application of ultrasound in periodontics

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J Indian Soc Periodontol. 2008 Sep-Dec; 12(3): 5561.

doi: 10.4103/0972-124X.44096

PMCID: PMC2813560

Application of ultrasound in periodontics: Part IIVivek K. Bains,1Ranjana Mohan,2 andRhythm Bains3

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Abstract

Ultrasound offers great potential in development of a noninvasive periodontal

assessment tool that would offer great yield real time information, regarding

clinical features such as pocket depth, attachment level, tissue thickness,

histological change, calculus, bone morphology, as well as evaluation of tooth

structure for fracture cracks. In therapeutics, ultrasonic instrumentation is

proven effective and efficient in treating periodontal disease. When used

properly, ultrasound-based instrument is kind to the soft tissues, require less

healing time, and are less tiring for the operator. Microultrasonic instruments

have been developed with the aim of improving root-surface debridement. The

dye/paper method of mapping ultrasound fields demonstrated cavitationalactivity in an ultrasonic cleaning bath. Piezosurgery resulted in more favorable

osseous repair and remodeling in comparison with carbide and diamond burs.

The effect of ultrasound is not limited to fracture healing, but that bone healing

after osteotomy or osteodistraction could be stimulated as well.

Keywords: LIPUS, microstreaming, microultrasonics, piezosurgery, ultrasonic

cleaner, ultrasound probe

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INTRODUCTION

Catuna[1] was first to use ultrasound technology in dentistry in 1953 for cavity

preparation. Ultrasound was first introduced in periodontal procedure as

ultrasonic scalers in 1955 by Zinner[2] and has undergone many changes since

then, and simple compact devices have replaced large, heavy units. The single,

bulky universal tip has been replaced by a variety of site specific, slimmer tips

(some of which have been coined as microultrasonic).[3]

Ultrasound offers great potential in development of a noninvasive periodontal

assessment tool that would offer great yield real time information, regarding

clinical features such as pocket depth, attachment level, tissue thickness,
http://dx.doi.org/10.4103%2F0972-124X.44096http://dx.doi.org/10.4103%2F0972-124X.44096http://www.ncbi.nlm.nih.gov/pubmed/?term=Bains%20VK%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Bains%20VK%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Mohan%20R%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Mohan%20R%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Mohan%20R%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Bains%20R%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Bains%20R%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Bains%20R%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/citedby/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/citedby/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/citedby/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT1http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT1http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT1http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT2http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT2http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT2http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT3http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT3http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT3http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT3http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT2http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT1http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/citedby/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/http://www.ncbi.nlm.nih.gov/pubmed/?term=Bains%20R%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Mohan%20R%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Bains%20VK%5Bauth%5Dhttp://dx.doi.org/10.4103%2F0972-124X.44096


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histological change, calculus, bone morphology, as well as evaluation of tooth

structure for fracture cracks.[4]

Spranger[5] was first to try ultrasonography in periodontology, he tried to

determine height of alveolar crest in periodontal patients. Palou et al.[6,7]

attempted to image the crest of alveolar bone by aiming ultrasound transducer

perpendicular to long axis of tooth. Eger et al.[8] assessed the measurement of

gingival thickness using an ultrasonic device with a 5 MHz transducer. While

these efforts proved the feasibility of ultrasonic imaging in dentistry, investigators

showed that ultrasonic device measures echoes from the hard tissue of tooth

surface, and periodontal attachment level can be inferred from these

echoes.[9,10] Periodontal structures mapping system using ultrasonic probe was

invented at NASA by Companion under supervision of Joseph Heyman and

patented in May 1998.[11] Reports also suggest role of ultrasound in

osteopromotion[12] and in piezoelectric bone surgery.[13] This paper is intendedto review the various applications of ultrasound in periodontics.

