KSUKSUCollege of DentistryCollege of Dentistry

PDSPDS

Presented by:

Dr.Khalid AL-Hezaimi

Presented by:

Dr.Khalid AL-Hezaimi

IntroductionIntroduction Scaling and root planingScaling and root planing Scaling &root planing techniquesScaling &root planing techniques Evidence-based studies in periodontal Evidence-based studies in periodontal

instrumentationinstrumentation Evaluation of scaling and root planingEvaluation of scaling and root planing Limitation of scaling and root planingLimitation of scaling and root planing Summary Summary

Periodontal therapy can be divided into Periodontal therapy can be divided into three but frequently overlapping phases .three but frequently overlapping phases .

The cause – related phase The cause – related phase (non – surgical (non – surgical periodontal therapy).periodontal therapy).

The corrective phase The corrective phase ( periodontal surgery).( periodontal surgery). The maintenance phase The maintenance phase (supportive periodontal (supportive periodontal

– therapy).– therapy).

Non – surgical periodontal therapy (NSPT)Non – surgical periodontal therapy (NSPT)

it is also called oral hygiene phase therapy it is also called oral hygiene phase therapy

(OHPT ).(OHPT ). All periodontal treatment is based on successful All periodontal treatment is based on successful

initial NSPT.initial NSPT.

Means of (NSPT):Means of (NSPT):

Patient information .Patient information . Self – performed plaque control methods. Self – performed plaque control methods. Scaling and root planning.Scaling and root planning. Adjunctive use of chemical agents.Adjunctive use of chemical agents. Post – initial therapy re – evaluation.Post – initial therapy re – evaluation.

ScalingScaling is is the process by which plaque the process by which plaque and calculus are removed from both and calculus are removed from both supragingval and subgingival tooth supragingval and subgingival tooth surfaces . surfaces .

Whereas root planning means :Whereas root planning means :

The process by which residual The process by which residual embedded calculus and portion of embedded calculus and portion of cementum are removed from the roots cementum are removed from the roots to produce a smooth ,hard and clean to produce a smooth ,hard and clean surface.surface.

The objective of scaling and root The objective of scaling and root planning:planning:

Restore gingival healthRestore gingival health Removal of root surface element Removal of root surface element

(plaque - calculus - endotoxine)(plaque - calculus - endotoxine)

Arrest the progression of further Arrest the progression of further periodontal disease destructionperiodontal disease destruction. .

Scaling and Root planning are not separate Scaling and Root planning are not separate procedure, however they are different .procedure, however they are different .

All principles of scaling apply equally to Root All principles of scaling apply equally to Root planning, the difference between scaling and planning, the difference between scaling and Root planning is only a matter of degree .Root planning is only a matter of degree .

Access to the Root surface.Access to the Root surface. The root surface are not easy to access The root surface are not easy to access

because Limitation of penetration of because Limitation of penetration of instruments.instruments.

In subgingival access.In subgingival access. scaling and root planing skills is needed. scaling and root planing skills is needed. in deep pockets .in deep pockets .open procedure may neededopen procedure may needed

) ) It was shown that pockets less than 3 mm were the It was shown that pockets less than 3 mm were the easiest sites for scaling and root planing. Pocket depths easiest sites for scaling and root planing. Pocket depths between 3 to 5 mm were more difficult to scale and between 3 to 5 mm were more difficult to scale and pockets deeper than 5 mm were the most difficult.) pockets deeper than 5 mm were the most difficult.)

Rabbani GM et al .1999Rabbani GM et al .1999

1- visual examination .1- visual examination .

2- tactile exploration .2- tactile exploration .

Supra gingival scaling technique:Supra gingival scaling technique:Sickles ,curettes ,and ultrasonic and sonic

instrument are most commonly used for removal of supragingival calculus .

Sub gingival scaling and Root Sub gingival scaling and Root planning technique:planning technique:

The curette is preferred by most clinicians The curette is preferred by most clinicians because of the advantages afforded by its because of the advantages afforded by its design. design.

Ultrasonic scaling:Ultrasonic scaling:Ultrasonic instrument have been used as a Ultrasonic instrument have been used as a

valuable adjunct to conventional hand valuable adjunct to conventional hand instrumentation .instrumentation .

Uses of Ultrasonic scaling devices :Uses of Ultrasonic scaling devices :1- Scaling and gingival curettage .1- Scaling and gingival curettage .

