KSU College of Dentistry PDS Presented by : Dr.Khalid AL-Hezaimi Presented by : Dr.Khalid AL-Hezaimi

 Introduction  Scaling and root planing  Scaling &root planing techniques  Evidence-based studies in periodontal instrumentation  Evaluation of scaling and root planing  Limitation of scaling and root planing  Summary

 Periodontal therapy can be divided into three but frequently overlapping phases.  The cause – related phase (non – surgical periodontal therapy).  The corrective phase ( periodontal surgery).  The maintenance phase (supportive periodontal – therapy).

Non – surgical periodontal therapy (NSPT)  it is also called oral hygiene phase therapy (OHPT ).  All periodontal treatment is based on successful initial NSPT.

Means of (NSPT):  Patient information.  Self – performed plaque control methods.  Scaling and root planning.  Adjunctive use of chemical agents.  Post – initial therapy re – evaluation.

 Scaling is the process by which plaque and calculus are removed from both supragingval and subgingival tooth surfaces.  Whereas root planning means : The process by which residual embedded calculus and portion of cementum are removed from the roots to produce a smooth,hard and clean surface. The process by which residual embedded calculus and portion of cementum are removed from the roots to produce a smooth,hard and clean surface.

The objective of scaling and root planning:  Restore gingival health  Removal of root surface element (plaque - calculus - endotoxine)  Arrest the progression of further periodontal disease destruction.

 Scaling and Root planning are not separate procedure, however they are different.  All principles of scaling apply equally to Root planning, the difference between scaling and Root planning is only a matter of degree.

 Access to the Root surface. The root surface are not easy to access because Limitation of penetration of instruments. The root surface are not easy to access because Limitation of penetration of instruments.  In subgingival access. scaling and root planing skills is needed. scaling and root planing skills is needed.  in deep pockets. open procedure may needed ) It was shown that pockets less than 3 mm were the easiest sites for scaling and root planing. Pocket depths between 3 to 5 mm were more difficult to scale and pockets deeper than 5 mm were the most difficult.) Rabbani GM et al.1999 Rabbani GM et al.1999

1- visual examination. 2- tactile exploration.

 Supra gingival scaling technique: Sickles,curettes,and ultrasonic and sonic instrument are most commonly used for removal of supragingival calculus.  Sub gingival scaling and Root planning technique: The curette is preferred by most clinicians because of the advantages afforded by its design.

 Ultrasonic scaling: Ultrasonic instrument have been used as a valuable adjunct to conventional hand instrumentation.  Uses of Ultrasonic scaling devices : 1- Scaling and gingival curettage. 2-Removal of satins. 3- Remove overhangs and excess cement

 Contraindications of ultrasonic scaling:  Patient with cardiac pacemaker.  Patients with Known communicable diseases.  Chronic pulmonary Disorder.  Porcelain bounded restoration.  Patient with Titanium implant ( plastic-tipped ultrasonic and sonic insert and Teflon-coated sonic scaler tips are available)

 There was no difference between hand and powered instrumentation in deposit removal and improved clinical parameters (Badersten et al.1981,loos et al. 1987,Laurell et al. 1988) (Badersten et al.1981,loos et al. 1987,Laurell et al. 1988)  There was no difference between hand and powered instruments in the treatment of class I furcation involved areas, while powered instruments were more effective than hand instruments in class II and III furcation due to smaller tip size ( Matia et al.1986,Leon &Vogel 1987) ( Matia et al.1986,Leon &Vogel 1987)

 End toxins are superficially attached to the root surface and can be removed by brushing (Moore et al.1986), polishing (Nyman et al.1988) or light overlapping strokes with ultrasonic scalers (smart et al.1990)  The critical probing depth for scaling and root planing is 2.9 mm ± 0.4 and for periodontal surgery is 4.2 mm ± 0.2 (Lindhe et al.1982 )  Scaling and root planing did not result in total removal of subgingival calculus particularly in deep pockets ( Rabbani et al.1981) ( Rabbani et al.1981)

 The adequacy of S/RP is evaluated when the procedure is performed and again later, after a period of time  First immediately after instrumentation.subgingival surfaces should be hard and smooth.  Then after 2 weeks postoperatively.because reepithialization of the wound created during instrumentation take 1 to 2 weeks.

 Meticulous and requires more experienced operator.  Time consuming(×2the time needed for surgery)  Less predictable in deep pockets,furcations and interproximal groove.  Ineffective as mono therapy in the treatment of aggressive periodontitis.

 Might cause dentine hypersensitivity.  Increased the risk of disease transmission ( aerosol of the powered instruments ).  Powered may interfere with pacemakers.  Patient discomfort.  Cost effectiveness.

 S/RP is an essential part of non-surgical periodontal therapy,yet dose not result in complete removal of calculus.  Patient motivation and cooperation is important in success treatment outcomes.  Self performed OH should be applied regularly and modified if needed.  Re-evaluation provides a check for treatment success and patient’s level of cooperation.