LxScaling and root planing
- 1. SCALINGANDROOT PLANING PRINCIPLES OF SCALING AND ROOT PLANING. Dr. Laxmi Pandey
- 2. SCALING :- It is the process by which biofilm and calculus are removed from both supragingival and subgingival tooth surface. ROOT SCALING :- It is the process by which residual embedded calculus and portions of cementum are removed from the roots to produce a smooth, hard, clean surface. NOTE:-BUT SCALING & ROOT PLANING SHOULD NOT BE VIEWED AS SEPARATE PROCEDURE. DEFINATION
- 3. OBJECTIVE :- 1. To restore gingival health by completely removing elements that provoke gingival inflammation (i.e. biofilm, calculus, and endotoxin) from the tooth surface. 2. Reduces and procedure a shift in the composition of gingival biofilm from one with high no. of gram- negative anaerobes to one dominated by gram- positive facultative bacteria compatible with health. 3. This microbial change can be sustained by the periodic scaling amd root planing performed during periodontal therapy. RATIONALE
- 4. Scaling alone is sufficient to remove biofilm and calculus completely from enamel ,leaving a smooth clean surface . Deposits of calculus on root surfaces are frequently embedded in cemental irregularities. A portion of the root surface must be removed to eliminate deposits because when dentin is exposed ,biofilm bacteria may invade dentinal tubules . But removal of extensive amount of dentin and cementum is not necessary to render the roots free of toxins and should be avoided. In areas where cementum is thin, dentin may get exposed, although it is not the aim of treatment, such exposure is unavoidable. Pt. with small amount of calculus and relatively healthy tissues can be treated in one appointment
- 5. No. of appointment needed is estimated on the basis of the no. of teeth in the mouth, severity of inflammation, amount and location of calculus, depth and activity of pockets, presence of furcation invasions, pt. comprehension and compliance with oral hygiene instructions, and need for LA. Of all clinical dental procedure, subgingival scaling and root planing in the deep pockets are the most difficult and exacting skills to master.
- 6. Visual examination of supragingival and subgingival calculus just below the gingival margin is not difficult with good lighting and clean field. Light deposits of supragingival calculus are often difficult to see when they are wet with saliva. Compressed air may be used to dry supragingival calculus until it is chalky white and readily visible. Air also may be directed into pocket in a steady stream to deflect the marginal gingiva away from the tooth so that subgingival deposits near the surface can be seen. Tactile exploration which is much more difficult than visual examination is performed by explorer or probe with light but stable modified pen grasp. When calculus is encountered, the tip of the instrument should be advanced apically over the deposits until the termination of the calculus on the root is felt. DETECTION SKILLS
- 7. The distance between the apical edge of the calculus and the bottom of the pocket usually ranges from 0.2mm to 1.0mm. When a proximal surface is being explored, strokes must be extended at least halfway across that surface past the contact area to ensure complete detection of interproximal deposits. Beginning students usually has difficulty detecting the fine calculus and altered cementum. Such detection should be done with recognition of ledges, lumps or spurs of calculus, then smaller spicules, then slight roughness and finally a slight graininess that feels like a sticky coating or film covering the tooth surface. Over hanging or deficient margins of dental restoration, caries, decalcification and root roughness caused by previous instrumentation are typically found during exploration.
- 8. Supragingival calculus is generally less tenacious and less calcified than subgingival calculus. Sickle, curettes and ultrasonic and sonic instruments are most often used for the removal of supragingival calculus, hoes and chisels are less frequently used. HOW TO USE SICKLE OR CURETTE:- Modified pen grasp Firm finger rest on the teeth adjacent to the working area. Blade angle with the surface to be scaled is slightly less then 90°. If the tissue is retractable enough to allow easy insertion of the bulky blade ,the sickle may be used slightly below the free gingival margin. SUPRAGINGIVAL SCALING TECNIQUE.