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APPLICATION OF ULTRASOUND IN DIAGNOSIS

Periodontal ultrasonography

Roots for the ultrasound technology used in periodontal ultrasonography are in

an ultrasound-based time-of-flight technique used routinely in NASA Langley

Research Center's Non-Destructive Evaluation Sciences Laboratory to measurematerial thickness and, in some cases, length.[3] The primary applications of that

technology have been in aircraft skin thickness for corrosion detection and bolt

length for bolt tension measurements.[3] Ultrasound probe works somewhat like

a sonogram. With a sonogram, the probe is pressed against the body and the

beam penetrates the womb and the echoes that come back are recorded and

displayed as an image of the fetal face. Same technology is adapted to image the

periodontal structures, mainly by making the probe that sends the ultrasound

signals and receives the echoes very small. Software in computer sorts out all of

echoes and makes an image of attachment level pocket depth, etc.

automatically.[14]

Current method of diagnosing periodontal disease (walking probe) is invasive,

uncomfortable, and inexact. Ultrasonography probe provides a mapping system

for noninvasively making and recording differential measurements of depth of

any patient's periodontal ligaments relative to a fixed point as cementoenamel

junction. Mapping system uses ultrasound to detect top of ligaments at various

points around each tooth and uses either ultrasound or an optical method to find

CEJ at same points. Depth of sulcus is calculated as difference between the

points.[3]
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Periodontal ultrasonic probe

It consists of transducer, which is housed within a contra angled handpiece at the

base of hollow conical tip. This is responsible for emitting and receiving sound

waves. Hollow tip focuses acoustic beam into periodontal tissue. Transducer is

mounted at the base of a dual taper, convergentdivergent coupler in order toprovide acoustically tapered interface with a throat area in order of 0.5 mm. A

throat area of 1.5 mm represents an active area reduction from transducer

element to aperture. Such a reduction is mandated by geometry and very small

window offered by gingival margin. An added virtue of attaining a small tip size is

ability of ultrasonic probe to examine interdental area.[4,9,14,15]

Equipments required to run the probe include computer, monitor, keyboard,

separate electron box for water pressure control, and foot pedal all mounted on

large cart to transport conveniently. Probe tip incorporates a slight flow of water

to ensure a good coupling of ultrasonic energy to tissues. Water can come eitherfrom a suspended IV-type sterile bag or plumbed from dental chair.[7]

Working of ultrasonic probe

Ultrasonic probe tip is held in a vertical position, parallel to long axis of the tooth.

Tip is gently placed on gingival margin until slight blanching of gingiva is

visualized; ensuring the complete coupling of water into gingival sulcus, the probe

is activated with a foot pedal. When foot pedals are engaged, a small stream of

water will flow into sulcus along with a thin beam of ultrasound waves. Ultrasonic

probe projects a narrow frequency (120 MHz) ultrasonic pulse into gingivalsulcus or periodontal pocket and then detects echoes of returning wave. An

ultrasonic beam entering the tissues is absorbed, reflected, or scattered. Reflected

portion is received by machine and used for reconstruction of ultrasonic image.

As these sound waves bounces of periodontal tissues, echoes are recorded by a

tiny transducer in handpiece and analyzed simultaneously by computer attached

to ultrasonic unit. As the examiner passes probe tip across the gingival margin,

computer records incoming data which employs artificial intelligence algorithms

to translate out data into estimates of probing depth in millimeters.[4,14]

Unlike manual probing where measurements are obtained at six sites per tooth,ultrasound probe tip is gently placed on gingival margin then swept along entire

gingival area. Thus, the probe is able to painlessly capture a series of observations

(depth measurements and contour) across entire subgingival area as probe tip

passes gingival margin so yielding more information.[4] Though this noninvasive

method for measuring pocket seems to be accurate long-term evidence-based

studies are needed.

