what is scaling and root planing instruments used,position of the patient and operator ,technique,comparison with ultrasonic and hand instruments

2. SCALING AND ROOT PLANING
By
DR.PUNIT
FIRST YEAR PG
29/02/2016
monday

3. CONTENTS
• Introduction
• Historical background
• Definitions
• Changes in root surface in periodontitis
• Rationale of SRP
• Objectives
• Calculus Detection methods

4. • Instruments for SRP
– Hand instruments
• Principles of instrumentation
• Technique of SRP
– Sonic and ultrasonic instruments
– Rotating instruments
– Reciprocating instruments
– LASERS for SRP
• Post SRP evaluation
• Healing after SRP
• Scaling around implants
• Endoscopy aided SRP
• Polishing
• Conclusion

5. Non
surgical
periodontal
therapy
Mechanical
non surgical
therapy
Pharmaco
therapeutics
Occlusal
adjustments
Minor tooth
movements
Plaque
control

6. INTRODUCTION
• Non surgical therapy aims to eliminate both living bacteria in the microbial
biofilm and calcified biofilm microorganisms from the tooth surface and
adjacent soft tissues. A reduction in inflammation of the periodontium due
to lesser bacterial load leads to beneficial clinical changes.
• SRP (scaling and root planing) –considered to be the gold standard of
periodontal therapy.

7. HISTORY

8. • Abu'l-Qasim (936-1013) was the preeminent physician and surgeon of the Western
Caliphate at Cordova. His contributions to dentistry and periodontology were
among his outstanding achievements.
• He had a clear understanding of the major etiologic role of calculus deposits and
described in detail the technique of scaling the teeth, using a sophisticated set of
instruments that he developed. He also wrote in detail on the extraction of teeth, the
splinting of loose teeth with gold wire, and the filing of gross occlusal
abnormalities

9. • Etiologic role of calculus
deposits
• Described in detail the
technique of scaling the
teeth, using a
sophisticated set of
instruments
Abu’l- Qasim(936-1013)

10. • Father of modern dentistry
• The Surgeon Dentist,(1728)
• Described in detail his
periodontal instruments
and the scaling technique to
"detach hard matter or
tartar from the teeth."
Pierre Fauchard (1678 -1761)
18th century…..
The five types of instruments used by
Fauchard for detaching tartar from the
teeth:
1, chisel; 2, parrot beak; 3, graver; 4,
convex
blade; and 5, Z-shaped hook.

11. 19th century……
• A Practical Guide to Operations on the
Teeth.
• set of 6 scalers mostly spear shaped
1832-James
Snell of
London
• cofounder of Baltimore college of dental
surgery
• The Dental Art
1839 – Chapin
Harris
• Developed a set of 11 instruments for
SRP.
1844- Paul
Goddard, of
Pennsylvania

12. • Designed a series of six
instruments.
• Rigg’s original set of six
instruments was the first to
have various instrument
designs for the different
tooth surfaces to be
treated.
John W Riggs (1811 - 1885 )
19th century……

13. • William J Younger (1838 – 1920 )
• Follower of Riggs
• Made a real improvisation of Riggs instruments
• Curette styled with delicate blades and slender shanks
but lack contra-angle.
• Robert Good
• Student of Younger
• Modified Younger’s instruments.
20th century……
Younger Good instruments

14. • C M Carr
• Major improvements in instrument design
• Contra-angling
• Two point contact on root surface
Carr’s partial set of Scalers
Entire set – 150 instruments with 144 hoes and 6 scalers.

15. • Younger Good set
• Mccall’s Set ( 8 planes, 3 sickles, 1 chisel, 18 curettes)
• Towner Periodontomes
• Austin James Planes ( concept of two point contact )
Till the mid twentienth century

16. • In 1930s CLAYTON H GRACEY of Michigan
• Offset blades
• Area specific
• Most popular till today.

