Ultrasonics

 Odontogenic extraoral sinus tracts are rare conditions that can be misdiagnosed as skin lesions and lead to unnecessary treatments. They are caused by dental infections spreading through bone and draining externally. Conservative nonsurgical endodontic treatment should be pursued first. However, conventional instrumentation and irrigation techniques cannot fully decontaminate root canal systems. New disinfection techniques, including ultrasonic activation of irrigation, photodynamic therapy (PDT), and lasers, have been developed as adjunctive techniques. Photobiomodulation (PBM) (also known as low-level laser therapy) has also demonstrated beneficial effects on tissue healing.

 This report presents a case of an extraoral sinus tract associated with a necrotic mandibular molar that was treated successfully with nonsurgical endodontic therapy using ultrasonically-activated PDT, PBM, and high-intensity laser therapy (HILT). Six- and 12-month follow-ups showed resolution of the sinus tract and healing of the apical lesion radiographically. The extraoral lesion had diminished significantly.

 Combining nonsurgical endodontic treatment with PDT with ultrasonic activation, PBM, and HILT allowed successful management of an odontogenic extraoral sinus tract without surgical intervention. Using PDT combined with ultrasonic activation enhanced disinfection while PBM and HILT improved wound healing. This report demonstrates a conservative approach to treating these lesions.

 Scaling and root planing (SRP) is an inevitable primary step in non-surgical periodontal therapy. Debridement carried out with manual instruments and ultrasonics results in the removal of tooth structure. Current research revolves around laser as an efficient adjunct to SRP. This study evaluated and compared the effectiveness of root surface calculus removal between ultrasonics and Er,Cr:YSGG laser.

 Twenty-eight single-rooted teeth extracted due to periodontal disease were selected for the study. The specimens were randomly assigned to two groups (n=14). Group I underwent ultrasonic instrumentation using a piezo ultrasonic scaler, and group II was subjected to laser instrumentation using Er,Cr:YSGG laser (Waterlase). The specimens were processed, fixed, viewed under a field emission scanning electron microscope and evaluated using the remaining calculus index (RCI) and loss of tooth substance index (LTSI).

 Ultrasonics-treated specimens revealed more remaining calculus (1.57±0.65) and lost tooth substance (1.71±0.61) compared to the Er,Cr:YSGG laser-treated specimens, with significantly lower RCI (0.71±0.61) and LTSI (1.00±0.56). There was a statistically significant difference (P<0.05) in the efficacy of root surface calculus removal between the two groups.

 Compared to ultrasonics, Er,Cr:YSGG laser demonstrated superior results by causing precise removal of root surface calculus without significantly affecting tooth structure and aiding in new attachment.

Cleaning is one of the most important steps in preparing surgical instruments for reuse. Thorough cleaning can ensure more effective sterilization, protect treatment teams and patients from transmissible infections, and extend the life of surgical instruments. This study was conducted to compare the manual, automated, and ultrasonic methods of cleaning surgical instruments. 

In this quasi-experimental study, three types of surgical instruments, namely curved hemostats, suction tips, and Metzenbaum scissors, (n=90) from among 20 surgical sets were randomly selected and assigned to three cleaning groups viz manual, automated, and ultrasonic. After the instruments were cleaned, surface protein and blood residue swab tests were conducted and the results were recorded on a data-registration form. Data were analyzed using SPSS version 16 and descriptive and inferential statistical methods.

According to the research results, in manually cleaned instruments group, 8 (26.7%) tested positive for blood and 10 (33.3%) tested positive for protein. Of the 30 automatically cleaned instruments, 6 (20%) tested positive for blood and 7 (23.3%) tested positive for protein and of the 30 ultrasonically cleaned instruments, 1 (3.3%) tested positive for blood and protein. The chi-square test showed a statistically significant difference between the three methods of cleaning residual blood and protein from the surgical instruments (p<0.05).

