principles of scaling & root planing dr alaa attia

Principles of scaling and

root planing

By

Associate professor Dr. Alaa Moustafa Attia

Scaling:

It is the process by which plaque and

calculus are removed from both

supragingival and subgingival tooth

surfaces.

Root planing:

It is the process by which residual

embedded calculus and portions of

cementum are removed from the roots to

produce a smooth, hard, and clean surface.

Scaling & root planing means phase 1 therapy

Objective of scaling and root

planing

The primary objective of scaling and root

planing is to restore gingival health by

completely removing elements that provoke

gingival inflammation (i.e. , plaque, calculus ,

and bacterial toxins).

Before scaling & root planing

After scaling & root planing

Radiograph before & after scaling &

root planing

Detection skills

Detection skills that required for the

accurate initial assessment of the extent

and nature of deposits and root irregulities

on root surface before scaling and root

planing: includes

- Visual examination

- Tactile exploration

Supragingival scaling procedures :

By means of scalers, sonic and ultrasonic

scalers, they were activated in obliaque and

vertical direction.

Subgingival scaling and root planing

procedures:

By means of curettes {(universal & Gracy

(area spesific)} and sometimes Hoe scalers

Subgingival scaling procedures

A= Curette inserted with the face of the blade flush against the tooth.

B= Working angulation (45-90) is established at the base of the pocket.

C= Lateral pressure is applied, and the scaling stroke is activated in the

coronal direction.

Instrumentation for calculus removal

A= Calculus is removed by engaging the apical or lateral

edge of the deposits with cutting edge of scaler; vertical

movement of the instrument will remove the fragment of

the calculus.

B= The instrument is moved lateraly and again engages the

edge of the calculus.

C= The final portion of the deposit is engaged and removed.

Shank position for scaling proximal surface

A= Correct shank position, parallel with the long axis

of the tooth.

B= Incorrect shank position, titled away from the

tooth.

C= Incorrect shank position, titled too far toward the

tooth.

The body position of the operator and the

location of the finger rest must be frequently

adjusted or changed to allow the following:

- Parallism

- Wrist-arm motion

Notice

Approaches of

scaling

and root planing

1- Maxillary anterior sextant: facial aspect,

surface toward the operator

Front position O. Position

Direct Illumination

Direct Visibility

Index finger of non operating hand Retraction

Intraoral, palm down. Fourth finger on the incisal edges or the

occlusal or facial surfaces of adjacent maxillary teeth.

Finger rest

2- Maxillary anterior sextant: facial aspect, surface

away from the operator

Front position O. Position

Direct Illumination

Direct Visibility

Index finger of non operating hand Retraction

Intraoral, palm up. Fourth finger on the incisal edges or the

occlusal or facial surfaces of adjacent maxillary teeth.

Finger rest

3- Maxillary anterior sextant: lingual aspect,

surface away from the operator

Back position O. Position

Indirect Illumination

Indirect Visibility

None Retraction

Intraoral, palm up. Fourth finger on the incisal edges or the

occlusal or facial surfaces of adjacent maxillary teeth.

Finger rest

4- Maxillary right posterior sextant: premolar

region only: facial aspect

Side or back position O. Position

Direct Illumination

Direct Visibility

Mirror or Index finger of non operating hand Retraction

Intraoral, palm up, Fourth finger on the occlusal surfaces of the

adjacent maxillary posterior teeth.

Finger rest

5- Maxillary right posterior sextant: facial aspect

Side position O. Position

Direct Illumination

Direct (indirect for distal surfaces of molars). Visibility

Mirror or index finger of non operating hand Retraction

Extra oral, palm up. Back of the middle and fourth fingers on the

lateral aspect of the mandible on the right side of the face.

Finger rest

6- Maxillary right posterior sextant: lingual aspect

Side or front position O. Position

Direct and indirect Illumination

Direct or indirect Visibility

None Retraction

Extraoral, palm up. Back of the middle and fourth fingers on the

lateral aspect of the mandible on the right side of the face.