17. SCALING
• Is the process by which plaque and calculus are removed
from both supragingival and subgingival tooth surfaces .
(Carranza 10th edn)
• Is a procedure which aims at the removal of plaque and
calculus from the tooth surface
(Lindhe 5th edition)
DEFINITIONS

18. Is the process by which residual embedded calculus and portions of
cementum are removed from the roots to produce a smooth, hard and
clean surface. (Carranza 10th edn)
A definitive treatment procedure designed to remove cementum or
surface dentin that is rough, impregnated with calculus or contaminated
with toxins or micro organisms. The definiton further states that “ when
done in a thorough fashion, some unavoidable tissue removal occurs”
(1989 proceedings of world workshop)
Denotes a technique of instrumentation by which the ‘softened
cementum’ is removed and the root surface is made “hard” and
“smooth”. (Lindhe 5th edition)
ROOT PLANING

19. CHANGES IN ROOT SURFACE IN PERIODONTITIS
• Plaque and calculus deposition
• Alterations in exposed cementum
Structural
changes
Chemical
changes
Cytotoxic
changes

20. Structural changes
• Light and TEM microscopy -Pathologic granules in exposed
root surface
• Represent areas of collagen degeneration or areas where
collagen fibrils have not been fully mineralized initially.
A hypermineralized surface zone- most frequent
– Thickness – 10 to 20 μm
Changes in organic matrix:
– Loss of collagen cross banding at or near the cementum
surface.
Areas of demineralization:
– Proteolysis of the embedded remnants of sharpey’s fibres
– The cementum may be softened and undergo
fragmentation and cavitation.

21. • Cytotoxic changes
– Exposed cementum becomes contaminated by
bacterial endotoxins.
– Toxic to epithelium and fibroblasts.

22. Chemical changes
– Mineral content of exposed cementum is increased.
• Calcium
• Magnesium
• Phosphorus
• Fluoride
• iron
Physical changes
– Microhardness of cemental surface in relationship to the
periodontal pocket and immediately apical to the
junctional epithelium is reduced when compared to a
normal cemental surface that is covered by connective
tissue

23. RATIONALE OF SCALING AND ROOT PLANING
Root Smoothness
• Focal resorption lacunae - would serve as foci for reinfection
(Schroeder H E, 1983)
• Rough surface of calculus does not in itself induce
inflammation but the deleterious effect of calculus relates to
its ability to provide an ideal surface for microbial
colonization(Waerhaug 1952).
• . When the root surface is exposed to plaque and pocket
environment, its surface is contaminated by toxic substances,
notably endotoxins (LPS). When dentin is exposed plaque
bacteria may invade dentinal tubules, so scaling alone is
insufficient, portion of root surface must be removed to
eliminate them. (Hatfield et al, 1971; Aloe J 1974)

24. Removal of diseased cementum
• Contaminated by toxic substances, notably endotoxins (LPS).
• Hatfield & Baumhammers, 1971; first described the cytotoxic
effect of diseased root surfaces in tissue cultures
• Aloe J 1974 - observed that human gingival fibroblasts did not
adhere to a root surface contaminated with LPS.
When dentin is exposed plaque bacteria may
invade dentinal tubules, so scaling alone is
insufficient, portion of root surface must be
removed to eliminate them.

25. • Nyman et al, (1986)
– Biocompatible root surfaces are characterized by absence of
endotoxin or presence of minimal endotoxin levels compatible with
health
– demonstrated in beagle dogs that the removal of diseased cementum
was not necessary for successful periodontal therapy
• Hughes et al, (1986 , 1988) - using an immunohistochemical
technique, showed that lipopolysaccharide was detectable on
the cementum surface only.
• Moore et al.(1986) showed that 99% of the LPS associated
with periodontally involved root surfaces could be removed
simply by rinsing and brushing with tap water.

26. • Root debridement may therefore be defined as the
removal of plaque and / or calculus from the root
surface without the intentional removal of tooth
structure. (Lindhe )

27. OBJECTIVES
• Suppression or elimination of the pathogenic periodontal
microflora and replacement with the sparse flora found in
health
• Conversion of inflammed, bleeding, or suppurative pathologic
pockets to healthy gingival sulcus
• Shrinking of the deepened pathologic pocket to a shallow,
healthy gingival sulcus
• Providing a root surface compatible with reestablishment of a
healthy connective tissue and epithelial attachment.

