principles of scaling & root planing dr alaa attia
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Associate prof, periodontology, Umm Alqura University, Saudi arabia, And Al-Azhar University, EgyptTRANSCRIPT
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