Background

Scaling and Root Planing is a non-surgical procedure to eliminate plaque, tartar, and bacteria from teeth.

Primary treatment for periodontitis targets chronic inflammation in gums, periodontal ligament, and alveolar bone supporting teeth.

Advancements in dental technology made procedures more effective with ultrasonic scalers and better diagnostic tools.

It is designed to eliminate bacterial biofilm and calculus that contribute to gum inflammation. It reduces periodontal pocket depth to prevent further bacterial colonization.

Scaling removes plaque and tartar from the tooth surfaces including below the gumline.

Root Planing smooths out rough areas on the root surfaces to prevent bacteria from reattaching and promote healing.

It acts as therapeutic and preventive measure that reduces inflammation and improves oral health.

Indications

Gingivitis

Periodontitis

Presence of Subgingival Plaque and Calculus

Pre-Surgical Periodontal Therapy

Peri-implant Mucositis

Halitosis

Contraindications

Uncontrolled diabetes mellitus

Uncontrolled hypertension

Severe immunosuppression

Bleeding disorders without proper medical management

Acute Necrotizing Ulcerative Gingivitis

Severe Dental Hypersensitivity

Patients on Anticoagulant or Antiplatelet Therapy

Pregnancy

Severe Anxiety

Outcomes

Decreased inflammation and bleeding from biofilm and calculus removal.

Improved probing pocket depth and gingival tissue reattachment in moderate periodontitis treatments.

Exposed roots can cause sensitivity after plaque removal. Gingival shrinkage post-inflammation may expose roots and affect aesthetics.

Poor oral hygiene risks plaque buildup and recurrent periodontitis without maintenance.

Equipment required

Mouth Mirror

Periodontal Probe

Explorer

Scalers

Curettes

Ultrasonic Scalers

Patient Preparation:

Comprehensive periodontal examination including probing pocket depth, bleeding on probing, and radiographic asses.

Medical history review to identify systemic conditions and medications affecting bleeding.

Educate patients on oral hygiene before procedure.

Informed Consent:

Explain the procedure’s risks and potential complications clearly to the patient.

Patient Positioning:

Patients are positioned in a semi-supine or supine position.

Scaling Procedure

Step 1: Instrumentation Selection

Start with ultrasonic scalers for heavy deposits. Use hand scalers and curettes for precision cleaning.

Step 2: Scaling Movements

Use short and controlled strokes with moderate pressure.

Adapt instrument tip to the tooth surface at approx. 45° to 90° angle.

Work systematically in quadrants to ensure thorough debridement.

Step 3: Frequent Irrigation

Flush pockets with water or antimicrobial agents to reduce bacterial load.

Root Planing Procedure

Step 1: Instrumentation:

Use Gracey curettes with angled at 60° to 70°.

Step 2: Technique:

Apply lighter and longer strokes compared to scaling. Ensure the surface feels smooth and glass-like to prevent bacterial adherence.

Figure. Scaling and Root Planing

Complications:

Pain & Discomfort

Gingival Bleeding & Swelling

Tooth Sensitivity

Gingival Recession

Root Surface Roughness

Disease Recurrence

Tooth Mobility

Periodontal Abscess Formation

References

Dental Scaling and Root Planing for Periodontal Health: A Review of the Clinical Effectiveness, Cost-effectiveness, and Guidelines – NCBI Bookshelf

References

Dental Scaling and Root Planing for Periodontal Health: A Review of the Clinical Effectiveness, Cost-effectiveness, and Guidelines – NCBI Bookshelf