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In the 1960s and early 1970s, hand instrumentation was taught as the best way to remove deposits from tooth and root surfaces. Aggressive instrumentation producing a smooth, glassy surface was the goal. Cementum was re-moved as well, leaving sensitive surfaces. During the next 2 decades, ultrasonic scaling burnished calculus and left deposits behind, producing chronic inflammation.
Currently, it has been acknowledged that a combination of both hand instrumentation with appropriate curettes and ultrasonic scaling produces superior results, even though complete removal of calculus may not be possible. Hand instrumentation is necessary where tooth curvatures, proximal depressions, and furcations limit the effectiveness of the straight profile of the ultrasonic tip. The goal of scaling and root planing is to create a biocompatible root surface where tissue can heal, safe from pathogens. Ultrasonic tips can reach some areas more easily than curettes, while curettes may reach curved root areas better than ultrasonic tips. Each has benefits; using both to achieve disruption of root deposits should provide a clinical advantage and a reduction in residual calculus deposits. The skill and experience of the clinician provides an equal advantage. Ultrasonic tips need to contact every millimeter subgingivally. Using a slow and methodical stroke with appropriate power settings (upper settings) will ensure that deposits are not polished over. Horizontal or vertical strokes with curettes will adapt to root morphology. Final use of thin ultrasonic tips on lower power flushes any remaining deposits remaining from hand instrumentation. Clinicians need to evaluate the combination of methods that will produce the best outcome. Sharpened instruments, experience, care, and use of appropriate ar-mamentarium will best serve the patient and the clinician.
(Source: Dimensions of Dental Hygiene, July 2008)
