Can ultrasonic scaling remove resin composite material...?

[john6cl]

I'd like to thank Dr. Daniel for helping me out on my previous thread. I figured I would start a new one for a quick follow-up question. Any answers are welcome!

As I mentioned earlier, I'm having some shallow resin composites replaced on three molars and I would like to avoid any drilling if possible. I'm told that ultrasonic scaling can remove resin composite material, and that this method actually leaves the enamel and dentin unharmed. Can anyone confirm?

I did some research on the matter and plenty of studies discuss how ultrasonic cleaning can wear away the resin composite. However, I can't find much information on ultrasonic scaling as a method of intentional composite removal. I appreciate any insights!

I plan to ask my dentist to use the ultrasonic tip instead of a bur. Do you think they would react kindly?


Thanks so much!!!!
John

 

[comfortdentist]

there are higher strength ultrasonic devices that have available tips to do small preparations. I have one and have used it but I much rather use a drill as it is much faster. I don't think many dentists have it though.

High strength ultrasonics can also be used to cut bone(excellent for that!!) and assist in tooth extractions with very little trauma.

 

[john6cl]

Thanks for the response. Do you think a dentist would know which ultrasonic tip and settings to select in order to take away just the composite and none of the actual tooth?

 

[comfortdentist]

if he has it then likely buy much more likely he won't have a high powered surgical unit

 

[john6cl]

Could I possibly ask you for more specifics? Is there a model number or a device name that you could give me? Then I could contact various dentists with my particular request.

Again, I'm looking for a method of ultrasonic scaling strong enough to remove the composite but delicate enough to leave the dentin totally intact.

I don't think a device capable of cutting through bone would be suited for this task, since so strong a force would likely harm the tooth. So the device I want should be weaker than a bone-cutter but stronger than a standard stain cleaner.

Thanks,
John

 

[drhirst]

Hi john6cl,

You would need more power to cut composite that bone. Bone is actually quite soft in comparison.
An ultrasonic that can cut composite will have different power setting for different tasks, you do not need different machines.
If your dentist has such a machine I am sure he will not mind using it. If he does not, I think it is unlikely he will purchase one just for you as then cost $thousands!
If you are happy with your dentist I would go with his recommendation. As comfortdentist says he may not view it as the best way to deal with your restorations. It is not the equipment so much as the skill of the operator that counts.

Good luck

Lincoln

 

[john6cl]

When you say this ultrasonic machine exists, do you mean that it can blast away the composite without causing more than microscopic damage to the dentin? That's my primary concern.

I'm willing to shop around for dentists until I find one willing to do this. I would even cross continents.

Hi john6cl,

You would need more power to cut composite that bone. Bone is actually quite soft in comparison.
An ultrasonic that can cut composite will have different power setting for different tasks, you do not need different machines.
If your dentist has such a machine I am sure he will not mind using it. If he does not, I think it is unlikely he will purchase one just for you as then cost $thousands!
If you are happy with your dentist I would go with his recommendation. As comfortdentist says he may not view it as the best way to deal with your restorations. It is not the equipment so much as the skill of the operator that counts.

Good luck

Lincoln

 

[comfortdentist]

When you say this ultrasonic machine exists, do you mean that it can blast away the composite without causing more than microscopic damage to the dentin? That's my primary concern.

I'm willing to shop around for dentists until I find one willing to do this. I would even cross continents.

Frankly Dr Hirst is right. Listen I like many dentists love finely made instruments and I have a piezosurgery surgical unit with a fine diamond tip that I can used for preps and have used but it really isn't the best way to go. A good dentist can give you an excellent result without this unit. In fact when preparing cervical cavitations for whatever reason I strongly prefer to make them retentive in design. They last for many more years without a worry this way. Also takes 4x as long to perform.

 

[john6cl]

I want to avoid traditional drilling so as to save myself from unbearable discomfort and further to preserve as much tooth matter as possible.

If ultrasonic scaling can remove composite without taking away dentin I don't see why drilling is necessary. Increased retention, or a deepened hole resulting from drilling, is exactly what I do not want. Events could proceed this way:

1. The dentist removes the shallow resin composite with ultrasonic scaling.
2. The tooth is now clear of all old resin composite. No additional tooth structure has been lost.
3. The dentist primers the bare biting surface of the tooth and applies the new resin composite. He shines his blue light. Done.

There is no additional drilling into the tooth whatsoever. While this results in decreased retention, it also spares as much dentin as possible, and that is my main aim. I prefer actual preservation of tooth over the possibility of a decreased lifespan for the new composite. Is this understandable?

A surgical ultrasonic unit might be too powerful, as I don't want to risk any accidental removal of tooth tissue. Is it conceivable that a standard cleaning unit could achieve the desired end?

