Patent Publication Number: US-2018049853-A1

Title: Ultrasonic scaler with laser therapy capability

Description:
FIELD OF THE INVENTIONS 
     The present inventions relate generally to dental scalers with light therapy functionality such as ultrasonic scaler devices with laser bacterial load reduction capability. 
     BACKGROUND OF THE INVENTIONS 
     Currently, nonsurgical periodontal therapy, including scaling and root planning, as well as periodontal scaling with root debridement involves a series of instrumentation procedures. Aerosol produced during the use of power scalers has droplet nuclei particles which linger in the environment for extended periods of time, and is a potential source of infection to patients as well as oral health care providers. The release of an increased bacterial load into the oral cavity may result in the spread of periodontal and oral pathogens. 
     Laser Bacterial Reduction (LBR) can be performed prior to procedures such as scaling to prevent the spread of periodontal pathogenic bacteria from a diseased site within the oral cavity to one of health. Clinicians will then proceed to use a power scaler, such as an Ultrasonic or Piezoelectric scaler, to remove the larger, calcified deposits while simultaneously disrupting the plaque biofilm. The more intricate work of scaling and root planning, utilizing a series of manual curettes, then follows. Once all visible and tactile deposits have been removed, the clinician may choose to utilize the laser again to perform soft tissue curettage of the tissues. 
     Scaling and root planning, also known as conventional periodontal therapy, non-surgical periodontal therapy, or deep cleaning, is the process of removing or eliminating the etiologic agents, dental plaque, its products, and calculus. Periodontal scalers and periodontal curettes are used for such procedures. 
     An ultrasonic scaler is a tool which utilizes various tips for supplying high-frequency vibrations to the tooth surfaces for the purpose of removal of adherent deposits and bits of inflamed tissue from the inner walls of the gingival sulcus or periodontal pocket. Mechanical root debridement results in a smear layer containing bacteria, bacterial endotoxins, and contaminated root cementum and usually does not remove plaque and calculus completely from interradicular septa and root concavities. A significant disadvantage of ultrasonic scalers, for the patient and the clinician, is the formation of a contaminated aerosol. 
     In recent years, the use of lasers in dentistry has continued to expand. Dental laser systems are cleared for marketing in the United States via the Food and Drug Administration (FDA) Premarket Notification (510(k)) process. The applications of lasers in dentistry include sulcular debridement, laser curettage, laser-assisted new attachment procedure (LANAP), reduction of bacteria levels in periodontal pockets (or pocket sterilization) referred to as laser bacterial reduction (LBR), laser-facilitated wound healing, and laser root planning. For example, erbium-doped: yttrium, aluminum, and garnet (Er:YAG) laser radiation has been suggested as an alternative instrumentation modality for the treatment of chronic periodontitis. Dental hygienists use lasers for laser bacterial reduction, laser curettage, intrasulcular debridement in scaling and root planning procedures, aphthous ulcer removal, and pit and fissure sealants. Periodontists use lasers for osseous surgery and to correct osseous defects, gingivectomies, frenectomies, gingival curettage, implant placement, and soft tissue crown lengthening. 
     Currently, periodontal probes, ultrasonic scalers, curettes, and dental lasers, each have their own application and working tip. Dental professionals measure the sulcus or periodontal pocket prior to instrumentation utilizing a periodontal probe to assess the geography. Prior to any instrumentation, the clinician may perform laser bacterial reduction. Next, an ultrasonic scaler can be used, followed by the use of curettes, to remove deposits from the tooth surfaces. Dental lasers can then be used again to remove the remaining soft tissue tags, continue reduction of bacterial levels, and possibly promote wound healing. 
     Time is taken away from patient care each time the clinician has to change instruments and switch back and forth between the periodontal probe, ultrasonic scaler, curette, and laser. Thus there remains a need in the art for a new device that combines these individual steps while promoting a potential healthier environment, and reducing the risk of disease transfer, both inside and outside of the oral cavity. 
