Scaling and root planing
I – introduction:
Periodontal disease is a multifactorial disease that causes more or less disabling sequelae on the functional level for the dental organ. The treatment of periodontal diseases is therefore divided into four stages;
– an etiological treatment phase called initial therapy during which, among several procedures, scaling-polishing-root surfacing is carried out.
– a phase of reassessment of the results of the initial therapy. This reassessment is decisive for whether or not corrective treatment is carried out.
– a stage of treatment of the after-effects of the disease called corrective treatment. It also addresses the correction of anatomical defects favoring the development of periodontal disease as well as “occlusal rehabilitation”.
– a maintenance phase to perpetuate the results obtained during the treatment.
II – definition of descaling:
This is a major therapeutic procedure whose main action is the elimination of tartar deposits above and below the gingival surface. This procedure can be performed on natural or artificial teeth. It is a procedure that requires very high tactile sensitivity.
III- definition of root surfacing:
It is the removal of necrotic and infiltrated cementum in order to obtain a smooth and hard surface to promote the healing of periodontal tissues (the reattachment of periodontal tissues on the root surface). A distinction can be made between “open” root planing performed during surgical debridement of periodontal pockets and blind root planing without detachment of the gingival flap.
IV- the different types of tartar:
- Supragingival tartar: called salivary, light yellow or whitish in color, breakable and crumbly and often located opposite the excretory ducts of the salivary glands (retroincisive area and vestibular region of the first upper molars)
- Subgingival tartar: called serum, dark in color (brown or black turning green) of firm consistency, hard, adheres to the cementum walls, this type is of serum origin (gingival fluid).
The calcified mass is fixed either by means of a film adhering to the enamel or directly on the surface of the tooth by taking advantage of its irregularities and this is observed at the level of the cementum.
V- purpose and indications of descaling and its limits:
- Aim :
- Prophylactic: allows the prevention of periodontal diseases and oral diseases in general
- Curative goal: in certain periodontal diseases, scaling may be sufficient to cure the disease.
- Associated with other therapies while occupying a very important place.
- In uncooperative and unmotivated patients, scaling is the only feasible therapy within the framework of periodontal treatment, regardless of the severity of the periodontal disease.
- directions:
All forms of periodontal diseases, especially those caused by bacterial plaque.
- Contraindications:
There are no absolute contraindications to scaling but there are cases of patients with a general disease with a high risk of infection who require antibiotic prophylaxis measures given that scaling and root planing is often a bloody procedure causing septicemia.
- boundaries:
Manual access, and to a lesser extent, visual access to the dental surface to be scaled is necessary for the procedure to be carried out properly. As a result, the possibility of performing scaling and root planing is limited by:
– the presence of obstacles preventing access to the dental surface (example: overflowing filling, orthodontic appliance, prosthetic restoration, etc.)
– presence of anatomical irregularities making access to tartar difficult (example: furcation areas, longitudinal grooves, posterior surfaces of posterior teeth, etc.)
– narrow and deep periodontal pocket
– in case of failure and recurrence of inflammation despite free access to instruments.
VI- instrumentation:
- manual instrumentation:
We distinguish:
– scalers (hoes, interdental, scissors) useful for supra or subgingival scaling
– files and curettes; in addition to their usefulness for scaling, these instruments are especially effective for root planing.
- Sonic instrumentation:
It works by using compressed air to vibrate an insert at frequencies below 6000 Hz (2000 to 6000 cycles per second).
- Ultrasonic instrumentation:
Used for over 40 years.
Ultrasonic generators use frequencies varying between 25,000 and 50,000 Hz and act by vibration, transforming the electric current into vibration, generating heat as a side effect, hence the need for water irrigation to avoid heating the inserts.
- Rotating instruments:
For example, the PERIPLANER contra-angle system is useful for subgingival scaling and root planing.
Manual scaling remains the benchmark action, and associated with mechanized scaling, we improve the comfort conditions for the patient and the practitioner and, above all, we reduce the pressure and traction constraints on the root and periodontal tissues.
VII- results:
Scaling and root planing cause the inflammation to disappear and therefore the erythema, bleeding and edema to disappear.
- In case of gingivopathies:
Erythematous gingivitis and gingivitis with slight edema, complete healing is achieved after scaling and polishing and the false pockets disappear.
Hypertrophic gingivitis: the results depend on the presence or absence of fibrosis reaction within the gingival connective tissue.
Hyperplastic gingivitis: disappearance of signs of inflammation but persistence of irregularity of the gingival architecture.
- In case of periodontal disease:
Results are possible in cases of periodontitis with periodontal pockets whose bottom and contents are accessible to root planing and scaling instruments, otherwise a gingival flap detachment and open root planing and scaling are necessary for periodontal healing.
The results sought after scaling and root planing that can be obtained are:
- Disappearance of signs of inflammation (erythema, edema and bleeding)
- Reduction of the depth of the gingival sulcus and in optimal cases we obtain a restoration of a normal depth of this sulcus (0.5-2mm) which means elimination of real pockets.
- Reduction of tooth mobility.
- Histology:
The availability of a healthy cement surface obtained after scaling-root planing promotes the formation of a “new epithelial-connective cicatricial attachment” thus allowing the reduction of the depth of the gingivo-dental groove and a “gain of attachment” sign of stabilization and/or stopping of the pathological process of periodontal disease.
CONCLUSION :
Scaling and root planing is one of several procedures (patient motivation, learning brushing methods, removing plaque retention factors, etc.) that are performed as part of the initial therapy in order to eradicate the etiology of periodontal disease and automatically the signs of inflammation. None of these procedures can be separated from the others.
Good tactile sense and a methodical mindset are factors in the successful removal of tartar, without forgetting the ergonomic aspect relating to the working position and the sharpening of scaling and root planing instruments.
Scaling and root planing
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