Scaling And Root Planing To Treat Gum Diseases
Scaling is the process by which biofilm and calculus are removed from both supragingival and subgingival tooth surfaces. No deliberate attempt is made to remove tooth substance along with the calculus.
Root planing is the process by which residual embedded calculus and portions of cementum are removed from the roots to produce a smooth, hard, clean surface.
The primary objective of scaling and root planing is to restore gingival health by completely removing elements that provoke gingival inflammation (i.e., biofilm, calculus, and endotoxin) from the tooth surface.
“Early Signs That Require Scaling And Root Planing”
Scaling and root planing are not separate procedures; all the principles of scaling apply equally to root planing. The difference between scaling and root planing is only a matter of degree. The nature of the tooth surface determines the degree to which the surface must be scaled or planed.
Deposits of calculus are frequently embedded in cemental irregularities; therefore scaling alone is insufficient, and a portion of the root surface must be removed to eliminate these deposits.
“Benefits Of Scaling And Root Planing For Gums”
Periodontal Instruments Supragingival Scaling
- It is done coronal to the gingival margin which allows direct visibility and freedom of movement. This makes adaptation and angulation of instruments much easier as compared to subgingival scaling and root planing.
Periodontal Instruments Instruments
Sickle scalers, curettes and ultrasonic and sonic instruments are most commonly used during supragingival scaling.
Periodontal Instruments Technique
Following are the steps to be followed during supragingival scaling:
- Grasp: Supragingival scaling is performed with sickle scaler or curette by holding them with a modified pen grasp.
- Finger rest: A firm finger rest is achieved on the teeth adjacent to working area.
- Adaptation and angulation: The blade is adapted with an angulation of slightly less than 90° to surface being scaled. Sharply pointed tip of sickle can easily lacerate marginal tissue or gouge exposed root surfaces, so careful adaptation is especially important when this instrument is being used.
- Strokes: The Cutting edge of blade should engage the apical margin of supragingival calculus. Short, powerful and overlapping scaling strokes should be activated coronally in a vertical or oblique direction.
- Endpoint: Final scaling should always follow with the finishing curette. The tooth surface is needed to be instrumented till it appears visually and tactilely free of all supragingival deposits.
“Steps In Scaling And Root Planing Procedure”
Subgingival Scaling and Root Planing
It is performed apical to the gingiva which impairs the visibility and freedom of movement. Visibility is also obscured by the bleeding which is inevitable during subgingival instrumentation. Adaptation and angulation of the instruments are more during subgingival scaling and root planing. However subgingival calculus is harder when compared to supragingival calculus and is fixed into root irregularities which make it more tenacious and hard to remove.
Subgingival Scaling and Root Planing Instruments
Subgingival scaling and root planing are commonly performed with either universal or area-specific (Gracey) curettes, Sickles, hoes, Hirschfeld files and thin ultrasonic tips may also be useful for the removal of subgingival calculus.
“Risk Factors For Complications During Scaling And Root Planing”
Subgingival Scaling and Root Planing Technique
Following are the steps to be followed during subgingival scaling:
- Grasp: A modified pen grasp is used to hold curette.
- Finger rest: A stable finger rest is established on the teeth adjacent to the working area. Location of the finger rest or fulcrum is important to keep lower shank of instrument to be parallel or nearly parallel to the tooth surface which is being treated and to enable the operator to use wrist-arm motion. Finger rest must be close enough to working area to fulfill these two requirements, except in some aspects of the maxillary posterior teeth, where these requirements can be met only with the use of extraoral or opposite-arch fulcrums.
- Insertion: The blade is inserted under the gingiva at 0°.
- Adaptation and angulation: The correct cutting edge should be adapted to the tooth, and the lower shank is kept parallel to the tooth surface with the face of blade nearly flush with the tooth surface. With the entry of cutting edge at base of the pocket, a working angulation is maintained between 45° and 90°, and pressure is applied laterally against the tooth surface.
“Understanding The Benefits Of Scaling And Root Planing”
- Strokes: Calculus is removed by a series of controlled, overlapping, short and powerful strokes primarily using wrist-arm motion. Longer, lighter root planing strokes are then activated with less lateral pressure until the root surface is completely smooth and hard. The instrument handle must be rolled carefully between the thumb and the fingers to keep the blade adapted closely to the tooth surface as line angles and developmental depressions in tooth contour are followed. During scaling strokes, force should be maximized by concentrating lateral pressure onto the lower third of blade. This small section, the terminal few millimeters of the blade, is positioned slightly apical to the lateral edge of the deposit, and a short vertical or oblique stroke is used to split the calculus from the tooth surface. Without withdrawing the instrument from the pocket, the lower third of the blade is advanced laterally and repositioned to engage the next portion of remaining deposit. Another vertical or oblique stroke is made, slightly overlapping the previous stroke. This process is repeated in a series of powerful scaling strokes until the entire deposit has been removed. The overlapping of these pathways or “channels” of instrumentation ensures that the entire instrumentation zone is covered.
- Endpoint: Final subgingival scaling and root planning should always follow with the finishing curette. The tooth surface is instrumented until all subgingival deposits are removed.
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