Universal air scaler tip for effective furcation treatment

Dr Claudia Springer and Dr Christian Graetz are both on the Periodontology faculty in the Department for Conservative Dentistry and Periodontology (Director Prof. Dr C. Dörfer) at the Kiel campus of the University Medical Center Schleswig-Holstein and were influential in the development of the new W&H diamond-coated working tip. Improvements for the mechanical removal of biofilm from root surfaces has been the focus of many studies in Kiel in recent decades [1-18]. The latest findings of ongoing studies also confirm the need for research into the effect and adverse effects of mechanical scaling.

As initiators of the development of the new diamond-coated 3AP air scaler tip, the two dentists recognized the need for improvement of the handling restrictions of the commercially available diamond-coated tips, especially during furcation treatment and when working in tight intraosseous pockets. This should be possible for both non-surgical (Figure 2) and surgical (Figure 3) procedures.

Fig. 2: Closed debridement of the furcations on teeth 26 and 36 in case of advanced attachment loss
(Fotos (Figures 2 -4): © Dr. Christian Graetz)

Fig. 3: Open debridement of the furcations on teeth 16 and 17 in case of advanced attachment loss

The aim was to develop a universally applicable tip in order to avoid time-consuming tip changes. In addition, it should be easier to use the new working tips in tight intraosseous pockets from distal and at the distal furcation entrance of maxillary molars, allowing more effective use of instruments as a result. This was achieved by employing an instrument curve with a larger diameter (Figure 1), which is highly advantageous for closed debridement on teeth with advanced attachment loss and involvement of furcation in particular (Figure 4).

Fig. 4: Closed debridement of the furcation on tooth 16 with advanced attachment loss

Following a range of different in-vitro studies with newly developed working tips with slimline designs [15, 16, 19], the authors have now also been using the diamond-coated 3AP working tip to treat patients for several months. As different studies conducted by the working group [11, 14, 16] have shown, systematic scaling is a skill requiring time and manual dexterity as well as motivation, but it is certainly not one of the most complex interventions encountered in clinical practice. The aim is to remove the micro-organisms organized in the biofilm from the exposed tooth surfaces whilst preserving the dental hard substance or at least to reduce them to a tolerable level for the individual host defence [20, 21]. This should create an almost smooth, bioacceptable root surface, which promotes the formation of an epithelial or even connective tissue attachment [20, 21].

Hand instruments are just as suited to this as mechanical scalers. The latter were originally developed to improve efficiency compared with the use of hand instruments. This is done by utilizing the kinetic energy of the oscillating working tip to process the root surfaces. Although the geometry of the oscillating working tips is basically similar in acoustic and ultrasonic scalers, it is still possible to identify differences in the various drive mechanisms, with air scalers displaying almost round/elliptical oscillations of the working tip due to their drive type and an oscillation frequency of up to 6,000 Hz [22]. In this respect, a partial advantage is evident compared with the more linearly oscillating tips of a piezoelectric drive [23] or the ovally/ovoidly oscillating tip of a magnetostrictive drive [24]. Particularly in tight intraosseous pockets when using instruments in the furcation or in cases of taut gingiva in deep gingival sulci, the low-frequency but powerful, almost circular oscillation of an air scaler tip can help to improve the efficacy with reduced destruction of the root surfaces [16]. The different types of oscillation patterns also produce a working area of different sizes, which, however, can only be achieved with both instrument families if they are held at the correct angle (Figure 5).

Fig. 5: Illustration of the different handling when an (a) air scaler and a (b) piezoscaler are used at the correct angle in the region of teeth 16 and 17. The working field is produced by the different oscillation patterns and is smaller for piezoscalers with linear oscillation characteristics than for air scalers. The dentist must compensate for this by more frequently adapting the position to the surface of the tooth in order to ensure that the instruments are used effectively but still atraumatically.

As studies have shown, this makes it easier for inexperienced dentists to use the instruments in the back of the buccal cavity in particular [15, 16]. A recent study showed that with corresponding systematic training with the respective instrument work with the tested Proxeo air scaler (W&H, Bürmoos, Austria) was more effective than that performed with hand instruments and ultrasonic scalers and even revealed time savings [16]. This also corresponds to the external evidence [25, 26]. Working with the mechanical scalers is also more ergonomic for the user compared with hand instruments, both in terms of the working posture and taking the loads for the wrist, elbow and shoulder joints into consideration (study results collected by the authors but not yet published).

In practice, it would appear that selection of instruments depends less on their already practically identical high efficacy and more on the accessibility of the exposed root surfaces as well as the individual dentist, his or her preferences and the structure of the practice. Nevertheless, the specific disadvantages due for example to the unavoidable aerosol formation [15] and the unpleasant sensations for the patient as a result of the coolant and suction devices as well as the noise level [27] associated with the use of mechanical instruments must not be disregarded. This can have a direct negative effect on the patient’s compliance and can put the long-term success of the entire periodontitis treatment at risk as a result of lack of cooperation on the patient’s part.
However, the wide range of instruments available in periodontitis treatment offers the dentists the possibility of switching between the specified instruments or ideally combining the different procedures together.

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