PERIODONTOLOGY DEPARTMENT

FACULTY OF DENTISTRY
HASANUDDIN UNIVERSITY

Scalling and Root

Planning
Fakrina Fathu Rahman (J014201006)
Khaerunnisa Ika Handayani (J014201094)
Classification of Periodontal
Instruments

◎ Periodontal instruments are classified according to the purposes

they serve, as follows:
1. Periodontal probes are used to locate, measure, and mark pockets,
as well as determine their course on individual tooth surfaces.
2. Explorers are used to locate calculus deposits and caries.
3. Scaling, root-planing, and curettage instruments are used for
removal of biofilm and calcified deposits from the crown and root of
a tooth, removal of altered cementum from the subgingival root
surface, and debridement of the soft tissue lining the pocket.
Classification of Periodontal
Instruments

4. Periodontal endoscopes are used for deep visualization into

subgingival pockets and furcations, thereby allowing the detection of
deposits.
5. Cleansing and polishing instruments, such as rubber cups, brushes,
and dental tape, are used to clean and polish tooth surfaces. Air-
powder abrasive systems are also available for supragingival and
subgingival cleaning and polishing of tooth, root, and implant
surfaces.
The parts of each instrument are referred to as the
working end, shank, and handle

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1. Periodontal probes

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2. Explorers

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 3. Scaling and Curettage Instruments

◎ A. Sickle scalers

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B. Curettes

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B.1. Universal Curettes

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B.2. Area-Spesific Curettes

Gracey Curettes
◎ Gracey #1-2 and #3-4: Anterior teeth
◎ Gracey #5-6: Anterior teeth and
premolars
◎ Gracey #7-8 and #9-10: Posterior
teeth, facial and lingual

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 Gracey Curettes
Gracey #11-12: Posterior teeth, mesial Gracey #13-14: Posterior teeth, distal

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Gracey Curettes

◎ Gracey #15-16 is not essential

◎ Gracey #17-18 is a modification of
the #13-14

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◎ Extended-Shank Curettes

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◎ Mini-Bladed Curettes

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◎ Periodontal Maintenance Langer and Mini-Langer Curettes
Curettes

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Schwartz Periotrievers

◎ Schwartz Periotrievers
comprise a set of two
double-ended, highly
magnetized instruments
designed for retrieval of
a broken instrument tip
from the periodontal
pocket

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Plastic and Titanium Instruments for Implants

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Plastic and Titanium Instruments for Implants

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Hoe Scalers
◎ Hoe scalers are used in the following manner:
◎ 1. The blade is inserted into the base of the
periodontal pocket so that it makes two-point
contact with the tooth.This stabilizes the
instrument and prevents nicking of the root.
◎ 2. The instrument is activated with a firm pull
stroke toward the crown, with every effort
made to preserve the two-point contact with
the tooth.

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 File
Their primary function is to fracture or
crush large deposits of tenacious
calculus or burnished sheets of calculus

Chisel Scalers
The chisel scaler, designed for the
proximal surfaces of teeth too
closely spaced to permit the use of other
scalers, is usually used in
the anterior part of the mouth

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 Quétin furcation curettes

◎ Quétin furcation curettes are actually

hoes with a shallow, halfmoon radius
that fits into the roof or floor of the
furcation. The curvature of the tip also
fits into developmental depressions on
the inner aspect of the roots. The shanks
are slightly curved for better access, and
the tips are available in two widths

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Diamond-coated files
◎ Diamond-coated files are unique instruments used for finalfinishing
of root surfaces. These files do not have cutting edges; instead, they
are coated with very fine-grit diamond

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Ultrasonic and Sonic Instruments

◎ Dental Endoscope
◎ The fiberoptic endoscope fits onto periodontal probes
and ultrasonic instruments that have been designed to
accept it.
◎ This device allows clear visualization deep into
subgingival pockets and furcations

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Cleansing and Polishing Instruments

◎ Rubber cups
◎ Bristle Brushes
◎ Dental Tape

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Air-Powder Polishing

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General Principles of Instrumentation
◎ Accessibility: Positioning of Patient and Operator
◎ The position of the patient and the operator should provide
maximal accessibility to the area of operation
◎ The clinician should be seated on a comfortable operating stool
that has been positioned so that his or her feet are flat on the
floor, with the thighs parallel to the floor.

