Saudi Journal of Oral and Dental Research

Abbreviated Key Title: Saudi J Oral Dent Res

ISSN 2518-1300 (Print) |ISSN 2518-1297 (Online)
Scholars Middle East Publishers, Dubai, United Arab Emirates
Journal homepage: [Link]

Review Article

Ultrasonic in Endodontics: Review

Dr. Shazia Salim1, Dr. Feroze Raheem2, Dr. Ganapati Anil Kumar3, Dr. Thouseef Ch4, Dr. Mohammed Mustafa5, Dr
Akhilesh Vajpayee6
1
Assistant Professor, Dept. of Conservative Dentistry and Endodontics, Mahe Institute of Dental Sciences and Hospital, Pondicherry University India
2
Registrar Endodontist, Armed Forces Hospital Southern Region, Saudi Arabia
3
Senior Lecturer, Dept. of Conservative Dentistry & Endodontics, Sibar Institute of Dental Sciences, Guntur, AP
4
Senior Lecture, Dept. of Conservative Dentistry & Endodntics, Malabar Dental College & Research Center, Malappuram, Kerala India
5
Associate Professor, Dept. of Conservative Dental Sciences, College of Dentistry, Prince Sattam bin Abdulaziz University, AlKharj - 11942, Saudi
Arabia
6
Post graduate student, Dept of conservative and endodontics, rural dental college, Pravara institute of medical sciences Loni, Tal Rahata, Ahmednagar,
Maharashtra, India

DOI:10.21276/sjodr.2019.4.6.22 | Received: 21.06.2019 | Accepted: 28.06.2019 | Published: 30.06.2019

*Corresponding author: Dr. Shazia Salim

Abstract
During the past few decades’ endodontic treatment has benefited from the development of new techniques and
equipment, which have improved outcome and predictability. Important attributes such as the operating microscope and
ultrasonics (US) have found indispensable applications in a number of dental procedures. Ultrasonics in endodontics has
enhanced the quality of treatment and represents an important adjunct in the treatment of difficult cases. Since its
introduction, Ultrasonics has become increasingly more useful in applications such as gaining access to canal openings,
cleaning and shaping, obturation of root canals, removal of intra canal materials and obstructions, and endodontic
surgery. Currently, although ultrasonics (US) is used in dentistry for therapeutic and diagnostic applications as well as for
cleaning of instruments before sterilization, its main use is for scaling and root planing of teeth and in root canal therapy,
both for orthograde and retrograde therapy. This review article brushes up the role of ultrasonics in endodontotlogy.
Keywords: Ultrasonic, Endodontics.
Copyright @ 2019: This is an open-access article distributed under the terms of the Creative Commons Attribution license which permits unrestricted
use, distribution, and reproduction in any medium for non-commercial use (NonCommercial, or CC-BY-NC) provided the original author and source
are credited.

INTRODUCTION tool in the removal of dental calculus and plaque [2].

In order to understand the basic concepts of the Currently, although US is used in dentistry for
use of ultrasonics (US) in dentistry, it must be therapeutic and diagnostic applications as well as for
underlined that ultrasound is sound energy with a cleaning of instruments before sterilization, its main use
frequency above the range of human hearing, which is is for scaling and root planing of teeth and in root canal
20 kHz. In dentistry the range of frequencies employed therapy, both for surgical and non-surgical approach.
in the first ultrasonic units was between 25 and 40 kHz. More recently, the concept of minimally invasive
Later, low-frequency ultrasonic handpieces operating dentistry and the desire for preparations with small
from 1 to 8 kHz were developed. These low-frequency dimensions has stimulated new approaches in cavity
devices were found to produce lower shear stresses, design and tooth-cutting concepts, including ultrasound
thus causing less alteration to the tooth surface [1]. In for cavity preparation [2]. The use of sonics and
dentistry ultrasonics (US) or ultrasonic instrumentation ultrasonics in canals has evolved from primary
was first introduced for cavity preparations, using instrumentation to a passive cleaning technique.
abrasive slurry. Although the technique received Although there have been significant advances in canal
favourable comments, it never became popular, because preparation and debridement, the fact remains that
it had to compete with the much more effective and dentinal debris is still routinely found within canal
convenient instruments, i.e. the burs mounted on high preparations and that clinicians have been slow to adopt
speed handpieces. However, a different application was ultrasonic or sonic instrumentation as an important
introduced in 1955, when Zinner reported on the use of adjunct in canal debridement. Ultrasonic irrigation of
an ultrasonic instrument to remove deposits from the the root canal can be performed with or without
tooth surface. This was improved upon by Johnson and simultaneous ultrasonic instrumentation. Passive
Wilson, and the ultrasonic scaler became an established ultrasonic irrigation can be an important supplement for

