This document discusses scaling and root planing (SRP), a common periodontal procedure. SRP involves removing plaque and calculus from both above and below the gumline using instruments. The goals are to restore gum health by eliminating irritants, reduce pockets, improve attachment, and produce a smooth root surface. SRP has local effects like removing bacteria and infected tissues, as well as systemic effects from the procedure. Proper technique is important, including instrument grasp, stroke direction, length and activation. SRP may cause temporary pain and sensitivity but improves periodontal outcomes.

1. Scaling and root planingScaling and root planing

2. Marginal periodontitis is induced by
bacterial plaque deposits and maintained by
subgingival plaque and calculus present on
root surfaces.
Therefore therapy of periodontally involved
teeth is primarily directed towards removal
of these accretions from root surfaces in
order to allow for healing.

3. Process by whichProcess by which
plaque and calculusplaque and calculus
are removed fromare removed from
both supra andboth supra and
subgingival toothsubgingival tooth
surface.surface.
Process by whichProcess by which
residual embeddedresidual embedded
calculus and portioncalculus and portion
of cementum areof cementum are
removed from the rootremoved from the root
to produce a smooth,to produce a smooth,
hard and cleanhard and clean
surfacesurface
ScalingScaling Root PlaningRoot Planing

4. Primary objectivePrimary objective
Restoration of gingival health byRestoration of gingival health by
completely removing elements thatcompletely removing elements that
provoke gingival inflamation.provoke gingival inflamation.
Scaling and root planing are not separableScaling and root planing are not separable
proceduresprocedures

5. Before Scaling & RootBefore Scaling & Root
PlaningPlaning
After Scaling & RootAfter Scaling & Root
planingplaning

6. Subgingival scaling and root planingSubgingival scaling and root planing
are measures which can be effective in:are measures which can be effective in:
Eliminating inflammationEliminating inflammation
Reducing probing depthsReducing probing depths
Improving clinical attachmentImproving clinical attachment

7. Objectives Of Root PlaningObjectives Of Root Planing
Securing biologically acceptable root surfacesSecuring biologically acceptable root surfaces
Resolving inflammationResolving inflammation
Decreasing pocket depthDecreasing pocket depth
Facilitating oral hygiene proceduresFacilitating oral hygiene procedures
Improving or maintaining attachment levelImproving or maintaining attachment level
Preparing the tissues for surgical proceduresPreparing the tissues for surgical procedures

8. RATIONALE OF ROOTRATIONALE OF ROOT
PLANINGPLANING

9. Recent data suggestsRecent data suggests
that root structurethat root structure
removal is not necessary.removal is not necessary.
The end point of scalingThe end point of scaling
and root planing isand root planing is
however a smooth roothowever a smooth root
surface as rough surfacessurface as rough surfaces
are more prone to plaqueare more prone to plaque
accumulation.accumulation.
Calculus can be seen inCalculus can be seen in
radiographs or detectedradiographs or detected
clinically.clinically.

10. Removal of contaminated root surfaceRemoval of contaminated root surface
Pre requisite for new connective tissuePre requisite for new connective tissue
attachmentattachment
Root surface demineralization with citric acidRoot surface demineralization with citric acid
PREPARATION FOR NEW ATTACHMENTPREPARATION FOR NEW ATTACHMENTPREPARATION FOR NEW ATTACHMENTPREPARATION FOR NEW ATTACHMENT
Accelerates new attachment in healing
periodontal wounds

11. To determine efficacy of therapy, therapeuticTo determine efficacy of therapy, therapeutic
goals must first be established. In periodontalgoals must first be established. In periodontal
therapy, our objectives are as follows:therapy, our objectives are as follows:
Suppression or elimination of pathogenicSuppression or elimination of pathogenic
bacteriabacteria
Establishment of a healthy root surfaceEstablishment of a healthy root surface
Conversion of inflamed to healthy tissuesConversion of inflamed to healthy tissues
Reduction of periodontal pocketsReduction of periodontal pockets

12. Scaling and root planingScaling and root planing has both localhas both local
and systemic sequelae.and systemic sequelae.
Locally, the results of scaling and rootLocally, the results of scaling and root
planing are:planing are:
Debridement of bacteria and calculusDebridement of bacteria and calculus
Removal of infected cementum and dentinRemoval of infected cementum and dentin
A shift in the microbial populationA shift in the microbial population

13. Scaling and root planing also hasScaling and root planing also has
systemic effects. These are a bacteremiasystemic effects. These are a bacteremia
and a host immune responseand a host immune response

