What is the difference between deep dental cleaning and root planing (periodontal debridement)?

From the Guidelines

Deep dental cleaning, also known as scaling and root planing (SRP), is a recommended treatment for patients with signs of gum disease, and it should be performed with adjunctive antibiotic therapy, such as metronidazole/amoxicillin, to achieve significant reduction in probing depth and clinical attachment level gain. This recommendation is based on the most recent and highest quality study available, which found that SRP with adjunctive antibiotic therapy resulted in greater reduction in probing depth and clinical attachment level gain compared to SRP alone 1. The study also suggested that metronidazole/amoxicillin was the most potent combination, with a significant reduction in probing depth by 0.53 mm and clinical attachment level gain by 0.45 mm.

Key Points to Consider

• The procedure typically requires local anesthesia and is performed using specialized instruments to clean tooth surfaces and smooth root surfaces.
• After the cleaning, an infusion cleaning may be performed, which involves applying antimicrobial medications directly into the periodontal pockets to help fight infection.
• Common medications used include chlorhexidine gluconate, minocycline microspheres, or doxycycline gel, which help reduce inflammation and promote healing of the gum tissue.
• Maintaining good oral hygiene after treatment is crucial, including gentle brushing twice daily, daily flossing, and using an antimicrobial mouthwash.

Benefits of Deep Dental Cleaning with Antibiotic Therapy

• Significant reduction in probing depth and clinical attachment level gain
• Improved pocket depth reduction and clinical attachment level gain
• Reduced inflammation and promotion of healing of the gum tissue
• Effective removal of bacterial biofilm that causes inflammation and bone loss around teeth, allowing the gum tissue to heal and reattach to tooth surfaces, as seen in the study 1, which found a significant reduction in probing depth by 0.99 mm and increased attachment level by 1.12 mm with locally delivered azithromycin.

From the Research

Deep Dental Cleaning

• Deep dental cleaning, also known as scaling and root planing, is a procedure used to treat periodontal disease by removing plaque, tartar, and bacteria from teeth both above and below the gum line 2.
• The goal of deep dental cleaning is to create a biologically compatible root surface and reduce the inflammatory burden, which can help to prevent further progression of periodontal disease 2.
• Studies have shown that deep dental cleaning can be effective in reducing probing depth and clinical attachment level parameters, especially in deep pockets 3.

Infusion Cleaning

• Infusion cleaning is not a widely recognized term in the field of dentistry, and it is possible that it may refer to the use of antimicrobial agents or other substances in conjunction with deep dental cleaning.
• Some studies have investigated the use of local antimicrobials in addition to scaling and root planing, and have found that they can provide a statistically significant but not clinically important benefit 4.
• The use of antimicrobial agents, such as chlorhexidine and metronidazole, has been shown to have a minimal effect when compared with placebo, although some studies have found that they can be effective in reducing probing pocket depth in deep or recurrent periodontal sites 4.

Comparison of Deep Dental Cleaning and Infusion Cleaning

• There is limited evidence available to directly compare the effectiveness of deep dental cleaning and infusion cleaning.
• However, studies have shown that deep dental cleaning can be effective in reducing probing depth and clinical attachment level parameters, and that the use of local antimicrobials can provide additional benefits in certain cases 3, 4.
• Further research is needed to fully understand the effectiveness of infusion cleaning and its potential benefits and drawbacks compared to deep dental cleaning.

Anesthesia Options for Deep Dental Cleaning

• Intrapocket and/or topical anesthetic options may offer an alternative to injected anesthesia during scaling and root planing in patients with shallow to moderate periodontal pockets 5.
• The use of local anesthetics, such as those applied topically or intrapocket, can help to reduce pain and discomfort during deep dental cleaning procedures 5.