47.SCALING-AND-ROOT-PLANING

Introduction

  • Overview of the presentation on Scaling and Root Planing by Dr. Trupti Giri.

Definition

  • Scaling: Instrumentation of the crown and root surfaces of teeth to remove plaque, calculus, and stains.

    • Source: Glossary of Periodontal Terms, 2001

  • Oral Prophylaxis: Removal of plaque, calculus, and stains for preventive control of local irritational factors.

    • Source: Glossary of Periodontal Terms, 2001

  • Root Planing: Treatment to remove rough cementum or surface dentin, contaminated with toxins or microorganisms.

    • Source: Glossary of Periodontal Terms, 2001

Non-Surgical Periodontal Therapy (NSPT)

  • NSPT combines scaling and root planing with oral hygiene instructions.

    • Elements:

      • Correction of plaque-retentive factors

      • Subgingival debridement

Advantages of Scaling and Root Planing

  • Gold standard treatment for chronic periodontitis.

  • Reduces plaque-induced inflammation and bacterial load.

  • Improves oral hygiene and reduces malodor.

Outcomes of Scaling and Root Planing

  • Reduction of plaque and calculus.

  • Resolves gingival inflammation and bleeding, thus preventing progression to periodontitis.

  • Enhances aesthetics by stain removal.

  • Secures a biologically acceptable root surface and facilitates improved attachment levels for surgical procedures.

Categories of Scaling and Root Planing

  • Scaling:

    • Supragingival scaling

    • Subgingival scaling

  • Root Planing:

    • Prophylactic: Historical interest only.

    • Therapeutic: Part of treatment procedures.

Procedure for Scaling and Root Planing

  • Use sharp instruments for hand scaling.

  • Scaling performed in apical to coronal direction with a proper angulation (45°-90°) to tooth surface.

Instruments Used

  • Hand Instruments: Sickle scalers, curettes, thin files, chisels, and hoes.

  • Mechanical Aids: Sonic and ultrasonic instruments.

Techniques of Scaling

Supragingival Scaling

  • Less tenacious calculus, easier to remove with sickles, curettes, and ultrasonic instruments.

    • Modified pen grasp with firm finger rest.

  • Blade inclination of less than 90 degrees to scale effectively.

Subgingival Scaling and Root Planing

  • More tenacious calculus hidden in root irregularities.

  • Curette preferred due to better adaptability for deep cleaning.

  • As calculus is removed, pressure is lessened to achieve smooth surfaces.

Instrumentation Techniques

  • Transition from short powerful strokes to longer lighter strokes as roughness lessens.

  • Avoid over-instrumentation to prevent root surface damage.

Adverse Effects of Scaling and Root Planing

  • Gingival recession in shallow pockets, potential loss of attachment.

  • Risk of tooth substance damage if over-instrumentation occurs.

  • Root sensitivity post-treatment, which generally resolves over time.

Machine vs. Hand Instruments

  • Evidence shows no significant efficacy differences between sonic/ultrasonic and hand instruments.

  • Sonic/ultrasonic methods may be faster.

Effects of Scaling and Root Planing

  • Improvement in clinical attachment levels and reduction in probing pocket depths.

  • Specific outcomes demonstrate dependence on disease severity and treatment extent.

Limitations of Scaling and Root Planing

  • Inaccessibility to deep pockets and certain tooth surfaces.

  • Inability to eliminate specific pathogens completely.

Conclusion

  • Effective treatment for gum disease when performed correctly.

  • Proper techniques enhance success and reduce future complications.

Closing Message

  • "You don't have to lose teeth to periodontal diseases. They often can be treated successfully."

Acknowledgment

  • Thank you for attending the presentation.