling material.

31.  BK-3 surgical tips have three
bends for easy access to any
preparation, including MB2
canals.
 BK-3s provide excellent visibility
and can finish an entire prep
with one tip. Water is delivered
down the three bends directly to
the surgical site.
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2. BASED ON USE:
• Access refinement tips
• Vibratory tips
• Bulk removal tips,
• Troughing tips
- DCNA 2004

33.  The refining tips are used for moving the mesial marginal ridges mesially
to have to direct lines access to the MB2 canal.
 The tips also can be used for delineating the outlines of the root canal
orifices
 The ultrasonic tips can be used to dig and follow the sclerosed canals until
patency is achieved.
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34.  Removal of intra radicular posts has always
been a challenge when performing endodontic
retreatment
 The implementation of ultrasonic energy has
provided the clinician with an important
adjunctive method for removal of posts.
 They are activated at the maximum intensity
and moved circumferentially until the post
loosens or dislodges.
 For eg: VT (Sybron Endo), Osada Enac
(ST09) and CPR1
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35. Extremely sharp and sturdy, operated at moderate or maximum
intensity of the ultrasonic unit.
 For ex: BUC 1 and CPR –2D
 Both of these tips are diamond coated and have an added
advantage of a water port for increased washing and cooling of
the operative site.
 These tips are designed primarily to remove dentine and core
material quickly before vibratory or troughing procedures.
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36.  Used to create a sufficiently deep trough around posts to maximize the
benefits of subsequently applied vibratory or extraction forces.
 In the past, troughing was performed with trephine drills. This process
was extremely destructive and frequently led to the cutting down and
perforation of root trunks.
 With ultrasonic tips on contrary troughing can be performed in a
predictable and controlled manner.
 For example: CPR 3D, CPR 4D and 5D, available in 17, 19 and 24 mm
in length, respectively.
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38. • Access refinement, finding calcified canals, and removal of
attached pulp stones.
• Removal of intracanal obstructions (separated instruments,
root canal posts, silver points, and fractured metallic posts).
• Increased action of irrigating solutions.
• Ultrasonic condensation of gutta-percha.
• Placement of mineral trioxide aggregate (MTA).
• Root canal preparation.
• Surgical endodontics: Root-end cavity preparation and
refinement and placement of root-end filling material.
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(JOE) Vol 33, No.2, Feb 2007)

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Advantages of ultrasonic tips:
They do not rotate, thus enhancing safety and
control, while maintaining a high cutting
efficiency.
 Visibility ( hand piece do not obstruct)
 Saves time
Method:
• Initially larger tips used in pulp chamber
• Then thinner and long tips used deep to
facilitate working in deeper areas while
maintaining clear vision.

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Ruddles technique:
• Gates Glidden drills (size 3 or 4)
• Circumferential “staging platform” at
the coronal aspect of the
obstruction.
• Fine tips can be used to work
counterclockwise around broken
instruments to cause unscrewing
Separated
Instruments

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• Metallic
• Fibre post
•A fiber-reinforced composite post with a significantly lower modulus of
elasticity than stainless steel or titanium conducts vibration less efficiently.
•Resin cements - not friable and do not tend to produce microfractures due
to ultrasonic vibration.
•The absence of a water spray seems to increase the action of Ultrasonics
when applied to posts cemented with resin cements –due to increase in
heat.

42. This method of post removal minimizes loss of tooth
structure and decreases the risk of tooth damage
Initial removal of restorative material(s) and luting
cement around the post
Application of the tip of an
ultrasonic instrument to the post
Ultrasonic energy is transferred through the
post and breaks down the cement until the
post loosens

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TECHNIQUE
Expose the coronal part of the obstacle
by cutting an estimated 2.0-mm trough
around the obstacle
Apply to side with full power with water
irrigation
Ultrasonic vibration is applied for periods of
a few seconds followed by drying with
compressed air

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Studies failed to demonstrate:
-the superiority of Ultrasonics as a primary
instrumentation technique, as no improved
debridement was accomplished compared with
hand.
The relative inefficiency of ultrasonic debridement has been attributed to file
constraint within the unflared root canal space.
A modification of the technique in which ultrasound is activated for a few
minutes after hand preparation has instead resulted in greater canal and
isthmus cleanliness compared with hand preparation alone.
Ultrasonics
and Sonics
Hand and
Rotary
methods

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•An important parameter to note is that the smaller files generate greater
acoustic streaming and hence much cleaner canals.
• Hence, after canals are fully prepared by whatever means, it is
recommended returning with a fully oscillating No 15 file for 3 minutes
with a free flow of 1 - 2.5% sodium hypochlorite.
• Others including Martin have recommended that the No 15 file be used
exclusively.
•Antibacterial efficacy of irrigants in Endosonics was further proved when
the viable counts of bacteria dramatically reduced when water as an
irrigant was replaced by NaOCl.

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• Ultrasonically activated
spreaders have been used to
thermoplaticise gutta -percha
in a warm lateral
condensation technique.
• Ultrasonic spreaders that
vibrate linearly produce heat
hence produce a more
complete three-dimensional
obturation of the root canal
system.
• Also placement of sealers
with an ultrasonically
energized file promotes a
better covering of canal walls
with better filled accessory
canals.

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Witherspoon and Ham described placement of MTA with ultrasonic
vibration and an endodontic condenser - improved the flow, settling, and
compaction of MTA
 Denser MTA radiographically, with fewer Voids hence a significantly
better seal was achieved.

48. Surgical Endodontics
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49. cavities be prepared to a depth of 2.5-3 mm.
The cavity walls should be parallel and follow the
anatomic outline of the pulpal space it has.
Also, root-end cavities should be initiated with a
diamond- coated retrotip, using its better cutting ability to
provide the main cavity.
This aids in the removal of root canal obturation
materials and should be followed by a smooth retrotip to
smooth and clean cavity walls.
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Ultrasonic retrotips come in a variety of shapes and
angles, thus improving some steps during the surgical
procedures
Enhanced access to root ends in a limited working space
such as deeper and more conservative cavities that
follow the original path of the root canal more closely
decreasing the number of exposed dentinal Tubules and
minimizing apical leakage
A better-centered root-end preparation also lessens
the risk of lateral perforation
They also enable the removal of isthmus tissue present
between two canals within the same root thus lower
failure rate.

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51. 1. Ultrasonics In Endodontics –
2. A Review Of The Literature – JOE, Vol 33, No.2, Feb 2007
3. Modern Endodontic Practice - DCNA 2004
4. Endosonics: Clinical Impressions
5. Journal Of Endodontics, Volume 11, Issue 4, Pages 181-187
6. Endodontic Practice – Grossman
7. Endodontic Therapy – Weine
8. Cohen – 10th edition
9. Ingle - 6th edition 51

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