Gracey curettes are first used on all accessible root surfaces. Visualization of these surfaces gives a better opportunity to obtain optimal smoothness of the roots and all visible calculus is removed. The ultrasonic scaler can be used in inaccessible surfaces such as furcations, and in areas where curettes have not removed all the calculus. Use of a slow speed handpiece with an ultrafine diamond bur is a valuable technique to smooth root surfaces that are still rough or which have calculus. The root surfaces are checked with explorers, and inspected visually to be certain that no obvious calculus is left.
Special care is needed to be sure the roots are clean and smooth.
The next surgical step is osseous surgery. A high speed handpiece with a rear air exhaust is used for osseous surgery so that there is no risk of air being forced into the tissues and so causing an air embolism. An osteoplasty procedure is first done to give a thin tapered bone margin on the palatal surfaces with accentuation of the interdental grooves. Interproximal craters are reduced by removing the palatal tip of bone. This palatal approach has the advantage of giving access to the interproximal surfaces and reduces the need to remove bone in the buccal furcations.