Calculus removal and the prevention of its formation.

Periodontitis is strongly associated with the presence of dental calculus on root surfaces. Although the rough calculus surface may not in itself induce inflammation in the adjacent periodontal tissues, dental calculus serves as an ideal substrate for subgingival microbial colonization. Therefore, causerelated anti-infective therapy aims to eliminate the microbial biofilm and calcified deposits from the diseased root surfaces by means of root surface debridement. Over the past 50 years, a large number of clinical and laboratory studies have been performed to determine the efficacy of calculus removal from diseased root surfaces by various methods. These studies aimed to determine whether complete removal of subgingival calculus by root surface debridement is possible. They also evaluated the importance of operator experience in the effectiveness of calculus removal. Possible differences in efficacy between hand tools and power-driven instruments or lasers have been investigated. The impact of tooth and site characteristics, such as probing depths, tooth type, tooth surfaces and furcation areas, has also been evaluated. In addition, side-effects such as unintentional root substance removal and patient discomfort have been assessed. This review focuses on the composition and formation of calculus, its significance for the disease process, the methods available for calculus removal, and prevention of its formation.