Benefits of Piezoelectronic Instrumentation for You and Your Patients

You're listening to The Dr. Phil Klein Dental Podcast from Viva Learning.com. Welcome to the show. I'm Dr. Phil Klein. Today we'll be discussing how electronic instrumentation is beneficial to the dental hygienist and the patient, specifically focusing on the piezo-electronic scaler. Our guest is Schelli Stedke, who has worked in many areas of dentistry, including clinical care, education, sales and marketing, and has most recently gained a certification as a registered yoga teacher. and certified health coach. She has a passion for helping her fellow dental professionals stay healthy and well for the duration of their career. Schelli , it's a pleasure to have you back on Dental Talk. Thank you, Dr. Phil. It's a pleasure to be here today. So to begin, talk to us briefly about the two kinds of electronic instrumentation that are used in dental practice today, and if you could focus on how they differ in the way they function. Absolutely. First of all, there's a piezo unit or piezo electronic unit and a magnetostrictive unit. A piezo electronic unit uses a transducer, which is made of ceramic crystals, and this produces a vibration with alternating electrical currents that creates a dimensional change and makes the working end vibrate in a linear or a back and forth motion. So all the sides are activated by this dimensional change, but only the lateral sides can be adapted. the tooth for the removal of the calculus. The crystals generate little heat and therefore less water is needed to cool the unit than a magnetostrictive unit. And this could possibly mean better visibility for the practitioner and a little less water buildup in the patient's mouth. The active tip area for a piezo electronic unit is about 2.2 to 3.5 millimeters, depending on the tip design and the frequency varies. from about 25 to 50,000 kilohertz. And then we've got the magnetostrictive unit in contrast with the piezo. It uses a core that is a stack of metal strips to create the tip. It's exposed to a copper wire inside of the handpiece. And when that touches, it creates a varying magnetic field and the electronic current runs through it. And then this alternating magnetic field causes that tip to vibrate in an elliptical or a football shaped manner. So heat is a byproduct caused by this vibration. Therefore, water has to be used to. cool the unit's tip, and this helps prevent tissue and pulp damage. And then the active tip area on a magnetostrictive unit compared to a piezo unit is about 4 .3 millimeters. They are both really similar in removing calculus and they both produce cavitation and lavage, which is good to break bacterial cell walls and to clean out pockets or a deep periodontal defect. Which one is more popular in the U.S. right now? In the U.S., by far, the magnetostrictive is more popular than the Piezo. However, in Europe... in other countries, the piezo is very commonplace there. I think it is becoming more popular in the U.S. as time goes by. You know, research is showing that they're both very effective at removing calculus. There is some research that shows that patients prefer the comfort of the piezo because it can be a little less aggressive on the tooth structure. But they are both used here. And I do believe, too, the magnetostrictive is taught more commonly in schools than the piezo. So therefore, you know, it kind of continues that cycle of use because it's what people are trained with and what they're used to. I went to dental school a long time ago. I won't tell you when, but that's another story. But at that point... Hand scaling was still very, very important and a key component to the hygiene school that was at Penn. Is electronic instrumentation a substitute for hand scaling at this point? Well, you and I both went to school a long time ago, and it was not commonly used when I was in school either. And I would not say it's a substitute for hand scaling. I really think that each instrument has its place in the dental hygienist armamentarium. I do think it is a staple, and if people are not using it, which most people are using some type of electronic instrumentation at this point, but it is very common and it is really necessary. i think it ergonomically it's a huge benefit it takes less time it's more efficient at removing calculus there are also some benefits like the lavage and the cavitation so with the cavitation it's basically sending the vibration of the water through the end of the unit or the end of the tip and that can act as a bactericidal effect it breaks up the cell walls and then flushes those out of the pocket so you can see really good results with that however i would say in in my personal opinion i think it's a combination of both electronic instrumentation and hand instrumentation there are you know a couple benefits and I always like to go back with an Explorer, like an 1112 Explorer, because the tactile sensitivity that you get from using that Explorer and checking the areas for calculus, it's just irreplaceable. And not to say you couldn't go back in. If there's, you know, a small piece of calculus left, scale it off with a hand instrument or go back in with