The Impact of Research on Scaling and Root Planing

Timothy J. O'Leary*
Accepted for publication 31 August 1985

The research expanding our knowledge of the periodontally involved root surface and
its treatment is reviewed. To improve communication in the clinic and classroom, definitions
are suggested for the terms "scaling" and "root planing." The objectives and limitations of
root planing procedures are discussed.

Research the past 30 years has had a marked

over of the cementum. Other investigators6-8 have expanded
impact understanding of the periodontal dis-
on our on Zander's study; it is now generally accepted that
eases, our concepts of treatment and its effectiveness. calculus also forms in scaling grooves, penetrates into
Yet the objectives of treatment have remained constant carious defects and can occupy any irregularity or break
for almost 100 years. In 1886 G. V. Black1 stated: "The in the continuity of the root surface. Daly et al.,9
most important measure in the treatment of calcic Zander5 and Sottosanti and Garrett10 have reported
inflammation of the periodontal membrane and gums microbial penetration into cementum in the presence
is the removal of the concretions from the teeth, and of an intact surface.
next an arousing in the mind of the patient of an active Selvig11 examined freshly extracted teeth that had
determination to keep them clean in the future." His been involved to varying extents with destructive peri-
statement is as true in 1985 as it was in 1886. odontal disease and in which cervical root surfaces had
It is beyond the scope of this paper to discuss all the been exposed to the oral cavity. He found four distinct
clinical, cellular, biochemical and physiologic changes variations in the root surfaces: (1) normal-appearing
that occur in the gingiva and bone during development areas, (2) areas of decreased radiopacity and cavitation,
and progression of the periodontal lesion. Readers are (3) areas of partial décalcification (up to 300 µ) without
referred to reports covering these areas.2-4 loss of surface contour and (4) highly mineralized areas.
The present review will be presented under four Selvig and Zander,12 employing chemical analysis and
headings: ( 1 ) The Root Surface in Periodontal Disease; microradiography on periodontally involved teeth, sub-
(2) Scaling and Root Planing Procedures, (including sequently reported an area of increased mineralization
two methods of evaluating their effectiveness); (3) The in the cervical area.
Question of Root Smoothness; and (4) Use of Chemical Possible toxicity of the periodontally involved root
Agents on Root Surfaces. The review will be followed has been investigated by Hatfield and Baumhammers,13
by some proposed definitions, objectives and limita- who placed such roots, which had been scaled and
tions in treatment of the periodontally involved root washed into sterile tissue cultures. Uninvolved roots
surface. were used as controls. Over 24 to 96 hours the control
roots had no effect on the viability of the tissue culture
THE ROOT SURFACE IN PERIODONTAL cells, while the cells exposed to the periodontally in-
DISEASE volved roots suffered irreversible morphologic changes.
The results suggested that a toxic factor, possibly endo-
Investigations of the periodontally involved root have
provided a much clearer understanding of the "hard toxin, had penetrated the diseased root surface and then
tissue" lesion and the difficulties encountered in mak- leached out again. Scaling had not removed the toxic
factor. Morris14-15 reported that human, diseased, root
ing a surface biologically acceptable to the contiguous
soft tissue. Zander5 reported four ways in which calcu- surfaces, when implanted subcutaneously in rats along
lus attaches to the root and commented on the difficulty with autogenous bone marrow, inhibited the abortive
or impossibility of removing it without removing some beginnings of a periodontal type of ligament arrange-
ment seen when healthy roots were used.
*
Professor and Chairman, Department of Periodontics, Indiana Aleo et al.,16 using a Limulus lysate assay for endo-
University School of Dentistry, 1121 West Michigan St, Indianapolis, toxin, reported that involved root surfaces depressed
IN 46202'. cell growth of tissue culture fibroblasts. The responsible
69
 i. Periodontol.
