The heart of all periodontal therapy is removal of calculus and plaque from the tooth. Removing debris from the crown of the tooth is often referred to as scaling, while root planing (debridment) refers to cleaning the root below the gum. This procedure is also referred to as deep cleaning. To successfully treat periodontal disease it is necessary to adequately debride the periodontal pocket. This is generally accomplished using curettes and/or ultrasonic scalers, although rotary instruments may be useful. Adequately cleaning a periodontal pocket takes time and skill, and many feel it is the most technically demanding procedure performed by dentists. Often a local anesthetic is used to assure patient comfort.
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| Scaling and Root Planing | |
With early and moderate pockets, up to 4 mm in depth, adequate pocket debridement is generally possible. However, with pockets greater than 4 mm, much of the root calculus is missed. One study has shown that even following instrumentation for periods of 25-42 minutes on a single tooth, the average depth for removal of all plaque and calculus was only 3.7 mm below the gumline (Stambaugh 1981)! Other studies demonstrated that the ability to completely clean a root surface decreased as the pocket depth increased (see graph), with an effective cleaning of only 32% when the pocket was greater than 6 mm (Caffesse 1986)
These studies, along with many others, demonstrate that nonsurgical debridement alone is inadequate to clean the root surfaces in pockets ³5 mm. Therefore, surgical intervention is necessary in order to access and clean the root surfaces. This minor surgical procedure consists of making a small incision to push back the gum edge, allowing access to deeper areas. This is known as open flap curettage, and is done under local anesthesia. Sutures are generally used, but there is little post-operative discomfort.
Graph caption – The relationship between the pocket depth (mm) and the ability to completely clean the root surface of plaque and calculus (Caffesse 1986)
