Sonic and Ultrasonic Devices and Instruments In

Endodontics
Introduction:

Ultrasonic instrumentation was first introduced into dentistry in the form of a drill
(Ctuna, 1953; Balamuth, 1967)

Such instruments were used with abrasive slurry for the preparation of tooth cavities
prior to restoration

This technique however was superseded by the advent of the high-speed hand piece
and a further development took place when Zinner (1955) recorded the use of an
ultrasonic instrument to remove deposits from the tooth surface

Johnson and Wilson (1957) improved upon the instrumentation and the ultrasonic
scalar became established in the removal of dental plaque and calculus

The idea of utilizing ultrasound in Endodontic therapy was suggested in 1957 by

Richman
This was not fully developed until 1976, when Martin developed a commercial system
harnessing the properties of ultrasonic energy in the preparation and cleaning of the
root canal
Tronstadt et al in 1985 were the first to report on the use of a sonic instrument for
Endodontics

These techniques were termed as Endodontics by Martin and Cunningham and have
now become a well recognized endodontic procedure.

An insight:

Endosonics denotes a device, which imparts sinusoidal vibration of high intensity to a

root canal instrument

The range, which is either or above that of audible perception, i.e. at ultrasonic
frequencies (20-42 kHz)

Both ultrasonic and sonic instruments are, however, similar in design, in that they
consist of driver, at the end of which is clamped an endosonic file usually at an angle
of 60 to 90 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

Endosonic instrumentation differs from hand and rotary instrumentation since the
cutting of dentin is facilitated by a mechanical device that imparts a sinusoidal
motion to the instrument by the transfer of vibrational energy along the shaft

The Physics behind Ultrasonics

There are two basic methods of producing ultrasound

The first is Magnetostriction, which converts electromagnetic energy into mechanical

energy

A stack of magnetostrictive metal in the handpiece is subjected to a standing and

alternating magnetic field, as a result of which, vibrations are produced
The second method is based on the Piezo-electric principle

A crystal is used which changes dimensions when an electrical charge is applied

This crystal deformation is converted to mechanical oscillation with no production of

heat

The magnetostrictive units have the disadvantage, when compared with the Piezo-
electric, that the stack generates heat and must be cooled This means tubing is
required to carry water to the hand piece, and if the irrigant is sodium hypo chloride,
then the water has to be led away by more tubing, after cooling the stack

A separate source by more tubing carries the sodium hypochlorite to the head of the
hand piece

Both these types work at ultrasonic frequencies and exhibit similar patterns of the
oscillation

At the ultrasonic frequencies used, the main driver oscillates in a true longitudinal
manner, and as it moves back and forth a transverse wave is generated along the
length of the endosonic file

This transverse oscillation is characterized by a series of Nodes and Antinodes along

the length of the file, the nodes representing sites of minimum oscillation of
displacement of the file and the antinodes representing sites of maximum oscillation
or displacement

The tip of the file that is totally unconstrained will oscillate with the greatest
displacement from rest

It is this motion of the file that almost certainly causes abrasion (filing) of the
canal walls when the instrument is moved vertically within the canal

The energy contained in the transverse oscillation of the file is low, however,
compared to that of the driver
consequently, if the file is constrained within a tightly fitting canal the oscillatory
pattern will be reduced or even eliminated

This is inefficient and more likely to occur in curved canals than straight ones

It is apparent that transverse oscillation is not a particularly effective mode of

movement for an endodontic procedure, as it may result in irregular cutting of dentin
or uncontrolled filing in the apical third of the root canal - dependent upon whether
the file is constrained or free with the canal

A true longitudinal action of the file would be an advantage, as this would enable a
filing action to take place along the total length of the root canal.