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General Principles of Instrumentation
◎ The patient should be in a supine position and placed so that the
mouth is close to the resting elbow of the clinician
◎ For instrumentation of the maxillary arch, the patient should be
asked to raise the chin slightly to provide optimal visibility and
accessibility.
◎ For instrumentation on the mandibular arch, it may be necessary
to raise the back of the chair slightly and request that the patient
lower the chin until the mandible is parallel to the floor

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Visibility, Illumination, and Retraction

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Visibility, Illumination, and Retraction

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◎ The following methods are
effective for retraction:
◎ 1. Use of the mirror to deflect
the cheek while the fingers of
the nonoperating hand retract
the lips and protect the angle
of the mouth from irritation by
the mirror handle.
◎ 2. Use of the mirror alone to
retract the lips and cheek

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◎ 3. Use of the fingers of the
nonoperating hand to retract
the lips.
◎ 4. Use of the mirror to retract
the tongue.
◎ 5. Combinations of the
preceding methods.

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Condition and Sharpness of Instruments

◎ Dull instruments may lead to incomplete calculus

removal and unnecessary trauma because of the
excess force usually applied to compensate for their
ineffectiveness.

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Maintaining a Clean Field

◎ The pooling of saliva interferes with visibility during

instrumentation and impedes control because a firm
finger rest cannot be established on wet, slippery
tooth surfaces.

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Instrument Stabilization

◎ Stability and control are essential for effective

instrumentation and avoidance of injury to the patient
or clinician. The two factors of major importance in
providing stability are the instrument grasp and the
finger rest.

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Instrument Grasp

The most effective and stable

grasp for all periodontal
instruments is the modified pen
grasp

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Instrument Grasp

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 Finger Rest
1. Conventional: The finger rest is 2. Cross-arch: The finger rest is
established on tooth surfaces established on tooth surfaces on the
immediately adjacent to the working other side of the same arch.
area.

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 Finger Rest

3. Opposite arch: The finger rest is 4. Finger on finger: The finger rest is
established on tooth surfaces on established on the index finger or thumb
the opposite arch. of the nonoperating hand.

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The two most common extraoral fulcrums
are used as follows:

◎ 1. Palm up: 2. Palm down:

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Instrument Activation
◎ Adaptation

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Angulation

◎ Angulation refers to the

angle between the face of
a bladed instrument and
the tooth surface. It may
also be called the
toothblade relationship

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Lateral Pressure

◎ Lateral pressure refers to the pressure created when force is

applied against the surface of a tooth with the cutting edge of a
bladed instrument. The exact amount of pressure applied must
be varied according to the nature of the calculus and whether the
stroke is intended for initial scaling to remove calculus or for root
planing to smooth the root surface.

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 Strokes

◎ exploratory stroke
◎ scaling stroke
◎ root-planing stroke

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Instruments for Scaling and Root Planing
◎ Universal Curettes

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Gracey Curettes

◎ Area Specificity
◎ Single Cutting Edge Used
◎ Blade Appears to Curve in Two Planes
◎ Offset Blade

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Principles of Use

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Gracey Curettes

◎ Extended-Shank Gracey Curettes

◎ Extended-shank Gracey curettes, such as After Five
curettes, are 3 mm longer in the terminal shank than
standard Gracey curettes but are used with the same
technique.

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Gracey Curettes
◎ Mini-Bladed Gracey Curettes

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 Definitions
Scaling is the process by which bifoilm and calculus are
removed from both supragingival and subgingival tooth
surfaces. No deliberate attempt is made to remove tooth
substance along with the calculus.
Root planing is the process by which residual embedded
calculus and portions of cementum are removed from the
roots to produce a smooth, hard, clean surface.

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Principles of Scalling
and Root Planing
Scalling and Root Planning

◎ The primary objective of scaling and root planing is to restore gingival

health by completely removing elements that provoke gingival
inlammation (i.e., bioilm, calculus, and endotoxin) from the tooth
surface.
◎ Bifoilm and calculus on enamel surfaces provoke gingival inflammation.
When bioilm and calculus form on enamel, the deposits are usually
supericially attached to the surface and are not locked into irregularities.
Scaling alone is suficient to completely remove biofilm and calculus from
enamel.

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Detection Skill

◎ Visual Examination
◎ Tactile Exploration
◎ Degrees of Roughness Interpretation
◎ Clinical Judgments

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 Supragingival Scaling
Technique
Supragingival calculus is generally less tenacious
and less calcified than subgingival calculus.
Because instrumentation is performed coronal to
the gingival margin, scaling strokes are not
conined by the surrounding tissues.

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Supragingival Scaling Technique

◎ Sickles, curettes, and ultrasonic and sonic instruments are most

often used for the removal of supragingival calculus; hoes and
chisels are less frequently used.
◎ The tooth surface is instrumented until it is visually and tactilely
free of all supragingival deposits.
◎ Supragingival calculus is generally less tenacious and less
calcified than subgingival calculus.