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cleaning the root canal system and, compared with of separation, perforation, and the inability to negotiate
traditional syringe irrigation; it removes more organic files to the radiographic terminus.2 Microscopic
tissue, planktonic bacteria and dentine debris from the visualization and ultrasonic instruments are a safe and
root canal. Passive ultrasonic irrigation is more efficient effective combination to achieve optimal results. In
in cleaning canals than ultrasonic irrigation with conventional access procedures, ultrasonic tips are
simultaneous ultrasonic instrumentation [2]. Root-end useful for access refinement, location of MB2 canals in
cavities have traditionally been prepared by means of upper molars and accessory canals in other teeth,
small round or inverted cone burs in a micro handpiece. location of calcified canals in any tooth, and removal of
In the mid- 1980s, standardized instruments and attached pulp stones [2]. Advantages of ultrasonic tips
aluminium oxide ceramic pins were introduced for are that they do not rotate, thus enhancing safety and
retrograde filling, but that system could not be used in control, while maintaining a high cutting efficiency.
cases with limited working space or in teeth with large This is especially important when the risk of perforation
oval canals. Since sonically or ultrasonically driven is high. The visual access and superior control that
microsurgical retro tips became commercially available ultrasonic cutting tips provide during access procedures
in the early 1990s, this new technique of retrograde root make them a most convenient tool, especially when
canal instrumentation has been established as an treating difficult molars. When locating the MB2 canals
essential adjunct in peri radicular surgery [1]. in upper molars, Ultrasonics is an excellent means for
the removal of secondary dentin on the mesial wall.
Physics behind Ultrasonics Ultrasonics works well when breaking through the
The first is magnetostriction, which converts calcification that covers the canal orifice. A troughing
electromagnetic energy into mechanical energy. A stack tip is always a good choice [2]. Bigger tips with a
of magnetostrictive metal in the handpiece is subjected limited diamond coated extension should be used
to a standing and alternating magnetic field, as a result during the initial phase of removing calcification,
of which vibrations are produced. The second method is interferences, materials, and secondary dentin, as they
piezoelectric principle. A crystal is used which changes offer maximum cutting efficiency and enhance control
the dimensions when an electric charge is applied. This while working in the pulp chamber. The subsequent
crystal deformation is converted to mechanical phase of finding canal orifices should be carried out
oscillations with no production of heat. At the with thinner and longer tips that facilitate cutting. The
ultrasonic frequency, the main driver oscillates in a true diamond-coated tips used in orthograde endodontic
longitudinal manner and as it moves back and forth a treatment have shown significantly greater cutting
transverse wave is generated along the length of the efficiency than either stainless steel tips or zirconium
endosonic file. This transverse wave is characterised by nitride– coated tips, but they have a tendency to break.
nodes and antinodes along the length of the file. The Moreover, thinner diamond-coated tips seem to be able
nodes represents site of minimum displacement or to transmit the oscillation of the ultrasonic unit more
oscillations and antinodes represents sites of maximum efficiently into dentin; this results in a more aggressive
displacement or oscillations. cutting action. Ultrasonic cutting seems to be
significantly influenced by the power setting, as larger
The most frequent applications of US in endodontics fragments of dentin are removed at higher power, and
are by the ultrasonic unit type used. Therefore, care should
 Access refinement, finding calcified canals, and be exercised while searching for canal orifices, as
removal of attached pulp stones. aggressive cutting may cause an undesired modification
 Removal of intracanal obstructions (separated of the anatomy of the pulp chamber [2].
instruments, root canal posts, silver points, and
fractured metallic posts) Ultrasonic & Separated instruments
 Increased action of irrigating solutions Clinicians are frequently challenged by
 Ultrasonic condensation of gutta-percha endodontically treated teeth that have obstructions such
 Placement of mineral trioxide aggregate (MTA) as hard impenetrable pastes, separated instruments,
 Surgical endodontics: Root-end cavity preparation silver points, or posts in their roots. If endodontic
and refinement and placement of root-end treatment has failed, these obstructions need to be
obturation material removed to perform nonsurgical retreatment. They
include appropriate burs; special forceps; ultrasonic
 Root canal preparation[1]
instruments in direct or indirect contact; peripheral
filing techniques in the presence of solvents, chelators,
Ultrasonic & Access cavity Preparation
or irrigants; microtube delivery using mechanical
One of the challenges in endodontics is to
locate canals, particularly in cases in which the orifice adhesion techniques; and different kits and extractors.
Ultrasonic energy has proven effective as an adjunct in
has become occluded by secondary dentin or calcified
the removal of silver points, fractured instruments, and
dentin secondary to the placement of restorative
cemented posts. It has often been advocated for the
materials or pulpotomies. With every access preparation
removal of broken instruments because the ultrasonic
in a calcified tooth, there is the risk of perforating the
tips or endosonic files may be used deep in the root
root. A lack of a straight-line access is the leading cause