2-Removal of satins .2-Removal of satins .

3- Remove overhangs and excess cement 3- Remove overhangs and excess cement

Contraindications of ultrasonic scalingContraindications of ultrasonic scaling::

Patient with cardiac pacemaker .Patient with cardiac pacemaker . Patients with Known communicable diseases .Patients with Known communicable diseases . Chronic pulmonary Disorder .Chronic pulmonary Disorder . Porcelain bounded restoration .Porcelain bounded restoration . Patient with Titanium implant Patient with Titanium implant ( plastic-tipped ultrasonic ( plastic-tipped ultrasonic

and sonic insert and Teflon-coated sonic scaler tips are available) and sonic insert and Teflon-coated sonic scaler tips are available)

There was no difference between hand and powered There was no difference between hand and powered instrumentation in deposit removal and improved clinical instrumentation in deposit removal and improved clinical parametersparameters

(Badersten et al.1981,loos et al . 1987,Laurell et al . 1988)(Badersten et al.1981,loos et al . 1987,Laurell et al . 1988)

There was no difference between hand and powered There was no difference between hand and powered instruments in the treatment of class I furcation involved instruments in the treatment of class I furcation involved areas , while powered instruments were more effective areas , while powered instruments were more effective than hand instruments in class II and III furcation due to than hand instruments in class II and III furcation due to smaller tip size smaller tip size

( Matia et al .1986 ,Leon &Vogel 1987)( Matia et al .1986 ,Leon &Vogel 1987)

End toxins are superficially attached to the root surface End toxins are superficially attached to the root surface and can be removed by brushing and can be removed by brushing (Moore et (Moore et al .1986),al .1986),polishing polishing (Nyman et al .1988)(Nyman et al .1988) or light overlapping or light overlapping strokes with ultrasonic scalers strokes with ultrasonic scalers (smart et al .1990)(smart et al .1990)

The critical probing depth for scaling and root planing is The critical probing depth for scaling and root planing is 2.9 mm ± 0.4 and for periodontal surgery is 4.2 mm ± 0.22.9 mm ± 0.4 and for periodontal surgery is 4.2 mm ± 0.2 (Lindhe et al .1982 )(Lindhe et al .1982 )

Scaling and root planing did not result in total removal of Scaling and root planing did not result in total removal of subgingival calculus particularly in deep pocketssubgingival calculus particularly in deep pockets

( Rabbani et al .1981) ( Rabbani et al .1981)

The adequacy of S/RP is evaluated when the procedure The adequacy of S/RP is evaluated when the procedure is performed and again later, after a period of timeis performed and again later, after a period of time

First immediately after instrumentation .subgingival First immediately after instrumentation .subgingival surfaces should be hard and smooth .surfaces should be hard and smooth .

Then after 2 weeks postoperatively .because Then after 2 weeks postoperatively .because

reepithialization of the wound created during reepithialization of the wound created during instrumentation take 1 to 2 weeks . instrumentation take 1 to 2 weeks .

Meticulous and requires more Meticulous and requires more experienced operator .experienced operator .

Time consuming(×2the time needed for Time consuming(×2the time needed for surgery)surgery)

Less predictable in deep Less predictable in deep pockets ,furcations and interproximal pockets ,furcations and interproximal groove. groove.

Ineffective as mono therapy in the Ineffective as mono therapy in the treatment of aggressive periodontitis .treatment of aggressive periodontitis .

Might cause dentine hypersensitivity .Might cause dentine hypersensitivity .

Increased the risk of disease transmissionIncreased the risk of disease transmission( aerosol of the powered instruments ).( aerosol of the powered instruments ).

Powered may interfere with pacemakers .Powered may interfere with pacemakers .

Patient discomfort .Patient discomfort .

Cost effectiveness .Cost effectiveness .

S/RP is an essential part of non-surgical periodontal S/RP is an essential part of non-surgical periodontal therapy ,yet dose not result in complete removal of therapy ,yet dose not result in complete removal of calculus .calculus .

Patient motivation and cooperation is important in Patient motivation and cooperation is important in success treatment outcomes .success treatment outcomes .

Self performed OH should be applied regularly and Self performed OH should be applied regularly and modified if needed . modified if needed .

Re-evaluation provides a check for treatment success Re-evaluation provides a check for treatment success and patientand patient’’s level of cooperation . s level of cooperation .