28. DETECTION SKILLS
• Visual examination
• Tactile exploration

29. INSTRUMENTS FOR SCALING AND ROOT PLANING
• Hand instruments
• Sonic and ultrasonic instruments
• Reciprocating instruments
• Ablative laser therapy

30. Hand instruments
• Scalers
– Supragingival (sickles)
– Subgingival (hoes, chisels and files)
• Curettes
– Universal
– Area specific

31. • A hand instrument is composed of three parts: The working part (the blade), the
shank and the handle. The cutting edges of the blade are centered over the long axis
of the handle in order to give the instrument proper balance . The blade is often
made of carbon steel, stainless steel or tungsten carbide.
• Curettes are instruments used for both scaling and root planing. The working part
of the curette is the spoon-shaped blade which has two curved cutting edges. The
two edges are united by the rounded toe. The curettes are usually made
"doubleended" with mirror-turned blades. The length and angulation of the shank
as well as the dimensions of the blade differ between different brands of the
instrument.

32. • Sickles

33. SUBGINGIVAL SCALERS
Chisel scaler
Used in interproximal area
Used in a push motion
File
Used to crush large pieces of
calculus deposits.
Hoe
Efficient in removing subgingival calculus
Blade is beveled at 45 degrees
Working end is bent at an angle of 99
degrees to shank.

34. Curettes

36. Standard instruments of tray for mechanical debridement of teeth

37. PRINCIPLES OF INSTRUMENTATION
• Accessibility (Positioning of Patient and Operator)
• Visibility, Illumination, and Retraction
• Condition of Instruments (Sharpness)
• Maintaining a Clean Field
• Instrument Stabilization
• Instrument Activation

38. INSTRUMENT STABILIZATION
 Instrument grasp
 Fulcrums
 Intraoral / Finger rests
 Extra oral fulcrums

39. Instrument grasp
TRIPOD effect
Enhances control
Tactile sensitivity

40. FINGER REST
IMPORTANCE OF FINGER REST:
• Fundamental requirement for maintaining adaptation and
optimal working angulation.
• Enables the operator to use wrist-arm motion to activate
strokes.

41. • Maxillary right posterior sextant: facial aspect
• Operator position: Side position.
• Illumination: Direct.
• Visibility: Direct (indirect for distal surfaces of molars).
• Retraction: Mirror or index finger of the nonoperating hand.
• Finger rest. Extraoral, palm up. Backs of the middle and fourth fingers on
the lateral aspect of the mandible on the right side of the face.

42. • Maxillary right posterior sextant, premolar region only:
• facial aspect:
• Operator position: Side or back position.
• Illumination: Direct.
• Visibility: Direct.
• Retraction: Mirror or index finger of the nonoperating hand.
• Finger rest. Intraoral, palm up, Fourth finger on the occlusal surfaces of the adjacent
maxillary posterior teeth.

43. Maxillary right posterior sextant: lingual aspect:
Operator position: Side or front position.
Illumination: Direct and indirect.
Visibility: Direct or indirect.
Retraction: None.
Finger rest. Extraoral, palm up. Backs of the middle and
fourth fingers on the lateral aspect of the mandible on
the right side of the face.

44. Maxillary right posterior sextant: lingual aspect
Operator position: Front position.
Illumination: Direct.
Visibility: Direct.
Retraction: None.
Finger rest: Intraoral, palm up,
finger-on-finger. Index finger of the nonoperating hand on the occlusal
surfaces of the maxillary right posterior teeth; fourth finger of the operating
hand or the index finger of nonoperating hand.

45. Maxillary anterior sextant: facial aspect, surfaces away from the
operator
Operator position: Back position.
Illumination: Direct.
Visibility: Direct.
Retraction: Index finger of the nonoperating hand.
Finger rest. Intraoral, palm up. Fourth finger on the incisal edges or
occlusal surfaces of adjacent maxillary teeth.
.

46. • Maxillary anterior sextant: facial aspect, surfaces toward the operator
• Operator position: Front position.
• Illumination: Direct.
• Visibility: Direct.
• Retraction: Index finger of the nonoperating hand.
• Finger rest. Intraoral, palm down. Fourth finger on the incisal edges or the occlusal
or facial surfaces of adjacent maxillary teeth.

47. Maxillary anterior sextant: lingual aspect, surfaces away from the operator
(surfaces toward the operator are scaled from a front position)
Operator position: Back position.
Illumination: Indirect.
Visibility: Indirect.
Retraction: None.
Finger rest. Intraoral, palm up. Fourth finger on the incisal
edges or occlusal surfaces of adjacent maxillary teeth.