your electronic instrument. So what are some machine features that should be considered when thinking of adding a piezo electronic scaler to your instrument repertoire? uh so some of the things that should be considered are basically the ease of use and setup of the instrument is it easy to house in your area in your dental operatory or you know is does it have to be moved around a lot so the ease of use is really important is the handpiece lightweight is the cord long enough that ergonomically you're not going to be stretching and pulling that where it gives the wrist tug back in that area i've also seen some newer ergonomic type things that actually attach to the wrist and the arm and and the cord so it keeps it nice and close With the handpiece itself, is it small and is it easy to maneuver in the posterior areas of the mouth? Does it have an auto-cleaning ability? So some units have just a flushing button where you can flush out the handpiece with fresh water between every patient. And of course, you should always be doing that and then flushing it at the beginning and the end of the day. The rheostat as well. are you able to touch all sides of the rheostat to activate it because ergonomically for our legs our ankles are lower spine that's really important too you don't want to have to flip around a rheostat in your dental operatory every time you are seeing a patient or move it out of the way and then have to move it back a couple other features is there a light in the handpiece some units have led lights in the handpiece that actually allow us to see our field of view a lot better and we all know that we're working in a dark moist environment that's pretty small so any light is good and then a couple other things you might want to consider are the available tip selections depending on what you're using it for piezos have a great range of tip selections so you can get anything from heavy calculus that's super gingival down to really deep periodontal pockets that may just need the biofilm flushed out, whether you can access furcations, left and right tips. So those are all things to consider. Yeah. And speaking of tips, I was going to ask you, how do the tips differ in piezo electronic scalers versus the magnetostrictive units? So with the magnetostrictive units, we talked a little bit about the metal stacks creating the tip in the magnetostrictive. it is a long cylindrical tip that actually inserts down into the handpiece itself, and then it's removed after each patient. With the piezo tip, it's a threaded tip that's very small, and it just screws on to the actual handpiece with a specialized wrench, and you... most units have a wrench that you tighten it and then it begins to click. And once you know that you've clicked it a few times, you know that that tip is seated into the unit and it will not loosen and come off. And how often is it necessary to change or replace the tips for the piezo electronic scaler? Really, it's pretty standard with any electronic scaler, and it depends on how often you're using the tips. If it's a tip you're using every day, Obviously, more frequent use, you're going to have to replace it more often. But with kind of the rule of thumb is that once there's two millimeters of wear on an electronic tip, you have lost 50% efficiency and effectiveness. So you're really not doing the job that you should be doing if you aren't replacing those tips regularly. And the other thing I would say about replacing the tips, every manufacturer makes slightly different tips. And with the piezo, that can be a little bit different than with a magnetostrictive unit. Because with the piezo, the thread patterns can be different on the tips. So you want to make sure when you purchase a tip, even if you're buying it from a different manufacturer that it is compatible with your unit the easiest thing honestly i think is just buying the tips from the same manufacturer that you purchase the unit from because then you're guaranteed that it's going to work well and then along with that every manufacturer has what's called a tip guide and that helps you measure the wear of the tip over time so that it will tell you if you've lost millimeter a half a millimeter all the way and then when you get to that two millimeter point you need to replace it but you really need to use the tip guide made by the manufacturer that you have the tip because each one is shaped a little bit differently so it's pretty important to use that let's say you neglect to keep track of your tips what's the downside what could happen uh well what could happen it's not going to seed into the hand piece right first of all and then you're going to get possibly water leakage you could possibly get improper vibrations the water is not going to flow through the tip correctly in order to give you the lavage that you need one good thing about a piezo as well there's a lot of good things but um one thing that is nice about a piezo is it doesn't take as much water to cool it as a magnetostrictive ultrasonic because of the stacks that are in the magnetostrictive it takes a lot more water to go down those and cool it and with the ceramic transducers they don't produce as much heat