Periodontics Root Planing — Procedure Guide, Recovery & Risks | MyMedicPlus

Scaling and root planing (SRP), also known as deep cleaning or root planing, is the non-surgical first-line treatment for periodontitis. It mechanically removes supragingival and subgingival calculus (tartar), bacterial biofilm (plaque), and infected cementum from root surfaces below the gum line, disrupting bacterial colonisation and allowing the inflamed periodontium to heal. SRP is performed quadrant by quadrant under local anaesthesia, distinguishing it from a routine prophylaxis cleaning. As the cornerstone of periodontal therapy endorsed by the European Federation of Periodontology (EFP) and the American Academy of Periodontology (AAP), SRP reduces pocket depths, decreases bleeding on probing, and often averts the need for surgical intervention in Stage I–II periodontitis. Full-mouth SRP completed within 24 hours may reduce systemic inflammatory markers more effectively than the quadrant-by-quadrant approach. Scaling and root planing (SRP) — also called deep cleaning or periodontal debridement — is the foundational non-surgical treatment for periodontitis. It involves mechanical removal of supragingival and subgingival calculus (tartar), bacterial biofilm, and diseased cementum from root surfaces to disrupt the pathogenic bacterial ecosystem in periodontal pockets. SRP is performed under local anaesthesia using ultrasonic scalers (Cavitron) and hand instruments (curettes, scalers) to access pockets up to 6–7 mm deep non-surgically. The procedure is performed quadrant by quadrant, allowing patient comfort and healing assessment. SRP is typically repeated at 6–8 week intervals for reassessment. Full-mouth disinfection — treating all quadrants within 24 hours with subgingival chlorhexidine irrigation — is an alternative protocol. SRP outcomes depend heavily on the patient's home oral hygiene practices and their commitment to the 3–4 monthly maintenance recall programme after active therapy is completed.

SRP is indicated for all patients diagnosed with Stage I–IV periodontitis exhibiting subgingival calculus, probing depths of 4 mm or greater, and bleeding on probing indicating active inflammation. It is the mandatory first step of active periodontal therapy before any surgical decision is made, as the tissue response to SRP determines whether surgery will be needed. Patients with gingivitis alone who have calculus deposits below the gumline benefit from SRP to eliminate subgingival bacterial reservoirs. SRP is also required before implant placement, orthodontic treatment, and major restorative dentistry. Contraindications to immediate SRP include uncontrolled systemic conditions such as uncontrolled diabetes, haematological disorders with coagulopathy, or acute periodontal abscess — the latter requires drainage and antibiotics before instrumentation. Anticoagulated patients should have their regimen reviewed with the prescribing physician before SRP.

The periodontist or dental hygienist administers local anaesthesia to one or two quadrants of the mouth. Ultrasonic scalers (piezoelectric or magnetostrictive) are used first to shatter and remove large calculus deposits above and below the gumline using high-frequency vibration and water irrigation. Subgingival access to pocket depths up to 9–10 mm is achieved with slender ultrasonic tips. Following ultrasonics, Gracey curettes — site-specific hand instruments designed for root surface anatomy — are used to plane the root surface smooth, removing remaining calculus and infected cementum. The endpoint is a hard, smooth, calculus-free root surface confirmed by tactile feel with the curette tip. In pockets deeper than 5 mm, subgingival irrigation with chlorhexidine or minocycline adjuncts may be applied. SRP is performed across 2–4 appointments, one or two quadrants per visit, allowing healing assessment at 6–8 weeks. The full-mouth disinfection protocol (all quadrants within 24 hours) is an alternative approach shown to reduce bacterial recolonisation. Curettes are inserted below the gingival margin to access the root surface and cementum. Deposits are removed using a pull stroke with firm lateral pressure. Ultrasonic tips are set at appropriate power and water settings to debride without excessive root surface removal. After SRP, the pocket is irrigated with saline or antiseptic. Local antibiotic application (doxycycline hyclate gel — Atridox; minocycline microspheres — Arestin) into persistent pockets provides adjunctive antibacterial effect for 14–21 days. Re-evaluation at 6–8 weeks determines the need for surgical intervention for pockets remaining over 5–6 mm with bleeding on probing.

SRP consistently reduces periodontal pocket depths by 1–2 mm in Stage I–II periodontitis and reduces bleeding on probing by 50–60%, converting active disease to a stable maintainable condition. Clinical attachment gain of 0.5–1.5 mm is achieved in most treated sites. Approximately 70–80% of patients with Stage I–II periodontitis can be managed successfully with SRP alone without progressing to surgical intervention. For Stage III–IV disease, SRP reduces pocket depths sufficiently to allow safer and more predictable surgical outcomes when surgery is subsequently needed. Adjunctive systemic antibiotics (amoxicillin plus metronidazole) in Stage III Grade C periodontitis associated with Aggregatibacter actinomycetemcomitans provide additional clinical benefit beyond SRP alone, supported by randomised controlled trial evidence. Scaling and root planing achieves clinically significant probing depth reduction (mean 1–2 mm) and clinical attachment gain (mean 0.5–1 mm) in moderate to severe periodontitis, preventing further bone loss and tooth mobility. Successful SRP eliminates the need for periodontal surgery in 70–80% of patients with moderate disease. Post-treatment maintenance SRP every 3–4 months reduces tooth loss risk by 80% compared to no treatment. Systemic benefits include reduced serum CRP and IL-6 levels, improved glycaemic control in type 2 diabetics, and possible reduction in cardiovascular inflammatory markers.

SRP is highly safe with minimal serious complications. Post-procedural discomfort and mild gingival bleeding lasting 24–48 hours are expected. Root surface sensitivity to cold, sweet, or air stimuli is the most common side effect, occurring in up to 40% of patients in the weeks following SRP, as calculus and inflamed gingival tissue that previously covered root surfaces are removed. Sensitivity typically diminishes over 4–8 weeks and is managed with desensitising toothpaste, fluoride varnish, and reduced intake of acidic foods. Gingival recession of 1–2 mm may become apparent after swelling resolves, reflecting the reduction of inflamed, hyperplastic gum tissue. Bacteraemia during SRP is transient and clinically insignificant in healthy individuals; antibiotic prophylaxis is required only for patients with specific cardiac conditions as per current AHA guidelines.

Patients may experience soreness and sensitivity for 24–72 hours post-SRP. Over-the-counter ibuprofen or paracetamol provides adequate analgesia for most patients. A soft diet is recommended for the first 24 hours. Chlorhexidine 0.12% mouthwash used twice daily for 2 weeks supports gingival healing and reduces bacterial load; it is discontinued after 2 weeks to avoid tooth staining. Normal tooth brushing resumes the day after SRP using a soft-bristled brush; interdental cleaning with floss or interdental brushes continues daily. The treated quadrant is reassessed at 6–8 weeks: pocket depths, bleeding on probing, and clinical attachment levels are compared with the pre-treatment chart. Persistent pockets of 5 mm or greater with ongoing bleeding at re-evaluation indicate the need for periodontal surgery. Subsequent supportive therapy visits every 3–6 months are essential for long-term stability.