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16 Mar 2022

Scaling and root planing: What does it consist of?

Root scaling and planing (RAR), also known as subgingival debridement, is a technique  that allows the removal of subgingival plaque and calculus, which in normal situations, a visual inspection is not possible.

The main objective of this process is to remove the subgingival calculus adhered to the root surface so that there can be a new insertion and a decrease in probing depth.

It is also expected to be able to control inflammation and infection, eliminate the deposits of microorganisms and calculus that are adhered to the  root surface and reduce the bacterial load and it is important that there is a microflora that is compatible with the host.

Periodontogram

Before performing a scaling and root planing, it is very important to know the periodontal status of the patient and that is why a periodontogram should be done.

The periodontogram is a file where all the data of a periodontal examination is recorded. It is a guide for the clinician to know the periodontal status of the patient.

When and how is the RAR carried out?

A subgingival debridement will be performed in the presence of periodontal pockets  ≥ 4mm. This is so, because when the procedure is done, there will be a gain of recession, the recession will increase (disadvantage), but there will also be a gain of insertion of the junctional epithelium and connective tissue (advantage) and therefore, the periodontal pocket decreases.

Knowing this, if a RAR is made in periodontal pockets of 3mm or less  (parameters that are considered as health) what is going to be obtained is an increase in the recession, which is going to be greater than the insertion gain, so in this case there  are more disadvantages than advantages.

What instrument is used in root planing?

Scaling and root planing can be performed with manual instrumentation and ultrasonic  devices.

Manual instrumentation

According to different articles, manual instrumentation provides a smoother root surface and eliminates more calculus than with ultrasound.

Ultrasonic Devices

But ultrasonic devices remove less dentin structure and generate less trauma, in addition to reducing treatment time.

That is why it has been seen that the best option to perform the treatment is combining  manual instrumentation together with ultrasonic devices.

How many sessions does root planing take?

It has also been observed that this treatment can be done by quadrants or sextants and  can be done in various ways.

It could be considered to do a “full-mouth”, that consists of doing it in 2 sessions with less than 24h.

Or by intervals, which would be to leave a week in between visits.

Both methods have been found to be effective.

Conclusion

In conclusion, the most important thing when doing a scaling and root planing is that the clinician should makes a good periodontogram to be able to correctly determine when  this treatment is necessary and when not.

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    Dr. José Nart Molina

    Dr. Jose Nart received his dental degree in 2001 from Universitat Internacional de Catalunya (UIC), Barcelona, Spain, and his Advanced Certificate in Periodontics and Implant Surgery from Tufts University in 2007. Dr. Nart was awarded Diplomate status by the American Board of Periodontology on May 2008, and he obtained his PhD in Dentistry in 2010 with the highest degree. Currently, he is Professor, Chairman and Program Director at the Department of Periodontology at UIC-Barcelona, and President for the Spanish Society of Periodontology and Osseointegration (SEPA). He maintains, with his family, a well-known multispecialty private practice in Barcelona, Nart Dental Clinic, as medical director. Dr. Nart is author of many international high-impact JCR publications (+110), worldwide speaker and reviewer of the highest impact factor Periodontology and Implant Dentistry journals.

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