so yeah but you'll see the cutting efficacy decrease right as your tips wear Oh, you will absolutely see the cutting efficacy decrease. And then what you could also have is some patient discomfort because you're trying extra hard to get that calculus off of there. You may be utilizing more pressure and not even realize it, and the tip is not working as effectively as it should be. So that's kind of like a downward spiral where you're not as comfortable, the patient's not as comfortable, you're working harder, and you're not getting the same results. So if an office has a magnetostrictive in their operatories, and it's on its last days and they're looking to replace it. How would they get introduced to a piezo electronic scaler if they haven't ever used one? Is that something they have to do like at a dental show or have a salesperson come in with a demo and show them how it's used? Yes. Actually, you probably would have to seek it out a little bit. And your sales representative would be a great place to start to have a manufacturer come in to give you a demo of those units. It's definitely worth shopping around and looking into replacing your magnetostrictive with the piezo. The salesperson is a great place to start. Dental shows are a wonderful place to start as well. There's always so many new and up and coming products at those shows and there are demonstrations available. But typically it would be something you would have to seek out or you would see in an advertisement and look to replacing it that way. But I would definitely highly recommend having a demonstration done if you are thinking about replacing it because they are wonderful units. Do you have any recommendations as far as a manufacturer that you like to work with? Do you prefer magnetostrictive over piezo electronic or the reverse? I honestly like both of them. I think they're both very effective at removing calculus. There are a few benefits that the magnetostrictive has. There are also a few benefits that the piezo has. I do like the fact with the piezo you can use less water. And there has been some research that has supported. more patient comfort with using a piezo because since only the lateral sides are active, you're not hitting against the tissue as aggressively maybe as with the magnetostrictive. I honestly prefer the NSK Varios unit. It has an LED light, it self flushes, and it has two 400 milliliter reservoirs of water. So I think it's great that you could use it. any regular dental office, but also if you work in a mobile unit area or if you work in public health and you may not have the ideal setup, this is a great unit that you can take with you and you don't even have to have water supplied to it. You can provide your own water or a medicament in order to flush out the pockets as you're cleaning, as you're providing periodontal therapy. And the NSK unit is a piezo-electronic scaler? It is a piezo-electronic scaler. Yes, it is. What are some precautions or considerations when deciding whether or not to use electronic instrumentation on a specific patient? Are there contraindications? There are definitely contraindications. As with pretty much anything, we always want to treat every individual as an individual. But if someone were to have... pulmonary disease, emphysema, asthma, severe asthma, you probably would not want to use a piezo or a magnetostrictive. Many years ago the magnetostrictive was recommended against use for someone that had a pacemaker. And I would still recommend getting medical clearance for this. Most pacemakers in today's day and age are shielded, and that means that they're not affected by that magnetostrictive unit. However, there have been exceptions, or there might be patients that actually can feel it somewhat, even though it's not really doing anything. So you want to get clearance for sure if you're using it with someone that has a pacemaker. If anyone has reduced oxygen levels for any reason, you don't want to use electronic instrumentation on them because you are creating an aerosol or an infectious disease. If somebody has, whether it's TB, COVID, anything like that, you're not going to want to use that. And then, of course, if someone has a herpes virus lesion on their mouth, you're not going to want to use that because they are really spreading out a large aerosol. So during the height of the pandemic, was it pretty typical for a dental office to shut down their ultrasonic scalers? Yeah, I do believe at one point it was recommended completely by the CDC to not use electronic instrumentation at all for a period of time. So we were really going back to hand scaling. And I believe what we were seeing is an uptick, even though we already have a lot of ergonomic issues the way it is, when we're hand scaling and we've been used to... electronic scaling it makes a big difference in the health of the arm, the wrist, the approach to the patient. So yes. Yeah. So going into that topic, actually, I'm glad you brought that up. Let's talk about ergonomics briefly. So when you compare a practitioner who primarily uses hand scaling versus electronic instrumentation, do you see a difference in ergonomic issues? You know, I don't know that a lot of