48. Maxillary left posterior sextant: facial aspect:
Operator position: Side or back position.
Illumination: Direct or indirect.
Visibility: Direct or indirect.
Retraction: Mirror.
Finger rest. Extraoral, palm down. Front surfaces of the
middle and fourth fingers on the lateral aspect of the
mandible on the left side of the face.

49. Maxillary left posterior sextant: facial aspect
Operator position: Back or side position.
Illumination: Direct or indirect.
Visibility: Direct or indirect.
Retraction: Mirror.
Finger rest. Intraoral, palm up. Fourth finger on the incisal edges or occlusal
surfaces of adjacent maxillary teeth.

50. Maxillary left posterior sextant: lingual aspect.
Operator position: Front position.
Illumination: Direct.
Visibility: Direct.
Retraction: None,
Finger rest: Intraoral, palm down, opposite arch, reinforced.
Fourth finger on the incisal edges of the
mandibular anterior teeth or the facial surfaces of the
mandibular premolars, reinforced with the index finger
of the non operating hand.

51. • Mandibular left posterior sextant: facial aspect
• Operator position: Side or back position.
• Illumination: Direct.
• Visibility: Direct or indirect.
• Retraction: Index finger or mirror of the nonoperating hand.
• Finger rest. Intraoral, palm down. Fourth finger on the incisal edges or the occlusal
or facial surfaces of adjacent mandibular teeth

52. Mandibular left posterior sextant: lingual aspect
Operator position: Front or side position.
Illumination: Direct and indirect.
Visibility: Direct.
Retraction: Mirror retracts tongue.
Finger rest. Intraoral, palm down. Fourth finger on the incisal edges or the
occlusal surfaces of adjacent mandibular teeth.

53. Mandibular left posterior sextant: lingual aspect
Operator position: Front or side position.
Illumination: Direct and indirect.
Visibility: Direct.
Retraction: Mirror retracts tongue.
Finger rest. Intraoral, palm down. Fourth finger on the incisal edges or the
occlusal surfaces of adjacent mandibular teeth.

54. Mandibular anterior sextant: facial aspect, surfaces toward the operator
Operator position: Front position.
Illumination: Direct.
Visibility: Direct.
Retraction: Index finger of the nonoperating hand.
Finger rest: Intraoral, palm down. Fourth finger on the
incisal edges or the occlusal surfaces of adjacent
mandibular teeth.

55. Mandibular anterior sextant: facial aspect, surfaces toward the operator
Operator position: Front position.
Illumination: Direct.
Visibility: Direct.
Retraction: Index finger of the nonoperating hand.
Finger rest: Intraoral, palm down. Fourth finger on the
incisal edges or the occlusal surfaces of adjacent
mandibular teeth.

56. Mandibular anterior sextant: facial aspect, surfaces away from the operator
Operator position: Back position.
Illumination: Direct.
Visibility: Direct.
Retraction: Index finger or thumb of the non operating
hand.
Finger rest. Intraoral, palm down. Fourth finger on the incisal edges or the
occlusal surfaces of adjacent mandibular teeth.

57. Mandibular anterior sextant: lingual aspect, surfaces away from the operator
Operator position: Back position.
Illumination: Direct and indirect.
Visibility: Direct and indirect.
Retraction: Mirror retracts tongue.
Finger rest. Intraoral, palm down. Fourth finger on the incisal edges or the occlusal
surfaces of adjacent mandibular teeth.

58. Mandibular anterior sextant: lingual aspect, surfaces
toward the operator
Operator position: Front position.
Illumination: Direct and indirect.
Visibility: Direct and indirect.
Retraction: Mirror retracts tongue.
Finger rest: Intraoral, palm down. Fourth finger on the incisal edges or the
occlusal surfaces of adjacent mandibular teeth

59. Mandibular right posterior sextant: facial aspect
Operator position: Side or front position.
Illumination: Direct.
Visibility: Direct.
Retraction: Mirror or index finger of the nonoperating
hand.
Finger rest. Intraoral, palm down. Fourth finger on the incisal edges or the
occlusal surfaces of adjacent mandibular teeth.

60. Mandibular right posterior sextant: lingual aspect
Operator position: Front position.
Illumination: Direct and indirect.
Visibility: Direct and indirect.
Retraction: Mirror retracts tongue.
Finger rest: Intraoral, palm down. Fourth finger on the incisal edges or the
occlusal surfaces of adjacent mandibular teeth.

