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Subgingival scaling involves the removal of subgingival calculus
from the tooth surface. This can be from the enamel (crown) or from
the root cementum surface, in which case it is termed root planing.
Subgingival curettage or root planing can be closed or open. If
open, some form of flap will have been made to aid vision and improve
efficiency.
Inadequate removal leaves an inflammatory focus present and the
disease process will continue. Continued attachment loss will cause
further deepening of the pocket.
Use appropriate ultrasonic
scaler tips (WORKPLACE chapter).
For subgingival scaling with hand instruments, use a subgingival
curette (e.g. Gracey curette SG 11/12 or 13/14). Place the blade
at 45°-90° to the root surface and pull firmly against the
tissue to remove as much debris and chronically inflamed tissue
as possible. Root cement is capable of being shaped by these instruments
as well as with the ultrasonic tips. Aim to smooth the root as much
as possible - multiple overlapping strokes may be required. Evaluate
again for smoothness with the probe.
The use of fine tips in an ultrasonic scaler has proven to be a
great deal more efficient for supragingival and subgingival scaling
when followed by hand instrumentation. FSI™ tips Slimline™
tips and TFI™ tips (Dentsply) and Odontoson™ are all ultrasonic
instruments that can be used under the gingival margin, albeit with
care, as the water supply is carried with the tip.
For FSI and Slimline tips the maximum safe distance for subgingival
use is 6-7mm. It is claimed that the Odontoson can be used as much
as 12mm subgingivally.
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