     SUMMARY OF THE INVENTIONS 
     An aspect of at least one of the inventions disclosed herein, includes the realization that a dental scaler tip assembly can be modified to include a passage allowing light to travel through the scaler tip assembly through the distal end of the tip assembly in the vicinity of operational end of the scaler tip assembly which can be pressed against deposits along patient&#39;s anatomy, such as on a patient&#39;s teeth and/or gums. For example, a dental scaler tip assembly can include a channel with an input opening configured to receive light from a light source, such as a laser light source, and an output opening on a distal portion of the tip assembly. The output opening can be disposed in the vicinity or at the distal-most portion of the scaler tip assembly. Thus, during use, light having an optical strength sufficient for bacteria load reduction can be directed towards deposits to be removed with the scaler during a procedure and thus treated with the bacteria load reducing light during scaling, or other procedures. Thus, the bacteria load can be reduced at the point of and simultaneous with the use of the scaler tip assembly. 
     Another aspect of at least one of the inventions disclosed herein includes the realization that using prior art techniques, such as the use of a separate laser bacteria load reducing technique prior to scaling is that such laser based bacteria load reducing techniques are limited in the depth to which the bacteria load is reduced at the deposit or anatomy. Thus, if a first bacteria load reducing technique is applied to a patient, then a scaling operation is performed, additional untreated bacteria can be uncovered during the course of the scaling procedure, thereby increasing the risk of aerosolizing untreated bacteria after having been uncovered during a scaling procedure. 
     Thus, an aspect of at least one of the inventions disclosed herein includes the realization that including a light discharge functionality with a scaler tip assembly provides the additional benefit of the ability to reduce the bacterial load of untreated bacteria contemporaneously uncovered during a scaling procedure. 
     In some embodiments, an ultrasonic scaler guides laser light to the tip of the scaler. As noted above, in some known prior art ultrasonic scalers, the traditional ultrasonic insert has only one function, which is to remove hard and soft deposits along with extrinsic stain, it does not contain a laser light. 
     Thus, in some embodiments, a scaler device can include an insert configured to guide laser light from a handheld portion to the tip of the scaler through a hollow canal. Thus, only one device is needed for the utilization of the ultrasonic scaler and dental laser. Such a device can reduce a procedure time significantly and also reduce the cost. 
     In some embodiments, ultrasonic insert can also guide the water to the tip of the scaler through a hollow canal. 
     In some embodiments, a tip of an ultrasonic scaler can be color coded, similar to that of a periodontal probe, to allow for measurement and reference as it is used. Additionally, a plurality of ultrasonic scaler tips having different sizes and color coded according to their different sizes can be packaged together in a kit. 
     Infection control is a constant and critical part of all dental hygiene procedures. Because ultrasonics can generate a significant amount of aerosol and splatter due the rapid vibration and water spray, use of the high speed evacuation is recommended by the Occupational Health and Safety Administration (OSHA). Without an assistant, many clinicians find themselves unable to adapt the high speed evacuation to where they are working with one hand, so frequently, they will settle for use of the slow speed suction because of its ease of use, despite the current recommendations. Ultimately, dental clinicians are exposing themselves and their patients to potentially pathogenic aerosol. Thus a device that combines ultrasonic scaling functionality and laser bacteria load reduction can reduce the number of pathogenic microbes from becoming airborne and potential reduce the amount of cross-contamination within the mouth as the instrument is taken from site to site 
     In some embodiments, an ultrasonic scaler can be configured to work with different laser sources. In such configurations, additional components can be unnecessary to accommodate different laser sources. 
     Another aspect of at least one of the inventions disclosed herein includes the realization that dental procedures, such as scaling, can be combined with measurement. For example, procedures such as scaling involve a practitioner moving a scaler device carefully over the surface of patient anatomy, and optionally using magnification to assist in visualizing the procedural field. The procedure such as scaling is also procedurally similar to probing, for example, inspecting patient&#39;s anatomy for defects and the measurements of the size of such defects. During the movements commonly used in scaling procedures, a practitioner can move the tip of a scaler assembly into close proximity and/or contact with a defect. 
     An aspect of at least one of the inventions disclosed herein includes the realization that dental scaler tip assemblies can be modified to simplify a process for measurement and/or estimation of measurements of dental defects, for example, with reference indicia. For example, a dental scaler tip assembly with reference indicia (such as color coding) can provide a reminder to a practitioner as to a dimension of a portion of the dental scaler tip assembly. For example, in some embodiments, a referenced dimension would be a maximum width of a distal tip of a dental scaler tip assembly. 
     Thus, during a procedure such as a scaling procedure, as a practitioner moves the dental scaler tip assembly around the patient&#39;s anatomy, the practitioner can estimate the size of anatomical features and/or defects with visual reference to the referenced dimension of the dental tip assembly. 
