Scaling & root instrumentation
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
Outline
• Classification of periodontal instruments
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
Classification of periodontal instruments
1. Periodontal probes are used to locate, measure, and mark pockets,
as well as determine their course on individual tooth surfaces.
2. Explorers are used to locate calculus deposits and caries.
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
Classification of periodontal instruments
3. Scaling, root instrumentation (root planing), and curettage instruments.
a. Sickle scalers are heavy instruments used to remove supragingival calculus.
b. Curettes are fine instruments used for subgingival scaling, root instrumentation (root planing),
and removal of the soft tissue lining the pocket.
c. Hoe and file scalers are used to remove tenacious subgingival calculus and altered
cementum. Their use is limited compared with that of curettes.
d. Implant instruments are plastic or titanium scalers and curettes designed for use on
implants and implant restorations.
e. Ultrasonic and sonic instruments are used for scaling and cleansing tooth surfaces and
curetting the soft tissue wall of the periodontal pocket.
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
Classification of periodontal instruments
4. Periodontal endoscopes are used for deep visualization into subgingival pockets
and furcations, thereby allowing the detection of deposits.
5. Cleansing and polishing instruments, such as rubber cups, brushes, and dental
tape, are used to clean and polish tooth surfaces.
• Air-powder abrasive systems are also available for subgingival cleaning and
polishing of tooth, root, and implant surfaces.
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
• Stainless steel is used most often in instrument manufacturing.
• High-carbon content steel instruments are available and are considered by some
clinicians to be superior.
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
1. Periodontal Probes
• Periodontal probes are used to measure the depth of pockets and to determine
their configuration.
• The typical probe is a tapered, rodlike instrument calibrated in millimeters, with
a blunt, rounded tip.
• Ideally, these probes are thin, and the shank is angled to allow easy insertion into
the pocket.
• Furcation areas can best be evaluated with the curved, blunt Nabers probe.
• When measuring a pocket, the probe is inserted with firm, gentle pressure to the
bottom of the pocket. The shank should be aligned with the long axis of the
tooth surface to be probed.
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
2. Explorers
• Explorers are used to locate subgingival
deposits and carious areas and to check
the smoothness of the root surfaces after
root instrumentation (root planing).
• The periodontal probe can also be useful
in the detection of subgingival deposits.
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
3. Scaling and Curettage Instruments
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
a. Sickle Scalers
• Sickle scalers have a flat surface and two cutting edges that converge in a
sharply pointed tip.
• The sickle scaler is used primarily to remove supragingival calculus.
• Because of the design of this instrument, it is difficult to insert a large sickle blade
under the gingiva without damaging the surrounding gingival tissues.
• Sickle scalers are used with a pull stroke.
• Sickles with straight shanks are designed to adapt to anterior teeth, and those with
• contra-angled shanks adapt to posterior teeth
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
2 Cutting edges
Triangular cross
section
Pointed tip
Only supragingival removal
of deposits
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
b. Curettes
• The instrument for removal of deep subgingival calculus, root instrumentation
(root planing) of altered cementum, and removal of the soft tissue lining the
periodontal pocket.
• Each working end has a cutting edge on both sides (depends on type) of the
blade and a rounded toe.
• Curettes are finer than sickle scalers and do not have any sharp points or
corners other than the cutting edges of the blade. Therefore, they provide good
access to deep pockets, with minimal soft tissue trauma.
• In cross section, the blade appears semicircular with a convex base.
• Both single- and double-end curettes may be obtained.
• 2 types: universal and Gracey (area specific) curettes.
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
Cutting edge
Semicircular cross
section
Rounded toe
Convex base
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
Curette Scaler
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
Universal Curettes
• Universal curettes have cutting edges that may be
inserted in most areas of the dentition by altering
and adapting the finger rest, fulcrum, and hand
position of the operator.
• The face of the blade is at a 90-degree angle
(perpendicular) to the lower shank when seen in
cross section from the tip.
• The blade of the universal curette is curved in one
direction from the head of the blade toward the
toe.
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
Area-Specific Curette (Gracey)
• Area specific curettes, a set of several instruments designed and angled to adapt to
specific anatomic areas of the dentition.
• These curettes and their modifications are the best instruments for subgingival
scaling and root instrumentation (root planing) because they provide the best
adaptation to complex root anatomy.
• Double-ended (7 instruments)Gracey curettes are paired in the following manner:
• Gracey #1-2 and #3-4: Anterior teeth.
• Gracey #5-6: Anterior teeth and premolars.
• Gracey #7-8 and #9-10: Posterior teeth, facial and lingual.
• Gracey #11-12: Posterior teeth, mesial.