70 O'Leary February, 1986

agent, an endotoxin-like material, could be extracted after treatment. With either approach, countless varia-
from the root surfaces with phenol/water and was re- bles must be considered, including root anatomy, types
sistant to autoclaving. The authors concluded that the of instrumentation, tooth types treated, depth of pock-
agent was probably endotoxin from the exposed, clini- eting and operator skills. With the second method,
cally normal-appearing cementum. In a subsequent in another variable is added: patient effectiveness and
vitro study the same investigators'7 determined that regularity in oral hygiene procedures, which must be
mechanical removal of the involved cementum resulted considered when evaluating the results of this type of
in root surfaces as amenable to attachment of cultured study. Both types of studies will be reviewed here.
gingival fibroblasts as those treated by phenol extrac- EFFECTIVENESS OF SCALING AND ROOT PLANING AS
tion. These studies indicate that this toxic substance
DETERMINED ON EXTRACTED TEETH
must be eliminated to secure adherence or close appo-
sition of the soft tissue to the root surface. Schaffer2' treated 18 teeth, both anterior and poste-
In another study,18 periodontally involved root sur- rior, with sulci varying from 2 to 7 mm in depth. Six
faces were thoroughly planed before extraction of the teeth were scaled with McCall or Gracey curets and the
teeth. Pooled samples of the planed root surfaces and other 12 were root planed. Under the light microscope,
of uninvolved teeth were assayed for Limulus activity the six scaled teeth had calculus remaining on many of
after being subjected to hot phenol/water extraction. the root surfaces, while of the 12 root planed teeth, one
Root planing rendered involved root surfaces as free of displayed a small amount of calculus on one surface.
detectable endotoxin as uninvolved root surfaces of Barnes and Schaffer22 planed 90 teeth subgingivally
unerupted teeth. A later report'9 showed that root prior to extraction: 30 with hoes, 30 with files and 30
planed teeth contained 2.09 ng/ml of endotoxin while with curets. Curets and hoes were most efficient.
ultrasonically treated teeth contained 16.8 ng/ml. Ito, In another study Stendhe and Schaffer23 compared
Hindman et al.20 attempted to elicit the Local Shwartz- the effectiveness of an ultrasonic instrument with hand
man Phenomenon in the gingiva and abdomen of curets. After treating 75 teeth with the ultrasonic device
rabbits by using the extract from untreated periodon- and 75 with hand curets, they reported no significant
tally involved root surfaces. A classic Local Shwartz- difference between the two methods in calculus re-
man Phenomenon was not elicited in any of the gingival moval. They stated that the ultrasonic device did not
or abdominal test sites. While the results indicated that plane the root surfaces.
a highly irritating substance could be obtained from Moskow and Bressman24 treated 95 teeth requiring
periodontally involved root surfaces, the authors ques- extraction with hand or with ultrasonic instruments.
tioned if the material extracted was actually endotoxin On evaluation with the stereomicroscope, 10 of 53
and stated that if it was a true endotoxin, it was present surfaces treated by ultrasonics had residual calculus,
only in extremely small amounts. compared to 5 of 42 treated by hand instruments. They
Comment. These studies emphasize the complexity stated that both instruments were effective for calculus
of the hard tissue lesion which we must treat. The removal. Jones et al.25 treated 54 teeth in situ with
involved root surface may exhibit numerous changes ultrasonic or hand curets. After evaluating the extracted
including résorption bays, cavitation or clefts and teeth under the electron microscope, they reported no
gouges from prior instrumentation. The area may be difference in efficiency of calculus removal.
covered by gross amounts of calculus or may display In a later study 48 periodontally involved proximal
little or no calcified material. The bacterial flora cov- root surfaces were treated with hand curets.18 The teeth
ering the surface and the calculus deposits may be had at least 5 mm of attachment loss. Of the 48 surfaces
copious or scant. The problem is further compounded treated, nine (18.75%) showed remaining calculus.
by the presence of a highly irritating substance on the Nishimine and O'Leary19 treated 46 teeth with hand
root surface which, if allowed to remain, would prevent instruments and a comparable group of 46 teeth with
adhesion or close adherence of the contiguous soft tissue an ultrasonic instrument. Ten (21.0%) of the hand
to the root surface. curetted teeth and 14 (30.0%) of the ultrasonically
treated teeth had residual calculus deposits.
