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Module 4

SCALING AND ROOT PLANING

UNIVERSITAS JENDERAL SOEDIRMAN


PURWOKERTO

Overview

KEY TERMS

This module presents (1) the manual scaling and root planing; and (2) the sonic
and ultrasonic scaling.

Manual scaler
Curetes
Ultrasonic scaler

Goals

Using manual scaler, demonstrate the calculus removal for phase 1 therapy.

Demonstrate the root planing

Demonstrate calculus removal with ultrasonic scaler

SCALING AND ROOT PLANING

SCALING AND ROOT PLANING

DEFINITION
Scaling is the process by which biofilm and calculus are removed from
both supragingival and subgingival tooth surfaces. No deliberate attempt is
made to remove tooth substance along with the calculus.
Root planing is the process by which residual embedded calculus and
portions of cementum are removed from the roots to produce a smooth, hard,

INSTRUMENT SET
Clean table tray
2 pcs mouth mirror
1 pcs calibrated probe
Set of periodontal scalers
Universal curetes
Gracey curetes (if available)

clean surface.

OBJECTIVE OF SCALING AND ROOT PLANING


The primary objective of scaling and root planing is to restore gingival
health by completely removing elements that provoke gingival inflammation
(i.e., biofilm, calculus, and endotoxin) from the tooth surface.

DETECTION SKILLS
Visual examination of supragingival and subgingival calculus just below the
gingival margin is not difficult with good lighting and a 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 the 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 of the tooth surfaces in subgingival areas of pocket depth,
furcations, and developmental depressions is much more difficult than visual
examination of supragingival areas and requires the skilled use of a fine-pointed
explorer or probe. The explorer or probe is held with a light but stable modified pen
grasp. This provides maximal tactile sensitivity for detection of subgingival calculus
and other irregularities. The pads of the thumb and fingers, especially the middle
finger, should perceive the slight vibrations conducted through the instrument shank
and handle as irregularities in the tooth surface are encountered.

SCALING AND ROOT PLANING

SUPRAGINGIVAL SCALING TECHNIQUE

Supragingival calculus is generally less tenacious and less calcified than


subgingival calculus. Because instrumentation is performed coronal to the
gingival margin, scaling strokes are not confined by the surrounding tissues.
This makes adaptation and angulation easier. It also allows direct visibility, as
well as a freedom of movement not possible during subgingival scaling.
Step-by-step of supragingival scaling
1.

The sickle or curette is held with a modified pen grasp, and a firm finger
rest is established on the teeth adjacent to the working area. The blade
is adapted with an angulation of slightly less than 90 degrees to the
surface being scaled.

2.

The cutting edge should engage the apical margin of the supragingival

Sickles and curettes are most often used


for the removal of supragingival
calculus.
Hoes and chisels are less frequently
used.

calculus while short, powerful, overlapping scaling strokes are activated


coronally in a vertical or an oblique direction.
3.

Calculus is removed by engaging the apical or lateral edge of the


deposit with the cutting edge of a scaler. The instrument is moved
laterally and again engages the edge of the calculus, overlapping the
previous stroke to some extent; the shaded drawing shows further
removal.

4.

Vertical movement of the instrument will remove the fragment of


calculus engaged by the instrument, as seen in the shaded drawing.

5.

The final portion of the deposit is engaged and removed. Note how the
procedure is performed in an interdental space by entering facially and
lingually.

SUBGINGIVAL SCALING AND ROOT PLANING TECHNIQUE


Subgingival scaling and root planing are much more complex and difficult to
perform than supragingival scaling. The overlying tissue creates significant
problems in subgingival instrumentation.
Vision is obscured by the bleeding that inevitably occurs during
instrumentation and by the tissue itself. In addition, the adjacent pocket wall limits

PLEASE REMEMBER
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.

the direction and length of the strokes.

SCALING AND ROOT PLANING

Subgingival scaling and root planing are accomplished with either universal
or area-specific (Gracey) curettes using the following basic procedure.
1.

The curette is held with a modified pen grasp, and a stable finger rest is
established. The correct cutting edge is slightly adapted to the tooth, with
the lower shank kept parallel to the tooth surface.

2.

The lower shank is moved toward the tooth so that the face of the blade is
nearly flush with the tooth surface. The blade is then inserted under the
gingiva and advanced to the base of the pocket by a light exploratory
stroke.

3.

When the cutting edge reaches the base of the pocket, a working angulation
of between 45 and 90 degrees is established, and pressure is applied
laterally against the tooth surface. Calculus is removed by a series of

The curette is preferred by most clinicians for


subgingival scaling and root planing because of the
advantages afforded by its design.

controlled, overlapping, short, powerful strokes primarily using wrist-arm


motion

SCALING AND ROOT PLANING

ULTRASONIC AND SONIC SCALING


Power instrumentation has the potential to make scaling less demanding, more
time efficient, and more ergonomically friendly. Modified tip designs allow for
improved access in many areas, including furcations. Newer, slimmer designs
operate effectively at lower power settings, thus improving patient comfort.
Sonic and ultrasonic tips can reduce the time needed for scaling.

Principles Of Instrumentation
1. Ultrasonic technique is different from instrumentation with hand scalers. A
modified pen grasp is used with an ultrasonic scaler along with an extraoral
fulcrum. The purpose of the extraoral fulcrum is that it allows the operator to
maintain a light grasp and easier access physically and visually to the oral
cavity.
2. Alternate fulcrums of cross arch or opposite arch fulcrums are acceptable
alternatives.
3. Light pressure is needed with a power instrument. The tip is traveling at a set
frequency in a set stroke pattern. Increased clinician pressure on the tip causes
decreased clinical efficacy.

SCALING AND ROOT PLANING

PATIENT INSTRUCTION AFTER SCALING AND ROOT PLANING


These are some helpful suggestions that will increase your comfort and help you
receive the maximum benefit from periodontal treatment.
1.

Tenderness is normal. To reduce tenderness and promote healing, every


two to three hours, rinse with warm salt water: 1/2 teaspoon salt in a 4
ounce glass of water.

2.

Avoid brushing or flossing the treated area for 12 hours. However, after 12
hours it is very important that you continue to brush well. Please be careful
brushing and use a toothbrush with soft bristles. You may moisten the
brush with warm water if tissues are tender.

3.

Methampyron or Ibuprofen may be used as recommended for discomfort.

4.

Highly nutritious food is necessary for the healing process. Avoid foods
that require excessive chewing, also, sticky, crunchy or coarse foods.

5.

Tooth sensitivity is normal and temporary. You may use a desensitizing


toothpaste of any major brand for sensitivity relief.

6.

You may also gently massage the areas treated with your washed fingers.
This will increase circulation and promote healing.

SCALING AND ROOT PLANING