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APPLICATION OF ULTRASOUND IMAGING FOR PERIODONTALASSESSMENT
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A recent study using the ULTRADERM (Longport International Ltd, Silchester,

U.K.) ultrasonic scanner that works at the frequency of 20 MHz in an animal (pig

jaw) model had shown that periodontal ultrasonography can produce images

suitable for the assessment of the periodontium as well as accurate measurement

of the dimensional relationship between hard and soft structures.[16,17] Thetechnique of ultrasonography has also been applied in human subjects. In various

studies the device was used to evaluate gingival thickness before and after

mucogingival therapy for root coverage.[17,18] It was also used to assess the

dynamics of mucosal dimensions after root coverage with connective tissue

grafts,[17,19] bioresorbable barrier membranes,[17,20] and for measurement of

masticatory mucosa.[17,21] Ultrasonic scanner provides satisfactory results both

in terms of accuracy and repeatability.[16]

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APPLICATION OF ULTRASOUND IN CALCULUS DETECTION

There are a variety of subgingival calculus detection systems in the market as

Detectar, Keylaser II, and Dental Endoscope[22] and for in

vitro studies.[23,24] Meissner et al.[25] developed an ultrasound-based device

for office use which was automatically able to detect subgingival calculus. They

showed that dental surfaces may be discriminated by the analysis of tip

oscillations of an ultrasonic instrument, which possesses computerized calculus

detection (CCD) features. This system may help to judge other systems in vivo.

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APPLICATION OF ULTRASOUND IN SCALING AND ROOT PLANING

The mechanism of removing calculus

Cavitation was assumed to be able to liberate some energy for the removal of

deposits. However, it has been found that using only the cavitation without the

touch of the vibrating tip is not sufficient to remove the calculus, and that a direct

contact between the vibrating tip and the calculus is necessary.[26] Therefore, it

is now generally accepted that the mechanical energy produced by the vibratingtip (chipping action) along with cavitation is responsible for the removal of

deposits.[2729]

Mechanism of removing biofilm or plaque

Cavitational activity has an adverse effect on bacteria within dental plaque.[30]

The effect of this cavitational activity disrupts bacterial cell wall and subgingival

microbial environment.[31] Microstreaming or acoustic mainstreaming,

generated by ultrasound in the presence of a fluid environment, also is effective in

removing bacterial plaque.[3,32] Ultreo

(Inc. today) is a revolutionary powertoothbrush that combines ultrasound waveguide technology with precisely tuned
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sonic bristle action for a deep, gentle, long-lasting feeling of clean. Clinical studies

prove that Ultreo can remove up to 95% of plaque from hard-to-reach areas in the

first minute of brushing.[33]

Endotoxin removal and root detoxification

Currently, it is understood that endotoxin (LPS) is a surface substance which is

superficially associated with the cementum and calculus and that it is easily

removed by washing, brushing, light scaling, or polishing the contaminated root

surface.[32,3439] Heat automatically generated from magnetostrictive units

may assist in endotoxin removal or detoxification, as a result, areas of the tooth

where the tip does not touch may inadvertently be detoxified as well.[3]

Cautions while using ultrasonics in scaling and root planing

As with any dental procedures universal precautions consists of wearingprotective eyewear and/of face shield, mask and gloves. In the beginning of the

day, hold the handpiece over a sink or drain, set power to low, activate the foot

control, and flush the water line of unit at maximum water-flow for at least 2

minutes to clear stagnant water and reduce water films in tubing.[3] All the

inserts are autoclavable and should be sterilized before every use. Having the

patient rinse with approved antimicrobials, and high vacuum suction, helps to

minimize aerosols. An aerosol reduction device (ARD) that is attached to the

ultrasonic handpiece has been shown to reduce contamination cloud by placing

suction in close proximity to the ultrasonic tip.[40] Harrel et al.[41] showed a

high volume evacuator attachment to an ultrasonic handpiece significantly

reduced the detectable aerosols splatter produced during ultrasonic scaling by

93%. Veksler et al.[42] reported 30-second rinse with an essential oil mouthrinse

before instrumentation reduces bacterial count in the aerosol by 92.1% and

salivary bacterial level by about 50% for up to 40 minutes and 97% reduction for

up to 60 minutes following two 30-second rinses with 0.12% chlorhexidine.