14. Scaling and root are notScaling and root are not
always the only measuresalways the only measures
that are required in orderthat are required in order
to properly eliminateto properly eliminate
subgingival infection insubgingival infection in
deep pockets.deep pockets.
Waerhaug(1978)Waerhaug(1978)
If, following scaling andIf, following scaling and
root planing, signs ofroot planing, signs of
“bleeding” on probing to“bleeding” on probing to
the bottom of the pocket”the bottom of the pocket”
persist, and if the clinicalpersist, and if the clinical
attachment level fails toattachment level fails to
improve, surgical therapyimprove, surgical therapy
should be consideredshould be considered
since this treatment maysince this treatment may
facilitate more adequatefacilitate more adequate
root debridment .root debridment .
Caffesee etal (1986)Caffesee etal (1986)

15. ACTIVATION OF INSTRUMENTACTIVATION OF INSTRUMENT
Adaptation- lower shank parallelAdaptation- lower shank parallel
Angulation- 45- 90 degree establishedAngulation- 45- 90 degree established
STROKESSTROKES
Stroke lengthStroke length
Stroke directionStroke direction
Stroke activationStroke activation

16. Terminal shank parallel to toothTerminal shank parallel to tooth
long axis.long axis.

17. STROKE DIRECTIONSTROKE DIRECTION
Vertical and oblique strokes are mostVertical and oblique strokes are most
effective strokes for root planing andeffective strokes for root planing and
exploring.exploring.

18. STROKE LENGTHSTROKE LENGTH
Root planing strokes extend from the baseRoot planing strokes extend from the base
of the pocket to the cemento enamelof the pocket to the cemento enamel
junction.junction.
STROKE ACTIVATIONSTROKE ACTIVATION
Wrist forearm motion is the fundamentalWrist forearm motion is the fundamental
means of activation.means of activation.

19. CHANNELS OFCHANNELS OF
INSTRUMENTATIONINSTRUMENTATION

20. FORCE MAXIMIZED BY SCALING INFORCE MAXIMIZED BY SCALING IN
CHANNELS AND BY CONCENTRATINGCHANNELS AND BY CONCENTRATING
PRESSURE ONTO LOWER ONE THIRD OFPRESSURE ONTO LOWER ONE THIRD OF
THE BLADE.THE BLADE.
Overlapping , short powerful stroke- LargeOverlapping , short powerful stroke- Large
calculus removalcalculus removal( Carranza,10( Carranza,10thth
ed)ed)
Root planing stroke- Long lighter overlappingRoot planing stroke- Long lighter overlapping
with less lateral pressurewith less lateral pressure( Carranza,10th ed)( Carranza,10th ed)

21. CHANNELS ON
TOOTH SURFACE

22. HEAVY LATERAL PRESSURE WITHHEAVY LATERAL PRESSURE WITH
SHORT CHOPPY STROKES AFTERSHORT CHOPPY STROKES AFTER
CALCULUS REMOVAL- ROOTCALCULUS REMOVAL- ROOT
SURFACE WITH NICKS AND GOUGESSURFACE WITH NICKS AND GOUGES
HEAVY LATERAL PRESSURE WITHHEAVY LATERAL PRESSURE WITH
LONG STROKES- SMOOTH BUTLONG STROKES- SMOOTH BUT
DITCHED OR GOUGED ROOTDITCHED OR GOUGED ROOT
SURFACESURFACE

23. NUMBER OF STROKESNUMBER OF STROKES
Root modification using periodontalRoot modification using periodontal
curette- 10 to 70 strokescurette- 10 to 70 strokes
20 strokes are sufficient for removing20 strokes are sufficient for removing
cementumcementum
Aggressive root planing involves -10 or 20Aggressive root planing involves -10 or 20
strokes morestrokes more

24. CEMENTUM REMOVALCEMENTUM REMOVAL
U.S scaler-1 to 7.2 μU.S scaler-1 to 7.2 μ
Sonic-4.3 to 7.8 μSonic-4.3 to 7.8 μ
Diamond file- 7.9 to 15.5μDiamond file- 7.9 to 15.5μ
Fine curette- 5 –22μ/strokeFine curette- 5 –22μ/stroke
ULTRASONIC SCALERS REMOVE LESSULTRASONIC SCALERS REMOVE LESS
CEMENTUM BUT LEAVE A ROUGHERCEMENTUM BUT LEAVE A ROUGHER
SURFACE.SURFACE.( KOCHER ET AL 2001)( KOCHER ET AL 2001)

25. Pain and discomfort during SRPPain and discomfort during SRP
Tissue trauma due to inadvertent curettageTissue trauma due to inadvertent curettage
Philstrom( 1999)Philstrom( 1999)
Pain of significant duration, peak in intensityPain of significant duration, peak in intensity
between 2 and 8 hrs post SRP- almost 25 % selfbetween 2 and 8 hrs post SRP- almost 25 % self
medicatedmedicated
Small portions of patients noted root sensitivity ,Small portions of patients noted root sensitivity ,
reduction occurred over 4 weeks . Tammaro etreduction occurred over 4 weeks . Tammaro et
al ( 2006)al ( 2006)

