Scaling

Root Planing

Process by which plaque and calculus are removed from both supra and subgingival tooth surface.

Process by which residual embedded calculus and portion of cementum are removed from the root to produce a smooth, hard and clean surface

A.

Plaque and Calculus deposition.

Supra and subgingival calculus have a rough surface capable of harboring plaque that cannot be removed by conventional oral hygiene techniques. Bauhammers et al,1973.

B. Alterations in

exposed cementum

Hypermineralized surface zone Changes in organic matrix

Endotoxins cytotoxic in tissue culture Aleo et al , 1974

Restoration of gingival health Scaling and root planing are not separable procedures

Restoration of gingival health Scaling and root planing are not separable procedures

Before Scaling & Root Planing

After Scaling & Root planing

Scaling and root planing are a prerequisite for the arrest and cure of periodontal disease; together with plaque control, they constitute the major means by which the disease is prevented.

Careful subgingival scaling and root planing is an effective mean to eliminate gingivitis and reduce the probing depth even at sites with initially deep periodontal pockets. Badersten, 1984

Eliminating inflammation Reducing probing depths Improving clinical attachment

Securing biologically acceptable root surfaces Resolving inflammation Decreasing pocket depth Facilitating oral hygiene procedures Improving or maintaining attachment level Preparing the tissues for surgical procedures

Garret in 1977 set forth the rationale for root planing

Root Smoothness Removal of Diseased Cementum Preparation for New Attachment

No biological evidence which relates smooth root surfaces to decreased plaque formation or increased ease of removal. It remains the only clinical indicator of calculus removal available at present.

Recent data suggests that root structure removal is not necessary. The end point of scaling and root planing is however a smooth root surface as rough surfaces are more prone to plaque accumulation.

Calculus can be seen in radiographs or detected clinically.

Deposits of calculus on root surfaces are frequently embedded in cemental irregularities ( Zander,1953; Moskow, 1969) Scaling alone is therefore insufficient to remove calculus. A portion of cementum must be removed to eliminate these deposits.

Root planing plays an important role in preparing root surfaces for demineralization and subsequent new attachment

To determine efficacy of therapy, therapeutic goals must first be established. In periodontal therapy, our objectives are as follows:

Suppression or elimination of pathogenic bacteria Establishment of a healthy root surface Conversion of inflamed to healthy tissues Reduction of periodontal pockets

Scaling and root planing has both local and systemic sequelae. Locally, the results of scaling and root planing are:

Debridement of bacteria and calculus Removal of infected cementum and dentin A shift in the microbial population

Scaling and root are not always the only measures that are required in order to properly eliminate subgingival infection in deep pockets.
Waerhaug(1978)

If, following scaling and root planing, signs of bleeding on probing to the bottom of the pocket persist, and if the clinical attachment level fails to improve, surgical therapy should be considered since this treatment may facilitate more adequate root debridment .
Caffesee etal (1986)

The microbial shift is effected by two mechanisms The removal of bacteria by scaling and root planing The clinical outcome of scaling and root planing which alters the environment favoring population by certain bacteria over others

Decreased pocket depth Smooth root surfaces Reduction of inflammation

Scaling and root planing also has systemic effects. These are a bacteremia and a host immune response

Micro ultrasonic teeth cleaning.flv Scaling and Root Planing- Part II Mandibular Teeth.flv

Scaling and Root Planing- Maxillary Teeth.flv