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Rationale for scaling and root planing

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Process by which residual embedded calculus and portion of cementum are removed ... are frequently embedded in cemental irregularities ( Zander,1953; Moskow, 1969) ... – PowerPoint PPT presentation

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Title: Rationale for scaling and root planing


1
Rationale for scaling and root planing
2
Scaling
Root Planing
  • Process by which plaque and calculus are removed
    from both supra and subgingival tooth surface.
  • Process by which residual embedded calculus and
    portion of cementum are removed from the root to
    produce a smooth, hard and clean surface

3
Changes in root surfaces in periodontitis
  • Plaque and Calculus deposition.
  • Supra and subgingival calculus have a rough
    surface capable of harboring plaque that cannot
    be removed by conventional oral hygiene
    techniques.
  • Bauhammers et al,1973.

4
Changes in root surfaces in periodontitis
  • B. Alterations in exposed cementum
  • Hypermineralized surface zone
  • Changes in organic matrix
  • Endotoxins cytotoxic in tissue culture
  • Aleo et al , 1974

5
Primary objective
  • Restoration of gingival health
  • Scaling and root planing are not separable
    procedures

6
  • Before Scaling Root Planing
  • After Scaling Root planing

7
  • Scaling and root planing are a prerequisite for
    the arrest and cure of periodontal disease
    together with plaque control, they constitute the
    major means by which the disease is prevented.

8
  • Careful subgingival scaling and root planing is
    an effective mean to eliminate gingivitis and
    reduce the probing depth even at sites with
    initially deep periodontal pockets.
  • Badersten, 1984

9
Subgingival scaling and root planing are
measures which can be effective in
  • Eliminating inflammation
  • Reducing probing depths
  • Improving clinical attachment

10
Objectives Of Root Planing
  • Securing biologically acceptable root surfaces
  • Resolving inflammation
  • Decreasing pocket depth
  • Facilitating oral hygiene procedures
  • Improving or maintaining attachment level
  • Preparing the tissues for surgical procedures

11
  • Scaling and root planing is an integral part of
    periodontal therapy. The rationale for scaling
    and root planing is the following
  • Removal of calculus and "infected" root structure
  • Achievement of a smooth root surface which is
    less prone to plaque accumulation

12
Rationale for root planing
  • Garret in 1977 set forth the rationale for root
    planing
  • Root Smoothness
  • Removal of Diseased Cementum
  • Preparation for New Attachment

13
Root Smoothness
  • No biological evidence which relates smooth root
    surfaces to decreased plaque formation or
    increased ease of removal.
  • It remains the only clinical indicator of
    calculus removal available at present.

14
  • Recent data suggests that root structure removal
    is not necessary. The end point of scaling and
    root planing is however a smooth root surface as
    rough surfaces are more prone to plaque
    accumulation.
  • Calculus can be seen in radiographs or detected
    clinically.

15
Removal of Diseased Cementum
  • Removal of exposed cementum by root planing, the
    fibroblasts adhered to both diseased and non
    diseased areas of the root.
  • Aleo et al, 1975.

16
  • Deposits of calculus on root surfaces are
    frequently embedded in cemental irregularities (
    Zander,1953 Moskow, 1969)
  • Scaling alone is therefore insufficient to remove
    calculus. A portion of cementum must be removed
    to eliminate these deposits.

17
Preparation for New Attachment
  • Root planing plays an important role in preparing
    root surfaces for demineralization and subsequent
    new attachment

18
  • To determine efficacy of therapy, therapeutic
    goals must first be established. In periodontal
    therapy, our objectives are as follows
  • Suppression or elimination of pathogenic bacteria
  • Establishment of a healthy root surface
  • Conversion of inflamed to healthy tissues
  • Reduction of periodontal pockets

19
  • Scaling and root planing has both local and
    systemic sequelae.
  • Locally, the results of scaling and root planing
    are
  • Debridement of bacteria and calculus
  • Removal of infected cementum and dentin
  • A shift in the microbial population

20
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21
  • Scaling and root are not always the only measures
    that are required in order to properly eliminate
    subgingival infection in deep pockets.
  • Waerhaug(1978)
  • If, following scaling and root planing, signs of
    bleeding on probing to the bottom of the
    pocket persist, and if the clinical attachment
    level fails to improve, surgical therapy should
    be considered since this treatment may
    facilitate more adequate root debridment .
  • Caffesee etal (1986)

22
  • The microbial shift is effected by two
    mechanisms
  • The removal of bacteria by scaling and root
    planing
  • The clinical outcome of scaling and root planing
    which alters the environment favoring population
    by certain bacteria over others
  • Decreased pocket depth
  • Smooth root surfaces
  • Reduction of inflammation

23
  • Scaling and root planing also has systemic
    effects. These are a bacteremia and a host immune
    response

