CAVITATION DAMAGE TO ULTRASONIC SCALERS

Cavitation Damage to Ultrasonic Scalers

Simon C. Lea Abstract
Objectives: It is assumed that cavitation is a useful byproduct of ultrasonic scaling which helps in the cleaning process. However, cavitation has been observed to cause wear on scaler inserts. The aim of this work is to provide a better understanding of how cavitation may damage metallic scaling instruments and demonstrate the magnitude of the detrimental effect. Methods: Two TFI-3 (30kHz) inserts were used; one new and unused the other demonstrating regions of wear, due to cavitational activity. Both tips were analysed, non-invasively, using a scanning white light interferometer (NewView 5000, Zygo Corporation, USA). Tips were positioned such that their anterior surface was horizontal and perpendicular to the interferometer light beam. Tips were then scanned to produce high resolution images of their surfaces. The interferometer was then focussed to obtain surface roughness (RA) values from key points on the tips. Results: The surface roughness (RA) values for the unused tip were between approximately 33 and 38. For the used tip, surface roughness values ranged from 33 to 193. Conclusions: Cavitation is powerful enough to produce wear of the metallic scaler surface. Better understanding of the occurrence of this phenomenon is required to enable its cleaning effects to be harnessed more effectively.

Introduction
Ultrasonic scalers are used for the removal of plaque and calculus from tooth and root surfaces. To regulate heating and clear debris during scaling procedures, water from the scaler ows over the treatment site. The combination of water and an ultrasound eld can lead to the inception of biophysical effects such as cavitation1,2 and acoustic streaming.3 The effects of cavitation on the surface of the tooth and for plaque removal have been investigated previously1 and it has been assumed that cavitation is

useful and helps in the cleaning process. However, following a recent investigation2, regions of increased wear, caused by cavitation, were observed on the surface of some designs of tips (Figure 1). The aim of this current work is to provide a better understanding of how cavitation bubbles can help to remove materials from the tooth surface with forces so powerful they can cause damage to metallic scaling instruments. Using a white light interferometer, the magnitude of the detrimental effects cavitation may have is demonstrated by scanning the surfaces of new and used ultrasonic scaler tips.
Figure 2. Cavitation and streaming around an ultrasonic scaler tip. a) The alternating pressure eld causes a bubble to expand and contract. b) When the bubble reaches resonant size, it may collapse creating a jet effect.

(collapse) cavitation.4 The ultrasound eld generated by the scaler is comprised of a series of compressions and rarefactions (regions of high and low pressure) which cause small bubbles, trapped in the water, to expand and contract (Figure 2a). Inertial cavitation bubbles oscillate violently and may expand to many times their original size before imploding. The collapse of such a bubble can result in shock waves associated with massive temperatures (5000 Kelvin) and pressures (500 bars).5 If the bubble collapses or implodes near to the surface of a tooth or a

Mechanism of cavitation damage

Figure 1. New (left) and used (right) TFI-3 scaler tips. The used tip shows two regions of wear (A1 and C1) due to cavitational activity.

Cavitation may be subdivided into two main types; stable and inertial

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scaler tip then the collapse is asymmetrical (Figure 2b) resulting in an inrushing jet of liquid targeted at the surface (Figure 2b). This jet of liquid is powerful enough to potentially remove calculus and other materials from the tooth surface.1,6 Further, the force of these jets is enough to visibly roughen the metallic surface of the ultrasonic scaler tip. used for a non-contacting study is New Tip Used Tip A / A1 35.783 193.389

Position along tip length B / B1 33.229 33.865 C / C1 37.534 181.023

Table 1. RA values for new and used tips at point A-C and A1 - C1 (as denoted in Figure 1)

Discussion
The surface prole maps of the two scaler tips (Figure 3) demonstrate the effect of wear on scaler tip surfaces due to cavitational activity. The surface prole of the used TFI-3 scaler tip is less at than the unused tip. Peaks and troughs may be observed down the length of the instrument. At the regions of wear (A1 and C1) it may be seen that cavitation has lead to an increase in roughness, with RA values increased by up to 540% when compared to similar regions on the new and unused tip (Table 1). At the region on the used tip where there was no apparent cavitation damage (B1), the RA value was comparable to that of the new tip at the same point. This work shows that cavitational activity is occurring along the length of the scaling tip and produces wear of the tip. This occurs in two distinct areas related to the maximum displacement of the scaling tip.7 Cavitation is powerful and this wear may have consequences for the overall working life of the scaling tip and for the tooth surfaces and biological tissues. In this investigation, the damaging effects of cavitation were observed for the TFI-3 scaler probe, which has a large, broad tip or probe.

