Supragingival Scaling

Supragingival scaling refers to the removal of dental calculus above the gingival margin. This is most easily accomplished in small animals utilizing power scalers. In a recent study the efficacy with which four different power scalers (ultrasonic magneto-strictive, sonic, ultrasonic piezoelectric, and rotosonic scalers) removed dental calculus in the dog was compared.6 The ultrasonic piezo electric scaler removed calculus significantly faster than all the other power scalers. The ultrasonic magnetostrictive scaler was faster in the removal of calculus than the sonic scaler and the sonic scaler was faster in the removal of calculus than the rotopro scaler. Electron microscopy of teeth scaled were all similar except the teeth that were instrumented with the rotosonic scaler. The surface of the enamel of these teeth contained multiple deep groves.

Prior to ultrasonic scaling the patient's mouth is lavaged with a 0.12% chlorhexidine solution to reduce external bacterial counts. Gross calculus is gently removed with an extraction forceps by gently closing the forceps across the calculus. A power scaler is used to remove the remaining plaque, calculus, and debrie. Adequate water flow is essential when using power scalers to cool the oscillating tip and flush away the debris. The side of a sickle-shaped scaling tip is placed on the tooth surface and moved gently and continuously over the tooth surface. Continuous scaling of any one tooth for more than 15 seconds must be avoided to prevent pulp tissue injury from excessive heat and potential production of subsequent pulpal necrosis.

Subgingival scaling removes debris that has accumulated below the gingival margin which causes inflammation of the supporting structures of the teeth. Failure to remove subgingival calculus promotes the progression of periodontal disease. Historically subgingival calculus has been removed with a curette. The instrument is inserted with the face of the blade flush against the tooth. When the instrument reaches the bottom of the pocket the working angulation of the instrument, usually 45 degrees, is established. The instrument is then pushed against the tooth and pulled coronally. This process is repeated until all subgingival calculus is removed. Root planing is the smoothing of the root surface using curettes. This procedure is not a distinct entity from subgingival scaling or cleaning of the root surfaces but rather a continuation of the process. When the root is adequately planed it should feel smooth and hard like glass. Alternatively specially designed periodontal ultrasonic scaling instrumentation with ultrasonic periodontal scaling tips made for subgingival scaling can be used. These tips are designed to be used at a low power setting for delicate root treatment. These tips are more efficient and effective in cleaning the root surface and helps prevent user fatigue.

Subgingival Curettage

Subgingival curettage is the removal of diseased soft tissue from the periodontal pocket. While one edge of the curet engages the root surface, the other edge engages the soft tissues of the periodontal pocket. Although this process is often not thought of as a deliberate procedure it removes the diseased soft tissue portion of the periodontal pocket. The specially designed periodontal ultrasonic scaling tips can be used for this purpose.

Polishing

After the removal of all calculus the teeth are polished with a rubber cup placed on a prophylaxis angle attached to a slow-speed handpiece. Prophy paste is placed on the teeth and the cup is rotated over all tooth surfaces at a low speed. The cup is then pressed gently but firmly at the gingival margin to permit polishing of the root surface adjacent to the crown.

Irrigation

After polishing, the gingival sulcus is irrigated with a 0.12% chlorhexidine solution using a blunted 23-gauge needle and a 12 ml syringe. Irrigation of the gingival sulcus removes loose calculus, prophy paste and debris and reduces the bacterial counts.