The Physics behind Sonics

Sonic instruments rely on the passage of pressurized air through the instrument hand
piece in order to use, operating at either or around 3-65 kHz

The sonic instruments have a main driver, which in contrast to the ultrasonic
driver produces an elliptical pattern of oscillation during activation

When the attached file is operated in air without any physical constraint, it sets up a
circular motion characterized by single antinodes at the tip and a node near the driver

The action of the driver imparts both a vertical and lateral component to the action
of the file

When the file is constrained is essentially eliminated, and a true vertical or

longitudinal file movement remains

This difference is oscillatory pattern may explain the reportedly superior

efficiency of the sonic instrument during clinical use
 Biophysical effects of endosonic:

Cavitation

Cavitation is defined as the growth and

subsequent violent collapse of a small gas
filled pre-existing in homogeneity in the
bulk fluid

When a vibrating object is immersed in a

fluid, oscillations are set up in the fluid,
which cause local increases (compression)
and decreases (rarefaction) in fluid
pressure

During the rarefaction phase, at certain pressure amplitude, the liquid can fail under
acoustic stress and form cavitation bubbles During the next positive pressure phase,
these primarily vapor filled cavities implusively

collapse, producing radiating shock waves Cavitation has been shown to be useful in
the removal of tooth deposits during operation of the ultrasonic scaler, as the scaler
has a larger surface area and displacement

amplitude, and thus is able to generate the threshold acoustic pressure amplitude

necessary to induce cavitation

Although it is theoretically possible that cavitational activity occurs also around

the oscillating endosonic file, it is highly unlikely that a confined area such as a
root canal would increase the probability of cavitation inception.

Acoustic Streaming
Acoustic streaming is defined as the generation of time independent, steady

unidirectional circulation of fluid in the vicinity of a small vibrating object When a

vibrating file is immersed in a fluid, the file is observed to generate a streaming fluid
comprising two components:-
The primary field consisting of rapidly moving eddies in
which the fluid element oscillates about a mean
position

The superimposed secondary field consisting a patterns

of relatively slow, time Independent flow

Characterstically the fluid is transported from the apical

end to the coronal end flows of liquid have a small
velocity, of the order of a few centimeters per second,

These but because of the small dimensions involved the rate of change of velocity
with distance from the file is high

This results in the production of large hydrodynamic shear stresses around the
file, which are more than capable of disrupting most biological material

In a endosonic file the greatest shear stresses will be generated around points of
maximum displacement, such as the tip of the file and the antinodes along its
length and it is probable that will also be important in moving the associated
irrigant around the canal so that maximum benefit is achieved from the chemical
irrigant

Although either type of endosonic instrument (sonic and ultrasonic) is capable of

producing acoustic micro streaming, the clinical efficiency of such forces will be
dependent upon the amount of file constraint that occurs - especially in tight or
curved canals.

Indications for use:

 Removal of calculus and stains.
 Periodontal debridement
 Easier access to furcations
 Prior to oral surgery
 Removal of orthodontic cement and de bonding
 Removal of overhangs on restorations

Contraindication:
 Communicable diseases
  Patients susceptible to infections
 Respiratory problems
 Patients with difficulty swallowing
 Cardiac pacemakers
 Demineralized enamel
 Sensitive teeth
Ultrasonics Sonics
 which sound as an energy source  Similarity
(at 20 to 42 kHz), activates an  Imparting vibrational type of
endodontic file resulting in three movement
dimensional activation  Involves only a hand piece
 Use compressed air
 Options for irrigating
 The frequency of 1.5 - 3 kHz
Power source: Holder and adaptor

Endo file :

 Rispi sonic
 Shaper sonic
 Trio sonic

CT TIPS:

 First ultrasonic tips for endodontic surgery

 made of stainless steel.
 Designed by Dr.Gary Carr
 First available in early 1990
KiS TIPS:

 1999 by Dr.Syngcuk Kim

 designed for use in endodontic microsurgery
 Diamond coating provides a micro-rough surface of the
inner wall of the retro prepared cavity

ADVANTAGES

 increased cutting efficiency due to their diamond

coating.
 The dentin surface is left smooth, yet microscopically rough, which results
in better adaptation of filling materials, fewer microfractures and less
leakage.