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canal system. Furthermore, the use of an ultrasonic The size of the heat carrier (ultrasonic spreader) can be
endodontic device is not restricted by the position of the chosen to match the diameter of the root canal, and the
fragment in the root canal or the tooth involved. The ultrasonic spreader can be curved to match the
prognosis of these cases mainly depends on the curvature of the root canal. Furthermore, gutta-percha
preoperative condition of the peri apical tissues. For this does not stick to the ultrasonic file when the ultrasonic
reason an attempt to remove broken instruments should unit is activated. Also, the low temperature produced by
be undertaken in every case. When these obstructions the unit at its lowest power setting may result in less
can be removed, successful treatment or retreatment volumetric changes of gutta-percha upon cooling. The
generally occurs. If an instrument can be removed or obturation technique recommended when using the
bypassed and the canal can be properly cleaned and ultrasonic techniques consists of initial placement of a
filled, nonsurgical endodontics is a more desirable and gutta-percha cone to the working length followed by
conservative approach. The removal of an obstacle from cold lateral condensation of two or three accessory
a root canal must be performed with a minimum of cones using a finger spreader. The ultrasonic spreader is
damage to the tooth and the surrounding tissues. Too then placed into the centre of the gutta-percha mass 1
much destruction of tooth structure will complicate the mm short of the working length and activated at
restorative phase and as a result will most likely intermediate power to prevent charring of root surfaces
decrease the overall prognosis. Although it is possible and fracture of the ultrasonic spreader [3]. After
to remove many fragments, a small number cannot be activation, the ultrasonic spreader is removed, and an
removed because of limited access, despite the use of additional accessory cone is placed, followed by
ultrasonic tips. When the obstacle prevents access to the energizing with the activated ultrasonic spreader. This
root apex, adequate preparation, disinfection, and process is repeated until the canal is filled. During each
obturation of the entire root canal system are not subsequent step, the ultrasonic spreader should be
possible. Straight-line access is essential and allows for placed slightly more coronally [3]. The ultrasonic
maximum visibility of the metallic fragment. For that spreader must be in the mass of gutta-percha for about
reason, the use of magnification (dental operating 10 seconds to achieve thermoplasticization. Leaving it
microscope or loupes) is essential, as it provides direct in the canal for more than 10 seconds can produce a rise
visualization with excellent illumination, allowing in temperature that is damaging to the root surface. In
instrumentation at high magnifications [2]. addition, it has been demonstrated that placement of
sealers with an ultrasonically energized file promoted a
Ultrasonic & GP Removal better covering of canal walls with better filled
The most common endodontic core material is accessory canals than placement of sealers with hand
gutta percha. Ultrasonically activated spreaders have instruments[3]. Using a probe tip or even a standard
been used to thermoplasticize gutta-percha in a warm prophylaxis tip, the machine is set to maximum power.
lateral condensation technique. In some in vitro If the ultrasonic instrument has been used to remove
experiments, this was demonstrated to be superior to materials from the pulp chamber, it is easy and
conventional lateral condensation with respect to uncomplicated to extend the tip into the orifices of the
sealing properties and density of gutta-percha. canals at the same time. This will also help to locate the
Ultrasonic spreaders that vibrate linearly and produce canals and clarify the internal anatomy. With copious
heat, thus thermoplasticizing the gutta-percha, achieved irrigation, the tip is inserted into each canal orifice. The
a more homogeneous mass with a decrease in number gutta percha will soften immediately and come out of
and size of voids and produced a more complete three- the canal. Depth of penetration into the canal will be
dimensional obturation of the root canal system. A limited by the length of the tip[4].
number of obturation protocols have been described for
ultrasonic condensation of gutta-percha: (a) ultrasonic Ultrasonic & Cleaning of Instrument
softening of the master cone followed by cold lateral Ultrasonic energy has been proven to be more
condensation ; (b) one or two times of ultrasonic effective at enhancing cleaning than other alternatives,
activation after completion of cold lateral condensation including spray washing, brushing, turbulation, air
(c) ultrasonic activation after placement of each second agitation, and electro-cleaning in many applications.
accessory cone; or (d) ultrasonic activation after The ability of ultrasonic activity to penetrate and assist
placement of each accessory cone. Warm lateral the cleaning of interior surfaces of complex parts is
condensation combines the advantage of having control especially noteworthy. Cleaning in most instances
over the length of the root fill, similar to cold lateral requires that a contaminant be dissolved, displaced or
condensation, with the superior ability of a both dissolved and displaced. The mechanical effect of
thermoplasticized material to replicate the three- ultrasonic energy can be helpful in both speeding
dimensional shape of the root canal. Ultrasonic dissolution and displacing particles. Just as it is
condensation of gutta-percha is quickly mastered and beneficial in cleaning, ultrasonics is also beneficial in
has several advantages over other warm lateral the rinsing process. Residual cleaning chemicals are
condensation techniques. It was observed that heat was removed quickly and completely by ultrasonic rinsing.
generated only during ultrasonic activation, and the While removing a contaminant by dissolution, it is
plugger appeared to cool rapidly once activation ceased. necessary for the solvent to come into contact with and

