Vista View Blog #4 - Spotlight on Ultrasonics: Piezo Pilot™
Posted by Dr. Richard Mounce, DDS on February 07, 2019
The use of ultrasonics in dentistry has traditionally been centered in the dental hygiene and endodontic realms, with piezo surgery emerging in popularity. This Vista View blog was written to describe the uses of ultrasonic electromechanical energy in endodontics and dental hygiene and describe the main differences in magnetostrictive (“MS”) and piezoelectric (“PE”) units. In addition, an affordable and clinically proven unit, the Piezo Pilot™ will be presented which can simultaneously be used in both endodontics and dental hygiene.
As an endodontist, I’ve been using ultrasonics daily since 1991. Ultrasonic units are a mainstay of the modern endodontic operatory. Their accompanying tips are used to remove very fine amounts of tooth structure in a highly controlled manner, for example, when attempting to find a canal (most frequently the MB2 canal of upper first molars), exploring an isthmus to find additional canals, and/or during apical surgery in retro-preparation. Other applications include the removal of separated instruments, posts, and canal obstructions of all kinds. Optimally, all ultrasonic tip use in endodontics is performed using loupes and surgical microscopes. A future Vista View Blog will discuss the use of specific ultrasonic tips and their clinical use in endodontics.
In addition to the indications mentioned above, ultrasonic electromechanical energy can be harnessed to provide acoustic streaming and cavitation (described below) by a device like the EndoUltra®, which activates endodontic irrigants, such as SmearOFF™ and Chlor-XTRA™, making them more clinically effective.
Ultrasonic electromechanical energy comes in two main forms in dentistry: PE and MS. Endodontic ultrasonic units and tips are all piezoelectric. Dental hygiene ultrasonic units can be either MS or PE as both are clinically effective for this application. MS units cannot be used for endodontic indications. Ultrasonic units, more commonly known as scalers, are ubiquitous in the practice of dental hygiene. In the USA, most hygiene units in use are MS. However, PE technology dominates the global market.
MS scalers work generally in the frequency of 25-30 kHz and PE units are generally more powerful with a frequency of 30-50 kHz. Ultrasonic tip vibrations produce cavitation. Cavitation is the energy release which results from the collapse of water bubbles generated by ultrasonics in endodontic irrigation and hygiene scaling. The resulting energy release is bactericidal, enhancing disinfection.
The ultrasonic energy generated by MS devices is produced by the resonation of a group of metal slices on the scaler tip (more commonly referred to as an insert). Alternatively, the ultrasonic energy generated by PE devices is produced by the resonation of a PE transducer (located in the handpiece) containing PE crystal stacks when subjected to an electrical field. This ultrasonic energy is then transmitted through the PE transducer to the scaler insert.
The energy transmitted to the ultrasonic tip of a MS unit and PE unit are slightly different. All of the surface of a MS ultrasonic scaling unit is active when energized, and it is the distal 4.0 mm of the end that is working to remove deposits.
The very end, or tip of a MS ultrasonic scaling insert is the most active point (literally). As a result, the end (tip) of a MS ultrasonic scaling insert must not be placed at a 90-degree angle on the tooth. Doing so can cause damage to tooth structure and discomfort for the patient.
All things being equal, the oscillation patterns of scaler tips are not, strictly speaking, depending on if the unit is MS or PE. Whether these oscillation pattern differences are of any clinical significance is a matter of clinical debate. Ultimately, the effectiveness of any given tip is likely to be more influenced by tip design and how the tip is used by the clinician.
The handpiece and ultrasonic tips of PE units do not heat up to the same degree as their MS counterparts, hence PE units use less water and produce less aerosols. PE units produce minimal handpiece vibration and are more economical than MS units. PE handpieces are lightweight, ergonomic, and have improved tactile sensitivity, relative to their MS counterparts.
MS ultrasonic units should be used with caution in patients with pacemakers. Some older pacemaker models can be disrupted by MS scalers and medical consultation may be indicated. Alternatively, all patients with pacemakers can be treated with a PE unit (whether endodontic or for hygiene) without undue concern.
Among other available commercial alternatives, Vista Dental markets the Piezo Pilot™, a reliable and cost-effective PE option that is suitable for both hygiene and endodontic use. The only difference between the endodontic version and the hygiene version of the Piezo Pilot™ are the tips that accompany the unit.
The Piezo Pilot™ units include:
- 2 - autoclavable handpieces
- 8 hygiene scaling tips or 8 endodontic tips (For the scaling tips, unique tip designs are available - for example, the Gracey Mini Curette Tip)
- 1 - Omni-directional foot pedal
- 1 - Quick-disconnect water line
- 8 - Torque wrenches
- Left or right mounting magnetic handpiece holder
- Push button controls
- Variable irrigation flow
- All Vista tips are warrantied against tip breakage
- 2-year warranty on unit and handpiece
It is noteworthy that Vista also markets a hygiene centered “ Piezo Co-Pilot™” (it comes with hygiene scaling tips) which is identical to the Piezo Pilot™ except that it contains internal liquid water reservoirs that can be filled with water, Peridex™*, Listerine®*, and other solutions.
The Co-Pilot™ can certainly be used for endodontic applications (with water, but not corrosive chemicals like sodium hypochlorite) utilizing the water reservoirs instead of using an external water source. The internal liquid reservoirs of the Co-Pilot™ allow either a hygienist or endodontist to move the unit from room to room without plugging into an external water source.
To order Vista’s Piezo Pilot™ hygiene or endodontic configuration, or for more information, please visit vista-dental.com. If there is a topic you would like addressed in the Vista View, or you have a clinical question about Vista products, write me at RMounce@vista-dental.com. See you at the Apex.
*Peridex™ is a registered trademark of 3M. Listerine® is a registered trademark of Johnson & Johnson Consumer Inc.
Note: Dr. Mounce is a practicing endodontist who writes and lectures nationally and internationally. He is the Chief Dental Officer of Vista Dental. Literature references available upon request.