Rationale for scaling and root planing
- 1. Scaling and root planingScaling and root planing
- 2. Marginal periodontitis is induced by bacterial plaque deposits and maintained by subgingival plaque and calculus present on root surfaces. Therefore therapy of periodontally involved teeth is primarily directed towards removal of these accretions from root surfaces in order to allow for healing.
- 3. Process by whichProcess by which plaque and calculusplaque and calculus are removed fromare removed from both supra andboth supra and subgingival toothsubgingival tooth surface.surface. Process by whichProcess by which residual embeddedresidual embedded calculus and portioncalculus and portion of cementum areof cementum are removed from the rootremoved from the root to produce a smooth,to produce a smooth, hard and cleanhard and clean surfacesurface ScalingScaling Root PlaningRoot Planing
- 4. Primary objectivePrimary objective Restoration of gingival health byRestoration of gingival health by completely removing elements thatcompletely removing elements that provoke gingival inflamation.provoke gingival inflamation. Scaling and root planing are not separableScaling and root planing are not separable proceduresprocedures
- 5. Before Scaling & RootBefore Scaling & Root PlaningPlaning After Scaling & RootAfter Scaling & Root planingplaning
- 6. Subgingival scaling and root planingSubgingival scaling and root planing are measures which can be effective in:are measures which can be effective in: Eliminating inflammationEliminating inflammation Reducing probing depthsReducing probing depths Improving clinical attachmentImproving clinical attachment
- 7. Objectives Of Root PlaningObjectives Of Root Planing Securing biologically acceptable root surfacesSecuring biologically acceptable root surfaces Resolving inflammationResolving inflammation Decreasing pocket depthDecreasing pocket depth Facilitating oral hygiene proceduresFacilitating oral hygiene procedures Improving or maintaining attachment levelImproving or maintaining attachment level Preparing the tissues for surgical proceduresPreparing the tissues for surgical procedures
- 8. RATIONALE OF ROOTRATIONALE OF ROOT PLANINGPLANING
- 9. Recent data suggestsRecent data suggests that root structurethat root structure removal is not necessary.removal is not necessary. The end point of scalingThe end point of scaling and root planing isand root planing is however a smooth roothowever a smooth root surface as rough surfacessurface as rough surfaces are more prone to plaqueare more prone to plaque accumulation.accumulation. Calculus can be seen inCalculus can be seen in radiographs or detectedradiographs or detected clinically.clinically.
- 10. Removal of contaminated root surfaceRemoval of contaminated root surface Pre requisite for new connective tissuePre requisite for new connective tissue attachmentattachment Root surface demineralization with citric acidRoot surface demineralization with citric acid PREPARATION FOR NEW ATTACHMENTPREPARATION FOR NEW ATTACHMENTPREPARATION FOR NEW ATTACHMENTPREPARATION FOR NEW ATTACHMENT Accelerates new attachment in healing periodontal wounds
- 11. To determine efficacy of therapy, therapeuticTo determine efficacy of therapy, therapeutic goals must first be established. In periodontalgoals must first be established. In periodontal therapy, our objectives are as follows:therapy, our objectives are as follows: Suppression or elimination of pathogenicSuppression or elimination of pathogenic bacteriabacteria Establishment of a healthy root surfaceEstablishment of a healthy root surface Conversion of inflamed to healthy tissuesConversion of inflamed to healthy tissues Reduction of periodontal pocketsReduction of periodontal pockets
- 12. Scaling and root planingScaling and root planing has both localhas both local and systemic sequelae.and systemic sequelae. Locally, the results of scaling and rootLocally, the results of scaling and root planing are:planing are: Debridement of bacteria and calculusDebridement of bacteria and calculus Removal of infected cementum and dentinRemoval of infected cementum and dentin A shift in the microbial populationA shift in the microbial population
- 13. Scaling and root planing also hasScaling and root planing also has systemic effects. These are a bacteremiasystemic effects. These are a bacteremia and a host immune responseand a host immune response
- 14. Scaling and root are notScaling and root are not always the only measuresalways the only measures that are required in orderthat are required in order to properly eliminateto properly eliminate subgingival infection insubgingival infection in deep pockets.deep pockets. Waerhaug(1978)Waerhaug(1978) If, following scaling andIf, following scaling and root planing, signs ofroot planing, signs of “bleeding” on probing to“bleeding” on probing to the bottom of the pocket”the bottom of the pocket” persist, and if the clinicalpersist, and if the clinical attachment level fails toattachment level fails to improve, surgical therapyimprove, surgical therapy should be consideredshould be considered since this treatment maysince this treatment may facilitate more adequatefacilitate more adequate root debridment .root debridment . Caffesee etal (1986)Caffesee etal (1986)
- 15. ACTIVATION OF INSTRUMENTACTIVATION OF INSTRUMENT Adaptation- lower shank parallelAdaptation- lower shank parallel Angulation- 45- 90 degree establishedAngulation- 45- 90 degree established STROKESSTROKES Stroke lengthStroke length Stroke directionStroke direction Stroke activationStroke activation
- 16. Terminal shank parallel to toothTerminal shank parallel to tooth long axis.long axis.
