Perio Mental Dental Video 9

Non-Surgical Periodontal Therapy

• Non-surgical periodontal therapy is designed to remove bacterial plaque and local factors that favor its accumulation.

Scaling and Root Planing

• Scaling is the removal of both supragingival and subgingival plaque and calculus.
• Root planing is the removal of embedded calculus and rough cementum, which is the outer layer of the tooth root surface.
• The primary objective of both scaling and root planing is to restore gingival health by removing etiologic factors.

Instruments Used in Scaling and Root Planing

• Sickle scalers are used for removal of supragingival calculus and have a very sharp tip with a triangular cross section.
• Curettes are used for subgingival calculus and have a rounded tip, either universal or adapted for specific areas of the mouth (Gracey curettes).
• Universal curettes have a semi-circular cross section and a rounded tip, allowing for use in any area of the mouth.
• Gracey curettes have a semi-circular cross section and are adapted for specific areas of the mouth, with one cutting edge.

Gracey Curettes

• Gracie 1-2 is used for the anterior region of the mouth.
• Gracie 5-6 is used for the anterior teeth and premolars.
• Gracie 7-8-9-10 is used in the posterior for facial and lingual surfaces only.
• Gracie 11-12 is used in the posterior for mesial and interproximal surfaces.
• Gracie 13-14 is used in the posterior for distal interproximal surfaces.

Ultrasonic Scalers

• Ultrasonic scalers are used for tenacious calculus and are contraindicated for patients with pacemakers, infectious diseases spread by aerosol, and at risk for respiratory disease.
• There are two types of ultrasonic scalers: magneto-restrictive (Cavitron) and piezo-electric.
• Magneto-restrictive ultrasonics vibrate in an elliptical pattern, while piezo-electric ultrasonics vibrate in a linear pattern.
• Ultrasonic scalers have several functions, including lavage, cavitation, mechanical vibration, and acoustic turbulence.

Strokes Used in Scaling and Root Planing

• Exploratory stroke: a light feeling stroke used with probes and explorers to measure pocket depth and detect calculus.
• Scaling stroke: a short, strong pull stroke used for scaling.
• Root planing stroke: a light to moderate poststroke used for final smoothing.
• Ultrasonic stroke: a light, intermittent stroke with a tip parallel to the tooth surface.

Angulation of Curettes

• When inserting a curette into the pocket, the angulation between the blade and the tooth should be zero degrees (closed angle).
• When scaling and root planing, the angulation should be 45 to 90 degrees (open angle).

Prophylaxis

• After scaling and root planing, a prophylaxis is provided to remove any supragingival plaque that remains on the tooth enamel.
• A prophy cup and brush are commonly used for prophylaxis.
• The prophy cup flexes on slight pressure to the contours of the teeth, and the brush enables better access to select occlusal grooves and interproximal areas.