Advanced Visualization Techniques Summary of Clinical Utility

The advantages and limitations of closed ScRP are well-established.^13,66 The removal of calculus and dental plaque biofilm with hand and ultrasonic scalers to achieve a biologically compatible root surface can result in significant clinical improvements.¹³ Complete calculus removal can rarely be reliably achieved, decreased effectiveness in removal of root surface deposits has been associated with increasing probing depths and operator experience.^16,17 Because increased residual calculus after closed ScRP has been found within deeper periodontal pockets and at root flutes, tooth line angles, and at CEJ sites, these sites prove particularly challenging to achieve optimal clinical outcomes with only closed ScRP.^67,68 In these cases, increased visualization through surgical access has been demonstrated to improve the efficacy of calculus removal, but—even with surgical debridement—complete calculus removal at the scanning electron microscope (SEM) level is rare.²⁰ In addition to the challenges of calculus removal, detection of subgingival calculus deposits in a closed environment is also limited by a lack of visualization and inaccuracy of tactile sensations and potential confounding due to radicular irregularities, differentiation of the CEJ or restorative margins from calculus deposits, and variable subgingival anatomy.^69,70 In these cases, the use of enhanced visualization technologies have been proposed to improve the efficiency of nonsurgical periodontal therapies by allowing better visual assessment of exposed or subgingival root surfaces. Overall, the use of magnification has been associated with enhanced outcome of most technical dental procedures, including scaling and root planing.¹