26. PERIDONTALPERIDONTAL
INSTRUMENTATIONINSTRUMENTATION
ACCESSIBILITY:POSITIONING OFACCESSIBILITY:POSITIONING OF
PATIENT AND OPERATORPATIENT AND OPERATOR
VISIBILITY, ILLUMINATIONVISIBILITY, ILLUMINATION
&RETRACTION&RETRACTION
CONDITION AND SHARPNESS OFCONDITION AND SHARPNESS OF
INSTRUMENTINSTRUMENT
MAINTAINING A CLEAN FIELDMAINTAINING A CLEAN FIELD
INSTRUMENT STABILISATIONINSTRUMENT STABILISATION
INSTRUMENT ACTIVATIONINSTRUMENT ACTIVATION

27. INSTRUMENT STABILISATIONINSTRUMENT STABILISATION
INSTRUMENT GRASPINSTRUMENT GRASP
MODIFIED PEN GRASPMODIFIED PEN GRASP
STANDARD PEN GRASPSTANDARD PEN GRASP
PALM AND THUMB GRASPPALM AND THUMB GRASP
FINGER RESTFINGER REST
CONVENTIONALCONVENTIONAL
CROSS ARCHCROSS ARCH
OPPOSITE ARCHOPPOSITE ARCH
FINGER ON FINGERFINGER ON FINGER

28. PEN GRASPPEN GRASP
THE THUMB, INDEX FINGER, & MIDDLETHE THUMB, INDEX FINGER, & MIDDLE
FINGER ARE USED TO HOLDFINGER ARE USED TO HOLD
INSTRUMENT AS PEN IN HELDINSTRUMENT AS PEN IN HELD

29. MODIFIED PEN GRASP:-ENSUREMODIFIED PEN GRASP:-ENSURE
GREATEST CONTROL IN PERFORMINGGREATEST CONTROL IN PERFORMING
INTRAORAL PROCEDURESINTRAORAL PROCEDURES

30. PALM AND THUMB GRASPPALM AND THUMB GRASP
FOR STABILIZINGFOR STABILIZING
INSTRUMENTSINSTRUMENTS
DURING SHARPENINGDURING SHARPENING
AND FORAND FOR
MANIPULATING AIRMANIPULATING AIR
AND WATERAND WATER
SYRINGESSYRINGES

31. FINGER RESTFINGER REST
CONVENTIONAL FINGER REST ISCONVENTIONAL FINGER REST IS
ESTABLISHED ON TOOTH SURFACEESTABLISHED ON TOOTH SURFACE
IMMEDIATELY ADJACENT TOIMMEDIATELY ADJACENT TO
WORKING AREAWORKING AREA

32. CROSS ARCH FINGER REST ISCROSS ARCH FINGER REST IS
ESTABILISHED ON TEETH SURFACE ON THEESTABILISHED ON TEETH SURFACE ON THE
OTHER SIDE OF THE SAME ARCHOTHER SIDE OF THE SAME ARCH
OPPOSITE ARCH FINGER REST ISOPPOSITE ARCH FINGER REST IS
ESTABLISHED TOOTH SURFACE ON THEESTABLISHED TOOTH SURFACE ON THE
OPPOSITE ARCHOPPOSITE ARCH

33. FINGER ON FINGER REST ISFINGER ON FINGER REST IS
ESTABLISHED ON THE INDEX FINGERESTABLISHED ON THE INDEX FINGER
OR THUMB OF THE NONOPERATINGOR THUMB OF THE NONOPERATING
HANDHAND

34. EXRA ORAL FALCRUMEXRA ORAL FALCRUM
FOR EFFECTIVE INSTRUMENTION OFFOR EFFECTIVE INSTRUMENTION OF
SOME ASPECTS OF THE MAXILLARYSOME ASPECTS OF THE MAXILLARY
POSTERIOR TEETHPOSTERIOR TEETH
PALM UP:- FULCRUM IS ESTABLISHEDPALM UP:- FULCRUM IS ESTABLISHED
BY RESTING THE BACKS OF THEBY RESTING THE BACKS OF THE
MIDDLE & FOURTH FINGER ON THEMIDDLE & FOURTH FINGER ON THE
SKIN OVERLYING THE LATERALSKIN OVERLYING THE LATERAL
ASPECTS OF THE MANDIBLE ON THEASPECTS OF THE MANDIBLE ON THE
RIGHT SIDE OF THE SIDERIGHT SIDE OF THE SIDE

35. THE PALM DOWN FULCRUMM IS ESTABLISHED BYTHE PALM DOWN FULCRUMM IS ESTABLISHED BY
RESTING THE FRONT SURFACE OF THE MIDDLE &RESTING THE FRONT SURFACE OF THE MIDDLE &
FOURTH FINGER ON THE SKIN OVERLYING THEFOURTH FINGER ON THE SKIN OVERLYING THE
LATERAL ASPECT OF THE MANDIBLE ON THELATERAL ASPECT OF THE MANDIBLE ON THE
LEFT SIDE OF THE FACELEFT SIDE OF THE FACE