     Another aspect of at least one of the inventions disclosed herein includes the realization that if a plurality of dental scaler tip assemblies are packaged together in a kit having a predetermined distribution of sizes of a referenced dimension, such as the largest width of a distal tip of such scaler tip assemblies, a practitioner can more easily measure or estimate a size of anatomical features and/or defects of patient anatomy during use. For example, a dental scaler tip kit can include a plurality of differently sized dental scaler tip assemblies, which can be color coded, so that a practitioner can readily identify a size of the referenced dimension of the scaler tip assembly to further simplify a process for measuring or estimating a dimension of an anatomical structure or defect. 
     In some embodiments, a dental scaler system can comprise an ultrasonic driver having an ultrasonic vibration signal output port, the ultrasonic driver configured to discharge an ultrasonic frequency vibration signal from the ultrasonic vibration signal output port. A laser light source can have a laser light output port; the laser light source configured to discharge laser light from the laser light output port. A hand-piece housing can have an outer surface configured to be graspable and manipulable with a user&#39;s hand, the hand-piece housing having an input assembly connected to the ultrasonic vibration signal output port so as to receive an ultrasonic vibration signal from the ultrasonic driver, the input assembly also connected to the laser light output port so as to receive laser light from the laser light source, the hand-piece also comprising a output assembly configured to output an ultrasonic vibration and laser light. An ultrasonic scaler member can have a proximal end and a distal end, the proximal end of the ultrasonic scaler member can be connected to the output assembly of the handpiece housing, the ultrasonic scaler member comprising a light guide extending from a light guide input at the proximal end of the ultrasonic scaler member to a light guide output at the distal end of the ultrasonic scaler member, the light guide output configured to discharge laser light from the distal end of the ultrasonic scaler member. 
     In some embodiments, the light guide is configured to receive laser light having a wavelength in the range of 0.4 μm to 3.0 μm. 
     In some embodiments, the light guide comprises a hollow passage extending from the proximal end of the ultrasonic scaler member to the distal end of the ultrasonic scaler member, the light guide comprising an inner surface with high reflectivity. 
     In some embodiments, the handpiece housing comprises a light coupling including a reflector, connecting the input assembly with the output assembly. 
     In some embodiments, the light coupling comprises a fiber coupler. 
     In some embodiments, the ultrasonic scaler member includes a concave portion, and water outlet port being disposed in the concave portion. 
     In some embodiments, the ultrasonic scaler member comprises a canal extending from the proximal end to the distal end of the ultrasonic scaler member, the canal configured to guide water from the proximal end to the distal end. 
     In some embodiments, a dental scaler can comprise a hand-piece housing having an outer surface configured to be graspable and manipulable with a user&#39;s hand. An ultrasonic scaler member can have a proximal end and a distal end, the proximal end of the ultrasonic scaler member being connected to the hand-piece housing, the proximal end of the ultrasonic scaler member including a light input portion and a light guide extending from the light input portion to a light output portion at a distal end of the ultrasonic scaler member, the light output portion being configured to discharge laser light from the distal end of the ultrasonic scaler member. 
     In some embodiments, an ultrasonic transducer can be disposed in the hand-piece and in vibrational communication with the ultrasonic scaler member, the ultrasonic transducer configured to vibrate the ultrasonic scaler member at an ultrasonic frequency. 
     In some embodiments, an ultrasonic driver can be operationally connected to the ultrasonic scaler member and configured to transfer an ultrasonic frequency vibration signal to the ultrasonic scaler member. 
     In some embodiments, a laser light source can be operationally connected to the ultrasonic scaler member and configured to provide laser light to the ultrasonic scaler member. 
     In some embodiments, an input device can be disposed on ab outer surface of the hand-piece housing configured to control discharge of light through the ultrasonic scaler member. 
     In some embodiments, the light guide is configured to receive laser light having a wavelength in the range of 0.4 μm to 3.0 μm. 
     In some embodiments, wherein the light guide has an upstream end and a downstream end, the upstream end being larger than the downstream end. 
     In some embodiments, the light guide has an inner diameter that gradually changes from a larger diameter at the upstream end to a smaller diameter at the downstream end. 
     In some embodiments, the handpiece housing comprises a light coupling including a reflector, connecting the input assembly with the output assembly. 
