Rationale for scaling and root planing

Process by which plaque and calculus are removed from both supra and subgingival tooth surface.

Root Planing
Process by which residual embedded calculus and portion of cementum are removed from the root to produce a smooth, hard and clean surface

Changes in root surfaces in periodontitis
A. Plaque and Calculus

Supra and subgingival calculus have a rough surface capable of harboring plaque that cannot be removed by conventional oral hygiene techniques. Bauhammers et al,1973.

Alterations in exposed cementum Hypermineralized surface zone Changes in organic matrix Endotoxins cytotoxic in tissue culture Aleo et al .Changes in root surfaces in periodontitis B. 1974 .

Primary objective Restoration of gingival health Scaling and root planing are not separable procedures .

Before Scaling & Root Planing After Scaling & Root planing .

they constitute the major means by which the disease is prevented. together with plaque control.Scaling and root planing are a prerequisite for the arrest and cure of periodontal disease. .

Careful subgingival scaling and root planing is an effective mean to eliminate gingivitis and reduce the probing depth even at sites with initially deep periodontal pockets. 1984 . Badersten.

Subgingival scaling and root planing are measures which can be effective in: Eliminating inflammation Reducing probing depths Improving clinical attachment .

Objectives Of Root Planing Securing biologically acceptable root surfaces Resolving inflammation Decreasing pocket depth Facilitating oral hygiene procedures Improving or maintaining attachment level Preparing the tissues for surgical procedures .

Scaling and root planing is an integral part of periodontal therapy. The rationale for scaling and root planing is the following: Removal of calculus and "infected" root structure Achievement of a smooth root surface which is less prone to plaque accumulation .

Rationale for root planing Garret in 1977 set forth the rationale for root planing Root Smoothness Removal of Diseased Cementum Preparation for New Attachment .

It remains the only clinical indicator of calculus removal available at present.Root Smoothness No biological evidence which relates smooth root surfaces to decreased plaque formation or increased ease of removal. .

.Recent data suggests that root structure removal is not necessary. The end point of scaling and root planing is however a smooth root surface as rough surfaces are more prone to plaque accumulation. Calculus can be seen in radiographs or detected clinically.

the fibroblasts adhered to both diseased and non diseased areas of the root. . 1975. Aleo et al.Removal of Diseased Cementum Removal of exposed cementum by root planing.

A portion of cementum must be removed to eliminate these deposits. 1969) Scaling alone is therefore insufficient to remove calculus.1953. . Moskow.Deposits of calculus on root surfaces are frequently embedded in cemental irregularities ( Zander.

Preparation for New Attachment Root planing plays an important role in preparing root surfaces for demineralization and subsequent new attachment .

our objectives are as follows: Suppression or elimination of pathogenic bacteria Establishment of a healthy root surface Conversion of inflamed to healthy tissues Reduction of periodontal pockets .To determine efficacy of therapy. therapeutic goals must first be established. In periodontal therapy.

Scaling and root planing has both local and systemic sequelae. Locally. the results of scaling and root planing are: Debridement of bacteria and calculus Removal of infected cementum and dentin A shift in the microbial population .


Caffesee etal (1986) . Waerhaug(1978) If.Scaling and root are not always the only measures that are required in order to properly eliminate subgingival infection in deep pockets. and if the clinical attachment level fails to improve. signs of ³bleeding´ on probing to the bottom of the pocket´ persist. following scaling and root planing. surgical therapy should be considered since this treatment may facilitate more adequate root debridment .

The microbial shift is effected by two mechanisms The removal of bacteria by scaling and root planing The clinical outcome of scaling and root planing which alters the environment favoring population by certain bacteria over others ± Decreased pocket depth ± Smooth root surfaces ± Reduction of inflammation .

Scaling and root planing also has systemic effects. These are a bacteremia and a host immune response .

. et al.Incidence of Bacteremia During Different Dental Procedures Heimdahl. 1990 Surgical Procedure Dental Extraction Scaling and Root Planing Third Molar Surgery Endodontic Treatment Bilateral Tonsillectomy % of Patients with Bacteremia %Viridans % group Anaerobes streptococci 100 70 55 20 55 85 55 40 15 40 75 65 45 5 40 .

For this reason. the incidence of bacteremia is down to 30%. This indicates that the host immune response is effective in eliminating the bacteria from the bloodstream. The same study also showed that ten minutes after the procedure. it is referred to as a transient bacteremia. resulting in the rapid decline in the recovery of bacteria. .Based on this study it can be seen that immediately after undergoing scaling and root planing the majority of patients (70%) will have a bacteremia.


by Buchanan and Robertson. . These were compared to similarly examined teeth that received no treatment prior to extraction.The Efficacy of Scaling and Root Planing A study published in 1987. Results were recorded as percentages of calculus positive teeth (CPT) and calculus positive surfaces (CPS). examined teeth (treatment planned for extraction) that were scaled and root planed for 12-15 minutes each. subsequently extracted 12and examined microscopically for residual calculus.

0 5.The Efficacy of Scaling and Root Planing Effect of Scaling and Root Planing on Calculus Removal Buchanan and Robertson. 1987 Treatment Probing Depth (mm) None S/RP 6. a fairly high percentage of calculus was remained after scaling and root planing.6 2. .4 % CPT % CPS 100 62 82 24 Even on treated teeth.7 2.

the results were fairly in keeping with logic .When comparing calculus removal by tooth type. tooth surface and probing depth. .

1987 Treatment Anterior Teeth Premolars Molars None S/RP 87 19 75 29 83 26 .The Efficacy of Scaling and Root Planing % Calculus Positive Surfaces After S/RP by Tooth Type Buchanan and Robertson.

1987 Treatment Mesial Distal Facial Lingual None S/RP 91 28 96 41 64 17 77 10 .The Efficacy of Scaling and Root Planing % Calculus Positive Surfaces After S/RP by Tooth Surface Buchanan and Robertson.

1987 Treatment None S/RP 0-2 67 2 2.The Efficacy of Scaling and Root Planing % Calculus Positive Surfaces by Probing Depth Buchanan and Robertson.190 36 >8 88 45 .1-4 2.1-8 6.184 24 6.1-6 4.169 14 4.

surfaces. but only slightly so. .These data indicate that generally calculus is harder to remove in the posterior teeth as compared to anterior teeth. or with proximal teeth. and in deeper pockets as compared to more shallow pockets. An interesting point is that calculus removal by scaling and root planing was more efficient in the molar region than in the premolar region. surfaces as compared to facial or lingual/palatal surfaces.

open debridement may be required in addition to scaling and root planing. and treatment may be aided by chemotherapeutic agents. To achieve this. .The endpoint of clinical therapy is the elimination of inflammation. inflammation.

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