Root Planing Isn’t Outdated, It’s Essential for Healing

In recent conversation I had with a new dental hygiene graduate, she mentioned that the program she had completed did not teach students how to root plane. I asked for the reasoning behind the omission of this procedure that is part of the American Dental Association’s Code on Dental Procedures and Nomenclature and one that I perform daily. Her response was that the faculty said it was outdated and no longer considered beneficial. The reasoning behind this point of view is that bacterial biofilm is the cause of periodontal diseases, therefore, glassy smooth roots are not necessary nor significant.

She went on to share that in her new position at a periodontal practice, the periodontist had complained that she had left the roots rough. Her new employer was upset about the absence of education on root planing, an integral part of nonsurgical periodontal treatment. He tried to approach the examining and licensing bodies involved but they were not interested. I foresee him adding a question about root planing in his future interviews when hiring dental hygienists. Meanwhile, this new hygienist is struggling to learn root planing on the job and feels disappointed in her career of choice, noting that it is difficult and not worth the pay. Last I heard, nursing will be her next pursuit.

I’m not privy to the reasons why the college has eliminated root planing from its curriculum, so I will respond to the importance of the root planing procedure with respect to healing following nonsurgical periodontal therapy.

I have used a dental endoscope for 16 of my 40 years as a practicing dental hygienist. I have seen with 50 to 100 times magnification, how root calculus is removed with an ultrasonic insert/tip or a hand instrument. Although I’ve watched a bladed hand instrument fracture subgingival calculus vs the layered removal by the motion of an ultrasonic insert/tip, both hand and ultrasonic instruments leave embedded calcified debris in the cementum if the root is not planed.

Embedded, residual calculus can be seen with an endoscope but is usually not felt with an explorer. Leaving any embedded calculus will impede the healing of the pocket. Live bacteria biofilm can latch on or connect via channels that remain following biomineralizarion of the calculus. Removing this layer of embedded calculus means removing some or all of the cementum that houses it. The purpose of cementum is attachment of the fibers from the periodontal ligament, which holds the tooth to the bone. It is this porous nature of cementum that also provides a perfect niche for bacterial biofilm to inhabit and calcify. A smooth root will retain less bacterial biofilm, which, in turn, will result in less calculus formation.

Removing the cementum is said to reduce the likelihood of healing through fiber attachment. Whether cementum is entirely removed or not, healing will be accomplished via the long junctional epithelium, not by fiber reattachment, because new attachment can only occur by the formation of new cementum. This requires the formation of cementoblasts on the root surface, which does not occur from the gingival connective tissue.

Either way, the pocket heals. Leaving calculus on or embedded in the root surface results in remaining pocket formation, inflammation, and progression of periodontal There is no beneficial reason to deliberately leave calculus or its embedded layer behind on a root surface, in fact, it is detrimental to healing.

The question should be whether to plane with traditional methods or to plane using a dental endoscope. Using a dental endoscope helps identify calculus, embedded necrotic cementum, and clean root structure, thus preventing over-instrumentation. If you are not using a dental endoscope to evaluate for a clean root surface, a dental explorer is traditionally used. Tactilely smooth roots are not a thing of the past but an important goal for periodontal health.