Scaling and Root Planing (SCRP/SRP) PDF

10.10.2023 PERIODONTOLOGY Scaling and Root Planing (SCRP/SRP) Assist. Prof. Ece RAKUNT TOPTAŞ Department of Periodontology [email protected] 1 Resources Newman and Carranza’s Clinical Periodontology 2 1 10.10.2023 SCALING Scaling is the process by which biofilm and calculus are rem...

10.10.2023 PERIODONTOLOGY Scaling and Root Planing (SCRP/SRP) Assist. Prof. Ece RAKUNT TOPTAŞ Department of Periodontology [email protected] 1 Resources Newman and Carranza’s Clinical Periodontology 2 1 10.10.2023 SCALING Scaling is the process by which biofilm and calculus are removed from both supragingival and subgingival tooth surfaces. No deliberate attempt is made to remove tooth substance along with the calculus. Triangular shape, double- cutting edge, and pointed tip. Both ends of a U15/30 scaler. Three different sizes of 204 sickle scalers. 3 SCALING 4 2 10.10.2023 Root planing Root planing is the process by which residual embedded calculus and portions of cementum are removed from the roots to produce a smooth, hard, clean surface. 5 SCRP The primary objective of scaling and root planing To restore gingival health by completely removing elements that provoke gingival inflammation (i.e., biofilm, calculus, and endotoxin) from the tooth surface 6 3 10.10.2023 SCRP 7 SCRP Instrumentation; Ø # subgingival m.o Ø gram-negative anaerobes gram- positive facultative bacteria Ø Spirochetes, motile rods, and putative pathogens (A. actinomycetemcomitans, P. gingivalis,and P. İntermedia) Reduction or elimination of inflammation clinically. Ø Coccoid cells 8 4 10.10.2023 SCRP Ø Scaling and root planing are not separate procedures; all the principles of scaling apply equally to root planing. Ø The difference between scaling and root planing is only a matter of degree. Ø The nature of the tooth surface determines the degree to which the surface must be scaled or planed. 9 SCRP vWhen biofilm and calculus form on enamel, the deposits are usually superficially attached to the surface and are not locked into irregularities. Scaling alone is sufficient to completely remove biofilm and calculus from enamel, leaving a smooth, clean surface. 10 5 10.10.2023 SCRP Deposits of calculus are frequently embedded in cemental irregularities; therefore scaling alone is insufficient, and a portion of the root surface must be removed to eliminate these deposits. 11 SCRP • Mastery of scaling and root planing is essential to the ultimate success of any course of periodontal therapy. • Of all clinical dental procedures, subgingival scaling and root planing in deep pockets are the most difficult and exacting skills to master. SURGERY?? 12 6 10.10.2023 Supragingival Scaling Technique • Supragingival calculus is generally less tenacious and less calcified than subgingival calculus. • Sickles, curettes, and ultrasonic and sonic instruments are most often used for the removal of supragingival calculus 13 Supragingival Scaling Technique • The blade angulation à slightly less than 90 degrees to the surface being scaled. • The cutting edge should engage the apical margin of the supragingival calculus. • WHICH GRASP????? Short, powerful, overlapping scaling strokes are activated coronally in a vertical or oblique direction. 14 7 10.10.2023 Supragingival Scaling Technique • The sharply pointed tip of the sickle can easily lacerate marginal tissue or gouge exposed root surfaces, so careful adaptation is especially important when this instrument is being used. • The tooth surface is instrumented until it is visually and tactilely free of all supragingival deposits. 15 SCALING 16 8 10.10.2023 SCALING 17 Subgingival Scaling and Planing Technique Subgingival calculus is usually harder than supragingival calculus and is often locked into root irregularities, thus making it more tenacious and more difficult to remove. 18 9 10.10.2023 Subgingival Scaling and Planing Technique v The overlying tissue creates significant problems in subgingival instrumentation. v Vision is obscured by the bleeding that inevitably occurs during instrumentation and by the tissue itself. v The clinician must rely heavily on tactile sensitivity to detect calculus and irregularities, guide the instrument blade during scaling and root planing, and evaluate the results of instrumentation. 19 Subgingival Scaling and Planing Technique v The curette is preferred for subgingival scaling and root planing; Ø Its design allows it; • To be inserted to the base of the pocket • To be adapted to variations in tooth contour with minimal tissue displacement and trauma. 20 10 10.10.2023 Subgingival Scaling and Planing Technique v To be adapted to variations in tooth contour with minimal tissue displacement and trauma. A) Curette B) Sickle Scaler 21 Subgingival Scaling and Planing Technique v Sickles, hoes, files, and ultrasonic instruments also are used for subgingival scaling of heavy calculus. v Although thin ultrasonic tips designed for scaling of deep pockets and furcations can be inserted more easily subgingivally, they must be used on low power. 22 11 10.10.2023 Subgingival Scaling and Planing Technique When low-power scaling is performed on heavy calculus !!!!thin ultrasonic tips are likely to burnish the calculus rather than thoroughly remove it. !!!! Therefore ultrasonic scaling should be followed by careful assessment with an explorer and further instrumentation with curettes when necessary. 23 Subgingival Scaling and Planing Technique Subgingival scaling and root planing are accomplished with either universal or area-specific (Gracey) curettes 24 12 10.10.2023 Subgingival Scaling and Planing Technique • Modified pen grasp • The correct cutting edge is slightly adapted to the tooth, with the lower shank kept parallel to the tooth surface. • The lower shank is moved toward the tooth so that the face of the blade is nearly flush with the tooth surface. 25 Subgingival Scaling and Planing Technique • Working angulation : between 45 and 90 degrees • Pressure à lateral. • Calculus is removed by a series of controlled, overlapping, short, powerful strokes primarily using wristarm motion 26 13 10.10.2023 Subgingival Scaling and Planing Technique As calculus is removed, resistance to the passage of the cutting edge diminishes until only a slight roughness remains. Longer, lighter root-planing strokes are then activated with less lateral pressure until the root surface is completely smooth and hard. 27 Subgingival Scaling and Planing Technique Scaling and root-planing strokes should be confined to the portion of the tooth where calculus or altered cementum is found; this area is known as the instrumentation zone. Sweeping the instrument over the crown where it is not needed • wastes operating time, • dulls the instrument, and • causes loss of control. ! 28 14 10.10.2023 Subgingival Scaling and Planing Technique 29 Ultrasonic Instrumentation Technique Ultrasonic instrumentation à light-to-moderate grasp Varying pressure à amount and tenacity of the deposit. Excessive pressure is not recommended à it can cause dampening of the vibration of the tip. The tip should be kept in constant motion and parallel to the tooth surface. 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. The ultrasonic tip must come in direct physical contact with calculus to fracture and remove it. The tip must also contact all aspects of the root surface to remove biofilm and toxins thoroughly. 30 15 10.10.2023 Ultrasonic Instrumentation Technique Only the terminal 1 to 2 mm of the tip will produce maximum vibration. The curved anatomy of teeth dictates that only this small portion of the tip can possibly contact a tooth at any point in time. During ultrasonic instrumentation, the tooth surface should be frequently examined with an explorer to evaluate the completeness of debridement. 31 Polishing 32 16 10.10.2023 Thank you… 33 17