24
Incidence of Bacteremia During Different Dental Procedures Heimdahl, et al., 1990 Incidence of Bacteremia During Different Dental Procedures Heimdahl, et al., 1990 Incidence of Bacteremia During Different Dental Procedures Heimdahl, et al., 1990 Incidence of Bacteremia During Different Dental Procedures Heimdahl, et al., 1990
Surgical Procedure of Patients with Bacteremia Viridans group streptococci Anaerobes
Dental Extraction 100 85 75
Scaling and Root Planing 70 55 65
Third Molar Surgery 55 40 45
Endodontic Treatment 20 15 5
Bilateral Tonsillectomy 55 40 40
25
  • Based on this study it can be seen that
    immediately after undergoing scaling and root
    planing the majority of patients (70) will have
    a bacteremia.
  • The same study also showed that ten minutes after
    the procedure, the incidence of bacteremia is
    down to 30.
  • This indicates that the host immune response is
    effective in eliminating the bacteria from the
    bloodstream, resulting in the rapid decline in
    the recovery of bacteria. For this reason, it is
    referred to as a transient bacteremia.

26
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27
The Efficacy of Scaling and Root Planing
  • A study published in 1987, by Buchanan and
    Robertson, examined teeth (treatment planned for
    extraction) that were scaled and root planed for
    12-15 minutes each, subsequently extracted and
    examined microscopically for residual calculus.
    Results were recorded as percentages of calculus
    positive teeth (CPT) and calculus positive
    surfaces (CPS). These were compared to similarly
    examined teeth that received no treatment prior
    to extraction.

28
The Efficacy of Scaling and Root Planing
Effect of Scaling and Root Planing on Calculus RemovalBuchanan and Robertson, 1987 Effect of Scaling and Root Planing on Calculus RemovalBuchanan and Robertson, 1987 Effect of Scaling and Root Planing on Calculus RemovalBuchanan and Robertson, 1987 Effect of Scaling and Root Planing on Calculus RemovalBuchanan and Robertson, 1987
Treatment Probing Depth (mm) CPT CPS
None 6.0 2.6 100 82
S/RP 5.7 2.4 62 24
Even on treated teeth, a fairly high percentage
of calculus was remained after scaling and root
planing.
29
  • When comparing calculus removal by tooth type,
    tooth surface and probing depth, the results were
    fairly in keeping with logic .

30
The Efficacy of Scaling and Root Planing
Calculus Positive Surfaces After S/RP by Tooth TypeBuchanan and Robertson, 1987 Calculus Positive Surfaces After S/RP by Tooth TypeBuchanan and Robertson, 1987 Calculus Positive Surfaces After S/RP by Tooth TypeBuchanan and Robertson, 1987 Calculus Positive Surfaces After S/RP by Tooth TypeBuchanan and Robertson, 1987
Treatment Anterior Teeth Premolars Molars
None 87 75 83
S/RP 19 29 26
31
The Efficacy of Scaling and Root Planing
Calculus Positive Surfaces After S/RP by Tooth SurfaceBuchanan and Robertson, 1987 Calculus Positive Surfaces After S/RP by Tooth SurfaceBuchanan and Robertson, 1987 Calculus Positive Surfaces After S/RP by Tooth SurfaceBuchanan and Robertson, 1987 Calculus Positive Surfaces After S/RP by Tooth SurfaceBuchanan and Robertson, 1987 Calculus Positive Surfaces After S/RP by Tooth SurfaceBuchanan and Robertson, 1987
Treatment Mesial Distal Facial Lingual
None 91 96 64 77
S/RP 28 41 17 10
32
The Efficacy of Scaling and Root Planing
Calculus Positive Surfaces by Probing DepthBuchanan and Robertson, 1987 Calculus Positive Surfaces by Probing DepthBuchanan and Robertson, 1987 Calculus Positive Surfaces by Probing DepthBuchanan and Robertson, 1987 Calculus Positive Surfaces by Probing DepthBuchanan and Robertson, 1987 Calculus Positive Surfaces by Probing DepthBuchanan and Robertson, 1987 Calculus Positive Surfaces by Probing DepthBuchanan and Robertson, 1987
Treatment 0-2 2.1-4 4.1-6 6.1-8 gt8
None 67 69 84 90 88
S/RP 2 14 24 36 45
33
  • These data indicate that generally calculus is
    harder to remove in the posterior teeth as
    compared to anterior teeth, or with proximal
    surfaces as compared to facial or lingual/palatal
    surfaces, and in deeper pockets as compared to
    more shallow pockets.
  • An interesting point is that calculus removal by
    scaling and root planing was more efficient in
    the molar region than in the premolar region, but
    only slightly so.

34
  • The endpoint of clinical therapy is the
    elimination of inflammation. To achieve this,
    open debridement may be required in addition to
    scaling and root planing, and treatment may be
    aided by chemotherapeutic agents.
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