     In some embodiments, wherein the light coupling comprises a fiber coupler. 
     In some embodiments, wherein the ultrasonic scaler member includes a concave portion, and water outlet port being disposed in the concave portion. 
     In some embodiments, wherein the ultrasonic scaler member comprises a canal extending from the proximal end to the distal end of the ultrasonic scaler member, the canal configured to guide water from the proximal end to the distal end. 
     In some embodiments, a dental scaler tip member can comprise a proximal end and a distal end, the proximal end of the dental scaler member being configured to be connectable to an ultrasonic scaler hand-piece housing, the proximal end of the ultrasonic scaler member including a light input portion and a light guide extending from the light input portion to a light output portion at a distal end of the ultrasonic scaler member, the light output portion being configured to discharge laser light from the distal end of the ultrasonic scaler member. 
     In some embodiments, the light guide has an inner surface with a reflectivity of at least 50%. 
     In some embodiments, the light guide is configured to guide laser light having a wavelength in the range of 0.4 μm to 3.0 μm from the proximal end to the distal end of the dental scaler tip member. 
     In some embodiments, the dental scaler tip member is configured to be vibrated at an ultrasonic frequency during a dental scaling procedure. 
     In some embodiments, a dental scaler tip kip can comprise at least first and second dental scaler tip members, each of the plurality of dental scaler tip members comprising a proximal end and a distal end, the proximal end of each dental scaler member being configured to be connectable to an ultrasonic scaler hand-piece housing, the distal end of each of the dental scaler tip members having a different dimension, each of the dental scaler tip members having a different color, and all of the plurality of dental scaler tip members being contained in a single container. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       These and other features of the inventions disclosed herein are described below with reference to the drawings of various embodiments of dental scaler systems and components which are intended to illustrate, but not to limit, the inventions. The drawings contain the following figures: 
         FIG. 1  is a schematic diagram of prior art ultrasonic dental scaler. 
         FIG. 2  is a schematic diagram of a prior art laser curettage device. 
         FIG. 3A  is a schematic diagram of an embodiment of a scaler system with light therapy functionality including a sonic driver unit and a light driver unit, both of which are connected to an embodiment of a scaler handheld piece and an embodiment of a dental scaling tip assembly. 
         FIG. 3B  is a schematic illustration of a further embodiment of the dental scaler system with light therapy functionality, including an integrated sonic and light driver and an integrated connector between the driver and handheld piece. 
         FIG. 3C  is a schematic diagram of the connections between the integrated driver, handpiece, and tip assembly of the embodiment of  FIG. 3B . 
         FIG. 4  is a schematic diagram of a dental scaler assembly including a handheld piece, a driver connector, and a scaler tip assembly in which light is transmitted to the handheld piece, and into the scaler tip assembly, and discharged through a distal end of the scaler tip assembly. 
         FIG. 5  is a modification of the embodiment of  FIG. 4 , including a water discharge opening in a concave area of the dental tip assembly. 
         FIG. 6  is a schematic illustration of a further modification of the embodiments of  FIGS. 4 and 5  in which an optical fiber extends through the handheld piece and the dental scaler tip assembly. 
         FIG. 7  is a schematic diagram of a further modification of the embodiments of  FIGS. 4-6  in which a fiber is used for directing light to the handheld piece, the handheld piece and a portion of the dental scaler tip assembly includes an optical passage and a distal portion of the scaler tip assembly includes an additional fiber for directing light to a distal end of the tip assembly. 
         FIG. 8  is a schematic illustration of yet another modification of the embodiments of  FIGS. 4-7 , including a light input port on the handheld piece, separate from the connector to the driver to the sonic driver unit, and including a reflector for directing the light parallel to the water channel. 
         FIG. 9  is a schematic diagram of a kit including plurality of color-coded dental scaler tip members with different dimensions. 
     
    
    
     DETAILED DESCRIPTION 
     Embodiments of the inventions disclosed herein are described in the context of ultrasonic dental scalers because they have particular utilities in this context. However, the inventions disclosed herein can be used in other contexts as well, such as other types of dental tools, surgical tools, and other medical devices. 
     In the following detailed description, terms of orientation such as “upper,” “lower,” “longitudinal,” “horizontal,” “vertical,” “lateral,” “distal”, “proximal”, “midpoint,” and “end” are used herein to simply the description in the context of the illustrated embodiments. Because other orientations are possible, however, the present inventions should not be limited to the illustrated orientations. Those skilled in the art will appreciate that other orientations of various components described herein are possible. 