important as this conrms that the damage observed was not due to the tip being scratched or abraded whilst contacted against teeth or other structures or surfaces. The surfaces of both tips were analysed, non-invasively, using a scanning white light interferometer (NewView 5000, Zygo Corporation, Middleeld, USA). In turn, each of the tips was positioned such that its anterior surface was horizontal and perpendicular to the interferometer light beam. The tips were then scanned to produce high resolution images of their surfaces. The white light interferometer was then focussed to region of wear (A1). Average roughness (RA) values were obtained from this point and the interferometer then re-focussed, in turn, at points B1 and C1 and RA values obtained for each. RA values were then obtained for the new tip at points A, B and C (Table 1).

Assessment of cavitation damage to a scaler tip

To assess the damage caused to a scaler tip through cavitational activity, two TFI-3 (30kHz) inserts were used. The rst insert was new and unused and had a tip which, upon visual inspection, appeared undamaged. The second tip had been used (in a non-contacting manner) in a previous experiment and demonstrated regions of wear, due to cavitational activity, in two distinct areas (Figure 1); at the point where the tip bends away from the long axis of the instrument (A1) and at the free end of the tip (C1). The tip being

Results
Full surface prole maps of the new and used tips were obtained and demonstrated the change in tip surface
Figure 3a

prole due to cavitational activity (Figure 3). RA values for the new and used tips (points A-C and A1-C1) were obtained and recorded (Table 1).

About the Author: Simon graduated from Birmingham University with an Honours degree in Physics in 1995. He went on to do a Masters degree in Medical Physics at Swansea University before joining Birmingham University School of Dentistry in 1999. Simon obtained his PhD in The Assessment of Ultrasonic Instruments used in Dentistry in 2004. Since 1999 Simon has contributed to more than 40 published papers and abstracts on the subject of dental ultrasound.
Figure 3b Figure 3. a) Surface prole image of the new and unused TFI-3 ultrasonic scaler tip. b) The surface prole of the used TFI-3 scaler tip is less at than the unused tip.

Address for correspondence: Address for correspondence: Dr Simon C. Lea BSc (Hons) MSc PhD CSci CPhys MInstP, Research Fellow, School of Dentistry, University of Birmingham, St. Chad's Queensway, Birmingham, B4 6NN. United Kingdom..

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The same effects were not noticed on the slimmer TFI-10 tip. The TFI-3 was the style of probe shown in a previous study to produce the most detectable cavitation, with the TFI-10 producing signicantly less2 and this may be why no tip damage was detected on the TFI-10. The current drive of manufacturers is to make the probes of ultrasonic scalers as slim as possible to enable greater access to furcation areas and beneath the gum line. However, cavitation, which is assumed to be an aid to cleaning with ultrasonic scalers, may at the powers utilised clinically, no longer be produced in signicant quantities around these slimmer tips. The production of cavitation around

slimmer designs of scaler probes (such as the Slimline and EMS P / PS tips) is currently being investigated.

2. Lea SC, Price GJ, Walmsley AD. A study to determine whether cavitation occurs around dental ultrasonic scaling instruments. Ultrasonics Sonochemistry 2005;12:233-236 3. Khambay BS, Walmsley AD. Acoustic microstreaming: detection and measurement around ultrasonic scalers. Journal of Periodontology 1999;70:626-631. 4. Barnett SB, Rott H-D, ter Haar GR, Ziskin MC, Maeda K. The sensitivity of biological tissue to ultrasound. Ultrasound in Medicine & Biology 1997;23:805-812. 5. Suslick KS.The chemical effect of ultrasound. Scientic American 1989; Feb:80-86. 6. Walmsley AD, Laird WRE, Williams AR. A model system to demonstrate the role of cavitational activity in ultrasonic scaling. Journal of Dental Research 1984;63:1162-1165. 6. Lea SC, Landini G, Walmsley AD. Ultrasonic scaler tip performance under various load conditions. Journal of Clinical Periodontology 2003;30:876-881. Acknowledgements This work was supported by EPSRC grant no: GR/T22551/01.

Conclusion
Cavitational activity occurs in distinct areas along the length of the ultrasonic scaling tip. Its occurrence is powerful enough to produce wear of the metallic surface. Better understanding of the occurrence of this phenomenon is required to enable its cleaning effects to be harnessed more effectively.

References 1. Walmsley AD, Laird WRE, Williams AR. Dental plaque removal by cavitational activity during ultrasonic scaling. Journal of Clinical Periodontology 1988;15:539-543

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Volume 47 No 2 of 6 March 2008