To evaluate the effectiveness of subgingival plaque
SCALING AND ROOT PLANING PROCEDURES
control, Waerhaug26 treated the subgingival areas on all
There are two ways in which the effectiveness of four surfaces of 31 periodontally involved teeth with
scaling and root planing procedures can be evaluated. hoes, curets and rotating diamond instruments. On
There are studies in which teeth have been treated in examination after extraction, only three teeth had all
vivo, then extracted and evaluated under the stereo, four subgingival surfaces free of plaque, and in six of
light or electron microscope. In a second method of the 31 teeth, none of the four surfaces were completely
evaluating these procedures, periodontal health status free of plaque and calculus. Waerhaug concluded that
is carefully recorded before the teeth are treated, and the probability of removing all subgingival plaque was
that status is again recorded at various time intervals fairly good in pockets of less than 3 mm, that the
Volume 57
Number 2 Research, Scaling and Root Planing 71

probability of failure was greater than the probability those secured with repositioned and apically positioned
of success in pockets of 3 to 5 mm and that in pockets flap procedures in 17 patients with severe periodontal
over 5 mm the probability of failure dominated. disease. All three treatments were carried out in each
Rabbani et al.27 thoroughly scaled and root planed subject. The patients were then recalled every 2 weeks
all four surfaces of 62 teeth. After extraction, the teeth for professional tooth cleaning. Six months after treat-
were washed, stained with méthylène blue, rinsed and ment, bleeding on probing was reduced from 78% to
examined under the stereomicroscope. They reported a 15% of surfaces treated by all three methods. Root
high correlation between per cent of residual calculus planing resulted in a more coronal attachment level but
and pocket depth. They concluded that pockets less less pocket reduction than the surgical procedures.
than 3 mm in depth were easiest to treat, those 3 to 5 Intermediate-Term Studies. Badersten et al.34-36 eval-
mm were more difficult and those over 5 mm the most uated the effects of supra- and subgingival debridement
difficult to treat. and oral hygiene instruction on moderate and deep
EFFECTIVENESS OF SCALING AND ROOT PLANING AS
periodontal pockets on nonmolar teeth. They reported
marked reductions in gingival bleeding and probing
DETERMINED FROM CLINICAL TRIALS
depth. Further, they found no difference in results
For ethical reasons patients participating in studies between areas treated by ultrasonics or hand instru-
of the effects of scaling and root planing are instructed ments, or between the results of two different operators.
in oral hygiene procedures and asked to carry them out Finally, they reported no difference in results between
on a routine basis. There is also a practical reason for the effects of single versus repeated instrumentation.
emphasizing hygiene procedures, since without them In a 17-month study on single-rooted teeth, Cercek
subgingival areas are quickly repopulated with micro- et al.37 studied the effects of plaque control measures
organisms.28 alone for 8 months followed by supra- and subgingival
Short-Term Studies. Tagge et al.29 evaluated the re- instrumentation. The instrumentation resulted in a fur-
sponse of soft tissue pockets to treatment by oral hy- ther decrease in mean bleeding scores and probing
giene procedures alone or by oral hygiene procedures depths and a further improvement in attachment levels
and root planing. Both types of treatment resulted in a in pockets initially 4.0 mm or more in depth.