       FIG. 1  schematically illustrates a prior art ultrasonic scaler. It consists of main unit  10  which can be considered as a sonic or ultrasonic driver, a handheld piece  20  and the ultrasonic tip assembly  30 . Some prior art ultrasonic tip assemblies have a hollow canal to guide the water to the opening in the concave region  32  of the insert so that the water can clean the examined region. The hollow canal may or may not reach the tip of the assembly  30 , therefore water may not be able to reach the tip. Such traditional assemblies  30  are not able to deliver the laser light to a tooth region. 
     Such prior art ultrasonic scaler systems can include a foot pedal actuator assembly  34  including a control line  36  and a foot pedal  38 . In this type of configuration, the foot pedal actuator assembly  34  includes a switch (not shown) in the foot pedal assembly  38 . The switch is actuatable by a moveable pedal member  39  which is pivotably mounted relative to a base of the foot pedal assembly  38 . The control line  36  can include one or more electrical wires configured to cooperate with the switch within the foot pedal assembly  38  and for providing an on/off signal and/or functionality for the main unit  10 . As such, the main unit  10  is configured to turn or turn off a sonic or ultrasonic signal delivered to the handheld piece  20 . In some systems, ultrasonic vibrations are conducted through an air passage to the tip assembly  30 . In piezoelectric systems, electrical signals are delivered to a piezo electric transducer in the handheld piece  20 . Thus, during use, a user can hold the handheld piece  20  placing the ultrasonic tip assembly  30  into proximity and/or contact with a patient&#39;s anatomy and use the foot pedal control assembly  34  for turning on or turning off the delivery of ultrasonic signal to the assembly  30 . 
     The handheld piece  20  is connected to the main unit  10  with a connector hose  22 . The connector hose  22  can include an ultrasonic delivery channel (delivering ultrasonic vibrations conducted by air or in the form of electrical signals to a piezoelectric transducer, and optionally a water delivery channel. The foot pedal assembly  34  can be used to control the actuation of the ultrasonic signal to the tip assembly  30  and/or water delivery to the tip assembly  30 . 
       FIG. 2  is a schematic illustration of a prior art laser curettage device. The laser curettage device of  FIG. 2  includes a laser driver unit  40 , an optical fiber unit  70 , handheld piece  50 , and a fiber probe  60 . Such a curettage device can be foot-pedal controlled. For example, the laser curettage prior art system can include a foot pedal assembly  42  including a foot pedal unit  44  connected to the driver  40  with a foot pedal control line  46 . The foot pedal unit  44  can include a user actuatable foot pedal member  49 . As such, the foot pedal control unit  42  can be used to trigger the driver  40  to turn on or turn off light energy, such as laser light energy, delivered to the fiber  70  and ultimately to the fiber  60 . 
       FIG. 3  illustrates an embodiment of a dental scaler with light therapy system  100  in accordance with an embodiment. Some components of the system  100  are described with the same reference numerals used for identifying portions of the systems shown in  FIGS. 1 and 2  because they can have similar construction, except as described below. 
     As shown in  FIG. 3A , the system  100  includes a driver unit  110 , a light driver unit  140 , a connector assembly  122 , a handheld piece  120 , and a scaler tip assembly  130 . 
     The driver unit  110  can be constructed in accordance with the driver unit  10  of  FIG. 1 , and can include a foot pedal control assembly  134 . Similarly, the light therapy driver unit  140  can be in the form of the light therapy unit  40  of  FIG. 3 , and can include a foot pedal control assembly  142 . 
     Optionally, the foot pedal control assembly  134  can be connected to both the driver unit  110  with a control line  136  as well as an optional light therapy control line  147 . In some embodiments, the foot pedal control assembly can include a single pedal  139  operably connected via the control lines  136 ,  147  to the driver units  110 ,  140 , respectively, for turning on the sonic signal from the driver  110  and the light from the driver  140  through a single operation. 
     Optionally, the handheld piece  120  can include an input device  124  accessible on an outer surface of the handheld piece  120 . For example, the input device  124  can be in the form of a user actuatable button, or any other type of input device. The input device  124  can be connected to the light therapy driver  140  with a control line  126  extending along and/or through the handheld piece  120  and the connector line  122 , into the light therapy device  140 , for performing essentially the same function as the foot pedal assembly  142 . 