61. INSTRUMENT ACTIVATION
• Adaptation
• Angulation
• Lateral pressure
• Strokes

62. ADAPTATION
• Adaptation refers to the manner in which the working end of
a periodontal instrument is placed against the surface of a
tooth.
• Objective of adaptation is to make the working end of the
instrument conform to the contour of the tooth surface.

63. ANGULATION
• Angulation refers to the angle between the face of a bladed
instrument and the tooth surface. It may also be called the
tooth-blade relationship.
0 degree 45 – 90 <45 >90

64. STROKES
Direction
Length
pressure
Number
Gingival position and
tone,
Pocket depth and shape,
Tooth contour
The amount and nature
of the calculus

65. LATERAL PRESSURE
• Lateral pressure refers to the pressure created when force is
applied against the surface of a tooth with the cutting edge of
a bladed instrument.
• firm, moderate, or light.
• Insufficient lateral pressure
– burnished calculus that are difficult to detect and remove.
– often occurs in areas of developmental depressions and along
the cementoenamel junction (CEJ).

66. TECHNIQUE OF SRP
• Supragingival scaling
– Supragingival calculus is generally less tenacious and less
calcified than subgingival calculus.
– adaptation and angulation easier
– direct visibility as well as a freedom of movement

67. • Subgingival scaling and root planing
– Subgingival calculus is usually harder
– often locked into root irregularities
– Vision is obscured by the bleeding
– clinician must rely heavily on tactile sensitivity
– the adjacent pocket wall limits the direction and length of
the strokes
– Varying root contours.

68. Subgingival scaling procedure.
A, Curette inserted with the face of the blade flush against the tooth.
B, Working angulation (45 to 90 degrees) is established at the base of the pocket.
C, Lateral pressure is applied, and the scaling stroke is activated in the coronal
direction.

70. Initial pocket depth Mean reduction in PPD
(mm)
Change in CAL (mm)
1-3 mm 0.03 -0.34
4-6mm 1.29 0.55
≥ 7 mm 2.16 1.19

71. • Evaluation of the response of the periodontium to
scaling and root planing should be performed no
earlier than 4 weeks following treatment (Caton et al.
1982, Kaldahl et al. 1988, Dahle´n et al. 1992).
• Measurements taken prematurely will not be
representative of completed healing and could
therefore be misinterpreted as a poor clinical
response.

72. SONIC AND ULTRASONIC INSTRUMENTS
The removal of plaque and
calculus is accomplished by
1. The vibration of the tip of the
instrument.
2. The spraying and cavitation
effect of the fluid coolant.

73. Advantages and disadvantages of hand and ultrasonic
instruments
ADVANTAGES DISADVANTAGES
Hand
instruments
Superior tactile sensation
Good access to tight pockets
Good adaptation to different root morphologies
No aerosols
No heat development
Angulation of the blade to root surface
is mandatory.
Frequent sharpening required.
Considerable working force for calculus
removal
Tiring for the operator
Negative time factor
Ultrasonic
instruments
Current tips are very slender
Instrumentation virtually without pressure
Most surfaces can be reached, especially
furcations
Destruction of the biofilm by cavitation
Bactericidal effect of acoustic energy
Little soft tissue damage
Pocket irrigation with antimicrobial agents
Requires less time
No sharpening required
Better patient acceptance
Less tiring to the operator
Poorer tactile sensation
Produces microscopic rippling of the
root surface
Aerosol is highly contaminated
Possible risk for patients with
pacemakers
Contraindicated in patients with
infectious diseases.

74. ROTATING INSTRUMENTS
• Fine grained diamonds
• Sonic scalers with diamond-coated inserts
• Carbide burs
ROTO-PRO BURS DESMOCLEAN BUR
•Root furrows, furcation areas can be easily instrumented.

