12 Casarin et al 1 found that hand and ultrasonic instrumentation produced the same level of defect depths, regardless of power settings. In regard to root defects, power setting, load of the ultrasonic insert/tip (UIT) on the tooth, and the cross-sectional shape of UITs may affect dentin defects with both magnetostrictive and piezoelectric ultrasonic technology. Researchers continue to investigate the causes of root defects, roughness, and unnecessary tooth surface removal with mechanical root debridement. This therapy is justified and is not considered overinstrumentation. At these times, additional instrumentation may be indicated due to tactile interpretation, bleeding points, visible inflammation, or endoscopic observation of calculus. During nonsurgical periodontal therapy, the patient’s response to individualized therapy is evaluated throughout multiple appointments and at the reevaluation visit. As such, the point of overinstrumentation may be different for each patient. The goal of debridement is to remove plaque biofilms, their byproducts, their retentive factors, and calculus-embedded cementum to create a biologically acceptable root surface conducive to optimal healing, while preventing unnecessary loss of tooth surface. 11 A smooth root or implant surface reduces the likelihood that plaque biofilms will reattach and, thus, may decrease the risk of periodontal diseases, peri-mucositis, and peri-implantitis. Over instrumentation can include creating root defects, leaving roughness, and removing unnecessary tooth structure-each of which may encourage biofilm accumulation and tooth sensitivity. Overinstrumentation is a clinician-created or iatrogenic problem stemming from the use of improper technique or debriding more than is necessary to encourage healing of adjacent tissues. Like hand instrumentation, however, the risk of overinstrumentation is possible with ultrasonic technology. In today’s sophisticated practice settings, ultrasonic instrumentation is routinely incorporated unless contraindications prevail. Its use in oral prophylaxis, nonsurgical periodontal therapy, and periodontal maintenance provides many potential advantages (Table 1).
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