PRO ULTRA TIPS

 Exists in two types namely

 Proultra endo 1-8
 Proultra surgical endo tips 1-6
 These tips are designed by Dr. Clifford J.
Ruddle

CPR TIPS

 CPR 1-5 are diamond coated and active along the side of the tips
 CPR 6-8 are titanium series

BUC TIPS

Designed by L. Stephen Buchanan

BUC-1: cutting and refining line angles, smoothing access walls

BUC-2: The Planer Disk Tip, medium diamond grit - planing pulp chamber floors and
safely plane attached pulp stones out without cutting the chamber floor
 BUC-2a: Smaller Disk-used for corners of molar and bicuspid access
preparations. 1mm in diamater
 BUC-3: The sharp tipped, fine diamond grit - very active tip for cutting into
 calcified roots and around posts

BK 3 TIPS

 three bends for easy access to any preparation including MB2 canals.
 provides increased visibility and can finish an entire prep with one tip.
 use with any application.

COMPARATIVE ANALYSIS

SHAPING OF ROOT CANALS

Ultrasonics

 High efficiency
 Reduced operator fatigue
 Ideal power driven
 One of the uncharted problems-enlarging instrument - the K file
 Replacing k-files with k-flex
 Curved canals: 15-k
 Factors affecting final shape:
1. Power setting
2. Interfacial force
3. Geometry
4. lrrigant
5. "Superimposition

SONICS

 Oscillatory pattern
 Free to oscillate
 20K for 15
 Cutting effeciency Rispi, shaper, ultra K
Straight canals Ultra diamond
Curved Canals Sonics
Debris extrusion Sonics
Flaring UltraSonic
ROOT END PREPARATION

 MOST CRUCIAL FACTOR

 ULTRASONIC RETRO PREPARATION
 TECHNIQUE
 ADVANTAGES - conservative, bevelling, clean walls and features
 RETRO PREPARATION TIPS – SONICS

Endodontic Re Treatment

INTRARADICULAR POST

Ultrasonics - high efficient

Involves:

 Coronol cement removal

 Buildup material
 Activating tip
 Sonic - ineffective
 Frequency or amplitude

SILVER POINT REMOVAL

 The tightly fitted, well cemented silver cone that is flush with the canal
orifice is a challenge to remove
 In such cases, removal is enhanced through the use of ultrasonic devices
 A conservative approach - advocated by Krell

GUTTA PERCHA REMOVAL

 Ultrasonic instrumentation - with a solvent

  The ultrasonic-chloroform technique may produce residual
slurry that may coat the canal wall
 Halothane - quick retrieval of the bulk
 Although ultrasonic instrumentation require less time
than hand instrumentation to attain the working length,
it uses significantly more solvent because the solvent
not only acts as an irrigant but also gets volatilized

SEALER PLACEMENT & GUTTA PERCHA OBTURATION

 Sealer placement significantly superior to hand reamer placement

 lateral and accessory canals well Filled
 A common - "whipping up" of the cement
 replacing the ZnO-Eugenol sealer with a resin sealer like AH-26
 The Helio Sonic files are also equally useful for coating the
canal wall with sealers and for placing calcium hydroxide
pastes
 Moreno first suggested the technique of plasticizing
gutta percha in the canal with an ultrasonic instrument

PRECAUTIONS DURING INSTRUMENTATION

 A roor canal instrument should not be forced if it binds

 To force an instrument, it is to invite to breakage of an instrument
 Always only controlled finger pressure should be used in
manipulating an instrument in the root canal.
 Always instrumentation of root canal should be done in a wet canal
 Instruments must be used extra vagantly particularly in the smaller sizes
 Once the working length of a tooth is determined, all
instruments must be kept within the confines of the root
canal
 Presented By: DR Mohamed Hamdy Atyia

Made BY: Ahmed Mohamed ahmed

Id : 200016804

REFERENCES

Pathways of Pulp - Cohen 4th, 6th,8th editions

Endodontic practice-Ingle 4th edition

DCNA-Modern endodontic practice

JOE-1987

Current trends in

EndodontologyDr.A.Parmeswaran, Dr.B.P.Rajan
FACE-1 Tooth Resorption- Dr.M.R. Srinivasan