• Gracey #13-14: Posterior teeth, distal.
• Single ended instruments are available and are 14 in number.
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
1-2 9-10 11-12 13-14
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
• The term offset blade is used to describe Gracey curettes because they are angled
approximately 70 degrees from the lower shank.
• This unique angulation allows the blade to be inserted in the precise position
necessary for subgingival scaling and root instrumentation (root planing),
provided the lower shank is parallel to the long axis of the tooth surface being
scaled.
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
Area-specific curettes also have curved blades. Whereas the
blade of the universal curette is curved in one direction, the
Gracey blade is curved from shank to toe and also appears to be
curved along the side of the cutting edge
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
Other Gracey curettes
• Gracey curettes are available with either a “rigid” or “finishing” type of shank.
• The rigid Gracey has a larger, stronger, and less flexible shank and blade. It allows
the removal of moderate to heavy calculus
• The finishing Gracey has enhanced tactile sensitivity.
• More recent additions to the Gracey curette set have been #15- 16 and #17-18.
• The Gracey #15-16 is a modification of the standard #11-12 and is designed for
the mesial surfaces of posterior teeth.
• The Gracey #17-18 is a modification of the standard #13-14 and is designed for
the distal surfaces of posterior teeth.
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
Other Gracey curettes
1. Extended-Shank Curettes.
• Extended-shank curettes, such as After Five curettes. The terminal shank is 3
mm longer, allowing extension into deeper periodontal pockets of 5 mm or more.
In addition to thinned blade for smoother subgingival insertion and reduced
tissue distention and a large-diameter, tapered shank.
• After Five curettes are available in finishing or rigid designs.
• For heavy or tenacious calculus removal, rigid After Five curettes should be used.
For light scaling or deplaquing in a periodontal maintenance patient, the thinner
finishing
• After Five curettes will insert subgingivally more easily.
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
Other Gracey curettes
2. Mini-Bladed Curettes.
Mini-bladed curettes, Mini Five curettes, blades that are half the length of After
Five or standard Gracey curettes.
• The shorter blade allows easier insertion and adaptation in deep, narrow
pockets; furcations; developmental grooves; line angles; and deep, tight facial,
lingual, or palatal pockets. In any area where root morphology or tight tissue
prevents full insertion of the standard Gracey or After Five blade,
• Mini Five curettes can be used with vertical strokes, with reduced tissue distention
and no tissue trauma.
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
Other Gracey curettes
3. Micro Mini Five Gracey curettes have blades that are 20% thinner and smaller
than the Mini Five curettes
• These are the smallest of all curettes, and they provide exceptional access and
adaptation to tight, deep, or narrow pockets; narrow furcations; developmental
depressions; line angles; and deep pockets on facial, lingual, or palatal surfaces.
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
Standard VS Mini
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
c. Plastic and Titanium Instruments for
Implants
• It is important that plastic or titanium instruments be used to avoid scarring and
permanent damage to implants.
• They may be used for implant maintenance with careful, light-pressured strokes
for biofilm and light calculus removal.
• Moderate- or heavy-pressured strokes should be avoided to prevent scratching
or roughening of implant surfaces.
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
Plastic instruments Titanium coated curettes
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
d. Hoe Scalers
• Hoe scalers are used for scaling of ledges or rings of calculus.
• The blade is slightly bowed so that it can maintain contact at two points on a
convex surface. The back of the blade is rounded, and the blade has been reduced
to minimal thickness to permit access to the roots without interference from the
adjacent tissues.
• Hoe scalers are used in the following manner:
• 1. The blade is inserted into the base of the periodontal pocket so that it makes
two-point contact with the tooth. This stabilizes the instrument.
• 2. The instrument is activated with a firm pull stroke toward the crown, with every
effort made to preserve the two-point contact with the tooth.
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
d. Files
• Files have a series of blades on a base. Their primary
function is to fracture or crush large deposits of
tenacious calculus or burnished sheets of calculus.
• Files can easily gouge and roughen root surfaces when
they are used improperly. Therefore they are not suitable
for fine scaling and root instrumentation (root planing).
• Files are sometimes used for removing overhanging
margins of dental restorations.
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
f. Chisel
• Use of the periodontal chisel scaler is extremely
limited.
• It is used solely for the removal of heavy
supragingival calculus deposits that bridge open
interproximal spaces of anterior teeth.
• The instrument is activated with a push motion while
the side of the blade is held firmly against the root.
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
e. Ultrasonic and Sonic Instruments
• Ultrasonic instruments may be used for removing biofilm, scaling, curetting, and
removing stains
• Sonic instruments use frequencies between 3-8
kHz, powered by compressed air, while
ultrasonic instruments operate at much higher
frequencies (18-50 kHz), powered by an electric
generator
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
4. Dental Endoscope
• The dental endoscope is used subgingivally in the diagnosis
and treatment of periodontal disease.