My research suggests it might work:

Effects of sonic and ultrasonic scaling on the surface roughness of tooth-colored restorative materials for cervical lesions - PubMed

This study investigated the effects of sonic and ultrasonic scaling on the surface roughness of five commonly used tooth-colored restorative materials for Class V cavities, including a flowable resin composite (Tetric Flow), a compomer (Compoglass F), a glass ionomer (Fuji II), a resin-modified...

pubmed.ncbi.nlm.nih.gov

-this study discussed composite wear resulting form scaling

And here is a passage from another report:

"In addition to root surfaces, restorative materials adjacent to areas instrumented with power-driven scalers may sustain chips, scratches, or loss of material. For example, porcelain and composite restorations can be significantly damaged by ultrasonic or sonic instrumentation."

Here are some other applicable excerpts from the same study. I'm sure none of this is new to you but I just would to have the information posted for reasons of discussion:

"There are 2 types of power-driven scalers: sonic and ultrasonic. Sonic scalers are air-turbine units that operate at low frequencies ranging between 3,000 and 8,000 cycles per second (Cps), with a vibratory-type tip movement that is primarily linear or elliptical in direction."

"Ultra-sonics are currently available in 2 basic types, magnetostrictive and piezoelectric, which differ in their mechanisms of action. Magnetostrictive instruments operate between 18,000 and 45,000 Cps, using flat metal strips in a stack or a metal rod attached to a scaling tip."

"A piezoelectric unit operates in the 25,000 to 50,000 Cps range and is activated by dimensional changes in crystals housed within the handpiece as electricity is passed over the surface of the crystals."

So the sonic and ultrasonic cleaners range in strength from 3,000 cps to 50,000.

This part here concerns the root, lower tooth structure, but might as well apply to general scaling:

"There are some data to suggest that one way to avoid creating extensive iatrogenic root surface damage during periodontal debridement is to perform the minimal number of multiple light overlapping strokes with an ultrasonic scaler that are necessary to achieve a clean root."

"Using the ultrasonic scaler on medium or low power or using the tip of the sonic scaler at an angle close to zero degrees to the tooth surface may enable the clinician to perform a thorough debridement without excessive damage to root surfaces."

Would this technique work with removing composite? Multiple light strokes?

Also notable:
"Sonics and ultrasonics can be useful for the removal of amalgam overhangs."



Thanks again,
John

 

[john6cl]

I might also note what Dr. Daniel mentioned on another post:

"I suggest you ask for the ultra-sonic tip because it can remove the resin filling without the enamel, unlike the bur which removes everything."

Later he adds, "Ultra sonic is quite safe also with dentin."

Could someone explain exactly what kind of ultrasonic instrument can do this? Magnetostrictive? Piezoelectric? The CPS rate? Would a standard cleaning ultrasonic treatment work?

I really appreciate any insights, and I hope Dr. Daniel has a chance to see this post.

John

 

[Renée]

As I mentioned earlier, I'm having some shallow resin composites replaced on three molars and I would like to avoid any drilling if possible. I'm told that ultrasonic scaling can remove resin composite material, and that this method actually leaves the enamel and dentin unharmed. Can anyone confirm?

Hello John,

I found the threads you created here very useful. For some time I've been trying to solve the same dilemma as you were having. Have you also considered dental laser? Do you mind sharing how your situation with replacing the fillings went? Were you happy with the procedure and the result? What instrument did the dentist use to do this work?

I do understand your desire to preserve as much tooth tissue as possible. I feel the exact same way and for that reason I am terrified of the dentists! Not so much because of pain that I have to go through to get the work done, but because I always have a feeling that the dentist doesn't care about how much tooth tissue he is removing. At least not as nearly as much as I do. In order to really care about it he will have to spend a lot of time preparing just 1 spot for a filling under a microscope and going very slow with a very gentle instrument. So, just wanted to hear your insights and also if you have found someone like that.
Again, thanks so much for bringing up this topic!!!

 

[gentledental]

I might also note what Dr. Daniel mentioned on another post:

"I suggest you ask for the ultra-sonic tip because it can remove the resin filling without the enamel, unlike the bur which removes everything."

Later he adds, "Ultra sonic is quite safe also with dentin."

Could someone explain exactly what kind of ultrasonic instrument can do this? Magnetostrictive? Piezoelectric? The CPS rate? Would a standard cleaning ultrasonic treatment work?

I really appreciate any insights, and I hope Dr. Daniel has a chance to see this post.

John

Hello John,
I don't know much about ultrasonics for the removal of composite, however the cutting efficiency won't be as good as conventional drills. If it does not cut as well then this will generate more heat and more likely to kill the pulp, which will then need root canal treatment. Also if it does not cut as well then the procedure is going to take much longer to perform.

 

[pleasehelpme]

I have talked to many dentists and the head of education director at top dental composite companies. They all say that composite is MUCH softer than teeth.