Subgingival scaling involves the removal of subgingival calculus from the tooth surface. This can be from the enamel (crown) or from the root cementum surface, in which case it is termed root planing. Subgingival curettage or root planing can be closed or open. If open, some form of flap will have been made to aid vision and improve efficiency. Inadequate removal leaves an inflammatory focus present and the disease process will continue. Continued attachment loss will cause further deepening of the pocket. For subgingival scaling with hand instruments, use a subgingival curette (e.g. Gracey curette SG 11/12 or 13/14). Place the blade at 45°-90° to the root surface and pull firmly against the tissue to remove as much debris and chronically inflamed tissue as possible. Root cement is capable of being shaped by these instruments as well as with ultrasonic tips. Aim to smooth the root as much as possible - multiple overlapping strokes may be required. Evaluate again for smoothness with the probe. The use of fine tips in an ultrasonic scaler has proven to be a great deal more efficient for supragingival and subgingival scaling when followed by hand instrumentation. FSI™ tips Slimline™ tips and TFI™ tips (Dentsply) and Odontoson™ are all ultrasonic instruments that can be used under the gingival margin, albeit with care, as the water supply is carried with the tip.
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