Scaling and root planing: removal of calculus and subgingival organisms

Scaling and root planing studies have shown that despite the best efforts of skilled clinicians, it is almost impossible to achieve calculus-free roots. Flap access nearly doubles the operator's ability to remove calculus. Furcation areas, however, continue to harbor significant amounts of calculus after scaling and root planing with or without the benefit of a flap. While thorough root debridement and planing are desirable treatment goals, not all would agree that complete cementum removal is either possible or desirable, or that the removal of calculus is more important than plaque or endotoxin removal in achieving clinical success.