- 9. Much more difficult to perform than supragingival scaling. Subgingival calculus is usually harder than supragingival calculus and is oftren locked into root irregularities making it more tenacious and is therefore more difficult to remove. Vision is obscured by the bleeding that inevitably occurs during instrumentation and by the tissue itself. The clinician must rely heavily o tactile sensitivity to detect calculus and irregularities. In addition ,the adjacent pocket wall limits the direction and length of the strokes. The complex and precise co-ordination of visual, mental and manual skills makes it one of the most difficult of all dental skills. SUBGINGIVAL SCALING AND ROOT PLANING TECHNIQUE
- 10. • The curette is preferred by most clinicians for subgingival scaling and root planing because the advantages offered by its design. • Its curved blade , rounded toe, and curved back allow the curette to be inserted to the base of the pocket and adapted to variation in tooth contour with minimal tissue displacement and trauma. • Sickles , hoed, files, and ultrasonic instrument also are used for subgingival scaling of heavy calculus. • Small files (but not the larger ones) may be inserted to the base of the pocket to crush or initially fracture tenacious deposits but • Hoes , files and standard large ultrasonic tips are all more hazardous than the curette in terms of trauma to the root surface and surrounding tissues.
- 11. Subgingival scaling and root planing are accomplished with either universal or area- specific ( Gracey ) curettes. HOW TO USE CURETTE:- Modified pen grasp and stable finger rest is established. Lower shank is kept parallel to the tooth surface : and moved toward the tooth so that the face of the blade is nearly flush with the tooth surface. Light exploratory stroke. Angle between cutting edge and tooth to be scaled is between 45° − 90° with lateral pressure against tooth surface. Calculus is removal by a series of controlled, overlapping , short powerful strokes primarily using wrist arm motion. The instrument handle must be rolled carefully between the thumb and finger to keep the blade adapted closely to the tooth surface as line angles , development depression and other changes in tooth contour are followed.
- 12. Scaling and root planing strokes should be configured to the portion of the tooth where calculus or altered cementum is found: this area is known as the instrumentation zone. The amount of lateral pressure applied to the tooth surface depends on the nature of the calculus and whether the strokes are initial calculus removal or final root planing. If heavy lateral pressure is continued , the result will be a rough surface roughened by numerous nicks and gouges , resembling th surface of a washboard. To avoid hazards of over instrumentation , a deliberate transition from short , powerful scaling strokes to longer lighter root planing strokes must be made as soon as the calculus and initial roughness have been eliminated.
- 13. Engaging large , tenacious ledge or piece of calculus with the entire length of cutting edge is not recommended because the force is distributed through a longer section of the cutting edge rather than concentrated. Much more lateral pressure is required to dislodge the entire deposit in one stroke. When a series of repeated whittling strokes is applied the calculus may be reduced to a thin smooth , burnished sheet that is difficult to distinguish from the surrounding root surface. For proximal surface it is extremely important to extend strokes at least halfway across the proximal surfaces so that no calculus or roughness remains in the interproximal area. With the lower shank of curette parallel to the long axis the blade of the curette will reach the base of the pocket and the toe will extend beyond the midline as strokes are advanced across the proximal surface.
- 14. The relationship between the location of finger rest and the working area is for two reason. 1. The finger or fulcrum must be position to allow the lower shank of the instrument to be parallel or nearly parallel to the tooth surface being treated .this parallelism is a fundamental requirement for optimal working angulation. 2. The finger rest must be close enough to the working area so as to fulfill these requirements. Effective wrist arm motion is possible only when these 2 fingers are kept together in a built up-fulcrum. As instrumentation proceeds from one tooth to the next the body position of the operation and the location of finger rest must be frequently adjusted or hanged to allow parallelism and wrist arm motion.
- 16. THE FOLLOWING APPROACHES MAY PROVIDED MAXIMAL EFFICIENCY FOR THE CLINICIAN AND COMFORT FOR THE PATIENTS.
- 23. THANKYOU