Scaling and root planing
Introduction : Scaling is a major therapeutic act in dental practice in general. In periodontics, it is one of the fundamental bases of etiological treatment.
1-Reminder on tartar : tartar is a calcification of dental plaque which is deposited on the teeth as well as on all other solid structures in the oral cavity.
2-Classification of tartar:
1-Supragingival tartar : located above the gingival margin and extends in the coronal direction. Yellow (light) in color and easily detachable. Its salivary origin explains its superficial location with regard to the excretory ducts of the salivary glands (lingual surfaces of the lower incisors and vestibular surfaces of the upper molars). It is not very adherent to colonized surfaces and is easily stained by tobacco, tea, food or products of bacterial catabolism.
2-Subgingival tartar : or serum tartar located in the gingivodental sulcus of brown color, firmly adherent to the dental surfaces (roots). It is formed from the components coming from the gingival fluid. It is visualized by separating the marginal gingiva with a periodontal probe or an air jet.
3- Definitions
– Descaling : therapeutic procedure eliminating tartar deposits, plaque and discoloration from coronal and root surfaces.
-Root surfacing : this is the removal of softened cementum and dentin surfaces that are rough or have tartar, infiltrated with toxins or microorganisms.
When these terms are used together (scaling and root planing), they define non-surgical procedures performed blindly without flap reclination, the root surface not being accessible to visual inspection.
4-Pathogenic power of tartar
-Reservoir of toxins and bacterial enzymes which maintain the inflammatory process.
-The solidity of deposits promotes the opening of the furrow allowing bacterial penetration more apically.
-The rough surface of tartar promotes microbial anchoring.
5-Purposes of scaling and surfacing:
-remove tartar above and below the gums
-reduce inflammation
-reduce pocket depth
-Allow easier cleaning of root surfaces by the patient and practitioner by providing harder, smoother and cleaner surfaces.
-significantly reduce the bacterial mass by disorganizing the biofilm and the bacterial endotoxins impregnating the cementum which is described as infiltrated.
6-Indications for descaling:
-Preparation for surgery (initial treatment).
-general condition contraindicating complex surgical procedures or long work sessions.
-Gingivopathies of inflammatory origin.
-Early and moderate periodontitis.
-Acute phase of periodontal diseases such as periodontal abscess (relieve pain, initiate healing processes).
-reassessment and maintenance.
Scaling and root planing
7-Indications for root planing :
– initial treatment of all periodontal pockets
It is now clearly established that scaling and root planing is indicated for all types of periodontitis, whether or not it is associated with antibiotic treatment depending on the diagnosis.
8-Contraindication of descaling
Relatives : require the agreement of the attending physician and antibiotic coverage
– Unbalanced diabetics
– Heart valve carriers
– History of RAA – Renal disorders
– Patients taking anticoagulants
– Poorly balanced hypertension.
– Subjects weakened by renal, nervous or endocrine damage
-Organ transplant recipients.
Formal
Haemophilia.
-White series hemopathies.
-Patients on intense corticosteroid therapy.
-OSLER disease and severe life-threatening heart disease.
– AIDS.
9-Contraindication of surfacing
-patient at high risk of developing an infectious focus (cardiopathy at Oslerian risk).
Scaling and root planing
10-Operating protocol
-lay an operating field
– administer local anesthesia and containment if necessary.
-work sequentially (tooth by tooth, sector by sector)
– The steps of descaling:
- removal of tartaric stones.
- polishing of dental surfaces.
-Apply a surgical dressing if necessary.
– surgical aspiration is used because extensive irrigation is essential to flush out the detached debris; deposits adhering to the cementum can then be visualized.
For root planing anesthesia is essential because:
-presence of soft tissue pain
-At the root level, the work aims to eliminate the cement reaching the dentin, which produces painful effects.
-the anesthesia reduces the bleeding which will be very abundant due to the inflammation of the tissues.
-ensure patient comfort for a safe procedure.
Post-operative care : eliminate acidic foods, advise warm liquids (due to the sensitivity of the necks). In the case of pronounced edema or erythema, applying a surgical dressing promotes healing.
11-Instrumentation
1-Hand instruments
-curettes
– instruments for descaling: sickles, hoes, files.
Hoes : Hoe-shaped scrapers are particularly designed to smooth cement surfaces. They are very rigid instruments used to remove large amounts of tartar above and below the gingival surface. They are used only with a pulling motion. They are used for the v and l faces of posterior teeth, as well as on the distal face of the last molars. However, they can also be used on the proximal faces of teeth adjacent to an endentation.