reduction of gingivitis and mean pocket depth. The Hill et al.38 compared the effects of scaling and root
combination of oral hygiene and root planing resulted planing with three modalities (pocket reduction surgery,
in significantly more improvement. Torfason et al.30 Widman flap surgery and subgingival curettage) in 90
used a split-mouth design to compare the effect of subjects after the hygiene phase of therapy. Following
ultrasonic and hand instrumentation in 18 subjects. the surgical and nonsurgical treatment, the teeth were
Each area was instrumented after initial data collection polished weekly for 3 to 4 weeks and the subjects
and was reexamined and reinstrumented 4 weeks later. received a prophylaxis every 3 months during the re-
The final examination was carried out after another 4 mainder of the 24-month study period. The main re-
weeks. There was a gradual reduction in bleeding points duction in pockets of 4 to 6 mm occurred during the
and pocket depth over the 8-week period. The gingival hygienic phase. For pockets initially >7 mm, significant
improvement achieved by all four operators was similar reductions were found both in the hygienic phase and
with both types of instrumentation. 1 to 2 years after treatment. The largest initial reduction
Morrison et al.31 evaluated the effects of scaling, root was found after pocket elimination therapy. None of
planing, oral hygiene instruction and occlusal adjust- the surgical treatment methods resulted in better main-
ment in 90 patients. Treatment was carried out for each tenance of attachment levels at any pocket depth, in-
participant in four to six sessions. The patients were dicating that complete debridement of involved root
reexamined 1 month following treatment. Mean pocket surfaces was more important than the surgical treat-
depths were significantly reduced for pockets >4 mm. ment of the soft tissue.
Reduction in pocket depth and more coronal attach- Lindhe et al.39 in a 24-month study compared the
ment levels were reported to be related to the initial effects of scaling and root planing to the Widman flap
level of severity. procedure. During active treatment and the subsequent
In a 1 -month study Hughes and Caffesse32 evaluated 6 months, participants received a professional tooth
the effect of scaling, root planing and oral hygiene on cleaning every 2 weeks and a prophylaxis every 3
61 labial and buccal areas with advanced or severe months thereafter for the remainder of the study. Scal-
gingival inflammation. They found a decrease in crevice ing and root planing alone were almost as effective as
depth of 1 to 2 mm in almost one half of the areas. their use in the Widman procedure in securing healthy
Approximately one fifth of the areas showed a 1-mm gingiva and preventing further attachment loss. Both
gain in new attachment. The effectiveness of plaque probing depth reductions and gains in attachment level
control was said to have had no influence on attach- were more pronounced in initially deep pockets than
ment levels or gingival position. in initially shallow ones.
Isidor33 compared the effects of root planing with Long-Term Studies. In the longitudinal studies of the
 J. Periodontol.
72 O'Leary February, 1986

Michigan group, subgingival curettage (planing of the attachment levels. Two factors probably account for
roots and intentional vigorous soft tissue curettage un- most of the apparent conflict in results between the two
der local anesthesia) was used rather than scaling and types of studies:
root planing (with inadvertent soft tissue curettage).40 1. The number of times the roots are instrumented
Subgingival curettage has subsequently been reported during the active and maintenance phases of the
to offer no advantage over scaling and root planing.4142 clinical trials.
Over an 8-year period, the results of subgingival curett- 2. The role of oral hygiene measures. In most short-
age were compared to those of the modified Widman and intermediate-term studies, routine elimina-
flap surgery and pocket elimination surgery in 43 pa- tion of the supragingival bacterial flora by per-
tients who were recalled for prophylaxis every 3 months sonal hygiene measures plays an important role.
after completion of active treatment.40 The group re- This along with periodic mechanical disruption of
ported that moderate and deep pockets can be reduced the subgingival microflora during maintenance
and maintained at the reduced level with all three procedures, would seem to be the critical element
treatment methods for 8 years while attachment levels in the results from longer term clinical trials.
are improved. Treatment sites kept free of plaque during the
The long-term (mean 22 years) retrospective results maintenance phase are associated with shallow
of periodontal therapy and maintenance in 600 patients crevices and maintenance of attachment levels.
have been reported by Hirshfeld and Wasserman.43 Conversely, sites with retained plaque exhibit in-
Periodontal surgery was performed on 230 patients. creased probing depths and loss of attachment.
Mean tooth loss over the study period was 7.1% and Further, the amount of plaque or calculus that can
did not appear to be related to the type of treatment remain on a root surface before inflammatory changes
given. are clinically evident is unknown.
