Investigation into patients' hearing following ultrasonic scaling.
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Biomedical subjects
Publications and source records attributed to W R Laird.
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Air-powder abrasive systems are used in dentistry to remove dental plaque, calculus and stain from the surfaces of teeth. A model system consisting of a thin layer (14 micron) of vacuum-deposited aluminium was used to demonstrate the effectiveness of such a system. Photomicrographic analysis showed two distinct areas of removal: an inner area where removal of aluminium was complete, surrounded by an area where removal was incomplete. With the aid of a relocation pin attached to the nozzle of the instrument it was demonstrated that nozzle-target distance, the air pressure input, the flow of water and the time of operation were all factors which affected the clinical efficiency of the instrument.
Ultrasonic instruments used in dentistry generally operate at frequencies of 25 to 42 kHz. A wire oscillating at these ultrasonic frequencies immersed in a liquid produces local flow patterns termed acoustic microstreaming. Large shear forces are produced which are able to rupture erythrocytes and platelets both in vitro and in vivo. This results in activation of the blood coagulation system with subsequent thrombus formation. The probe tip of an ultrasonic scaler was positioned to touch a mammalian mesenteric artery. The probe was operated for 10 to 20 s at a displacement amplitude of 15 micron. Acoustic microstreaming occurred which disturbed blood flow and this microstreaming ceased when the power was switched off. After continued operation of the probe, thrombi were formed against the vessel wall with fragments embolising downstream. These thrombi eventually grew to occlude the vessel. Furthermore, an in situ model demonstrated that acoustic energy was transmitted through the tooth during typical ultrasonic scaling procedures. As a consequence of these observations, it is possible that acoustic microstreaming fields may be generated within the blood vessels entering the tooth apex which are large enough to induce platelet damage. Therefore there is a potential hazard from the use of the ultrasonic scaler which may induce similar thrombi formation within the pulpal or perapical tissues of the teeth. If this were to occur it could result in tooth death which might not become evident until a long time after the ultrasonic exposure.
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A model system consisting of vacuum-deposited aluminum on glass was developed to demonstrate the effectiveness of cavitational activity (occurring within the cooling water supply of a dental ultrasonic scaler) in the removal of particulate material from solid surfaces. The amount of solid material removed from the model system by this cavitational activity was quantified by a spectrophotometric technique. It was shown that cavitational activity occurring within the cooling water is an important contributory factor in the cleaning efficacy of the ultrasonic scaler operated under conditions similar to those employed clinically.
The literature on the subject of dental bacterial plaque is extensive. In spite of considerable research, the mode of its formation together with the variability in bacterial content requires further clarification. Mechanical methods of plaque control are effective but limited in a population sense. Of the numerous chemotherapeutic agents in plaque control, chlorhexidin appears the most effective.
Mechanical attachments used to improve retention of overdentures have their limitations. With the recent development of the cobalt-samarium magnet an alternative method of achieving increased overdenture retention is offered. The most suitable form of magnet appears to be of a reverse split pole design with a ferromagnetic disc or keeper which will ensure a closed magnetic field. Clinical techniques involve conventional endodontic therapy, and the basic method of overdenture construction can be followed with only minor modification.
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