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Tenacious calculus and reevaluation protocol

I just came back from work and I feel totally defeated today.
I had SRP on a patient who had significant radiographic sub calculus.
I worked as much as I can to remove everything and took a post Bws after the SRP. I removed most of them except distal of #1 and #2. I went back with cavitron and hand scalers and tried to remove couple of times and just cannot get that sub calculus on that teeth. Pt has moderate boneloss that is seen on radiograph and the location of the calculus is almost on the root surface of the teeth. What should I do? She is coming back for an evaluation and prophy after about a month. Should I try to rescale that area?

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1 Answer

A few things to consider here are pocket depths, instrument quality, instrument choice, and adequate appointment time.
Are your instruments sharp? Are your instruments passed their prime and need to be replaced? Instruments only last 9-18 months depending on many factors. Ultrasonic inserts wear out too. Do you have the wear guide that came with them to check if they are passed their prime? If your instruments are not sharp and/or are worn out, they aren’t going to remove calculus effectively.
How deep are the pockets around #1 and #2? Hand instruments are only effective to about 6mm and some studies show even less.
Were you using a universal and maybe need to try a site-specific Gracey? Remember root anatomy and make sure you are adapting your instrument properly. Lastly, are you given enough time to treat the patient?
When the patient returns, do rescale that area. Use an 11/12 explorer after you scale to check your work.

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