In another retrospective study, McFall44 reported on
the status of 100 patients who had been treated and SMOOTHNESS OF ROOT SURFACES
maintained for periods of 15 to 29 years. As with the FOLLOWING INSTRUMENTATION
Hirshfeld and Wasserman study, one could not con-
The question as to whether hand or ultrasonic instru-
clude that tooth loss over the study period was related
mentation leaves smoother root surfaces has been the
to the type of treatment given.
Pihlstrom et al.45 compared the effects of scaling and subject of numerous studies.22'24,25'48-57 Some have
stated that the hand-activated curet is superior in
root planing with oral hygiene instruction to the effects
of the same therapy followed by Widman flap surgery achieving a smooth surface, while others have reported
better results with the ultrasonic instrument. One report
in 10 patients over 6-1/2 years. Sustained pocket re-
has indicated that the degree of smoothness has no
duction in 4 to 6 mm pockets was achieved with both
effect on clinical parameters.58 As with hand instru-
types of treatment, while attachment gain was greater
with scaling and root planing. There were no differences mentation, a number of factors play a role in the
smoothness of the root surfaces treated with the ultra-
between procedures in the sustained gain of attachment
sonic device.
found in pockets >7 mm deep. The authors later re-
A major problem in evaluating reports of root
ported no differences between molar and nonmolar smoothness after instrumentation has been the lack of
teeth in clinical attachment level with either treatment
method for pockets initially >7 mm.46 objective criteria for evaluating the surface. In a recent
Reporting the results of a long-term study comparing report Hunter et al.59 evaluated the smoothness of
surfaces after instrumentation using the criterion that
surgical and nonsurgical treatment, Lindhe et al.47 surfaces exhibiting gouges or ripples of less than 50 µ
stated that the critical determinant was the complete
were smooth. They reported that of 244 hand-planed
debridement of the root surface and not the technique
used to achieve it. They further reported that patients specimens, 138 (56.6%) were smooth compared to only
48 (18.8%) of 256 ultrasonically treated surfaces.
maintaining a high percentage of plaque-free surfaces Comment. The significance of a smooth root surface
displayed little evidence of recurrent disease. is unclear. Areas of root résorption covered by healthy
Comment. When periodontally involved teeth are
tissues tend to be filled in by new cementum. However,
scaled and planed just prior to extraction, investigators
a rough area on the root which is exposed to the oral
report that a significant percentage exhibit residual environment would appear to favor plaque and calculus
calculus. As pocket depth increases, they state that
accumulation.
complete removal of calculus becomes more difficult.
However, in studies ranging from a month to many USE OF CHEMICAL AGENTS
years, investigators have reported that scaling and root
planing combined with oral hygiene procedures have There continues to be great interest in the use of
resulted in mean decreases in probing depth, and an chemical agents to complement instrumentation in
improvement in, or at least maintenance of, initial treatment of periodontal pocketing.
Volume 57
Number 2 Research, Scaling and Root Planing 73

Mayrhofer60 introduced the combination of sodium The last objective (No. 6) may be controversial.
hypochlorite and citric acid as an organic solvent. De- However, depending on the philosophy of the individ-
spite use over many years, little objective data are ual or the school, surgery may be considered necessary
available concerning its effectiveness.61-64 One recent for successful treatment of areas not responding to root
animal study concluded that chemical curettage (use of instrumentation procedures.