- 17. STROKE DIRECTIONSTROKE DIRECTION Vertical and oblique strokes are mostVertical and oblique strokes are most effective strokes for root planing andeffective strokes for root planing and exploring.exploring.
- 18. STROKE LENGTHSTROKE LENGTH Root planing strokes extend from the baseRoot planing strokes extend from the base of the pocket to the cemento enamelof the pocket to the cemento enamel junction.junction. STROKE ACTIVATIONSTROKE ACTIVATION Wrist forearm motion is the fundamentalWrist forearm motion is the fundamental means of activation.means of activation.
- 20. FORCE MAXIMIZED BY SCALING INFORCE MAXIMIZED BY SCALING IN CHANNELS AND BY CONCENTRATINGCHANNELS AND BY CONCENTRATING PRESSURE ONTO LOWER ONE THIRD OFPRESSURE ONTO LOWER ONE THIRD OF THE BLADE.THE BLADE. Overlapping , short powerful stroke- LargeOverlapping , short powerful stroke- Large calculus removalcalculus removal( Carranza,10( Carranza,10thth ed)ed) Root planing stroke- Long lighter overlappingRoot planing stroke- Long lighter overlapping with less lateral pressurewith less lateral pressure( Carranza,10th ed)( Carranza,10th ed)
- 22. HEAVY LATERAL PRESSURE WITHHEAVY LATERAL PRESSURE WITH SHORT CHOPPY STROKES AFTERSHORT CHOPPY STROKES AFTER CALCULUS REMOVAL- ROOTCALCULUS REMOVAL- ROOT SURFACE WITH NICKS AND GOUGESSURFACE WITH NICKS AND GOUGES HEAVY LATERAL PRESSURE WITHHEAVY LATERAL PRESSURE WITH LONG STROKES- SMOOTH BUTLONG STROKES- SMOOTH BUT DITCHED OR GOUGED ROOTDITCHED OR GOUGED ROOT SURFACESURFACE
- 23. NUMBER OF STROKESNUMBER OF STROKES Root modification using periodontalRoot modification using periodontal curette- 10 to 70 strokescurette- 10 to 70 strokes 20 strokes are sufficient for removing20 strokes are sufficient for removing cementumcementum Aggressive root planing involves -10 or 20Aggressive root planing involves -10 or 20 strokes morestrokes more
- 24. CEMENTUM REMOVALCEMENTUM REMOVAL U.S scaler-1 to 7.2 μU.S scaler-1 to 7.2 μ Sonic-4.3 to 7.8 μSonic-4.3 to 7.8 μ Diamond file- 7.9 to 15.5μDiamond file- 7.9 to 15.5μ Fine curette- 5 –22μ/strokeFine curette- 5 –22μ/stroke ULTRASONIC SCALERS REMOVE LESSULTRASONIC SCALERS REMOVE LESS CEMENTUM BUT LEAVE A ROUGHERCEMENTUM BUT LEAVE A ROUGHER SURFACE.SURFACE.( KOCHER ET AL 2001)( KOCHER ET AL 2001)
- 25. Pain and discomfort during SRPPain and discomfort during SRP Tissue trauma due to inadvertent curettageTissue trauma due to inadvertent curettage Philstrom( 1999)Philstrom( 1999) Pain of significant duration, peak in intensityPain of significant duration, peak in intensity between 2 and 8 hrs post SRP- almost 25 % selfbetween 2 and 8 hrs post SRP- almost 25 % self medicatedmedicated Small portions of patients noted root sensitivity ,Small portions of patients noted root sensitivity , reduction occurred over 4 weeks . Tammaro etreduction occurred over 4 weeks . Tammaro et al ( 2006)al ( 2006)