Sickles : The sickle scaler is specifically indicated for the removal of tartar in narrow interproximal spaces, particularly in the anterior sector.
Curettes : are used to remove scale from the anterior and posterior parts of the arch. They perform curettage of fine stones and pre-polishing of the root canal.
Among these instruments, we can cite the GRACEY curettes numbered from 1 to 14:
-The first 6 for the anterior teeth
-The following 4 for the vestibular and lingual surfaces of the posterior teeth.
-The last 4 for the mesial and distal surfaces of the posterior teeth.
Curettes are universal with two cutting edges or specific to a particular area with a single cutting edge. They are used in traction.
2-Mechanical instruments: surgical aspiration is required.
Scaling and root planing
-Indications:
-Bleeding gums, inflammation, tissue hypersensitivity (GUNA)
-Detersion of lesions by spraying antiseptics
– ultrasonic devices should only be used as a complement to manual instruments and never replace them.
-Contraindications:
– pace-makers
-infectious diseases (AIDS, tuberculosis)
Ultrasonic instruments
Ultrasonic generators use frequencies ranging from 25,000 to 50,000 Hz (20,000 to 40,000 cycles/second). Several insert shapes have been developed, with round, rectangular and diamond-shaped sections with blunt or sharp edges.
Ultrasonic devices are used for plaque, tartar and stains. Ultrasonic scaling makes surfaces rough, which is why it has been suggested to combine the use of hand instruments to smooth dental surfaces.
Sonic instruments : They work by vibrating an insert at frequencies below 600Hz (2000 to 6000 cycles/second). Sonic scaler inserts generally have a smaller tip than ultrasonic scalers, which provides more tactile sensitivity.
Technique used: scaling is achieved by vibrating the tip of the instrument, with projection of cooling liquid (water, antiseptic solution). The tip of the instrument is applied to the tooth with very light pressure and moved back and forth so that the vibrations are parallel to the surface of the tooth.
12- New technologies
LASER: Laser has been proposed to replace conventional manual and/or ultrasonic instrumentation. Although its bactericidal action is controversial, it has the ability to eliminate granulation tissue, which could facilitate access to certain difficult sites.
By vaporizing the water from the tartar residues, the laser increases the pressure and explodes these deposits, but any thermal damage should be avoided. Used alone or as an adjuvant to scaling and root planing, the laser gives similar results and is not superior to scaling and root planing alone in terms of the amount of tartar removed, bleeding indices, attachment gain, and bone gain. Only the operating time is shortened and greater comfort for the patient with less pain are clearly identified. Finally, the high cost of the device does not make it efficient in terms of cost/benefit ratio. The laser radiation usable in odontostomatology is located in the infrared, which is an invisible part of the electromagnetic wave spectrum located in wavelengths greater than 800 nm.
Scaling and root planing
13-Healing:
-after one week: the marginal inflammation is regressing
-after 15 days: reappearance of gingival pitting
-after 21 days: the gum returns to its normal morphology.
Conclusion : Scaling and surface treatment has long been recognized as the etiological treatment of periodontal disease. Today, it is evolving towards a more conservative act of periodontal tissues. These therapies, when well conducted, are often sufficient in the treatment of chronic periodontitis in terms of reducing inflammation and pocket depth as well as in gaining attachment.
As part of the maintenance phase, scaling and root planing plays a key role in maintaining periodontal health.
Scaling and root planing
Bibliography:
– BARREL
-EP BENQUET E.JAQUET descaling EMC23601 C10 12-1975
-Gérard Rey-Patrick Missika periodontal and laser treatments in general dental practice, effective simplicity
-Philippe Bouchard periodontology implant dentistry volume 1- periodontal medicine
-P.Laffargue, S.Saliveres, E.Challot, F.Jame, P.Gilbert scaling and root planing EMC 23-445-E-12 (2004)
– Non-surgical periodontal therapeutic EMCs.
Scaling and root planing
Untreated cavities can reach the nerve of the tooth.
Porcelain veneers restore a bright smile.
Misaligned teeth can cause headaches.
Preventative dental care avoids costly treatments.
Baby teeth serve as a guide for permanent teeth.
Fluoride mouthwash strengthens tooth enamel.
An annual checkup helps monitor oral health.