The objective of this course if to develop competency in ultrasonic scaling use and techniques.

1. Ultrasonic Scaling
Course
SOUTHERN CALIFORNIA ORTHODONTIC ASSISTING SCHOOL

2. Introduction to
Ultrasonic Scaling
 An ultrasonic scaling unit legally can
only be used by an RDA or OA that has
successfully completed a board
certified 4 hour Ultrasonic Scaling
course
 The ultrasonic scaler is primarily used
during cleaning treatment sby the
dentist or Registered Hygienists
 To remove deposits of tartar by force
of vibration the ultrasonic tip sends
high frequency sound waves to the
tooth, dislodging unwanted build-up
or cement

3. Introduction to Ultrasonic Scaling
 Electricity is converted into mechanical energy that can generate 50,000
vibrations per second from the scalers tip, making techniques pressure
sensitive
 These vibrations will make the tip hot, never keep in one place to avoid
patient discomfort or damage to root/tissue
 Water is constantly sprayed from the scaler tip to prevent overheating
 It is best to have direct vision of the area being worked on. If this is not
possible, indirect vision can be achieved with the use of a mouth mirror
 All operators of the ultrasonic scaler must wear full PPE: Gloves, facemask,
lab coat or disposable gown and glasses.

4. Advantages of Ultrasonic Scaling
Reduces operator
fatigue
01
Fast, effective scaling
when proper
technique is
demonstrated
02
Fewer instruments
required
03
No instrument
sharpening required
04

5. Disadvantages of Ultrasonic Scaling
Produces potentially
infectious aeresols
01
Requires a power
source
02
Possible heat
damage to tooth if
used incorrectly
03
Magneto- restrictive
risk to patients with
health issues
Potential damage to
restorations
04 05

6. Types of Ultrasonic Scalers
 Magnetostrictive: This type of device uses rods of magnetic metal that when
magnetized creates a 360° motion. More heat is generated with this type of
ultrasonic scaler, so a cooling agent is important (water). Since the tip is
moving in an elliptical motion, when you leave the teeth it takes a moment
to slow down, thus creating a slight banging motion against the teeth.
 Piezoelectric: This type of device utilizes electrical currents, resulting in two
sides working together instead of the 360° motion. This method requires less
water because less heat is generated from it. A pro for this type of device is
that it is much softer of the tooth’s crown because it works in a linear
motion, stopping immediately. This prevents surface roughness.

7. Parts of Ultrasonic Scaler Unit
Ultrasonic Tip Insert
Hand Piece
Rheostat

8. Types of Tips/Parts of Tip
As the tips wear over time & use, the
efficiency of the scaler will decrease.
Replace periodically.
Universal Universal
Thin
Triple
Bend
Beaver
Tail
Concave
side Convex
backside
Tip Lateral
surface

9. Goals of Ultrasonic
Scaling
 The goal of ultrasonic scaling in
Orthodontics is to remove cured
band cement from the tooth surface
 Indications of using ultrasonic scaler:
 Easy accessibility to teeth receiving
treatment
 Using ultrasonic scaling method
would be more time efficient

10. Contraindications of Ultrasonic Scaling
 Always check health history before performing ultrasonic scaling. Do not
proceed if the patient has any of the following health issues:
 Tooth sensitivity
 Cardiac issues (pace makers or defibulaters)
 Heart issues
 Communicable disease (disease that can be spread through aerosol
transmission
 Prosthetic joints
 Diabetes
 If patient wears a hearing aid
 Dysphagia

11. Contraindications of Ultrasonic Scaling
 Do not perform ultrasonic scaling of a tooth that has exposed dentin present,
apparent cavities or demineralized areas

12. Assistant
Responsibilities
 To use sterile equipment and that is
operating correctly
 To protect themselves, the patient and
third parties from danger
 To avoid contamination and minimize
aerosols
 It is mandatory that operators wear
proper PPE during procedure at all
times to prevent to possibility of
infection
 Obtain informed consent from patient
or responsible party

13. Assistants with an Ultrasonic Scaling
Certification May Not…
Use the ultrasonic as a prophylaxis
Remove calculus and build-up from
subgingival or supragingival tissues
Remove cement related to restorations
ect. fillings or crowns

14. Armamentarium for Ultrasonic Scaling
 Bib for patient
 Cotton Rolls
 2x2 Gauze
 Scaling Tip Insert
 Goggles for patients eyes
 Saliva Ejector/HVE
 Mouth Mirror
 Scaler
 Band Removing Plier
 Prophy angle and paste
 Mouth rinse
 Floss