75. Desmoclean®
• For curettage of the root surface in deep pockets, for bi-
and/or trifurcation and in the approximal area
• For removal of tightly adhering granulations
• For removal of concrement (subgingival plaque)
• For periost ablation during flap surgery
•Non-cutting hexagonal head
•Four shapes
•Use with 7.000–10.000 rpm with light pressure and water
spray

76. Reciprocating instruments
• Profin® Directional System
1.2mm
20000-30000
strokes/min
10 000-15 000
rpm

77. PROFIN :uses and applications:
• Root Planing, scaling, and reshaping of existing restoration
margins, extensions and overhangs.
• Reshaping restorations made of: amalgam, composite,
porcelain, precious and semi-precious metals.
• Refining inter-dental gingival and incisal embrasures.
• Contouring, spacing and individualizing anterior restorations.
• Finishing shoulder margins and refining preparations.
• Reshaping contacting tooth surfaces and minute incisal and
occlusal adjustments.
• Fine-finishing porcelain or metal margins prior to
cementation.
• Stripping, reshaping and polishing anterior and posterior
teeth with comfort and safety.

78. • PERIO-TOR® instruments
Mengel et al. (1994)- PER-IO-TOR" instruments have similar planing
properties as manual hand instruments, but cause minimal removal of
tooth structures.

79. LASERs for SRP
Advantages
• Haemostatic effects
• Selective calculus ablation
• Bactericidal effects
(Aoki et al. 1994, 2004, Ando et al. 1996,
Folwaczny et al. 2002)

80. Lasers most commonly used in periodontics
• Semiconductor diode lasers
• Nd:YAG laser (neodymium doped: yttrium, aluminium, and
garnet)
• Er:YAG laser (erbium doped:yttrium, aluminium, and garnet)
• Carbon dioxide (CO2) laser
Wavelength ranges from 635 to 10, 600 nm

81. Er:YAG laser
• wavelength of 2940 nm in the near-
infrared spectrum (Ishikawa et al.
2004).
• High absorption of its emission
wavelength by water-effectively
remove calculus from periodontally
diseased root surfaces without
causing thermal side effects to the
adjacent tissue (Aoki et al. 1994,
Eberhard et al. 2003, Schwarz et al.
2003)

82. Fluorescence- controlled (feedback system)
Er:YAG laser
• Recently, 655 nm InGaAsP (indium gallium arsenide
phosphate) diode laser radiation has been included in an
Er:YAG laser device to induce fluorescence in subgingival
calculus (Folwaczny et al. 2002b, Krause et al. 2003).
• Enabled an effective removal of subgingival calculus and a
predictable root surface preservation in comparison with
hand instruments (Schwarz et al. 2006, Krause et al. 2007).

83. RCTs comparing lasers and mechanical debridement in the treatment of chronic periodontitis
J Can Dent Assoc 2010;76:a30
Schwarz et al. 2008

84. SMEAR LAYER
• A smear layer is formed when dentin is cut or abraded.
• Close microscopic examination of the root surfaces after SRP
reveals the resulting smear layer.
• organic matrix composed of cementum, dentin, and calculus
smeared but not completely removed from the tooth surface.

85. POST SRP EVALUATION
• Immediately and after soft tissue healing.
• Immediately after instrumentation
– Visual examination
– Explorer / probe.
• Subgingival surfaces should be hard and smooth.
• Although complete removal of calculus is definitely necessary
for the health of the adjacent soft tissue, Nevertheless,
relative smoothness is still the best immediate clinical
indications that calculus has been completely removed.

86. • The ultimate evaluation is based on tissue response.
• Clinical evaluation of the soft tissue response to scaling and
root planing, including probing, should not be conducted
earlier than 2 weeks postoperatively.
• Evaluation of the response of the periodontium to scaling and
root planing should be performed no earlier than 4 weeks
following treatment (Caton et al. 1982, Kaldahl et al.
1988,Dahle´n et al. 1992)

87. 1-2 WEEKS AFTER ROOT PLANING:-
• Resolution of edema
• Shrinkage of gingival margin.
• Color is about normal.
• Moderate pocket depth may be present but there is
little or no bleeding from the base of pocket when
probed
• Histological epithelialisation is about completed

88. 2 - 3 WEEKS AFTER ROOT PLANING:-
• Color is normal.
• Consistency is firm.
• No bleeding from base of pocket.
• Tooth mobility may decrease.

89. Histologically
• Immediate blood clot in pocket. Hemorrhage in tissues with
dilated blood vessels and abundant neutrophils.
• Rapid proliferation of granulation tissue.
• Tissue maturation with decrease in number of small blood
vessels.
Since periodontal disease is site specific (Goodson et al 1982,
Hafajee 1983), each tooth or tooth surface should be
evaluated for wound healing.
If treated lesion still elicits bleeding nature of bleeding should
be assessed.

