Root Surface Following Scaling and Root Planing
Hello Jill – Can you point me to some current references on this topic? The theory when I was in school was that the surface should feel like glass. Now I am told this interferes with reattachment. I have also read that root planing creates a bacterial smear layer that is detrimental to healing.
I have done some preliminary research – however, are there some key articles/books that substantiate the current thinking on the technique of root planing and what the root surface should feel like? Also, does it make a difference if the surface is subgingival or exposed?
I need evidence!
Hi – tough questions! First, let me say that I know what you mean about being taught to make the root surface “glassy smooth.” I was taught the same thing as a dental hygiene student – we must be of the same vintage 😉 The main reason this theory fell out of favor is that many patients were being over-instrumented with too much root structure removed. This resulted in severe hypersensitivity as well as loss of important root structure. So the concept of assessing healing response versus glassy smoothness became mainstream. However, this did not mean that it was OK to leave calculus on root surfaces. In fact, we still want the root surfaces smooth, just not over-instrumented. So that may be why you’ve had difficulty finding evidence to support that it”s OK for the surface to NOT be smooth.
I searched some past articles on the Dimensions website and found a great interview with Anna Pattison (see link below). Here”s an excerpt that might be helpful for you:
“Years ago when I was a student at USC, the best clinical instructors would feel with a sharp explorer and insist on glassy, smooth root surfaces. We now know through endoscopy that they were feeling very clean root surfaces and, most likely, all the embedded residual calculus was gone. At that time it was the best immediate, empirical evidence they had without laying a surgical flap. Today, we can examine subgingivally with the endoscope to see if anything is left. Since less than 300 endoscopes are currently in use, your best indication of success is lack of bleeding on probing.3,4 Although this is not 100% foolproof, if there is still bleeding on probing when you reevaluate after 4 weeks the treatment team should decide if a referral to a periodontist is the next step. If the patient is not referred, all of the bleeding areas need to be rescaled.”
There are lots of great references along with the interview, so hopefully that will be helpful to you.
There”s also some great information in Kathleen Hodges” book, “Concepts in Nonsurgical Periodontal Therapy.” There”s a link to the chapter where she discusses glassy smooth root surfaces below. Lots of good references are provided in this book as well.
As far as there being a difference between a subgingival or exposed root surface, I haven”t seen this addressed anywhere. It”s definitely an interesting thought, and if I hear of anything about this I will be sure and let you know (and vice-versa!)
Thanks for such thought-provoking questions, and for searching for the evidence!