The results revealed that according to the research results, of the three cleaning methods, ultrasonic cleaning was by far the most effective in removing blood and protein residues from the surgical instruments. Hence, we suggest that ultrasonic cleaning can be routinely utilized as an efficient cleaning method in medical centers.

One of the basic practices in the field of waste management is the collection and treatment of leachate. Leachate from municipal waste due to high chemical oxygen demand (COD) and dark color is a potential pollutant of the environment, which causes a lot of problems in the absence of treatment and direct discharge to the environment. This study aimed to determine the efficiency of ultrasonic process in combination with coagulation and flocculation process using sodium ferrate in COD and color reduction.

In this experimental study, all experiments were performed in batch conditions and with changing process variables such as pH and sonication time, and the effect of three parameters, including ultrasonic reaction time (15, 30, and 45 min), pH (2, 4, 5/5, and 7), and coagulant dosage (from 1 to 150 g/l) on the COD reduction and color removal, was evaluated. Coagulant concentration and then the removal efficiency of COD and color were analyzed by ANOVA using SPSS 18.

The COD reduction and color removal were 87.05% and 88.6% in optimal condition (using 120 g/L of sodium ferrate at pH 5.5), with coagulation/flocculation, after ultrasound (15 min). Ultrasound (15 min) + sodium ferrate (without coagulation/flocculation) achieved 46.25% of COD reduction and 90.35% of color elimination, whereas the ultrasonic process alone allowed removing the COD and color in the leachate by less than 50%.

The results indicate that C–F followed by ultrasonic can be used to efficiently reduce the organic matter and color from municipal waste leachate, and it would be an ideal option for leachate treatment.

 A mineral trioxide aggregate (MTA) apical plug is commonly applied prior to endodontic treatment of open-apex teeth. However, difficult application and condensation of MTA in the apical region is a drawback of this technique.

This study aimed to compare the microleakage of MTA apical plug applied by the manual technique and indirect use of ultrasonic with different powers.

In this in vitro, experimental study, divergent open apices were created in 48 single-rooted, single-canal teeth using ProFile. The teeth were randomly divided into four experimental groups (n=10). All groups received 5-mm thick MTA apical plug at the apical region using one of the following methods. In group 1, MTA was manually condensed while in groups 2-4, indirect ultrasonic energy with minimum, medium, and maximum power levels was used for MTA plug condensation. After setting of MTA, the apical microleakage of the MTA plug was quantified using the fluid filtration method. Data were analyzed using the Mann-Whitney and Kruskal-Wallis tests (p < 0.05).

Significant differences were noted in microleakage of MTA plug between the manual group and ultrasonic groups with medium (p = 0.043) and maximum (p = 0.029) power levels. No significant difference was noted in microleakage of other groups (p > 0.05).

Considering the current results, it seems that application of MTA with indirect ultrasonic energy at medium or high power level would decrease the microleakage of MTA plug in open-apex root canals.

This study aimed to assess the efficacy of low-intensity pulsed ultrasound (LIPUS) for orthodontic pain control.

This spilt-mouth randomized controlled clinical trial was performed on 44 mandibular first molars of 22 orthodontic patients at the Orthodontics Department of Shahid Beheshti Dental University. Elastomeric separators were placed at the mesial and distal of mandibular right and left first molars by separating pliers. Randomly, LIPUS was used at one side for 7 min and the same device with 0-degree intensity was used as sham for the other side on the facial skin. The same procedure was repeated after 24 h. Patients recorded their level of pain at 1, 6, and 24 h, and also on days 2 to 7 after, using a visual analog scale (VAS).

The effect of type of treatment (P=0.019), time of assessment (P<0.000) and the interaction effect of type of treatment and time of assessment (P=0.055) on the pain score were all significant. The mean pain score in the LIPUS group was significantly lower than that in the control group at 24 h (P=0.002), 4 days (P=0.031) and 5 days (P=0.035).

LIPUS can be safely used during orthodontic treatment for pain control since it is safe, non-invasive, low-cost, and easy to use.