     In some configurations, the connector line  122  can be bifurcated, including a common end  127  connected to an input end of the handheld piece  120 , and a bifurcated portion  128  at which location the connector line  122  is split into a sonic driver portion  123  and a light therapy connector portion  170 . Other configurations can also be used. 
     In operation, a sonic signal from the sonic driver unit  110  can be delivered to the handheld piece  120 , and then to the ultrasonic scaler tip assembly  30 . Light, such as laser light, from the light therapy unit  140  can also be delivered to the handheld piece  120  through the connector portion  170 , which can contain an optic fiber. 
     As such, ultrasonic signal and light therapy features are integrated and can be simultaneously delivered to the handheld piece  120 . Thus, the system  120  can reduce potentially pathogenic microorganisms in the air, providing a safer working environment. 
     The ultrasonic tip assembly  130  can be configured to deliver both light and water to a desired target area, as well as ultrasonic energy. For example, the connector  122  can be configured to deliver water from the sonic driver  110 , to the handpiece  120 , and to the ultrasonic tip assembly  130 . The system  100  can also reduce the possible transfer of periodontal pathogenic bacteria from a diseased pocket to healthy sulcus. 
     In some embodiments, the ultrasonic tip assembly  130  can be color coded, providing an indicia indicating a size of a referenced dimension of the tip assembly  130 . Such a color coding technique can allow a clinician or practitioner to have a convenient means for measuring or estimating a measurement of an area, such as an anatomical structure or defect of a patient. For example, if an anatomical structure such as a pocket, is smaller than an ultrasonic tip assembly  130  then being used by the clinician, the clinician can find a smaller size tip, indicated by color coding of the tip, switch to a smaller size tip by installing onto the handheld piece  120 , and continue the procedure. 
     Additionally, the system  100  can provide a further advantage in that a dental professional can use a single device to perform both scaling and root planning, remove any remaining soft tissue tags, reduce bacteria levels, and promote wound healing. 
       FIG. 3B  illustrates a modification of the embodiment of  FIG. 3A . In the embodiment of  FIG. 3B , the modified embodiment is identified generally by the reference numeral  100 A. Components, parts, and features, and functionality of the system  100 A can be similar or the same as those of the system  100  described above and thus corresponding components have been identified with the same reference numeral, except that a letter A has been added thereto. 
     With reference to  FIG. 3B , the system  100 A can include an integrated sonic and light driver device  110 A which includes the components and functionalities of both the driver  110  and the light therapy driver  140  of the system  100  described above. 
     Optionally, the integrated driver  110 A can include a single output port  112  including outputs for both ultrasonic signal and light for delivery to the handheld device  120 A. Additionally, the control line  126 A can extend from the input device  124 A to the integrated driver  110 A. As such, the integrated driver unit  110 A can be configured to deliver any one or any combination of ultrasonic signal, water, and light for delivery to the tip assembly  130 A. 
     The integrated driver  110 A can receive a control signal from the input  124 A through the control line  126 A. The driver  110 A can be configured to use the signal from the control line  126 A to control any one or any combination of delivery of sonic energy and/or light. Similarly, the control assembly  134 A can be connected to the integrated driver  110 A and can be used to control any one of or any combination of sonic energy and light delivered to the ultrasonic tip assembly  130 A. 
       FIG. 3C  is a schematic diagram illustrating the connections between the integrated driver unit  100 A and the ultrasonic tip assembly  130 A. As shown in  FIG. 3C , the integrated driver  110 A can include a light source  180 , sonic energy source  182 , and a water source  184 . Additionally, the integrated driver  110 A can include a light control connector  186   o,  a light energy connector  188   o,  a water supply connector  190   o,  and a sonic energy connector  192   o.    
     The connector assembly  122 A can include a like control line  126 A, a light optical fiber  170 , a water channel  172 , and a sonic energy conduit  174 . Additionally, the connector assembly  122 A can include an input end  194  and an output end  196 . The input end  194  can be configured to connect to the output port  112  of the integrated driver  110 A. For example, the input end  194  can include corresponding connectors  186   a,    188   a,    192   a ,  190   a.  As such, the input end  194  of the connector assembly  122 A can connect to the connector  112  with the connectors  186   a,    188   a,    192   a,    190   a,  connecting with the connectors  186   o,    188   o,    190   o,    192   o,  respectively. 