research has been done on that, honestly. That would be a great project for someone just to actually dig into the real difference in the ergonomic situation or if it extends career life or career comfort. What I will say is that it has been shown for electronic instrumentation. They're very light. They're very effective. So you are increasing your efficiency. So where you might have been scaling a patient's teeth for 40 minutes prior to using. an electronic instrumentation, now you're sitting with that same patient for maybe 15 to 20 minutes and getting the same or better results and more thorough results. So obviously, if we're taking less time to complete the same job in just as an effective way, ergonomically, it's going to be better for our bodies long term. If also used properly in the... machine is positioned correctly so that you're not having a lot of tug from that cord or from the handpiece. You've really got easy access into the mouth and the size of the handpiece itself is a little larger than a hand instrument. which makes it easier for the grasp and you're not having to grasp it as hard or as tightly long-term to remove that calculus. So you've got less hand and wrist strain. And then of course that travels up through the elbow and through the shoulder into the spine. So I know NSK focuses a lot on ergonomics with their hand pieces. Does that carry through with their piezo-electronic scaler that you recommended? Yes, it does. They actually have the lightest and slimmest handpiece. So it is larger than a hand instrument, but it's not too big. It's a really good size. So it's the lightest, slimmest handpiece on the market for use in a piezo electronic scaler and one that incorporates an LED light, which is really good so that we can visually see the field that we're working on and allows us to get in there a little bit easier and maybe quicker because you can see the field better. Yeah, I know the folks at NSK fairly well, and I know they focus very, very stringently on ergonomics, having the handpieces that they sell be lightweight, and they take in consideration the number of hours a practitioner holds that handpiece and uses that across the day, a week, a year. And they've come out with some really phenomenal stuff. I've seen it at the dental shows. I'll be going to the New York show right after Thanksgiving. I'm going to take a look at some of their new stuff as well. Let me wrap up this podcast with a question about how and why the use of electronic instrumentation, generally speaking, has grown over the last 20 years in the dental profession. Yes. Well, going back to what you said earlier, I won't say when I went to school, but at that time, the electronic instrumentation was thought of as kind of a supplement. It was something you had to use before you graduated on a patient in order to show you were, you know. efficient at using it but as time has gone by manufacturers have developed slimmer and more readily usable tips that can access deeper pockets that can access vacations so probably in the 80s they had A few tips, you know, 80s and 90s, they had a few larger tips. They were great for removing supergingival calculus. And then the hygienist would go back in and hand scale to remove all of the subgingival calculus. And they started to realize that, hey, there's really a need for this to be used more effectively subgingivally as well as supergingivally. Then they also found out the benefit of cavitation and microacoustic streaming that go hand in hand with that. as well as the benefit of being able to use medicaments in there for an antibacterial. So I think it's just evolved over time and the development of the style of the tips that they can be used that are made by the manufacturers and the availability to clean those deep pockets where we couldn't do that before with the hand instruments. I mean, I'm sorry, with the electronic instruments. Yeah. So those tips have really became a game changer for ultrasonic without a doubt. Truly. Yeah. That's been very insightful, Schelli . It really helped us understand the differences between the two electronic instrumentation machines that are currently being used in this country and I guess around the world. Europe is a little bit more popular with the piezo electronic scaler. Magnetostrictive seems to keep its momentum going up in the U.S., although I do hear a lot of dentists. when I speak to them, that they are moving to the piezo electronics scaler. Yeah. It's being introduced in more schools. I've been seeing that recently and just being at some dental shows have actually had hygienists that come up and say they've made a switch and they absolutely love it and wouldn't switch back. So it can be a personal preference for sure, but there's definitely a place for both in the marketplace. Yeah. So we encourage our listeners, if you're looking to purchase a machine like this, try out both, do some research, listen to more podcasts. talk to Schelli , whatever you wish, and you'll get the insight on what's going on. Thank you so much, Schelli . We appreciate your time and look forward to having you on more podcasts in the future. Thank you, Dr. Klein. It was great speaking with you today.