Scaling and Root Planing (Tooth Cleaning)

Scaling is the removal of the biofilm (dental plaque) and calculus from the tooth surfaces (supragingival and subgingival surfaces) with the use ultra

 What is mean by scaling and root planing (SRP) (Tooth Cleaning) ?

Scaling is the removal of the biofilm (dental plaque) and calculus from the tooth surfaces (supragingival and subgingival surfaces) with the use ultrasonic scalers or by the use of hand scalers such as chisel, hoe scalers. It will be done by the dentists and certified oral hygienists.

Root planing or root instrumentation is the procedure of removing the calculus, biofilm which is attached to the root surfaces and portions of porous contaminated root surfaces to produce clean, smooth, hard surface to promote new homeostatic biofilm. Curettes are used for root planing. 

Scaling and root planing (SRP) are not separate procedures. All the principles of scaling apply to root planing). The difference between scaling and root planing is only to some extent. The nature

of the tooth surface determines the degree to which the surface must be scaled or instrumented. 

Objectives of scaling and root planing (SRP)

The primary objectives of scaling and root planing (SRP) is to restore the gingival health by removing the factors that induces the gingival inflammation i.e,, biofilm, calculus and bacterial products such as endotoxins which is present in the tooth surfaces. By doing the instrumentation of the tooth surfaces, it has shown that it reduces the number of subgingival microorganisms and alters the subgingival biofilm composition from gram-negative anaerobes to gram-positive facultative bacteria which is compatible with the gingival health. These microbial changes accompanied by a reduction or elimination of inflammation clinically. So to sustain the gingival health periodic scaling and root planing is necessary. 

Review following Scaling and root planing (SRP)

So the effectiveness of the scaling and root planing can be done immediately as well as later. Immediately following SRP, it is evaluated visually under the optimal lighting with the help of the mouth mirror and a probe. The tooth surfaces must be smooth and hard. The smoothness indicates the effective removal of the plaque or calculus from the tooth surface. 

The later evaluation of effectiveness of the scaling and root planing is done by the response of the tissue. It can be evaluated by bleeding on probing by walking the periodontal probe along the tooth surface. But it cannot be done earlier than 2 weeks, because re-epithelization of the soft tissue can be takes place during this period. After 2 weeks the bleeding on probing indicates there is a presence persistent inflammation or inadequate plaque control. So it is better to evaluate the tissue response to scaling and root planning after 4 weeks to 8 weeks.

Techniques for scaling and root planing (SRP)

There are two types of techniques for removing the calculus from the tooth surface. They are  

1. Supragingival scaling technique
2. Subgingival scaling technique 

SUPRAGINGIVAL SCALING TECHNIQUE

The calculus present in the supragingival region of the tooth is less tenacious than the subgingival margin. The instrumentation done coronal to the gingival margin, scaling strokes are not dependent on the adjacent tissues. So it makes the adaptation & angulation easier for instrumentation. It will be easier for the operator for removing the supragingival calculus due to the direct visibility and freedom of movements but it is not possible in subgingival calculus.

Sickle scalers, curettes, sonic and ultrasonic instruments are widely used for the removal of supragingival calculus. So to remove the  supragingival calculus, the scaler is held in modified pen grasp position and the finger rest is established on the tooth adjacent to working area firmly. The

instrument blade is adapted with an angulation of slightly less than 90 degrees to the surface being scaled. The cutting edge of the instrument adapted apical margin of the supragingival calculus while short, powerful, overlapping scaling strokes are activated coronally in a vertical or oblique direction.

The tooth surface is instrumented until it is visually and tactilely free of all supragingival deposits.

SUBGINGIVAL SCALING  AND ROOT INSTRUMENTATION (Root Planing) TECHNIQUE

As compared to supragingival calculus, the removal of subgingival calculus is much more difficult. Because it is more harder than the supragingival calculus and it is situated in the root irregularities or concavities, which makes it more difficult to remove. The overlying tissues of the calculus makes the scaling difficult by obscure the vision and bleeding is occurs during the subgingival scaling. So the dentist is solely depends on the tactile sensitivity to detects the subgingival calculus.

Files, hoe, sickle scalers and ultrasonic instruments are used for subgingival scaling of heavy calculus.

Subgingival scaling and root planing (root instrumentation) are done with curettes by using the following basic steps. The curettes is recommended by the most dentists for subgingival scaling and root planing.

The modified pen grasp and finger rest is established with a curette. The cutting edge is adapted to the tooth, with the lower shank aligned parallel to the tooth surface. The lower shank is moved toward the tooth so that the face of the blade is nearly touches 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. When the working end reaches the base of the pocket, the angulation of between 45° and 90° is established, and pressure is applied laterally to the tooth surface. Calculus is removed by a series of controlled, overlapping, short, powerful strokes primarily using wrist-arm motion.

SCALING AND ROOT PLANING BENEFITS

Ultrasonic scaling removes the local factors such as plaque and calculus responsible for the gingivitis & periodontitis, thereby improving the gingival health. So, it is used as the treatment of gingivitis and initial phase of treatment plan for periodontitis. The scaling and root planing should be done twice in a year at the interval of 6 months to maintain the good oral health along with proper brushing techniques.

Before and after scaling