Scaling and Root Planning

(SRP)

WHY ARE WE REMOVING

PLAQUE?
BECAUSE PLAQUE IS

Biofilm( that is sticky and cant easy to remove by

normal motions of oral tissues)

Including many of microorganisms( bacteria, fungus,

viruses etc.)

That a place easily growing all of microorganisms(

water, food, O2)

Facilitate the growing and adhering other bacteria etc.

Transforming and producing calculus

Why Antibiotic is useless for

plaque?
Antibiotics are ineffective because the dormant

bacteria at the heart of the film are unaffected by

the antibiotics targeting rapidly multiplying DNA.

When the danger has passed, they reanimate and

build another biofilm, or join one already in
progress.

They grow quietly and then symptoms start to

accumulate once more.

In addition to this antibiotics cant enter into the

biofilm. The biofilm is never really destroyed. The

survivors are altered, and a new antibiotic must be
used.

 Scaling: is the process by which plaque and

calculus are removed from both supra- and subgingival tooth surfaces.

Root planning: is the process by which residual

calculus and portion of cementum are removed
from the roots to produce a smooth, hard, clean
surface.

 Scaling and root planning known as conventional

periodontal therapy, non-surgical periodontal therapy,
deep cleaning, or dental prophylaxis

Scaling and root planning are not separable procedures

All the principles of scaling apply equally to root

planning ,the only difference between them is matter of
degree ,since the nature of tooth surface determines the
degree to which the surface must be scaled.

When plaque and calculus form on enamel ,the

deposite are usually superficially attached to the
surface and are not locked into irregularities. In
such situations scaling alone is sufficient
to
remove plaque and calculus completely from
enamel ,leaving a smooth ,clean surface .

While when dentine is exposed ,plaque bacteria

may invade dentinal tubules, therefore scaling
alone is insufficient to remove them ,and a portion
of root surface must be removed to eliminate these
deposite.

Scaling and Root Planning

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 planning is

an effective mean to eliminate gingivitis and reduce
the probing depth even at sites with initially deep
periodontal pockets.

Changes in root surfaces in

periodontitis
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.

Changes in root surfaces in

periodontitis
B. Alterations in exposed

cementum

1. Hypermineralized surface
zone

2. Changes in organic matrix

3. Endotoxins cytotoxic in
tissue culture

Primary objective
Restoration of gingival health

Subgingival scaling and root planning

are measures which can be effective in:
Eliminating inflammation

Reducing probing depths

Improving clinical attachment

Objectives of Root Planning

1. Securing biologically acceptable root surfaces
2. Resolving inflammation
3. Decreasing pocket depth
4. Facilitating oral hygiene procedures
5. Improving or maintaining attachment level

6. Preparing the tissues for surgical procedures

Rationale for root planning

Root Smoothness

Removal of Diseased Cementum

Preparation for New Attachment

Scaling and root planning has both local and

systemic effects.
Locally, the results of scaling and root planning
are:

1) Debridement of bacteria and calculus

2) Removal of infected cementum and dentin

3) A shift in the microbial population

 If, following scaling and

Scaling

and
root
planning are not always
the only measures that
are required in order to
properly
eliminate
subgingival infection in
deep pockets.

root planning, 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 .

After thorough scaling and root planning , a

dramatic reduction in the number of subgingival
microorganisms with a shift in the composition of
subgingival plaque from high numbers of gram()
negative anaerobes to gram (+) positive facultative
bacteria compatible with health.
Gram () anaerobes

Gram(+) facultative

The microbial shift is effected by two

mechanisms

1.The removal of bacteria by scaling and root

planning

2.The clinical outcome of

scaling and root

planning which alters the environment favoring
population by certain bacteria over others
A. Decreased pocket depth
B. Smooth root surfaces
C. Reduction of inflammation

Scaling and root planning also

has systemic effects. These are a
bacteremia and a host immune
response

Incidence of Bacteremia During Different Dental

Procedures Heimdahl, et al., 1990
Surgical
Procedure
Dental
Extraction

% of Patients
with
Bacteremia

%Viridans
%
group
Anaerobes
streptococci

100

85

75

Scaling and
Root Planing

70

55

65

Third Molar
Surgery

55

40

45

Endodontic
Treatment

20

15

Bilateral
Tonsillectomy

55

40

40

 Based on this study it can

be seen that immediately
after undergoing scaling
and root planning the
majority of patients (70%)
will have a bacteremia.

This indicates that the host

immune

response

is

effective in eliminating the

bacteria

from

the

bloodstream, resulting in

The same study also

the rapid decline in the

showed that ten minutes

recovery of bacteria. For

after the procedure, the

this reason, it is referred to

incidence of bacteremia is

as a transient bacteremia.

down to 30%.

 The endpoint of clinical therapy is the elimination of

inflammation. To achieve this, open debridement may be
required in addition to scaling and root planning, and
treatment may be aided by chemotherapeutic agents.

