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

Guity M Rabbani , Major M Ash & Raul G CaffeseeJOURNAL OF PERIODONTOLOGY ; MARCH 1991

Dr Shivani IyerPG 1ST YEAR

CONTENTS

1. INTRODUCTION 2. AIM OF THE STUDY3. MATERIALS AND METHODS 4. RESULT5. DISCUSSION6. CONCLUSION 7. REFERENCES

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.

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

Stripped Of Periodontal Attachment

Contains Remnants Of Embedded Calculus , Bacteria

Exposed To Septic Contents Of Periodontal Pocket

2. CHANGES SEEN IN THE DISEASED CEMENTUM

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

RATIONALE FOR SCALING & ROOT PLANING

To restore gingival health by completely removing elements that provoke gingival inflammation.

RATIONALE FOR ROOT PLANING

Garret in 1977 * set forth the rationale for root planing

Root SmoothnessRemoval of Diseased CementumPreparation for New Attachment

*Garrett JS : Root planing : A Perspective .J Periodontol 1977 Sep;48(9):553-7

*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

AIM OF THE STUDY

a. Whether any correlation exists between remaining calculus & depth of the pocket.

b. Whether the type of tooth scaled ( anterior or posterior ) will influence the amount of remaining calculus.

MATERIALS AND METHODS

STUDY FLOWCHART

Advanced Periodontitis Patients selected N= 25

EXPERIMENTAL TEETHN = 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

RESULTS

Correlation Between Percent Of Calculus & Pocket Depth On Scaled & Unscaled Teeth.

VARIABLE N r PSCALED 62 0.060 <0.01

UNSCALED 57 0.50 <0.01

RELATION BETWEEN PERCENT OF CALCULUS & POCKET DEPTH ON SCALED TEETH

RELATION BETWEEN PERCENT OF CALCULUS & POCKET DEPTH ON UNSCALED TEETH

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 completeRemoval of calculus from root surfaces is difficult.

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 subgingivalscaling and root planing are due to lack of visual control.

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.

In addition, calculus is likely to be inaccessible to the sealer if it islocated 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.

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.

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 intreating deep pockets.

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.

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