15. Proper Method for Use of Ultrasonic
Scaler
 Hand Placement:
 It is important that your chosen hand placement allows for
steady and swift movements, prevents fatigue of the hand and
maximum flexibility. Always establish a fulcrum in the same
quadrant you are working in.
 Pen grasp: Main area of support is from the inside area of the
thumb and index finger. The scaler tip rests on the side of the
middle finger.
 Modified Pen grasp: Resembles the pen grasp, but instead of
the scaler tip resting on the side of the middle finger, the
middle finger slides forward and is closer to the working end
of the scaler tip
 With opposite hand, use mouth mirror for cheek/tongue
retraction

16. Operator
Positioning
 Correct chair position helps with
visibility and accessibility
 Illumination and retraction are utilized
to allow comfortable positioning
 Proper positioning eliminates operator
fatigue and strain
 Position the patients head so it is
supported by the headrest
 Position patient in the supine position

17. Operator
Positioning
 Right Handed: The operators zone is
between 7 o’clock and 12 o’clock
 Left Handed: The operators zone is
between 5 o’clock and 12 o’clock

18. Proper Method for Use of Ultrasonic
Scaler
 Settings
 Adjust the hand piece so that the water and power are
performing at maximum efficiency with as little discomfort
to patient as possible
 Ideal comfort for patient is with power adjusted as low as
efficiently possible and the water to where droplets are
occurring and a fine mist as necessary
 Do not create a heavy mist. Avoid aerosols outside of the
mouth that can spread germs and bacteria
“In Phase” for light to
heavy cement removal
“Out of Phase” for sensitive patients

19. Maneuvering
Around
Orthodontic
Bands
 When performing ultrasonic scaling on a bracketed and
banded patient, it is important not to break or loosen
anything that would inconvenience the orthodontist
 When scaling around cemented bands, use a wider tip such
as a beavertail at a 10°- 30° angle
 Along with proper technique, use a lower power setting
around bands
 Always check for loose bands or appliances with a
weingardt after using ultrasonic scaler to confirm it did not
come loose.

20. Tips for Cement Removal
 You can often find band cement at the most inner crevasses between the buccal and
lingual cusps
 Use gentle tapping motion to remove large deposits of cement
 Keep insert moving at all times
 Work starting from the crown and moving in a back and forth stroke motion toward the
gum line
 Use light pressure
 Control aerosols by using saliva ejector frequently
 The tip and concave surface of scaler are most effective
Mesiobuccal
cusp
Distobuccal
cusp
Distolingual
cusp
Lingual
groove
Mesiolingual
cusp
DISTAL
MESIAL

21. How to operate Ultrasonic Scaler
 Turn power on
 Check water supply
 Select desired insert tip and seat into the hand piece until it is locked
 Set power knob to suitable level
 Hold the hand piece with the tip pointing into a cup or drain. Step on
rheostat for a few seconds and allow water to flow out
 Adjust water appropriately for proper technique to reach the “In Phase” or
“Out of Phase” setting

22. How to operate
Ultrasonic Scaler
 Always flush the waterline for 2
minutes before first use of ultrasonic
for the day & for 30 seconds between
each patient
 Try and keep the angle between the
patients tooth surface and the hand
piece as close to 30° as possible

23. After Cement Removal with Ultrasonic
Scaler
 Use a hand scaler or band remover to confirm all
cement is removed
 Use ultrasonic scaler again if necessary and repeat this step
 Polish the area that was scaled
 Floss to confirm all contacts are open
 Have patient gargle antimicrobial mouth rinse

24. Equipment Sterilization
 Remove insert from hand piece and allow hand piece to run for a couple
of seconds to drain any possible contamination left inside
 Outer surface of hand piece should be wiped with a chemical disinfectant
 Cable connecting to hand piece should be scrubbed with solution at the
end of each day
 Insert must sit in ultrasonic cleaner with cleaning solution, rinsed and dried
thoroughly, packed in sterilization pouch and placed in an autoclave
 The main unit should be swabbed with alcohol or a disinfectant and kept
away from dust

25. Infection
Control
Between Each
Patient
Includes
 Always disinfect the following
 Loose instruments (packaged or not)
laying around operatory
 Walls, floors, countertops and dental
chair surrounding where scaling was
performed
 Overhead light handle/operatory
switches
 Dental chair controls
 Any object the assistant touches after
scaling begins