DD -Perio Page 345 -378

Anatomic Features of Teeth

• Mesial surfaces of maxillary premolars and proximal surfaces of mandibular incisors are most likely to have flutings.
• Root proximity is a problem when performing scaling and root planing on mandibular incisors.
• Furcations on maxillary first molars are the most difficult to adequately instrument (root planing).

Limitations of Calculus Removal

• Anatomic features of teeth frequently limit the effectiveness and efficiency of calculus removal.

Success of Scaling and Root Planing

• The best criterion to evaluate the success of scaling and root planing is no evidence of bleeding on probing.
• Bleeding on probing indicates inflammation in the tissue.
• The amount of inflammation present is used to determine the effectiveness of periodontal instrumentation and home care by the patient.

Periodontal Instrumentation

• Cementum, dentin, and calculus are removed during root planing.
• Scaling refers to the removal of deposits from the root surface, whereas planing means smoothing the root to remove infected and necrotic tooth substance.
• Curettage refers to the intentional removal of diseased soft tissue from the gingival wall of a periodontal pocket.

Indications and Contraindications for Curettage

• Indications for curettage are very limited.
• Curettage should always be preceded by scaling and root planing.
• Gingival curettage always requires some type of local anesthesia.
• Contraindications for gingival curettage as a definitive procedure include:
  • Acute periodontal inflammation
  • Firm, fibrotic tissue
  • Intrabony pockets
  • Mucogingival involvement
  • When the lateral gingival wall is extremely thin

Periodontal Probes and Furcation Probes

• Periodontal probes are instruments used to detect, measure, and mark pockets.
• A furcation probe is a blunt-tip curved instrument used to detect and evaluate bone loss in the furcation areas of multi-rooted teeth.

Probing Technique for Pocket Assessment

• The probe is inserted into the base of the pocket with a steady and gentle pressure.
• The shank of the probe should be positioned parallel to the vertical axis of the tooth and "walked" along the circumference of each tooth to determine the pocket depth.

Ultrasonic and Sonic Instrumentation

• Ultrasonic instruments have a light touch and light pressure, keeping the tip parallel to the tooth surface and constantly in motion.
• Leaving the tip in one place for too long or using the point of the tip against the tooth can produce gouging and roughening of the root surface or overheating of the tooth.
• Contraindications to the use of ultrasonic and sonic scaling devices include:
  • Older cardiac pacemakers
  • Known communicable diseases that can be transmitted by aerosols
  • Patients at risk for respiratory disease, including patients who are immunosuppressed or have chronic pulmonary disorders
  • Patients with titanium implants, porcelain or bonded restorations (unless plastic-tipped inserts are used)

Dental Endoscope and EVA System

• A dental endoscope allows clear visualization deeply into subgingival pockets and furcations.
• The EVA system uses motor-driven diamond files to correct overhanging or overcontoured proximal alloy or resin restorations.

Polishing Devices

• The Prophy-Jet air-powder polishing device is very effective for the removal of extrinsic stains and soft deposits.
• Contraindications to the use of air-powered polishing devices include:
  • Respiratory illnesses
  • Hemodialysis
  • Hypertension
  • Infectious diseases

Power-Driven Instruments

• Power-driven instruments work best with quick hand movement - rapid, controlled movements.

Sharpening Instruments

• The objective of sharpening is to restore the fine, thin, linear cutting edge of the instrument.
• Principles of sharpening include:
  • Choose a sharpening stone appropriate for the instrument
  • Use a sterilized sharpening stone if the instrument to be sharpened will not be resterilized before it is used on a patient
  • Establish the proper angle between the stone and the surface of the instrument
  • Maintain a stable, firm grasp of both the instrument and the sharpening stone
  • Avoid excessive pressure
  • Avoid formation of a "wire edge"
  • Lubricate the stone during sharpening### Angulation in Scaling and Root Planing
• Optimal angulation is between 45 and 90 degrees for effective calculus removal.
• Angulation of less than 45 degrees causes the cutting edge to slide over the calculus, smoothing or burnishing it.
• Angulation of more than 90 degrees leads to the lateral surface of the blade being against the tooth, failing to remove calculus and potentially burnishing it.

Stroke Directions and Factors

• Three basic stroke directions used in scaling and root planing: vertical, oblique, and horizontal.
• Vertical and oblique strokes are most commonly used.
• Horizontal strokes are used on line angles and deep pockets.
• Factors determining stroke direction, length, pressure, and number include:
• Gingival position and tone
• Pocket depth and shape
• Tooth contour
• Amount and nature of calculus or roughness

Dental Hand Instruments

• Dental hand instruments have three basic parts: handle, shank, and working-end (blade).
• The working-end or blade is divided into three parts: toe/tip, middle, and heel.
• The tip-third of a scaler and toe-third of a curette are the surfaces that remain in contact with the tooth surface during instrumentation.

Objectives and Outcomes of Scaling and Root Planing

• The objective is to remove etiologic agents that promote gingival inflammation, including plaque, calculus, endotoxins, and other local factors.
• Scaling and root planing improve pocket depths and clinical attachment levels in mild to moderate periodontitis cases.
• Scaling and root planing can successfully treat chronic periodontal disease if adequate plaque control is maintained.
• Factors influencing effectiveness include pocket depth and complex root anatomy.
• Residual deposits commonly occur at the cemento-enamel junction, line angles, and infurcations.

Healing and Assessment

• Healing following scaling and root planing is largely due to a reduction in edema and is characterized by the formation of a long, thin junctional epithelium.
• Bleeding on probing (BOP) is a simple assessment of the inflammatory status of the gingiva.
• Lack of BOP is highly correlated with stability and a lack of inflammation.
• Tissue healing, as evidenced by a reduction or absence of bleeding on probing, is a stronger predictor of success than calculus removal and smooth root surfaces.

This quiz covers the anatomic features of teeth that affect the effectiveness and efficiency of calculus removal during scaling and root planing procedures.