90. HEALING AFTER SRP
 Within few hours – an acute inflammatory reaction occurs in
the soft tissue pocket wall.
 Within 2 days – remnants of pocket epithelium proliferate and
the pocket wall is fully epithelialized. Involution of pocket
epithelium gives rise to junctional epithelium.
 In 14 days – epithelial reattachment is complete and new
gingival sulcus is formed near the crest of the gingiva. At this
time some gingival recession is apparent following reversal of
inflammatory swelling.
 At 3-6 weeks – formation of functionally oriented collagen
takes place to replace granulation tissue.
 After 6 weeks – maturation of the CT component may
continue for several months

91. • Restoration and re-epithelialization of sulcus in 2 to 7 days.
• Restoration of junctional epithelium within 5 days.
• Immature collagen fibres form within 21 days.
• Healing is mostly by long junctional epithelium with islands of
connective tissue attachment
• connective tissue maturation continues for 21 to 28 days.
• Final gingival contouring may not be seen for 3-6 months.

92. SCALING AROUND IMPLANTS
• Do not scratch the titanium abutment.
• Instrumentation should be restricted to supragingival deposit
removal.
• Strokes : short, controlled and activated with light pressure.

93. INSTRUMENTS FOR SCALING IMPLANTS
Material softer than titanium should be used.
• Plastic instruments
• Instruments with graphite fillers- for debriding crown or
denture supported by the implant structure.
• Sonic and ultrasonic instruments with plastic sleeves over the
metal tip.

94. PLASTIC INSTRUMENTS
Wrench shaped
Crescent shaped
Hoe shaped
Plastic instruments similar
to conventional curets and
sickle scalers

95. ImplaKlean™ Implant
Scalers.
Hu friedy

98. • The power of the ultrasonic unit should be kept at a low
setting.
• The point of the tip should never be placed directly on the
implant, but rather the side of the tip is applied with light
pressure.
• Overlapping horizontal, vertical, or oblique strokes should be
used.

99. Endoscopy aided SRP
• Michaud et al (2007)
• No significant improvement in calculus removal
compared to traditional SRP

100. POLISHING
• Polishing smoothed the tooth surface so that the causative
agents of disease would be less likely to reaccumulate, and
patient would be motivated to maintain smooth shiny tooth
surface, the clinician created.
• coronal polishing is, at best , a cosmetic procedure with no
health benefits and at worst, a procedure that damages the
tooth surfaces.

101. But today, research literature has shown the following:
Thorough brushing and flossing at home can produce the same effect as
polishing
Polishing does not improve the uptake of fluorides.
The use of an explorer and forceful rinsing are as effective as polishing
before sealant placement.
Fluoride in the outer layers of enamel is removed by polishing, making the
tooth vulnerable to tooth decay.
In the past,
It was important to have smooth, stain free surfaces to impede the
build up of new plaque.
Stains and plaque must be removed before a fluoride treatment to
allow adequate uptake of fluoride in the enamel.
It was necessary to polish tooth surfaces before sealent placement to
ensure proper acid etching and sealant penetration.

102. CONCLUSION
S/RP is an essential part of non-surgical
periodontal therapy, yet does not result in
complete removal of calculus .
Patient motivation and cooperation is
important in successful treatment
outcomes .
Re-evaluation provides a check for
treatment success and patient’s level of
cooperation

103. REFERENCES
• Carranza’s clinical periodontology – Newman ,Takei Klokkevold Carranza -
tenth edition
• Clinical periodontology and implant dentistry- Jan lindhe Thorkild karring
iklaus p. lang - fourth edition
• Periodontics in the tradition of gottileb and orban sixth edition Grant,
stern
• Periodontal therapy clinical approach and evidence of success Myren
nevins – vol I
• Periodontics medicine, surgery and implant by Rose and Mealey
• Henry M Goldman and D. Walter Cohen – 1980 – Periodontol therapy 6th
edn.
• Periodontology-The essentials, -Mueller
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evidence-based perspective of scaling and root planing. J Clin Periodontol
2002; 29 (Suppl 2): 6–16.
• Drisko . Nonsurgical periodontal therapy Periodontology 2000, Vol. 25,
2001, 77–88

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