THE CLINICAL EFFECTIVENESS OF OPEN VERSUS CLOSED SCALING AND ROOT PLANING ON MULTI-ROOTED TEETH

SCALING AND ROOT PLANING ARE THE MOST COMMON techniques utilized to ac hieve a biologically-acceptable root surface. Thorough root debridemen t is a demanding task, with residual deposits of plaque and calculus a not uncommon finding after instrumentation. This study evaluated the effectiveness of scaling and root planing via a closed versus an open flap approach. Sixty multi-rooted teeth were assigned to one of three groups: untreated controls, closed scaling/root planing, and open flap scaling/root planing. Following debridement, teeth were extracted, im mersed in methylene blue, and examined for the percent surface area ha ving stainable residual deposits. The mean percent stained surface are a covered by residual plaque and calculus was 54.3% in the closed loot planing group compared to 33.0% in the open flap root planing group. The untreated control teeth had 91.0% of the root surface covered with stainable deposits. Within-group comparisons showed no significant di fference in the percent stained residual plaque and calculus in shallo w areas of the pocket (less than or equal to 3 mm apical to the gingiv al margin) compared to deeper areas (> 3 mm subgingival). Examination of furcation regions demonstrated heavy residual stainable deposits fo r both treatment methods, with no significant differences between tech niques. There was no correlation between the time spent in root debrid ement and the percent residual deposit area. The results demonstrate t hat hand instrumentation alone is inadequate for thorough debridement of furcations and suggest that new approaches are needed to provide a root surface which is compatible with formation of new periodontal att achment. High frequency ultrasonic instruments, rotary burs, and chemi cal agents may assist in debridement of such surfaces. Further evaluat ion of these and other novel approaches to root debridement are needed .