Calculus removal by scaling/root planing with and without surgical access

Area of Science:

• Periodontology
• Dental Implantology
• Oral Surgery

Background:

• Subgingival calculus is a primary etiological factor in periodontal disease.
• Effective calculus removal is crucial for successful periodontal therapy.
• Residual calculus can impede periodontal healing and lead to treatment failure.

Purpose of the Study:

• To compare the efficacy of scaling and root planing (S/RP) alone versus S/RP with a modified Widman flap in removing subgingival calculus.
• To assess the presence and extent of calculus on root surfaces after different periodontal treatments.

Main Methods:

• Teeth were extracted after receiving S/RP alone, S/RP with a modified Widman flap, or no treatment.
• Subgingival root surfaces were examined for pocket depth (PD), exposed root surface area (A), and retained calculus (C).
• Calculus-positive teeth (CPT), calculus-positive surfaces (CPS), and calculus-to-area ratio (C/A) were calculated for each group.

Main Results:

• S/RP with a modified Widman flap resulted in significantly lower CPT (37%) and CPS (14%) compared to S/RP alone (62% and 24%).
• The advantage of the flap procedure was most evident on facial/lingual surfaces and anterior/premolar teeth.
• In pockets deeper than 8 mm, CPS remained constant at 17% with the flap procedure, whereas it increased to approximately 45% with S/RP alone.

Conclusions:

• Surgical access via a modified Widman flap enhances subgingival calculus removal compared to non-surgical S/RP.
• The benefits of surgical intervention are particularly notable in deeper periodontal pockets.
• Complete calculus eradication remains a challenge, but flap surgery improves root surface cleanliness.