     Similarly, the output end  196  of the connector assembly  122 A can include connectors  186   b,    188   b,    190   b,  and  192   b.  Additionally, the handheld piece  120 A can include corresponding connectors  186   c,    188   c,    190   c,  and  192   c.  As such, the input end of the handheld piece  120 A can connect to the output end  196  of the connector assembly  122 A, with the connectors  186   c,    188   c,    190   c,    192   c  connecting with the connectors  186   b,    188   b ,  190   b,    192   b,  respectively. 
     The connector  186   c  can provide electrical connection to the input device  124 A for providing the signal to the light energy source  180 . 
     The connector  186   c  can provide an optical connection to the ultrasonic scale or tip assembly  130 A, described in more detail below. 
     The connector  190   c  can provide a connection for water from the water source  184  to the ultrasonic tip assembly  130 A. Finally, the connector  192   c  can provide a fork connection and transfer of sonic energy from the sonic energy source  182  to a sonic actuator  194  within the handheld piece  120 A. 
     The ultrasonic tip assembly  130 A can include an optical connector  188   d  and a water connector  190   d.  As such, the ultrasonic tip assembly  130 A can receive light energy from the light source  180  of the connector,  188   d  and water from the water source  184  through the water connector  190   b.  The various connecters described above can be in the form of any known connector, including butt connectors, male-female connectors, or other types of connectors well known in the art for various types of connecting functionalities. 
       FIG. 4  illustrates a modification of the handheld piece  120 , identified generally by the reference number  220 . Parts, components, features, and functionality of the handheld piece assembly  220  are similar or the same as the handheld pieces  120 ,  120 A described above, are identified generally with the same reference numerals except that “ 100 ” has been added thereto. 
     With reference to  FIG. 4 , handpiece  220  can be connectable to connector assembly  222 A with connectors  288 C for receiving light from the fiber  270  and the connector  290 C for receiving water through a water channel  272  within the connector assembly  222 A. The handheld piece  220  can include a central passage  271  configured to guide both light and water to the ultrasonic tip assembly  230 . With such an embodiment, both light, such as laser light from the fiber  270  and water from the channel  272  are fed to the handheld piece  220  and then to the ultrasonic tip assembly  230 . The inner surface of the passage  270  can be smooth with a high reflectivity sufficient to guide light, such as laser light, to the ultrasonic tip assembly  230  with sufficient efficiency for bacterial load reduction results. 
     In some embodiments, the proximal end  230   a  of the ultrasonic tip assembly  230  can be engaged to the distal end of the handheld piece  220  with any type of engagement configuration, such as a threaded engagement, butt connector, male-female connector, or any type of connector known in the art. Some prior art devices use threaded connections, and such a connection can be used in the embodiment of  FIG. 4 . 
     In some embodiments, the ultrasonic tip assembly  230  includes an internal passage  231  that is configured to guide both light and water to a distal end  230   b  of the ultrasonic tip assembly  230 . The distal end  230   b  of the ultrasonic tip assembly  230  is configured to be pressed against patient anatomy, such as teeth and/or gums, for scaling in the manner well-known in the art. The distal end  230   b,  however, can include an aperture  231 A configured to allow light and/or water to be discharged from the distal end  230 B. Thus, as illustrated in  FIG. 4 , the light represented by the dashed line  270 A is guided through the passage  271 , and through the passage  231 A, to the aperture  231 A. Thus, during operation, both light and water can be discharged from the distal end  230   b  of the ultrasonic tip assembly  230 . 
     Similarly to the passage  271 , the passage  231  can include sufficient smoothness and reflectivity to guide light, such as laser light, to the aperture  231 A with sufficient efficiency that the light discharged from the aperture  231 A has sufficient intensity so as to provide desired bacterial reduction. For example, using a typical power output setting of a known laser curettage device, the passage  231  can have a 50% reflectivity or more and sufficiently guide laser light out of the tip assembly  230  for bacterial load reduction. 
     In some embodiments, as illustrated in  FIG. 4 , an internal dimension, such as a diameter, of the passage  231  can reduce gradually from the proximal end  230 A to the distal end  230 B. Such a gradually reducing inner dimension of the passage  231  can provide for more light to be delivered to the distal end  230 B and discharged through the aperture  231 A. 
