The goal of the prophylaxis treatment is healthy periodontal tissue. Subgingival instrumentation is one factor in a step towards a healthier mouth, in combination with good dental hygiene techniques performed by the patient.

There are some basic rules that apply to a proper instrumentation technique. To achieve an effective technique for hand instrumentation, it is advised to use the "five step technique":

1. Position the instrument at the correct angle against the tooth surface.
2. Change the angle of the instrument - the cutting edge should be in the right position against the tooth surface (do not use lateral pressure).
3. Use light lateral pressure and push the cutting edge against the surface.
4. Pull the instrument along the tooth surface towards incisal or occlusal (pulling stroke).
5. Relax.

The instrument is held in the modified pen grip. This way of holding the instrument improves control over the instrument and prevents the instrument slipping away during the treatment. It also reduces hand fatigue and improves tactility. The point of support should be close to the working area and should be stable but flexible. The fourth finger (ring finger) is often the support point. It is not recommended to support the hand on the soft tissues (cheeks/lips) or on mobile teeth. The blade of the instrument should always be into contact with the root surface. Therefore it is important that the operator has knowledge of the working angle of the different instruments. The instrument should be moved over the surface with overlaying movements. This is because the contact surface between the instrument and the root is small. It is recommended to scale from the bottom of the pocket towards the gingival margin. And it is preferable that all tooth surfaces should be completed in one session.

Scaling and rootplaning should be performed selectively, the operator deciding where to clean and on which pockets to work, based on pocket depths and the level of bleeding produced when probing.

During the prophylaxis treatment, (ultra)sonic instruments are required. It is however a common misconception that it will save a lot of time. Mindlessly moving an (ultra)sonic scaler along the root surfaces, hoping for a good result is na?ve. The (ultra)sonic scaler should be used properly and with the right technique. For the best result (and for a convenient way of working for the operator) it is recommended to combine the use of (ultra)sonic instruments with the hand instruments. Start with (ultra)sonic scaling and rootplaning and then use hand instruments for finishing and smoothing of the surfaces. If properly used the ultrasonic and sonic instruments can be valid substitutes for hand instruments. In difficult to reach areas (for example furcation areas or small, deep pockets) they may be the best choice. A demonstration of the various movements that should be performed with the ultrasonic scaler can be found here.

Knowledge of tooth anatomy is essential. The operator should be aware of the fact that convex or concave surfaces can be present. And it becomes more complex when treating teeth with more than one root.

The use of sharp instruments is necessary. Therefore sharpening is very important (unless you are using any of the new generation of scalers and curettes that do not require sharpening). There are different ways of sharpening instruments. Personal preference of the operator is relevant.