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 Subgingival Scaling and
Root-Planing Technique
Subgingival calculus is usually harder than
supragingival calculus and is often locked into
root irregularities, thus making it more
tenacious and more dificult to remove

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Subgingival Scaling and Root-Planing Technique

◎ The overlying tissue creates significant problems in subgingival

instrumentation. Vision is obscured by the bleeding that
inevitably occurs during instrumentation and by the tissue itself.
◎ The curette is preferred by most clinicians for subgingival scaling
and root planing because of the advantages afforded by its
design. Sickles, hoes, iles, and ultrasonic instruments also are
used for subgingival scaling of heavy calculus.

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Dental Chair Position

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Maxillary Instrumentation

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Maxillary Instrumentation

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Maxillary Instrumentation

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Maxillary Instrumentation

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Madibulary
Instrumentation

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Madibulary
Instrumentation

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Madibulary
Instrumentation

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 Ultrasonic and Sonic
Scaling
◎ Ultrasonic scalers may be used for removing
plaque and stain, scaling, root planing, curetting,
and surgical debridement. The two types of
ultrasonic units are magnetostrictive and
piezoelectric.

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Ultrasonic and Sonic Scaling

◎ Sonic units consist of a handpiece that attaches to a compressed-

air line and uses a variety of specially designed tips.
◎ Larger tips are used for removal of heavy supragingival calculus
and heavy subgingival calculus where tissue is inlamed and
retractable. Thinner tips are designed for more deinitive
subgingival debridement.
◎ Patients with known communicable diseases that can be
transmitted by aerosols should not be treated with ultrasonic or
sonic scaling devices.

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How to use The Ultrasonic Device

1. Wipe the ultrasonic unit with a disinfectant.

2. Direct the patient to rinse for 1 minute with an antimicrobial oral
rinse such as 0.12% chlorhexidine.
3. Protective eyewear or face shields and masks wearing.
4. Dental unit, ultrasonic and aspiration device preaparation.
5. The instrument is grasped with a light to moderate pen or
modified pen grasp, and a inger rest or extraoral fulcrum should
be established to allow a light touch.

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How to use The Ultrasonic Device

6. Use short, light, vertical, horizontal, or oblique overlapping

strokes. Keep the working tip adapted to the tooth surface as it
passes over the deposit.
7. The working end should be kept in constant motion, and the tip
should be kept parallel to the tooth surface or at no more than a
15-degree angle to avoid etching or grooving the tooth surface.
8. Any remaining irregularities of the root surface may be removed
with sharp standard or mini-bladed curettes if necessary.

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Instrument Sharpening
◎ It
◎ It is
is impossible
impossible to
to carry
carry out
out periodontal
periodontal procedures
procedures
eficiently with
eficiently with dull
dull instruments.
instruments. AA sharp
sharp instrument
instrument
cuts more
cuts more precisely
precisely and
and quickly
quickly than
than aa dull
dull
instrument.
instrument.

◎ To
◎ To do
do its
its job
job at
at all,
all, aa dull
dull instrument
instrument must
must bebe held
held
more irmly
more irmly and
and pressed
pressed harder
harder than
than aa sharp
sharp
instrument.
instrument.

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Evaluation of Sharpness

◎ The cutting edge of an instrument is formed by the angular

junction of two surfaces of its blade. The cutting edges of a
curette, for example, are formed where the face of the blade
meets the lateral surfaces.
◎ When the instrument is sharp, this junction is a ine line running
the length of the cutting edge. As the instrument is used, metal is
worn away at the cutting edge, and the junction of the face and
lateral surface becomes rounded or dulled.

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Sharpening

◎ The objective of sharpening is to restore the ine, thin, linear

cutting edge of the instrument. This is done by grinding the
surfaces of the blade until their junction is once again sharply
angular rather than rounded.
◎ Sharpening stones categories :
1. Mounted rotary stones
2. Unmounted stones or Sharpening cards
3. Diamond sharpening cards

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Principles of Sharpening
1. Choose suitable sharpening card
2. Establish the proper angle between the sharpening stone or
card and the surface of the instrument
3. Maintain a stable, firm grasp of both the instrument and the
sharpening stone.
4. Avoid excessive pressure the formation of a “wire edge,”
characterized by minute ilamentous projections of metal
extending as a roughened ledge from the sharpened cutting
edge.
5. Lubricate it during sharpening. Sharpen instruments at the
first sign of dullness.
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Curette Sharpening

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Sickle Sharpening

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Chisel and Gingivectomy Sharpening

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Thank you!

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