       FIG. 5  illustrates yet another modification of the handheld piece  120 , identified generally by the reference numeral  320 . Parts, components, features and functionality of the handheld piece  320  that are similar or the same as the previously described embodiments of the handheld piece described above are identified with the same reference numeral, except that  200  has been added thereto. 
     As shown in  FIG. 5 , the ultrasonic scaler tip assembly  330  includes an additional aperture  332  positioned approximately in the concave portion  332 . The aperture  332  is defined in the passage  331  and is configured to allow the discharge of water from the internal passage  331  at a position spaced away from the distal portion  330   b.    
       FIG. 6  illustrates yet another modification of the handheld piece  120 , identified generally by the reference numeral  420 . Parts, components, features, and functionality of the handheld piece  420  are identified with the same reference numerals used above with regard to the system  100 , except that  300  has been added thereto. 
     As shown in  FIG. 6 , an optical fiber  436  is disposed in the tip assembly  430  to deliver laser light to the distal end  430   b  of the tip assembly  430 . Using such an additional portion of optical fiber  436  in the tip assembly  430  can provide an optional additional advantage of improving light transmission efficiency as compared to using hollow passage, such as in the embodiments of  FIGS. 4 and 5 . Optionally, an opening  432   a  in the concave region of the insert can be configured to deliver water for cleaning purposes during dental procedures such as scaling. In some embodiments, the laser light from the laser fiber  470  is directly coupled into the optical fiber  436  in the insert  30 . 
       FIG. 7  illustrates yet another modification of the handheld piece  120 , identified generally by the reference numeral  520 . Parts, components, features, and functionality of the handheld piece  520  are identified with the same reference numerals used above with regard to the system  100 , except that  400  has been added thereto. In this embodiment, the optical fiber  536  only extends from the tip to the opening  532   a  of the tip assembly  530 . 
     The embodiments of  FIGS. 4-7  have internal components to couple the laser light from the fiber  270 ,  370 ,  470 ,  570  through the corresponding handheld piece to the optical fiber  436 ,  536  or a hollow canal within the tip assembly. Any known art light coupling hardware or methods can be used inside the various embodiments if the handheld pieces to couple the laser light to the hollow canal or optical fiber in the tip assembly, for example, direct fiber contact in  FIG. 6 , hollow light pipe in  FIGS. 4, 5 and 7 . Other methods, such as the coupling lens can be used as well. All those coupling methods can be optimized using well known techniques to maximize the coupling efficiency for the current invention. The fibers for the lasers in embodiments in  FIGS. 4-7  can be connected to different laser sources. 
       FIG. 8  illustrates yet another modification of the handheld piece  120 , identified generally by the reference numeral  620 . Parts, components, features, and functionality of the handheld piece  520  are identified with the same reference numerals used above with regard to the system  100 , except that  600  has been added thereto. 
     As shown in  FIG. 8 , in some embodiments, light coupling can be accomplished a reflector  673  disposed in the passage  671  within the handheld piece  620 . The light from the laser fiber  72  can be coupled into the hollow canal  631  of the tip assembly  630  directly by the concave reflector  673 . In some embodiments, the light can be introduced into the passage  671  by a fiber  672  connected to the passage  671  at an oblique or perpendicular angle. By using the different fiber connecting to different laser sources, dental professionals can easily perform different procedures with different laser wavelengths. 
       FIG. 9  is a schematic illustration of a kit  700  including a plurality of dental scaler tip members  702 ,  704 ,  706  having different widths  703 ,  705 ,  707  at their respective distal ends. Each of the dental scaler tip members  702 ,  704 ,  706  can have different colors, and as such can be considered as being color-coded according to the widths  703 ,  705 ,  707 . In some embodiments, the different widths can be offset from each other by predetermined amounts such as 0.5 mm, 1 mm, 2 mm, or other magnitudes. The kit  700  can include any type of container for containing a plurality of dental scaler tip members. 
     These and other advantages of the present inventions will be apparent to those skilled in the art from the foregoing specification. Accordingly, it will be recognized by those skilled in the art that changes or modifications may be made to the above-described embodiments without departing from the broad inventive concepts of the inventions disclosed herein. It should therefore be understood that the inventions are not limited to the particular embodiments described herein, but are intended to include all changes and modifications that are within the scope and spirit of the inventions disclosed herein.