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dissolve the contaminant. The cleaning activity takes ultrasonics as an aid in post removal. Resin cements are
place only at the interface between the solvent and the not friable and do not tend to produce micro fractures
contaminant. As the solvent dissolves the contaminant, due to ultrasonic vibration. It was suggested that the
a saturated solvent layer develops at the interface absence of a water spray seems to increase the action of
between the solvent and the contaminant. Once this has ultrasonics when applied to posts cemented with resin
happened, cleaning action stops as the saturated solvent cements, possibly because of the increase in heat. The
can no longer attack the contaminant and fresh solvent capacity of adhesion of a resin cement, and
cannot reach the contaminant. Ultrasonic cavitation and consequently mechanical retention, gradually reduces
implosion effectively displace the saturated solvent with the number of thermal cycles [2]. Several studies
layer to allow fresh solvent to come into contact with point to the fact that ultrasonic vibration of posts
the contaminant remaining to be removed. This is facilitates their removal while conserving tooth
especially beneficial when irregular surfaces or internal structure and reducing the possibility of fractures or
passageways are to be cleaned. root perforations. Several studies have demonstrated a
reduction in tensile failure loads of intra radicular-
Ultrasonic & Post Removal cemented posts after ultrasonic vibration.
Nonsurgical endodontic retreatment of teeth
restored with intra radicular posts continues to present a Recommended Protocols
challenge because of the inherent difficulties of Based on the best available evidence to date,
removing posts without weakening, perforating, or we recommend the following protocols to provide safe
fracturing the remaining root structure. Ultrasonics has and effective therapy using ultrasonic devices in intra
provided clinicians with a useful adjunct to facilitate radicular obstruction removal. Attempt to
post removal with minimal loss of tooth structure and radiographically image residual dentin thickness for the
root damage. Many studies have focused on the working level within the root (this will help judge heat
removal of metallic posts; however, retreatment of transfer rates to the attachment); thicknesses less than 1
fiber-reinforced composite posts cemented with mm, in combination with metallic or ceramic posts, will
adhesive systems presents a new challenge in cases in transmit heat rapidly. Use devices that allow water to
which endodontic treatment has failed [2]. Different bur reach the working end of the ultrasonic tip to provide
kits have been proposed to remove fiber posts; maximum cooling effect. Use copious water spray and
however, the preservation of maximum root structure effective suction at a continuous rate; there is ample
requires the use of specific ultrasonic tips and adequate evidence that when the working end of any ultrasonic
magnification. The disruption of the composite device is deep within the root, heat generation occurs
structure through the action of ultrasonic vibration rapidly. Monitor the post temperature at one- to two
seems to be the most effective technique in fiber post minute intervals; this seems to be the most prudent
removal. Esthetic white posts are more difficult to standard given the evidence that extreme temperatures
remove because their color matches that of dentin, on the root surface can be reached in five minutes even
whereas the black carbon fiber posts clearly contrast to when a coolant is used. When possible, monitor heat
dentin. Removal is done in a dry field using a buildup in the post by touching it; even a gloved finger
continuous stream of air with direct vision of the will be able to sense a post overheating. If post removal
ultrasonic tip and the coronal portion of the post, attempts are continued beyond 10 minutes, allow for
alternated by air and water spray to clean the remnants two-minute rest intervals (using timers with beepers)
of fibers and dentin [2]. It is important that the entire between ultrasonic device applications; heat buildup
composite material that was used in the luting appears to be dissipated in stages, and recovery of
procedure be removed. If the adhesive procedure was physiological temperatures occurs slowly. Use a
done well, removal of the tenaciously attached adhesive refrigerant spray applied to a cotton swab or an ice stick
materials will be difficult, and high magnification must to cool down the post if necessary; the expansion-
be used to guide the ultrasonic tip to selectively remove contraction effects of this strategy are minimal
the attached composite material. If the ultrasonic tip compared with the severe outcomes of a burn injury.
leaves behind gray streaks, it is a clear indication that Use post-pullers act as adjuncts to ultrasonic energy [5].
resin composite or resin composite cement is still
present. The need of consuming fiber posts is based on Ultrasonic & Placement of MTA
the fact that the viscoelastic nature of composite resin Ultrasonics can be used in the placement of
dampens vibrations and adsorbs energy [2]. MTA but it has poorer adaptation to the canal walls and
Conductance of vibration forces within a post is surface voids in the set cement. An invitro study by
proportional to the square root of the modulus of Anita et al. found that ultrasonic tip pushes the MTA
elasticity of the post material. Therefore, a fiber- material against the tube wall, leaving voids in the body
reinforced composite post with a significantly lower of the material as the tip was removed from the
modulus of elasticity than stainless steel or titanium specimen. Although the tube-wall surfaces appeared
conducts vibration less efficiently. Combining the low visually covered with MTA, the core of the MTA
modulus of elasticity of post materials with composite specimens had voids that created radiolucent areas,
resin cements causes a change in the effectiveness of which was seen radiographically[6]. Ultrasonics has the

