Scaling and root planing (SRP) is a periodontal procedure that involves removing plaque, calculus, and toxins from tooth surfaces to treat periodontal disease. SRP includes: 1) Scaling to remove calculus and plaque from above and below the gumline. 2) Root planing to smooth root surfaces and remove calculus embedded deep within pockets. 3) Using instruments like curettes and ultrasonic scalers carefully and precisely to remove all calculus while minimizing trauma to soft tissues. Proper technique and multiple appointments may be needed for deep cleaning depending on the amount of calculus and a person's oral health status. SRP is a key part of periodontal therapy but requires skill to perform it

1. SCALINGANDROOT PLANING
PRINCIPLES OF SCALING AND ROOT PLANING.
Dr. Laxmi Pandey

2. SCALING :- It is the process by
which biofilm and calculus are
removed from both supragingival
and subgingival tooth surface.
ROOT SCALING :- It is the
process by which residual embedded
calculus and portions of cementum
are removed from the roots to
produce a smooth, hard, clean
surface.
NOTE:-BUT SCALING & ROOT
PLANING SHOULD NOT BE
VIEWED AS SEPARATE
PROCEDURE.
DEFINATION

3. OBJECTIVE :-
1. To restore gingival health by
completely removing elements
that provoke gingival inflammation
(i.e. biofilm, calculus, and
endotoxin) from the tooth
surface.
2. Reduces and procedure a shift in
the composition of gingival biofilm
from one with high no. of gram-
negative anaerobes to one
dominated by gram- positive
facultative bacteria compatible
with health.
3. This microbial change can be
sustained by the periodic scaling
amd root planing performed
during periodontal therapy.
RATIONALE

4. Scaling alone is sufficient to remove biofilm and calculus completely from
enamel ,leaving a smooth clean surface .
Deposits of calculus on root surfaces are frequently embedded in
cemental irregularities.
A portion of the root surface must be removed to eliminate deposits
because when dentin is exposed ,biofilm bacteria may invade dentinal
tubules .
But removal of extensive amount of dentin and cementum is not
necessary to render the roots free of toxins and should be avoided.
In areas where cementum is thin, dentin may get exposed, although it is
not the aim of treatment, such exposure is unavoidable.
Pt. with small amount of calculus and relatively healthy tissues can be
treated in one appointment

5. No. of appointment needed is estimated on the basis of the no. of teeth in the
mouth, severity of inflammation, amount and location of calculus, depth and
activity of pockets, presence of furcation invasions, pt. comprehension and
compliance with oral hygiene instructions, and need for LA.
Of all clinical dental procedure, subgingival scaling and root planing in the deep
pockets are the most difficult and exacting skills to master.

6. Visual examination of supragingival and subgingival calculus just below the
gingival margin is not difficult with good lighting and clean field.
Light deposits of supragingival calculus are often difficult to see when they
are wet with saliva.
Compressed air may be used to dry supragingival calculus until it is chalky white
and readily visible. Air also may be directed into pocket in a steady stream to
deflect the marginal gingiva away from the tooth so that subgingival deposits
near the surface can be seen.
Tactile exploration which is much more difficult than visual examination is
performed by explorer or probe with light but stable modified pen grasp.
When calculus is encountered, the tip of the instrument should be advanced
apically over the deposits until the termination of the calculus on the root is
felt.
DETECTION SKILLS

7. The distance between the apical edge of the calculus and the bottom of
the pocket usually ranges from 0.2mm to 1.0mm.
When a proximal surface is being explored, strokes must be extended at
least halfway across that surface past the contact area to ensure complete
detection of interproximal deposits.
Beginning students usually has difficulty detecting the fine calculus and
altered cementum.
Such detection should be done with recognition of ledges, lumps or spurs
of calculus, then smaller spicules, then slight roughness and finally a slight
graininess that feels like a sticky coating or film covering the tooth
surface.
Over hanging or deficient margins of dental restoration, caries,
decalcification and root roughness caused by previous instrumentation are
typically found during exploration.

8. Supragingival calculus is generally less tenacious and less calcified than
subgingival calculus.
Sickle, curettes and ultrasonic and sonic instruments are most often used for
the removal of supragingival calculus, hoes and chisels are less frequently
used.
HOW TO USE SICKLE OR CURETTE:-
 Modified pen grasp
 Firm finger rest on the teeth adjacent to the working area.
 Blade angle with the surface to be scaled is slightly less then 90°.
 If the tissue is retractable enough to allow easy insertion of the bulky
blade ,the sickle may be used slightly below the free gingival margin.
SUPRAGINGIVAL SCALING
TECNIQUE.

