Twelve years have gone by since the first edition of Periodontal Instrumentation appeared. Dentistry and Medicine, and indeed society, have been rocked by the emergence of AIDS. Periodontics has seen a vast increase in the understanding of the etiology and pathogenesis of the various forms of periodontal disease. Despite this, the fundamental concepts and techniques of periodontal instrumentation and its role as the foundation of periodontal therapy has changed little. When we sit down next to our patients in the dental chair, we still treat periodontal disease by removing plaque, calculus, and altered cementum. All of these advances have underscored the importance of instrumentation skills in successfully treating periodontal disease. For this reason, the material dealing with basic instrumentation skills has been retained from the first edition. New material has been added on both fundamental and advanced instrumentation skills for this edition, expanding the application of this text from beginning to advanced students and beyond to the experienced private practitioner.

A significant number of patients suffering from periodontal disease could be treated more successfully if general dentists and dental hygienists were better educated in periodontal examination techniques and in scaling and root planing procedures. Much of the periodontal surgery that is performed today most certainly could have been avoided by earlier recognition of periodontal disease, better patient education, and more thorough instrumentation in the early stages of gingivitis and periodontitis.

Proficiency in periodontal instrumentation especially scaling and root planing, is essential to the ultimate success of any course of periodontal therapy. Even the most sophisticated or complex surgical procedure will not be successful if the clinician has not scrupulously debrided the tooth surfaces. Of all clinical periodontal procedures, subgingival scaling and root planing is the most difficult and exacting skill to master. It seems to be only the exceptional clinician who is able to confidently and consistently perform thorough instrumentation of root surfaces. Because this skill is so commonly performed in dental practice, it is unfortunate that relatively little has been written in the major periodontal textbooks about instrumentation. Also, a relatively small portion of the clinical curricula of most dental schools is devoted to the teaching of this skill, which is the cornerstone of periodontal therapy in the general practice of dentistry.

The book is organized in six modules, which appear in the sequence of the steps in initial periodontal therapy. Module I, Examination Procedures, introduces the extraoral and intraoral examination and the periodontal examination. Module II, Detection of Calculus, describes the use of the explorer and compressed air. Module III, Scaling and Root Planing, teaches the fundamentals of scaling and root planing with universal and Gracey curets, sickles, hoes, files, and ultrasonic sealers. Module IV, Instrument Sharpening, discusses principles of sharpening and demonstrates sharpening of curets and sickles. Module V, Polishing, includes fundamentals of polishing and polishing technique. Module VI, The Periodontal Patient, includes advanced root instrumentation, new instruments specially modified for periodontal patients, and adjunctive procedures such as treatment planning, pain and anxiety control, and gingival curettage.

Each module begins with prerequisites, a general objective and directions for use of the module. This is followed by a series of skills lessons. We have long been concerned about education that teaches "how" but does not emphasize "why". Therefore, each procedure is preceded by a discussion of its rationale. The lessons are followed by review questions, an answer key, and a performance check when appropriate. The performance checks are designed for self-evaluation alone or for self- and instructor evaluation.