the chemical agent with manual instrumentation) did The following factors which limit the effectiveness of
not result in improved healing.65 root planing should be made known to students so that
Use of citric acid on planed root surfaces has been they will not become discouraged and lose interest in
advocated to promote new connective tissue attach- periodontics when their clinical efforts do not yield an
ment.66-69 Studies using the dog as the experimental optimal result:
model have reported considerable amounts of cemen- 1. Anatomy of roots
tum deposition and a new connective tissue attach- 2. Depth of pockets
ment.7071 A study in primates72 has reported no more 3. Position of teeth
coronal attachment levels following its use, while results 4. Inadequate instruments for diagnosis
of human studies indicate that use of citric acid has 5. Inadequate instruments for treatment
little or no effect on attachment levels.73"75 6. Area of mouth being treated
A number of other agents for removing the debris 7. Size of mouth
from instrumented roots, detoxifying the periodontally 8. Elasticity of cheeks
involved root surface and exposing collagen fibrils of 9. Range of opening
the organic matrix of the root have been tested.76"78 10. Dexterity of operator
Some have been shown to be as effective as citric acid Comment. A number of these factors are beyond our
in removing surface debris, and more effective in de- control. Unfortunately, two of the areas where signifi-
toxifying the surface. cant change could be made are receiving little or no
Comment. At this time there are insufficient data on attention. When we consider that instrumentation of
the efficacy of any chemical agent to advocate its use tooth and root surfaces is one of the most common
in humans. procedures carried out in the dental office and has a
In view of the reported impossibility of removing all marked impact on the periodontal health of the popu-
cementum from the more apical areas of periodontally lation, the lack of interest of federal health agencies in
involved surfaces, agents capable of removing the sur- developing better instruments for diagnosis and treat-
face debris from both dentin and cementum following ment is puzzling.
root planing merit further study.79
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1979. nature of root surfaces after curette, cavitron, and alpha-sonic instru-
31. Morrison, E. G, Ramfjord, S. P., and Hill, R. W.: Short-term mentation. J Periodont Res 11: 374, 1976
effects of initial, nonsurgical periodontal treatment (hygienic phase). 56. Ewen, S. W., and Gwinnett, A. J.: A scanning electron micro-
J Clin Periodontol 1: 199, 1980. scopic study of teeth following periodontal instrumentation. J Perio-
32. Hughes, T. P., and Caffesse, R. G.: Gingival changes following dontol 48: 92, 1977.
scaling, root planing and oral hygiene. J Periodontol 49: 245, 1978. 57. Meyer, K, and Lie, T.: Root surface roughness in response to
33. Isidor, F.: Effect of Periodontal Surgery. Thesis, School of periodontal instrumentation studied by combined use of microrough-
Dentistry, University of Aarhus, Denmark, 1981. ness measurements and scanning electron microscopy. J Clin Perio-
34. Badersten, ., Nilveus, R., and Egelberg, J.: Effect of nonsurg- dontol 4: 77, 1977.
ical periodontal therapy. I. Moderately advanced Periodontitis. J Clin 58. Khatiblou, F. ., and Ghodossi, .: Root surface smoothness
Periodontol 8: 57. 1981. or roughness in periodontal treatment. J Periodontol 54: 365, 1983.
35. Badersten, ., Nilveus, R., and Egelberg, J.: Effect of nonsurg- 59. Hunter, R. K, O'Leary, T. J., and Kafrawy, A. H.: The
ical periodontal therapy. II. Severely advanced Periodontitis. J Clin effectiveness of hand versus ultrasonic instrumentation in open flap
Periodontol U: 63, 1984. root planing. J Periodontol SS: 697, 1984.
36. Badersten, ., Nilveus, R., and Egelberg, J.: Effect of nonsurg- 60. Mayrhofer, B.: Uber antiformin in der Zahnheilkunde erge-
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J Clin Periodontol 11:114, 1984. 61. Box, K. F.: Periodontal disease and treatment. J Ont Dent
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Relative effects of plaque control and instrumentation on the clinical 62. Haley, P. S.: Antiformin: clinical and experimental observa-
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Number 2 Research, Scaling and Root Planing 75
tions. Acad Rev 5: 109, 1957. repair responses following the use of citric acid in periodontal therapy.
63. Tussing, G. J.: Chemical curettage. F. M. Wentz (ed), Princi- /Periodontol 48: 261, 1977.
ples and Practice of Periodontics, p. 78. Springfield, Charles G 74. Froum, S. J., Kushner, L., and Stahl, S. S.: Healing responses
Thomas, 1978. of human intraosseous lesions following the use of debridement,
64. Kalkwarf, . L., Tussing, G. J., and Davis M. J.: Histologie grafting, and citric acid therapy. J Periodontol 54: 67, 1983.
