The Effectiveness Of Sub Gingival Scaling And Root Planing In Calculus Removal

1. The Effectiveness Of Sub Gingival Scaling And Root
Planing In Calculus Removal
Guity M Rabbani , Major M Ash & Raul G Caffesee
JOURNAL OF PERIODONTOLOGY ; MARCH 1991
Dr Shivani Iyer
PG 1ST YEAR

2. CONTENTS
1. INTRODUCTION
2. AIM OF THE STUDY
3. MATERIALS AND METHODS
4. RESULT
5. DISCUSSION
6. CONCLUSION
7. REFERENCES

3. INTRODUCTION
DEFINITION :
SCALING : Is the process by which plaque & calculus are removed from both
supragingival & subgingival tooth surfaces.
ROOT PLANING : Is the process by which residual calculus & portions of
cementum are removed from the roots to produce a smooth , hard , clean surface.

4. 1. CHANGES IN ROOT SURFACES IN PERIODONTITIS
Plaque & Calculus Deposition
supra & subgingival calculus have a rough
surface capable of
harboring plaque that cannot be
removed by conventional methods

5. Stripped Of Periodontal Attachment
Contains Remnants Of Embedded Calculus , Bacteria
Exposed To Septic Contents Of Periodontal Pocket
2. CHANGES SEEN IN THE DISEASED CEMENTUM

6. Structural changes
• Hypermineralisation
/demineralisation
• Presence of
pathological
granules
Chemical changes
• Changes in the conc
of Ca , Mg ,
Phosphate
Cytoxic changes
• Adsorption of
endotoxins
• invasion of bacteria
• Cell mediated
resorption lacunae
3. ALTERATIONS IN EXPOSED CEMENTUM

7. RATIONALE FOR SCALING & ROOT PLANING
To restore gingival health by completely removing elements that provoke
gingival inflammation.

8. RATIONALE FOR ROOT PLANING
Garret in 1977 * set forth the rationale for root planing
Root Smoothness
Removal of Diseased Cementum
Preparation for New Attachment
*Garrett JS : Root planing : A Perspective .J Periodontol 1977 Sep;48(9):553-7

9. *Polson AM , Caton J : Factors influencing periodontal repair and regenration ;J Periodontol 53:
617 , 1982
Polson & Caton ( 1982 ) in their study on experimental periodontitis in
rhesus monkeys concluded that pathologically altered root surface rather
than reduced periodontium – prevented regeneration

10. AIM OF THE STUDY
a. Whether any correlation exists between remaining calculus & depth of the pocket.
a. Whether the type of tooth scaled ( anterior or posterior ) will influence the amount
of remaining calculus.

11. MATERIALS AND METHODS

12. STUDY FLOWCHART
Advanced Periodontitis Patients selected
N= 25
EXPERIMENTAL
TEETH
N = 62
CONTROL
TEETH= 57
119 teeth included
Prior to extraction
Calculus was scored
according to
Calculus index of
P.D.I
SCALED &
ROOT PLANED
WITH HAND
INSTRUMENTS
TEETH VIEWD UNDER
STEREMICROSCOPE

13. RESULTS

14. Correlation Between Percent Of Calculus & Pocket Depth On Scaled & Unscaled Teeth.
VARIABLE N r P
SCALED 62 0.060 <0.01
UNSCALED 57 0.50 <0.01

15. RELATION BETWEEN PERCENT OF CALCULUS &
POCKET DEPTH ON SCALED TEETH
RELATION BETWEEN PERCENT OF CALCULUS &
POCKET DEPTH ON UNSCALED TEETH

16. DISCUSSION
Earlier experimental procedures have shown that a normal dental epithelial
junction can be re-established in areas where all the subgingival plaque & calculus
have been removed.
However , the results of many other previous studies have indicated that complete
Removal of calculus from root surfaces is difficult.

17. Schaffer scaled 6 teeth & root planed 12 others. He found out that all 6 scaled teeth
had calculus after extraction. Remaining calculus was reported even over smoothed
surfaces after root planing.
Jones & O’Leary inspected 48 subgingival root planed surfaces visually after
extraction and found out 18.75% had remaining visible flecks of calculus. Although
the surfaces were inspected only visually, a high percent of remaining calculus was
reported.
Jones et al by using different types of instruments, reported no difference in the
efficiency of removal of calculus between the various instruments employed.
Considerable amounts of calculus were found to be retained over some areas which
were left clinically "smooth".
It can be assumed that some of the causes of failure in subgingival
scaling and root planing are due to lack of visual control.

18. The instrument which usually is used to ascertain the presence of calculus clinically is a
sharp explorer guided by the sense of touch.
This is not an accurate method in accomplishing the objective of assessing tooth surface
characteristics. The explorer tip may not record differences between burnished calculus
and the cementum.
Thus, smooth burnished calculus may deceive the tactile sense of the operator using an
explorer.

19. In addition, calculus is likely to be inaccessible to the sealer if it is
located in cemental crevices and résorption lacunae, in irregularities in the
tooth surface.
Complete removal of Sub gingival calculus is hard to achieve because of
technical and anatomical problems which together make complete root
planing difficult.

20. First, the amount of residual calculus may increase with the increase in size
of the surface to be scaled.
Second, as the pocket becomes deeper, more irregularities are usually
observed on the tooth surfaces.
Third, when the pocket gets deeper, the apical part of the pocket is narrower
making accessibility to the bottom of the pocket difficult and the removal of
calculus unlikely.

21. Considering the results of this and previous studies, which indicate problems
related to complete scaling and root planing, it seems that supplemental
treatment such as reflecting flaps should be used in
treating deep pockets.

22. CONCLUSION
1. There is a statistically significant correlation between depth of pockets and percent of
residual calculus following scaling & root planing.
2. There is a statistically significant correlation between pocket depth & percent of calculus
present on unscaled teeth.
3. There is no statistically significant difference between anterior and posterior teeth in the
percent of residual calculus following scaling and root planing.