Aerosols can be suspended in air for up to 30 minutes after using power-driven

scalers,[43] so, infection control is to be maintained even after the procedure is

finished. A light pen grasp, and fulcrum (intra or extraoral) should be used.

Lightest amount of lateral pressure possible while still maintaining control ofinstrument and proper adaptation of tip is necessary for calculus removal.[3]

Increasing the pressure decreases the mechanical vibrations, the chipping action,

and ultimately the effectiveness of ultrasonics.[44] To prevent root damage in

SRP the assessed magnetostrictive ultrasonic scaler should be the used at 0.5 N

lateral pressure, low or medium power setting, and tip close to zero degree

angulation with tooth.[44] Increasing the power also increases aerosol formation,

which results in reduced water cooling and cavitational effect and can increase

patient sensitivity. Chapple et al.[45] showed that use of half power setting was as

effective as using the ultrasonic scaler at full power. Ultrasonic tips are now

shaped more like probes. Insert the tip vertically, parallel to long axis of tooth,
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walk the tip into proximal surfaces, keeping the tip adapted to tooth-like probe.

To ensure patient comfort, keep the tip moving at all the times when in contact

with tooth.[3] Direct vision is preferred when using ultrasonics, as indirect vision

is compromised by mist of irrigant. Ultrasonic tips do not last forever. As tip

wear, scaling efficiency decreases. One millimeter of tip wear results inapproximately 25% loss of efficiency and 2 mm of wear results in approximately

50% loss of efficiency and at this point tip should be replaced.[3,46] Clinicians

who retain their inserts for years may find their instrument tips become reduced

in length through wear, potentially leading to a detrimental change in

performance of scaling system.[47] The instrument should be kept away from

bone to avoid possibility of necrosis and sequestration.[48]

Go to:

APPLICATION OF ULTRASOUND IN CURETTAGE

Ultrasound is effective for debriding the epithelial lining of periodontal pockets

resulting in microcauterization. Morse scaler-shaped and rod-shaped ultrasonic

instruments are used for this purpose.[49] Investigators found ultrasonic

instruments to be as effective as manual curettage[5052] and less inflammation

and less removal of connective tissue.[49]

Go to:

APPLICATION OF ULTRASOUND ASMICROULTRSONICS

Kwan[53] and Peggy Hawkins[54] coined the term microultrasonics in early

1990s as a generic term that identifies the refined use of powered

instrumentation in supragingival and gross debridement. Microultrasonics is

innovative, power-driven (magnetostrictive or piezoelectric) scaler products

featuring thinner tips and varied shapes. These are small, approximating the size

of a periodontal probe and can be used for supra and subgingival treatment at low

to high power, with less to no water spray, and little or no adjunctive use of hand

instrumentation.[3,53,54]

Tips of microultransonic instruments measure about 0.20.6 mm in diameter.These are powered to move up to ultrasonic speeds (25000 to more than 40000

cycles per second), with active working sides on all surfaces of vibrating

instrument and provide ultrasonically activated lavage in working field.[53]

Ultrasonic motors need no deceleration mechanism because they have high

torque output in low rotation speed.[55] Microultrasonic instruments are less

likely to overinstrument roots because they are neither sharp nor abrasive.[53]

The periodontal endoscope allows for visual access to root surfaces with great

magnification, lessening the need for surgical intervention. Combined with a

simple array of microultrasonic instruments, endoscopic debridement can be
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accompanied in a nonsurgical, minimally invasive way by the dentist or

periodontist.[53]

Go to:

APPLICATION OF ULTRASOUND AS ULTRASONIC CLEANER

The dye/paper method of mapping ultrasound fields demonstrated cavitational

activity in an ultrasonic cleaning bath.[56] The ultrasonic cavitation implosion

effect is incredibly effective in displacing the saturated layer of contaminant,

allowing fresh cleaning solvent to come in contact with the unsaturated surface to

attack and dissolve the remaining contaminant. It is especially effective on

unsmooth and out-of-reach surfaces that are normally inaccessible through

conventional means such as brushing. It has been shown to speed and enhance

the effect of numerous chemical reactions. The most probable reason for this

enhancement is due to the levels of high energy created by the high temperaturesand pressure emitted by millions of individual cavitation bubble implosions.[57]