9. Much more difficult to perform than supragingival scaling.
Subgingival calculus is usually harder than supragingival calculus and is oftren
locked into root irregularities making it more tenacious and is therefore more
difficult to remove.
Vision is obscured by the bleeding that inevitably occurs during
instrumentation and by the tissue itself.
The clinician must rely heavily o tactile sensitivity to detect calculus and
irregularities.
In addition ,the adjacent pocket wall limits the direction and length of the
strokes.
The complex and precise co-ordination of visual, mental and manual skills
makes it one of the most difficult of all dental skills.
SUBGINGIVAL SCALING AND
ROOT PLANING TECHNIQUE

10. • The curette is preferred by most clinicians
for subgingival scaling and root planing
because the advantages offered by its
design.
• Its curved blade , rounded toe, and curved
back allow the curette to be inserted to the
base of the pocket and adapted to
variation in tooth contour with minimal
tissue displacement and trauma.
• Sickles , hoed, files, and ultrasonic
instrument also are used for subgingival
scaling of heavy calculus.
• Small files (but not the larger ones) may be
inserted to the base of the pocket to crush
or initially fracture tenacious deposits but
• Hoes , files and standard large ultrasonic
tips are all more hazardous than the
curette in terms of trauma to the root
surface and surrounding tissues.

11. Subgingival scaling and root planing are accomplished with
either universal or area- specific ( Gracey ) curettes.
HOW TO USE CURETTE:-
 Modified pen grasp and stable finger rest is established.
 Lower shank is kept parallel to the tooth surface : and
moved toward the tooth so that the face of the blade is
nearly flush with the tooth surface.
 Light exploratory stroke.
 Angle between cutting edge and tooth to be scaled is
between 45° − 90° with lateral pressure against tooth
surface.
 Calculus is removal by a series of controlled,
overlapping , short powerful strokes primarily using
wrist arm motion.
 The instrument handle must be rolled carefully between
the thumb and finger to keep the blade adapted closely
to the tooth surface as line angles , development
depression and other changes in tooth contour are
followed.

12. Scaling and root planing strokes should be configured
to the portion of the tooth where calculus or altered
cementum is found: this area is known as the
instrumentation zone.
The amount of lateral pressure applied to the tooth
surface depends on the nature of the calculus and
whether the strokes are initial calculus removal or final
root planing.
If heavy lateral pressure is continued , the result will be
a rough surface roughened by numerous nicks and
gouges , resembling th surface of a washboard.
To avoid hazards of over instrumentation , a deliberate
transition from short , powerful scaling strokes to
longer lighter root planing strokes must be made as
soon as the calculus and initial roughness have been
eliminated.

13. Engaging large , tenacious ledge or piece of calculus with the entire length of
cutting edge is not recommended because the force is distributed through a longer
section of the cutting edge rather than concentrated.
Much more lateral pressure is required to dislodge the entire deposit in one stroke.
When a series of repeated whittling strokes is applied the calculus may be reduced
to a thin smooth , burnished sheet that is difficult to distinguish from the
surrounding root surface.
For proximal surface it is extremely important to extend strokes at least halfway
across the proximal surfaces so that no calculus or roughness remains in the
interproximal area.
With the lower shank of curette parallel to the long axis the blade of the curette
will reach the base of the pocket and the toe will extend beyond the midline as
strokes are advanced across the proximal surface.

14. The relationship between the location of finger rest and the working area is
for two reason.
1. The finger or fulcrum must be position to allow the lower shank of the
instrument to be parallel or nearly parallel to the tooth surface being
treated .this parallelism is a fundamental requirement for optimal working
angulation.
2. The finger rest must be close enough to the working area so as to fulfill
these requirements.
Effective wrist arm motion is possible only when these 2 fingers are kept
together in a built up-fulcrum.
As instrumentation proceeds from one tooth to the next the body position of
the operation and the location of finger rest must be frequently adjusted or
hanged to allow parallelism and wrist arm motion.

16. THE FOLLOWING APPROACHES MAY PROVIDED MAXIMAL
EFFICIENCY FOR THE CLINICIAN AND COMFORT FOR THE PATIENTS.

23. THANKYOU