Is hand scaling really necessary when a cavitron is used?

I'm from the old school and would like to know when rootplaning was done ONLY with the cavitron and no currettes. I have contacted our local periodontist and he advised me that it couldn't be done without scalers. Does anyone have any advise ? We have a new RDH in the office that says we don't need currettes that it may all be done with cavitron! Just curious to see what others have to say!
handscale
Official Townie
Member # 8138

Well, first I would tell the RDH in your office that scale and root plane can’t be done without curettes. Next I would probably try to find a new RDH. In my opinion you must use curettes to complete scale and root planing. These are the only instruments that can smooth the root surface. The cavitron may very well remove most of the calculus, but the other part of treatment is to leave as smooth of a root surface as possible--which requires hand instruments. This RDH is not providing complete treatment if she/he just uses cavitron which is only scaling.
nettles
Official Townie
Member # 8314

Go to www.perio.org and then to the products and reports section. You should be able to access reports and position papers. There is one on ultrasonic scalers that you should find helpful. I think you will be pleased to know that you can achieve an acceptable clinical result with ultrasonics. Your office may want to invest in and try some of the new scaler tips that allow much better access. I personally still provide smoothing of the root surface with a sharp curette after ultrasonic scaling. Just a personal preference.
stevedavis
Official Townie
Member # 8209

While I accept that one can "achieve an acceptable clinical result with ultrasonics," I do not believe one can truly plane roots with an ultrasonic instrument. In our office, the RDH uses both when performing RPC. This of course calls into question whether one really needs to plane those roots. But in my office, I allow the RDH to perform these procedures as they feel most comfortable, so long as otherwise fastidious-home-care patients aren't having problems with relapse after perio tx.
drgr8ful
Official Townie
Member # 7967

Our office just finished our initial meeting with a hygiene consultant to refine our soft tissue management program. The use of ultrasonics and Gracey curettes definitely go hand in hand. There are several types of cavitron inserts that should be used as each serves a different purpose such as: Larger standard--Deposit removal Thinner/slimlines--Deplaquing: Ball end insert--Furcations; Extra thin (perio)--Narrow and deep pockets; Curved inserts--Furcations; Larger Flat Inserts--Stain and cement removal. Hand instrumentation follows ultrasonic use. However, ultrasonics are used as a final step to ensure that the pocket is free of any microscopic tooth or bacteria particles that may be present, and to leave the cementum surface receptive for reattachment.
brian
Official Townie
Member # 8108

I will toss in my vote for ultrasonics and hand scalers/curettes both being needed for SRP procedures. While we rely heavily on the Cavitron in our practice, hand scalers are almost always needed for refinement. Cynthia Fong, who lectures for Dentsply~Cavitron also espouses this viewpoint. She has some interesting in vivo and vitro studies of the efficacy of both. I think that one of the things that Marshall was suggesting is whether root 'planing' actually needs to be a treatment goal. I would agree with you 100%. The concept/goal of SRP therapy being 'glass smooth' root surfaces is outdated and has been disproved as a necessity for perio health. This goal has led to the mutilation of root structure and removal of healthy cementum. Sensitivity frequently followed. Unfortunately, it is still being taught in many dental schools and hygiene programs. The AAP in it's position papers lists "The therapeutic objective of scaling and root planing is to remove plaque and calculus in order to reduce the number of oral bacteria below the threshold level capable of initiating inflammation."-a 'de-paraphrased' summary of several of the boards comments.

A 'glass smooth surface' is not a necessity if healthy tissue and attachment are achieved.
mmelkers
Official Townie
Member # 7957

A USC symposium 5 or 6 years ago addressed the controversy of ultrasonics versus hand instruments. There were strong advocates on both sides of the issue. The final panel conclusion was that you could obtain a good end result with either approach. A large majority of the "expert" panel felt that using both hand and ultrasonic scalers worked best. As to the controversy of whether you need to "plane" the root surface vs. "root debridement", that is less settled than it once was. I have used the Perio-Vue micro camera system that puts a camera on the end of the curette or the ultrasonic tip and allows you to see to the bottom of the sulcus. When scaling refractory cases that have not responded to traditional root planing (hand and/or ultrasonic) the camera will invariably show a rough area on the root surface and when you have planed it smooth the pocket almost always goes away or is greatly reduced. It has made me rethink the need for a smooth root surface.
skh1
Official Townie
Member # 8164