In view of the use of such baths as a part of the process of controlling cross-

infection in dentistry, it is suggested that manual cleaning of reusable

instruments may be necessary as well.[56]

Figure 1Ultrasonic periodontal probe with probe tip at the gingival margin and

ultrasound projected into the periodontal pocket. The echoes returning from the

crest of the periodontal ligament are shown (Hinders M And Companion

J;www.acoustics.org)

Figure 2

The hand piece contains a probe tip, which is small enough to permit scanning of

the area between teeth. The ultrasonic transducer is mounted in a probe tip shell

(a fluid-filled dual taper delay line), which has a throat diameter small enough to

project ...

Figure 3

Ultrasonographic periodontal probe in use; (as.wm.edu/Faculty/Hinders/NDE-Projects.html)
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Figure 4

Ultrasonic device (B) measuring gingival thickness at a grafted recession site.

(Muller H P, Stahl M, Eger T; 1999)

Figure 5

Camera and micro ultrasonics for endoscopic instrumentation; (Kwan J Y; 2005)

Figure 6

Scaler, probe and microultrasonic insert. (Kwan J Y; 2005)

Go to:

APPLICATION OF ULTRASOUND IN BONE SURGERY

Ultrasonic bone-cutting surgery has been recently introduced as a feasible

alternative to conventional tools of craniomaxillofacial surgery, due to its

technical characteristics of precision and safety.[58] Piezosurgery (Mectron

Medical Technology, Carasco, Italy) is a new and innovative method that uses

piezoelectric ultrasonic vibrations to perform precise and safe osteotomies.[59] It

was first invented by Tomaso Vercelotti to overcome the limitations of traditional

instruments in oral bone surgery.[60] It was first reported for preprosthetic

surgery, alveolar crest expansion, and sinus grafting.[60,61] The equipment

consists of a piezoelectric handpiece, and a foot switch that is connected to a main

unit, which supplies power, and has holders for handpiece and irrigation fluids. It

contains a peristaltic pump for cooling with a jet of solution that discharges from

the inserts with an adequate flow of 060 ml/minute and removes detritus from

the cutting area.[62] Piezoelectric surgery uses a specifically engineered surgicalinstrument characterized by a surgical power that is 3-times higher than normal

ultrasonic instruments.[63] The device used is unique in that the cutting action

occurs when the tool is employed on mineralized tissues, but stops on soft

tissues.[61] Nerves, vessels, and soft tissues are not injured by the

microvibrations (60200 mm/sec), which are adjusted to target only mineralized

tissue.[64] It has variable modulations of frequency (2530 kHz) that gives

inserts a specific vibration that allows the cut to keep clean of bone splinters. The

elevation of membrane from the sinus floor is performed using both piezoelectric

elevators and the force of a physiologic solution subjected to piezoelectric

cavitation.[63] Piezosurgery resulted in more favorable osseous repair and
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remodeling in comparison with carbide and diamond burs. Also, force necessary

to obtain a cut by the operator is much less compared to a rotational bur. Patients

perceive greater comfort with this instrument in osseous surgery as it eliminates

noise of high-speed handpiece.[65]

Figure 7

Angled insert, modified curved/ angled insert, and furcation probe. (Kwan J Y;

2005)

Go to:

APPLICATION OF ULTRASOUND IN OSTEOCONDUCTION

Since the first therapeutic ultrasound application in 1932, ultrasound therapy has

evolved within the physiotherapy practice mainly to treat soft tissue disorders.

