Periodontal-Health-&-Treatm

Root planing is a non-surgical treatment that usually done together with deep dental scaling. It is done after the supragingival (or superficial) plaque and calculus were remove through gross scaling. The aim of this treatment is to removes the roughened cementum and surface dentin that is impregnated with calculus, microorganisms and their toxins leading to the creation of a clean smooth root surface. Usually this implies that some cementum and dentin are removed. Deep scaling and root planing are done under local anaesthesia and requires 25-45 minutes per quadrant. If the pockets are deeper, the procedure becomes more significantly more difficult and more time is needed.

How root planing is done?

root-planing

After supra-gingiva calculus and tartar are removed by gross scaling, the gums condition will be assessed to see if the are any pocketing. Usually, the dentist will do a periodontal carting (a record of the gum condition) to see which area along the gum margins present of gingiva pockets (a space between your teeth and gum which has a depth of more than 3mm on probing).  He will explain to you the condition of your gum and he might probably plan another visit to treat those pocketing with root planing.

Basically, the root planing involves scraping and smoothing the root surface of your teeth. Gum tissue will firmly reattach to roots that are clean and smooth. It is done by either using the ultrasonic scaler or hand instrument such as Periodontal Gracey curettes set. Usually, before the procedure, local anaesthetic will be given to numb the gum area. Duration of treatment is depended on how deeps the pockets and how severe the condition is; usually between 25 and 45 minutes per quadrant.

Dental Scaling

Ultrasonic Scaler

Ultrasonic scaler which is powered by the electrical system that causes the tip to vibrate. They vibrate at a frequency that breaks down bacterial cell membranes and removes both plaque and calculus that are attached to the root surfaces. Ultrasonic scalers are fast but they can’t reached the periodontal pockets that are too deep. Moreover, the dentist can’t feel if the root surfaces are smooth or cleaning when using the ultrasonic scaler, hence, he might left some tartar behind.

Gracey Curettes. Hand instrument used to remove

Periodontal Gracey Curettes. Hand instruments that reused during root planing

Therefore, hand instruments such as Periodontal Gracey Curettes are used to complete the root planing and remove anything the ultrasonic scaler left behind. Periodontal Gracey curettes are seem to look like tiny scrappers that are place in the pockets under the gum margin, against the root surface. As the clinician moves this instrument in an outwards direction, the curette scraps the tartar and plaque along the way leaving the root surface clean and smooth.

root-planing2

The curette is placed in the gum pocket against the root surface. As it moves outward, it scraps away the tartar and plaque along the way

 

What can I expect afterwards?

  • Discomfort can vary after root planing, but one can expect it to be more sore afterwards since it’s usually in a deeper region under the gums.
  • The teeth themselves can become a bit more sensitive to temperature, and bleeding might occur for a little while.
  • Painkillers such as ibuprofen work very well to alleviate discomfort, but stronger painkillers can be given should you need them.
  • Brushing and flossing can be delayed or done more gently to avoid aggravating any bruised or tender gum areas.
  • Your dentist or hygienist may recommend salt water or chlorhexidine rinses.

What is the difference between an ordinary cleaning and root planing?

There is some confusion about the difference between scaling and root planing. Scaling is basically the process of removing dental tartar from the surfaces of the teeth. Root planing is the process of smoothing the root surfaces and removing any infected tooth structure. If you have gum disease or gum pocketing, the gum pockets around the teeth will have deepened, thereby allowing tartar deposits to form under the gum margin. The two processes tend to blur together since during the cleaning process, the dental worker scales away tartar and performs any necessary root planing at the same time. Any roughness can be planed away to result in a silky smooth surface.

Treatment Outcome

Scaling and root planing is considered the basic treatment of periodontal diseases and best to treat mild cases of periodontitis. However, it may also be the initial therapy prior to future surgical needs. For the procedure to be considered effective, the patient must be able to be maintained at a level of periodontal health that will prevent reinfection with periodontal pathogens.This requires optimal home care and ongoing periodontal maintenance therapy, usually every 3-4 months to sustain health.

Measuring pockets using a perio probe

Periodontal pocket: The depth of the periodontal pocket is measured using a periodontal probe

It is effective only when certain conditions are fulfilled. A complete removal of calculus from the periodontal pockets using hand and ultrasonic instruments is not totally effective. The depth of the pocket (picture above), when identified by the probe, exceeds more than 3mm then calculus removal becomes more insufficient. The maximum access of a probing instrument is up to 6mm, any calculus beyond that can’t be reached. If there is calculus exceeding more than 6mm, then scaling and root planing are ineffective and the best treatment option in such cases will be surgical access for complete pathogen and calculus free area. The probing depth and methods affects the success of the procedure, and factors like root grooves, concavities, and furcation involvement may limit visibility of underlying deep calculus and debris. In severe periodontal disease where there is a systemic involvement, scaling and root planing are insufficient and surgery is required.Scaling and root planing are ineffective in cases where tooth mobility is severe; such conditions require periodontal surgery and placement of bone grafts.

Risks

Root planing and scaling can introduce harmful bacteria into the bloodstream. Gum tissue is also at risk of infection. You may need to take antibiotics before and after surgery if you have a condition that puts you at high risk for a severe infection or if infections are particularly dangerous for you. You may need to take antibiotics if you:

  • Have certain heart problems that make it dangerous for you to get a heart infection called endocarditis.
  • Have an impaired immune system.
  • Had recent major surgeries or have man-made body parts, such as an artificial hip or heart valve.

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