Finger rest

7- Maxillary right posterior sextant: lingual aspect

Front position O. Position

Direct Illumination

Direct Visibility

None Retraction

Intraoral, palm up, finger on finger Finger rest

8- Maxillary left posterior sextant: facial aspect

Side or back position O. Position

Direct or indirect Illumination

Direct or indirect Visibility

Mirror Retraction

Extroral, palm down. Front surfaces of the middle and fourth

fingers on the lateral aspect of the mandible on the left side of

the face.

Finger rest

9- Maxillary left posterior sextant: facial aspect

Back or side position O. Position

Direct or indirect Illumination

Direct or indirect Visibility

None Retraction

Intraoral, palm up. Fourth finger on the incisal edges or the

occlusal surfaces of adjacent maxillary teeth.

Finger rest

10- Maxillary left posterior sextant: lingual aspect

Front position O. Position

Direct Illumination

Direct Visibility

None Retraction

Intraoral, palm down, opposite arch, reinforced. Fourth finger on

incisal or facial surfacs of mandibular teeth.

Finger rest

11- Maxillary left posterior sextant: lingual aspect

Front position O. Position

Direct and indirect Illumination

Direct and indirect Visibility

None Retraction

Extraoral, palm down. Front surface of middle and fourth fingers

on the lateral aspect of the mandible on the left side of the face.

Finger rest

12- Maxillary left posterior sextant: lingual aspect

Side or front position O. Position

Direct Illumination

Direct Visibility

None Retraction

Intraoral, palm up. Fourth finger on the occlusal surfaces of

adjacent maxillary teeth.

Finger rest

1- Mandibular anterior sextant: facial aspect,

surfaces toward the operator

Front position O. Position

Direct Illumination

Direct Visibility

Index finger of the non-operating hand Retraction

Intraoral, palm down. Fourth finger on the incisal edge or the

occlusal surfaces of adjacent mandibular teeth.

Finger rest

2- Mandibular anterior sextant: facial aspect,

surface away from the operator

Back position O. Position

Direct Illumination

Direct Visibility

Index finger or thumb of the nonoperating hand Retraction

Intraoral, palm down. Fourth finger on the incisal edge or the

occlusal surfaces of adjacent mandibular teeth.

Finger rest

3- Mandibular anterior sextant: lingual aspect,

surfaces away from the operator

Back position O. Position

Direct or indirect Illumination

Direct and indirect Visibility

Mirror retract the tongue Retraction

Intraoral, palm down. Fourth finger on the incisal edge or the

occlusal surfaces of adjacent mandibular teeth.

Finger rest

4- Mandibular anterior sextant: lingual aspect,

surfaces toward the operator

Front position O. Position

Direct and indirect Illumination

Direct and indirect Visibility

Mirror retract the tongue Retraction

Intraoral, palm down. Fourth finger on the incisal edge or the

occlusal surfaces of adjacent mandibular teeth.

Finger rest

5- Mandibular right posterior sextant: facial aspect

Side or front position O. Position

Direct Illumination

Direct Visibility

Mirror or index finger of nonoperating hand Retraction

Intraoral, palm down. Fourth finger on the incisal edge or the

occlusal surfaces of adjacent mandibular teeth.

Finger rest

6- Mandibular right posterior sextant: lingual aspect

Front position O. Position

Direct and indirect Illumination

Direct and indirect Visibility

Mirror retracts the tongue Retraction

Intraoral, palm down. Fourth finger on the incisal edge or the

occlusal surfaces of adjacent mandibular teeth.

Finger rest

7- Mandibular left posterior sextant: facial aspect

Side or back position O. Position

Direct Illumination

Direct or indirect Visibility

Index finger or mirror of the nonoperating hand. Retraction

Intraoral, palm down. Fourth finger on the incisal edge or the

occlusal surfaces of adjacent mandibular teeth.

Finger rest

8- Mandibular left posterior sextant: lingual aspect

Front or side position O. Position

Direct and indirect Illumination

Direct Visibility

Mirror retracts the tongue Retraction

Intraoral, palm down. Fourth finger on the incisal edge or the

occlusal surfaces of adjacent mandibular teeth.

Finger rest

Thank You