- 26. PERIDONTALPERIDONTAL INSTRUMENTATIONINSTRUMENTATION ACCESSIBILITY:POSITIONING OFACCESSIBILITY:POSITIONING OF PATIENT AND OPERATORPATIENT AND OPERATOR VISIBILITY, ILLUMINATIONVISIBILITY, ILLUMINATION &RETRACTION&RETRACTION CONDITION AND SHARPNESS OFCONDITION AND SHARPNESS OF INSTRUMENTINSTRUMENT MAINTAINING A CLEAN FIELDMAINTAINING A CLEAN FIELD INSTRUMENT STABILISATIONINSTRUMENT STABILISATION INSTRUMENT ACTIVATIONINSTRUMENT ACTIVATION
- 27. INSTRUMENT STABILISATIONINSTRUMENT STABILISATION INSTRUMENT GRASPINSTRUMENT GRASP MODIFIED PEN GRASPMODIFIED PEN GRASP STANDARD PEN GRASPSTANDARD PEN GRASP PALM AND THUMB GRASPPALM AND THUMB GRASP FINGER RESTFINGER REST CONVENTIONALCONVENTIONAL CROSS ARCHCROSS ARCH OPPOSITE ARCHOPPOSITE ARCH FINGER ON FINGERFINGER ON FINGER
- 28. PEN GRASPPEN GRASP THE THUMB, INDEX FINGER, & MIDDLETHE THUMB, INDEX FINGER, & MIDDLE FINGER ARE USED TO HOLDFINGER ARE USED TO HOLD INSTRUMENT AS PEN IN HELDINSTRUMENT AS PEN IN HELD
- 29. MODIFIED PEN GRASP:-ENSUREMODIFIED PEN GRASP:-ENSURE GREATEST CONTROL IN PERFORMINGGREATEST CONTROL IN PERFORMING INTRAORAL PROCEDURESINTRAORAL PROCEDURES
- 30. PALM AND THUMB GRASPPALM AND THUMB GRASP FOR STABILIZINGFOR STABILIZING INSTRUMENTSINSTRUMENTS DURING SHARPENINGDURING SHARPENING AND FORAND FOR MANIPULATING AIRMANIPULATING AIR AND WATERAND WATER SYRINGESSYRINGES
- 31. FINGER RESTFINGER REST CONVENTIONAL FINGER REST ISCONVENTIONAL FINGER REST IS ESTABLISHED ON TOOTH SURFACEESTABLISHED ON TOOTH SURFACE IMMEDIATELY ADJACENT TOIMMEDIATELY ADJACENT TO WORKING AREAWORKING AREA
- 32. CROSS ARCH FINGER REST ISCROSS ARCH FINGER REST IS ESTABILISHED ON TEETH SURFACE ON THEESTABILISHED ON TEETH SURFACE ON THE OTHER SIDE OF THE SAME ARCHOTHER SIDE OF THE SAME ARCH OPPOSITE ARCH FINGER REST ISOPPOSITE ARCH FINGER REST IS ESTABLISHED TOOTH SURFACE ON THEESTABLISHED TOOTH SURFACE ON THE OPPOSITE ARCHOPPOSITE ARCH
- 33. FINGER ON FINGER REST ISFINGER ON FINGER REST IS ESTABLISHED ON THE INDEX FINGERESTABLISHED ON THE INDEX FINGER OR THUMB OF THE NONOPERATINGOR THUMB OF THE NONOPERATING HANDHAND
- 34. EXRA ORAL FALCRUMEXRA ORAL FALCRUM FOR EFFECTIVE INSTRUMENTION OFFOR EFFECTIVE INSTRUMENTION OF SOME ASPECTS OF THE MAXILLARYSOME ASPECTS OF THE MAXILLARY POSTERIOR TEETHPOSTERIOR TEETH PALM UP:- FULCRUM IS ESTABLISHEDPALM UP:- FULCRUM IS ESTABLISHED BY RESTING THE BACKS OF THEBY RESTING THE BACKS OF THE MIDDLE & FOURTH FINGER ON THEMIDDLE & FOURTH FINGER ON THE SKIN OVERLYING THE LATERALSKIN OVERLYING THE LATERAL ASPECTS OF THE MANDIBLE ON THEASPECTS OF THE MANDIBLE ON THE RIGHT SIDE OF THE SIDERIGHT SIDE OF THE SIDE
- 35. THE PALM DOWN FULCRUMM IS ESTABLISHED BYTHE PALM DOWN FULCRUMM IS ESTABLISHED BY RESTING THE FRONT SURFACE OF THE MIDDLE &RESTING THE FRONT SURFACE OF THE MIDDLE & FOURTH FINGER ON THE SKIN OVERLYING THEFOURTH FINGER ON THE SKIN OVERLYING THE LATERAL ASPECT OF THE MANDIBLE ON THELATERAL ASPECT OF THE MANDIBLE ON THE LEFT SIDE OF THE FACELEFT SIDE OF THE FACE