At the end of this lecture, you will be asked if you would like to take this course for continuing education units.
California Continuing Education Credits: 4 units
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| One of the most important parts of periodontal surgery is root planing. Gracey curettes are first used on all accessible root surfaces. | |
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| Visualization of these surfaces gives a better opportunity to obtain optimal smoothness of the roots and all visible calculus is removed. | |
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| The ultrasonic scaler can be used in inaccessible surfaces such as furcations, and in areas where curettes have not removed all the calculus. | |
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| Use of a slow speed handpiece with an ultrafine diamond bur is a valuable technique to smooth root surfaces that are still rough or which have calculus. This bur can reach into the depths of the bony crevices as well as hard-to-reach root surfaces. | |
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| The root surfaces are checked with explorers, and inspected visually to be certain that no obvious calculus is left. Special care is needed to be sure the roots are clean and smooth. | |
| The next surgical step is osseous surgery. A high speed handpiece with a rear air exhaust is used for osseous surgery so that there is no risk of air being forced into the tissues and so causing an air embolism. A #8 round bur is applied to those areas of the alveolar process where the bone is thick and irregular. An osteoplasty procedure is first done to give a thin tapered bone margin on the palatal surfaces with accentuation of the interdental grooves. | | |
| Interproximal craters are reduced by removing the palatal tip of bone. This palatal approach has the advantage of giving access to the interproximal surfaces and reduces the need to remove bone in the buccal furcations. Once the craters have been opened up and reduced, contouring of the bone on the palatal surface of each tooth is carried out so that a flowing, curved bone margin is obtained. | | |
| This is the straight end of the Kirkland chisel. The back action chisel on the other end is used in areas where it fits. | | |
| The bone margin next to the tooth areas is removed with minimal effect on the root surface. In interproximal regions, the straight end also refines the bone margin next to the tooth. | | |
| A similar approach is used on the buccal, beginning with an osteoplasty using the round bur. This is used to thin the alveolus and to develop a tapered bone margin next to the teeth. | | |
| The interdental grooves are emphasized. Bone is removed slowly with a minimum of pressure in order to keep the temperature gradient as low as possible. Copious amounts of coolant are essential. Minimal bone height is removed interproximally in the areas where craters exist. | | |
| The two ends of the Kirkland chisel are then passed along the bone margins to give a more controlled finish to the final contour of the bone and to round off any sharp edges. | | |
| A disposable plastic syringe filled with sterile saline is able to wash and cleanse the surgical area of any remaining debris. | | |
PERIODONTICS INFORMATION CENTER