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ability to improve the placement and seal of MTA as an authors. Furthermore, Ultrasonics produced less smear
apical barrier in the pulpless immature root. The layer in a retro-end cavity compared to a slow-speed
inherent irregularities and divergent nature of some handpiece. The refinement of cavity margins that were
open apices may predispose the material to marginal obtained with the ultrasonic tips may positively affect
gaps at the dentin interface. The ultrasonic vibration the delivery of materials into the cavities and enhance
applied to an endodontic condenser improves the flow, their seal, even if cavities prepared with erbium: YAG
settling, and compaction of MTA apically [7]. During lasers have been shown to produce significantly lower
placement of the MTA, the ultrasonic energy seemed to microleakage than ultrasonic preparations [2].
flow the MTA apically more efficiently than with only
hand instruments. Also, the ultrasonically condensed Ultrasonic & Removal of Smear Layer
MTA appeared denser radiographically with fewer Ultrasonic delivery system activated by NaOCl
voids [7]. The recommended placement method consists can create smear-free canal surfaces. Whilst
of selecting a condenser tip, then picking up and placing concentrations of 2–4% sodium hypochlorite in
the MTA with the ultrasonic tip, followed by activating combination with ultrasonic energy were able to
the tip and slowly moving the MTA material down remove smear layer, lower concentrations of the
using a 1- to 2-mm vertical packing motion. Direct solutions were unsatisfactory [9]. The apical region of
ultrasonic energy will vibrate and generate a wavelike the canals showed less debris and smear layer than the
motion, which facilitates moving and adapting the coronal aspects, depending on acoustic streaming,
cement to the canal walls. In a case of repairing a which was more intense in magnitude and velocity at
defect apical to the canal curvature, Ruddle the apical regions of the file. Cameron compared the
recommends incrementally placing MTA deep into a effect of different ultrasonic irrigation periods on
canal, then shepherding it around the curvature with a removing smear layer and found that a 3- and 5-min
flexible trimmed gutta-percha cone utilized as a irrigation produced smear-free canal walls, whereas 1-
plugger. A precurved 15 or 20 stainless steel file is then min irrigation was ineffective [9]. Researchers who
inserted into the material and placed to within 1 or 2 found the cleaning effects of ultrasonics beneficial used
mm of the working length. This is followed by indirect the technique only for the final irrigation of root canal
ultrasound, which involves placing the working end of after completion of hand instrumentation. Ahmad et al.
an ultrasonic instrument on the shaft of the file. This claimed that direct physical contact of the file with the
vibratory energy encourages MTA to move and canal walls throughout instrumentation reduced
conform to the configurations of the canal laterally as acoustic streaming. Acoustic streaming is maximized
well as controlling its movement. This technique was when the tips of the smaller instruments vibrate freely
recommended initially for placing MTA in open and in a solution.
diverging apices, but it can also be used to put the
material in root-end cavities, in perforations, and Recent Advances
especially in perforations of the floor of the pulp The SINE tips feature a patented and
chamber [8]. innovative double composite diamond coating, specially
designed working ends, and a water delivery system.
Ultrasonic & Rootend Cavity Preparation Synergistically, these combined features promote
The development of ultrasonic and sonic retro precision, efficiency, durability and safety. The specific
tips has revolutionized root end therapy, improving the SINE instrument chosen is based on the appropriate tip
surgical procedure with better access to the root end, configuration required to effectively perform any given
resulting in better canal preparation. Ultrasonic retro procedure. SINE tips should be used with a light brush-
tips come in a variety of shapes and angles, thus cutting motion and are ideal for progressively refining
improving some steps during the surgical procedures. A and finishing the access cavity. They may be used dry
number of studies compared root-end preparations or wet. In general, ultrasonic instruments are used at the
made with microsurgical tips to those made with burs. lowest power setting that will efficiently accomplish the
They demonstrated additional advantages of this clinical task. When performing certain ultrasonic
technique, such as deeper and more conservative procedures, such as those requiring higher energy levels
cavities that follow the original path of the root canal conducted over longer intervals of time, then water
more closely. A better-centered root-end preparation should be used to provide a coolant. SINE Ultrasonic
also lessens the risk of lateral perforation. Furthermore, Instruments are for use only with piezoelectric
the geometry of the retro tip design does not require a ultrasonic units and work optimally on the Satelec P5
beveled root-end resection for surgical access, thus generator (Tulsa Dental Specialties). The instrument
decreasing the number of exposed dentinal tubules and whose length, diameter, and tip shape best suits the
minimizing apical leakage [2]. They also enable the procedural task should be selected and activated at a
removal of isthmus tissue present between two canals low power setting, then the power increased to the
within the same root. It is considered a timesaving point, but not beyond, where the tip is efficiently
technique that seems to have a lower failure rate. The completing the required task. All SINE tips have been
cleaning effect and the cutting ability of ultrasonic retro designed with water ports. Water port technology
tips have been described as satisfactory by many affords both a spray and a coolant which some