evaluation of gingival curettage facilitated by sodium hypochlorite 75. Renvert, S., and Egelberg, J.: Healing after treatment of peri-
solution. J Periodontol 53: 63, 1982. odontal intraosseous defects. II Effect of citric acid conditioning of
65. Vieira, E. M., O'Leary, T. J., and Kafrawy, A. H.: The effect the root surface. J Clin Periodontol 8: 459, 1981.
of sodium hypochlorite and citric acid solutions on healing of peri- 76. Sarbinoff, J. ., O'Leary, T. J., and Miller, G H.: The com-
odontal pockets. J Periodontol 53: 71, 1982. parative effectiveness of various agents in detoxifying diseased root
66. Register. . .: Bone and cementum induction by dentin, surfaces. J Periodontol 54: 77, 1983.
demineralized in situ. J Periodontol 44: 49, 1973. 77. Lasho, D. J., O'Leary, T. J., and Kafrawy, A. H.: A scanning
67. Register, . ., and Burdick, F. .: Accelerated reattachment electron microscope study of the effects of various agents on instru-
with cementogenesis to dentin, demineralized in situ I. Optimum mented periodontally involved root surfaces. J Periodontol 54: 210,
range. J Periodontol 46: 646, 1975. 1983.
68. Register, . ., and Burdick, F. .: Accelerated reattachment 78. Slater, G ., Jr.: A Scanning Electron Microscope Study of
with cementogenesis to dentin demineralized in situ. II. Defect repair. the Effects of Various Agents on Instrumented Periodontally Involved
J Periodontol 47: 497, 1976. Root Surfaces. Thesis, Indiana University School of Dentistry, Indi-
69. Garrett, J. S., Crigger, M., and Egelberg, J.: Effects of citric anapolis, IN, 1983.
acid on diseased root surfaces. J Periodont Res 13: 155, 1978. 79. O'Leary, T. J., and Kafrawy, A. H.: Total cementum removal:
70. Crigger, M., Bogle, G., Nilveus, R.: The effect of topical citric a realistic objective? / Periodontol 54: 221, 1983.
acid application on the healing of experimental furcation defects in 80. O'Leary, T. J.: The inflammation reduction phase of peri-
dogs. J Periodont Res 13: 538, 1978. odontal therapy: oral hygiene and root planing procedures. Alpha
71. Ririe. C. M., Crigger, M., and Selvig, . .: Healing of Omegan 76(3): 32, 1983.
periodontal connective tissues following surgical wounding and ap-
plication of citric acid in dogs. J Periodont Res 15: 314, 1980.
72. Nyman, S., Lindhe, J., and Karring, T.: Healing following
surgical treatment and root demineralization in monkeys with peri- Send reprint requests to: Dr. Timothy O'Leary, Professor and
odontal disease. / Clin Periodontol 8: 249, 1981. Chairman, Department of Periodontics Indiana University School of
73. Stahl, S. S., and Froum, S. J.: Human clinical and histologie Dentistry, 1121 W Michigan St, Indianapolis, IN 46202.

Announcements
AMERICAN ACADEMY OF ORAL MEDICINE
AMERICAN ACADEMY OF ORAL PATHOLOGY
JOINT SYMPOSIUM ON VIRAL DISEASES
This symposium will be held in conjunction with the annual
meetings of both Academies at the Westin Hotel, Toronto, Canada,
Sunday, May 11, 1986. Topics for discussion will include AIDS,
Herpes Simplex Infections, and the Human Papilloma Virus.
For further information, contact either: Dr. Dean K. White, Uni-
versity of Kentucky College of Dentistry, Lexington, KY 40536 or
Dr. Norman S. Alperin, Suburban Hospital Medical Building, 4200
Warrensville Center Road, Warrensville Heights, OH 44122.

AMERICAN ACADEMY OF ORAL PATHOLOGY

The 40th Annual Meeting of the American Academy of Oral
Pathology will be held at the Westin Hotel in Toronto, Ontario,
Canada from Monday, May 12 through Friday, May 16, 1986. For
further information, contact Dr. Dean K. White, University of Ken-
tucky College of Dentistry, Lexington, KY 40536.