The first prospective randomized double blind clinical trials were published in the

nineties. The results of these studies indicated that the healing time of fresh tibial

and radial fractures could be reduced by 38% after ultrasound was applied.[12]

Here, low intensity pulsed ultrasound was used with an intensity of 30 mW/cm2,

20 minutes a day, by placing a transducer onto the skin across the fracture. It also

became clear that slow or nonuniting fractures could be healed by the application

of ultrasound. Furthermore, it seemed that the effect of ultrasound is not limited

to fracture healing, but that bone healing after osteotomy or osteodistractioncould be stimulated as well. It was, therefore, concluded that there may be a

potential for ultrasound to stimulate maxillofacial bone healing.[12] Based on the

literature, it seems to be reasonable to assume that ultrasound has an effect on

bone cells during bone healing, but that a possible observed effect may be related

to the mechanical and circulatory conditions at the site. However, Schortinghuis

J et al,[66] showed that low intensity pulsed ultrasound is not effective in

stimulating bone growth into a rat mandibular defect, either with or without the

use of osteoconductive membranes. Also, no evidence suggests that low-intensity

pulsed ultrasound (LIPUS) stimulates osteoconduction in a bone defect in the rat

mandible that is covered by a collagen membrane.[66,67]

Go to:

ULTRASOUND MAY HELP TO REGROW TEETH?

High-intensity focused ultrasound has been shown to stop bleeding in blood

vessels noninvasively,[68] whereas LIPUS) has been reported to be effective in

liberating preformed fibroblast growth factors from a macrophage-like cell line,

and it stimulates angiogenesis during wound healing,[69] enhances mandibular

growth in growing baboons,[70] enhances bone growth into titanium porousimplants,[71] accelerates healing of resorption by reparative cementum,[72] and
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT65http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT65http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT65http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/figure/F0007/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/figure/F0007/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT12http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT12http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT12http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT12http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT12http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT12http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT66http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT66http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT66http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT66http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT66http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT67http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT67http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT67http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT68http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT68http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT68http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT69http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT69http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT69http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT70http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT70http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT70http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT71http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT71http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT71http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT72http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT72http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT72http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/figure/F0007/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT72http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT71http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT70http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT69http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT68http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT67http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT66http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT66http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT12http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT12http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/figure/F0007/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813560/#CIT65


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enhances bone healing after fractures[73] and mandibular osteodistraction.[74]

Routine use of low-intensity ultrasound appears to have a modest beneficial effect

on recurrent aphthous stomatitis.[75] Reports also suggest that LIPUS can

enhance the growth of mandibular incisor apices and accelerate the rate of

eruption in teeth that received ultrasound in rabbits.[76] Using LIPUS, Dr TarakEl-Bialy from the faculty of medicine and dentistry and Dr Jie Chen and Ying Tsui

from the faculty of engineering have created a miniaturized system-on-a-chip that

offers a noninvasive and novel way to stimulate jaw growth and dental tissue

healing.[7779] The prototype ultrasound device can be mounted on braces or a

plastic removable crown.[79] The wireless device, roughly half the size of a nail on

the baby finger, will be able to gently massage the gums to stimulate growth of the

tooth root.[80] LIPUS seems to play an effective role in repair and healing, still

their role in periodontal regeneration needs to be investigated. Till now, there are

not enough studies that specify the role of LIPUS in periodontal regeneration.

Go to:

CONCLUSION

Diagnostic application of mega Hertz ultrasound includes use of ultrasonography

for dimensional assessment of periodontal structures. The advantage of using

noninvasive assessments without ionizing radiations could lead to applications in

the evaluation of soft and hard tissue healing after periodontal surgery

(regenerative, mucogingival, or implant surgery) as well as for clinical assessment

and treatment planning prior to implant placement. In therapeutics, ultrasonicinstrumentation is proven effective and efficient in treating periodontal disease.

When used properly, ultrasound is kind to the soft tissues, requires less healing

time, and is less tiring for the operator. LIPUS seems to play an effective role in

repair and healing, still their role in periodontal regeneration needs to be

investigated. Though ultrasound application in both diagnosis and periodontal

therapy seems to present promising results, long-term evidence-based studies are

required to use ultrasound in routine periodontal practice.

Go to:

FootnotesSource of Support: Nil

Conflict of Interest: None declared.

Go to:

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