The dentist should estimate the number

of appointments needed on the basis of
:
1.The number of teeth in the mouth
2.Severity of inflammation

3.Amount and location of calculus

4.Depth and activity of pocket

5.Presence of furcation invasions

6.Patients understanding of compliance with
oral hygiene instructions
7.Need for local anesthesia

Supragingival Scaling Technique:

Supragingival calculus is generally less tenacious and
less calcified than subgingival calculus ,Instrumentation is
performed coronal to the gingival margin ,so scaling stroke
are not confined by surrounding tissue.

this :
Makes adaptation and angulation easier,
Allows direct visibility and Allow freedom of movement

 Subgingival Scaling And Root Planning Technique:

Subgingival calculus is usually harder than supragingival calculus and
is often locked into root irregularities ,making it more tenacious and
therefore more difficult to remove .

Vision is obscured by the bleeding that occurs during instrumentation

and by the tissue itself ,so the clinician must rely heavily on tactile
sensitivity to detect calculus and irregularities ,also must form a
mental image of the tooth surface.

The curette is preferred by most clinicians for subgingival scaling and

root planning because of the advantages afforded by its design and
ultrasonic instruments also are used for subgingival scaling of heavy
calculus

Methods of Scaling:
1. Manual scaling - used hand scalers for removing
supragingival calculus (sickle, chisel, hoes, curettes).

2. Sonic scalers - are air-turbine units that operate at low

frequencies ranging between 2000-6000 cycles per
second, with a vibratory-type tip movement.

3. Ultrasonic scaling are currently available in 2 basic

types- magnetostrictive and piezoelectric, which differ
in their mechanism of action.

Sickle scalers
Is

primarily

used

for supra-gingival
removal.

calculus

There are two types:

Anterior, with blade designed in mon-angle form. It

used for scaling dental calculus of anterior teeth.

Posterior, with blade designed in bin-angle (two)

form that permit access between premolars and
molars.

Sickle scalers
Technique:
Both types of the sickle scalers used the movement
of pushing and traction the blocks of supra-gingival
calculus

Chisel scalers
Used in the anterior part of the mouth.
Designed for proximal surface of the
teeth.

Position of the instrument is at the long

axis of the tooth.

Removing the calculus is made by

pulling, traction movements to occlusal

surface or marginal edge

Chisel scalers

Hoe scalers
The blade is bent in 99-100 degree,the cutting edge is
beveled at 45 degree,

They are used in anterior teeth.

They are indicated for removing the supra- and subgingival calculus

Position of the instrument is at the long axis of the

tooth by pushing and traction movements to dislodge
the calculus.

Classification of Curettes
1. Universal curettes:
1. One curettes is designed for all areas and
surfaces.

2. The face of the universal curettes blade

beveled to 90 degrees to the lower shank.

3. Curved in one plane.

Classification of Curettes
2. Specials (Curettes Gracey)
are a set of area-specific instruments that were designed by Dr.
Clayton H. Gracey of Michigan

They are area specific: there are 7 pairs of curettes in the set:
#1-2 and 3-4 are used on anterior teeth.
#5-6 are used on both anterior teeth and premolar teeth.
#7-8 and 9-10 the facial and lingual surfaces of posterior teeth.
#11-12 for mesial surfaces of posterior teeth.
#13-14 for distal surfaces of posterior teeth.

Only one cutting edge on each blade is used, work with outer edge only.

Ultrasonic Scaler
1. Magnetostrictive (e.g. Dentsply, Cavitron,
Odontosson).
Inside the hand-piece a live coil generates an
alternating electromagnetic field that leads to
expansion or contraction of the ferromagnetic
material.

The resulting vibrations are conducted to the

scaler tip, causing oscillation at frequencies of
20,000 Hz to 45,000 Hz.

Ultrasonic Scaler
2. Piezoelectric scalers (e.g. Amdent, EMS
Piezon master, Satellec Suprasson.)
Oscillate with frequencies of 20,000 to 45,000 Hz.
The vibration is generated by changes in dimension
of a quartz crystal caused by the application of an
alternating current.

The resulting oscillation mode of the piezoelectric

scaler tip is linear.

Indications of Ultrasonic
Scaler:
1. Supra-gingival and sub-gingival calculus and periodontal
pockets.

2. In initial phases of chronical gingivitis and superficial

periodontitis.

3. Necrotizing ulcerative gingivitis and gingivostomatitis.

4. In haemolitic patients and in acute periodontitis with
increased bleeding, because of less traumatic lesion when
we use ultrasonic scaler than manual instrumentation.

5. Colored spots on the enamel surface.

Contraindications of Ultrasonic
Scaler
1. Should not used when treating patient with
transmissible diseases.

2. Patients with excessive vomiting reflex.

3. Pronounced dentin hyperesthesia.
4. In small children
5. Patients with a cardiac pacemaker.

6. Patients at risk for respiratory disease.

Advantages of Ultrasonic
Scaling:
1. Modern, ergonomically, efficient scaling.
2. Atraumatic action on tooth surfaces and gingiva.
3. Removal of pigmented deposits from the tooth
surfaces.

4. Well supported, painless to patients.

5. Ultrasonic instrumentation is accomplished with a
light touch and light pressure.

Disadvantages of Ultrasonic
Scaling:
1. Strong vibrations applied for too long can cause
dislocation of the enamel.

2. Strong vibration can disrupt the junction epithelium.

3. Under the action of vibrations the scaler can dislocate
the metal filliings and composite materials from the
tooth.

4. The hyperesthesia pains sometimes can be intolerable

(unpleasant for patietns).