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 Shazia Salim et al; Saudi J Oral Dent Res, June 2019; 4(6): 421-427

clinician’s desire when performing certain clinical

procedures. Water is adjusted according to the task at Endo success apical surgery ultrasonic kit
hand, typically a light mist [10]. This ultrasonic tips kit is the perfect solutions
for the problems most commonly encountered during
SL (surface lesion) ultrasonic tips apical surgery. It contains AS3D, AS6D, AS9D, ASLD,
Spartan’s new Surface Lesion SL Tips have ASRD tips, on an autoclavable metal support.
been designed to accomplish restorative preventative
procedures while conserving sound tooth structure. START-X
Occlusal sealants/composites, cervical restorations, Start-X ultrasonic tips are a new, simple
repairs to crown margins, retentive preparations for addition to the current DENTSPLY Maillefer ultrasonic
bonded composites and other restorative dentistry can Endodontic tips range, designed to improve the quality
now be done with greater precision, visibility and of Endodontic treatments. START.X Ultrasonic Tips
accessibility. Spartan, a leader in Ultrasonic Innovation, achieve higher control and precision with ultrasonic
brings to restorative dentistry the technology that has inserts specifically designed for access cavity
revolutionized endodontics. Spartan Ultrasonic Tips refinement and canal orifice location. These simple-to-
have become the standard of care for endodontic use tips have multiple applications so that the dentist
retreatment, microsurgery and access refinement. They knows exactly which tip to use in which situation. The
are ideal for micropreparations on occlusal tips are made of hard tempered stainless steel so they
surfaces/proximal areas. They are highly efficient in have strong resistance to wear and tear and the tips can
crown margin repair, cervical restorations and retentive vibrate in the air without breaking. A micro-milled
preparations for bonded composite restorations. active part creates a smooth finish and minimises the
Diamond coating provides micro-abrasive cutting risk of diamond grit loss in the patient’s mouth [12].
efficiency and precision preparations. The operator
should be aware that ultrasonic tips with small CK TIP
diameters are subject to breakage at any time. In order CK tips are used for removal of broken
to reduce the incidence of premature breakage or instruments, irrigation and troughing. It has CK tip with
failure, only a very light pressure should be applied by file and CK tip with needle. For ultrasonic energy in a
the operator, and the suggested intensity settings should root canal, Ultrasonic vibration through a file ensures
be followed. All SL instruments incorporate a contra- an efficient cleaning of the root canal system through
angled shape allowing for improvement in procedural acoustic micro streaming.
access into formerly difficult to treat areas. These are
