Several factors, including access and visualization problems, make total deposit removal during scaling and root planing procedures extremely difficult. This study examined the effectiveness of a mode of therapy designed to improve access and visualization for sonic scaling compared to closed sonic instrumentation. Teeth with moderate to deep probing depths in six patients scheduled to receive immediate dentures were divided into three experimental groups: Group I, sonic scaling with access augmented by interdental papilla reflection and fiber optic illumination/transillumination (34 surfaces); Group II, closed sonic scaling (34 surfaces); and Group III, untreated controls (35 surfaces). Immediately after treatment the experimental teeth were extracted, stained with toluidine blue, and interproximal areas evaluated for remaining accretions with a microscope-digitizing pad-computer system. Group I had a significantly lower percentage (P less than 0.01) of remaining subgingival accretion coverage than Group II (1.30 +/- 0.25% vs 6.35 +/- 1.08%), and both Group I and II demonstrated significantly (P less than 0.01) fewer deposits than the control surfaces (46.61 +/- 4.32%). These findings suggest that minimal tissue reflection and fiber optic illumination/transillumination are beneficial adjuncts to deposit removal in moderate to deep periodontal pockets.