To enhance treatment planning and efficacy, several systems for calculus detection and/or elimination have been developed, based on different technologies ( Meissner and Kocher, 2011 Bhusari et al., 2013). Correct evaluation of a cleaned surface is a key to thorough debridement. The location and inflammatory status of the gingiva also impact the detection and subsequent removal of deep-seated calculus.Ĭlinicians are frequently uncertain about the nature of a subgingival root surface while performing periodontal instrumentation. The drawback of traditional tactile perception of the subgingival environment is that the clinician may lack visibility and accessibility before and after treatment, leading to residual calculus and/or the undesirable removal of cementum.

This step is followed by tactile perception with a periodontal probe, explorer, or curette, until the root surface feels smooth and clean. These toxins are found on, but not within, the periodontally diseased root surfaces hence, the surfaces should be treated carefully without extensive removal of the underlying cementum ( Nyman et al., 1986).Ĭurrent subgingival root debridement techniques involve the systematic treatment of all diseased root surfaces by hand, sonic, and/or ultrasonic instruments. Because of its porous nature, calculus can adsorb a range of toxic products and retain substantial levels of endotoxin that can damage the periodontal tissues. The rough calculus surface may not, in itself, induce inflammation in the adjacent periodontal tissues, but may serve as an ideal substrate for subgingival microbial colonization ( Jepsen et al., 2011).Ĭause-related anti-infective therapy aims to eliminate the microbial biofilm and calcified deposits from diseased root surfaces through root surface debridement ( Jepsen et al., 2011). Their accumulation and attachment are facilitated by a roughened root surface ( Zander, 1953 Waerhaug, 1956 Mamoru et al., 2004). Bacterial plaque and calculus are accepted etiological agents in the initiation and progression of periodontal disease ( Ash et al., 1964).

Subgingival tartar removal