• This device allows clear visualization deep into subgingival
pockets and furcations.
• It permits operators to detect the presence and location of
subgingival deposits and guides them in the thorough
removal of these deposits.
• The dental endoscope can also be used to evaluate
subgingival areas for caries, defective restorations, root
fractures, and resorption
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
5. Cleansing and Polishing Instruments
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
Rubber Cups
• They are used in the handpiece with a prophylaxis angle. The
handpiece, prophylaxis angle, and rubber cup must be
sterilized after each patient use, or a disposable plastic
prophylaxis angle and rubber cup may be used and then
discarded.
• A good cleansing and polishing paste that contains fluoride
should be used and kept moist to minimize frictional heat as
the cup revolves.
• Polishing pastes are available in fine, medium, or coarse grit
and are packaged in small, convenient, single-use containers.
• Aggressive use of the rubber cup with any abrasive may remove
the layer of cementum, which is thin in the cervical area.
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
• Recently, an innovative
anti-splatter prophylaxis
angle has been introduced.
• A small plastic flange
positioned against the side
of the rubber cup prevents
splatter by removing excess
saliva and polishing paste
from the spinning cup
(Lotus DPA, Diamond Bar,
CA).
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
Bristle Brushes
• The brush is used in the prophylaxis angle
with a polishing paste.
• Because the bristles are stiff, use of the
brush should be confined to the crown to
avoid injuring the cementum and the
gingiva.
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
Dental Tape
• Dental tape with polishing paste is used for
polishing proximal surfaces that are
inaccessible to other polishing instruments.
• The tape is passed interproximally while
being kept at a right angle to the long axis of
the tooth and is activated with a firm
labiolingual motion.
• Particular care is taken to avoid injury to the
gingiva. The area should be cleansed with
warm water to remove all remnants of paste.
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
Air-Powder Polishing
• Delivers an air-powered slurry of warm water and sodium bicarbonate for
polishing and is very effective for removing extrinsic stains and soft deposits.
• The slurry removes stains rapidly and efficiently by mechanical abrasion and
provides warm water for rinsing and lavage. The flow rate of the abrasive
cleansing power can be adjusted to increase the amount of powder for heavier
stain removal. Both supragingival and subgingival tips that use various powder
formulas are available.
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
• Using sodium bicarbonate and aluminum trihydroxide on cementum and dentin show
that significant tooth substance can be lost. Damage to gingival tissue is transient and
insignificant clinically, but amalgam restorations, composite resins, cements, and other
nonmetallic materials can be roughened.
• Polishing powders containing glycine or erythritol rather than sodium bicarbonate are
commonly used for subgingival biofilm removal from root surfaces and implants also
restorative material.
• No soft tissue abrasion occurs, and at probing depths of 1 mm to greater than 5 mm,
the use of glycine or erythritol powder in an air-polishing device with a subgingival
nozzle is more effective for subgingival biofilm removal than the use of either manual
or ultrasonic instruments.
• Patients with a medical history of respiratory illness or hemodialysis are not candidates
for the use of the air-powder polishing device. Powder containing sodium bicarbonate
should not be used on patients with a history of hypertension, sodium-restricted diet, or
medication use affecting electrolyte balance.
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
Subgingival nozzle
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
Aerosol-Generating Devices and Communicable Diseases
• Aerosol-generating devices (AGDs) such as air polishers and ultrasonic scalers create a large amount of
contaminated aerosol.
• Patients with diseases that can be transmitted by aerosols should not be treated in the dental office or clinic.
However, since any patient could be an asymptomatic or prodromal carrier of coronavirus disease 2019
(COVID-19), tuberculosis, or other communicable blood-borne or airborne disease, air polishers should
only be used with proper aerosol control measures.
• Aerosols linger in the air for 30 minutes up to several hours in the entire operatory and in areas of the
dental office outside the operatory.
• Unprotected patients are more susceptible to infection by aerosols than dental personnel who wear
protective barriers such as face shields, respirators, masks, gloves, eyewear, and disposable clinical clothing.
• High volume evacuation, preprocedural rinsing with antimicrobial mouth wash, flushing of the handpiece
and water lines or a self-contained sterile water source, disinfection of environmental surfaces, adequate
ventilation and air filtration units with high-efficiency particulate air (HEPA) filters are all important
measures to minimize the hazards of microbial aerosols
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board
Thank you
Sara Abdulmannan Fareed BDS, DPCD MRCSI, MFD RCSI,
MClinDent, Jordanian Board