The heart of all periodontal therapy is removal of calculus and plaque from the tooth. Removing debris from the crown of the tooth is often referred to as scaling, while root planing (debridment) refers to cleaning the root below the gum. This procedure is also referred to as deep cleaning.
To successfully treat periodontal disease it is necessary to adequately debride the periodontal pocket. This is generally accomplished using curettes and/or ultrasonic scalers, although rotary instruments may be useful.
Adequately cleaning a periodontal pocket takes time and skill, and many feel it is the most technically demanding procedure performed by dentists. Often a local anesthetic is used to assure patient comfort.
Set of curettes
Curette under gum
Using curette on model
Curette entering pocket
Curette in pocket
Curette cleaning pocket
With early and moderate pockets, up to 5 mm in depth, adequate pocket debridement is generally possible. However, with pockets over 5 mm, much of the root calculus is missed. Many studies have shown that deeper pockets are cannot be adequately cleaned with any technique, unless the gum is reflected to improve access. This minor surgical procedure consists of making a small incision to push back the gum edge, allowing access to deeper areas. This is known as open flap curettage, and is done under local anesthesia. Sutures are generally used, but there is little post-operative discomfort.
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