the same designs found in virtually all dental Pro ultra-piezo flow ultrasonic irrigation needle
instruments as well as ultrasonic tips for scaling and Pro Ultra Piezo Flow Ultrasonic Irrigation
periodontal use [11]. Needles are for use in non-surgical root canal irrigation
by application of ultrasonic vibration. The Piezo Flow
Endo success retreatment ultrasonic kit irrigation needles are used in conjunction with a
The Endo Success Retreatment kit addresses piezoelectric ultrasonic energy-generating unit to
the problems most commonly met during endodontic provide the energy for tip oscillation. A syringe or other
retreatment procedures. The use of the patented irrigation source is attached to the Luerlock connection
Titanium-Niobium alloy is a major innovation giving on the ultrasonic needle. Removal of irrigant is through
optimal ultrasound use in the most delicate of the operatory vacuum source. Syringes, extension tube-
circumstances. At the end of the treatment or the sets, and wrenches are available separately (SKU#
retreatment, cleaning of the root canal is essential to PIEZOFLOWAP). Compatible irrigants include sodium
guarantee success. Passive ultrasonic irrigation hypochlorite (up to 6%), EDTA (up to 17%),
performed with the new irrisafe instruments safely Chlorhexidine (up to 2%) and BioPure MTAD however
removes the smear layer, the dentine debris and the working times may vary [13].
bacteria from the root canal.
CONCLUSION
Endo success cap ultrasonic kit The piezoelectric ultrasonic device has the
Supplied with the CAP1, CAP2, CAP3 micro- potential to become routinely incorporated into almost
blade tips, a metallic support, and an universal every component of endodontic treatment, re-treatment,
autoclavable wrench. The success of endodontic and apical microsurgery. It is an indispensable and a
treatment involves shaping an irreproachable access precise tool with which the most challenging clinical
cavity. The new "EndoSuccess™ Canal Access Prep" situations, such as finding hidden root canals and
ultrasonic tip kit is the perfect solution for locating and removing root canal obstructions, can be done with
opening hidden or calcified canals and shaping and relative ease, predictability, and conservancy. It can be
finishing the access cavity. These new CAP tips greatly seen by the few innovative studies which take
enhance the endodontic treatment allowing the advantage of the energizing ability of ultrasound that a
practitioner to perform the best possible endodontic thorough understanding of how ultrasonic tips and files
work. behave with irrigants and tooth structure can produce

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methods and conditions to truly enhance the beneficial using two different techniques. Journal of
effect of such energy in the confined root canal space. Endodontics, 29(10), 679-682.
7. Ahmadi, F., McLoughlin, I. V., Chauhan, S., &
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