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PERIODONTAL DRESSING
Muthukumarasamy1,Nazargi Mahabob2
CORRESPONDING ADDRESS
Dr.Muthukumaraswamy, M.D.S.,
Asst.Professor, Dept of Periodontia
TNGDC,Chennai-3
Ph.no:9840994822
ABSTRACT
The periodontal dressing is a physical barrier that is placed in the surgical site to protect the
healing tissues from the forces produced during mastication for comfort and close adaptation.
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After setting it should have sufficient rigidity Liquid
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The dressing should have Smooth surface Eugenol, vegetable oil, added to dissolve
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The dressing should have bacteriocidal Eugenol thymol, a weak antiseptic. colour
property additives the setting involves both chemical and
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The dressing should not interfere with physical properties and is influenced by moisture,
healing proportions of powder and liquid used ,mixing time
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The dressing should have Dimensional and temperature . Eugenol can induce an allergic
stability reaction that produces reddening of the area and
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The dressing should not induce reaction burning pain in some patients .
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The dressing should have acceptable taste.
Disadvantages:
? Unpleasantness
Zinc oxide eugenol dressing contain 40 -50 % ? Spicy taste
eugenol, increases in amounts as zinc eugenate ? Burning sensation
decomposes. It has been shown to cause tissue ? Lack of smoothness
necrosis and delayed healing. ? Difficulty with adaptation
? Frequency of fracture
Radden 1992 found that free eugenol ? Crazing of acrylic materials
caused a marked inflammatory reaction , delayed
healing and tissue necrosis. Non-Eugenol Dressings (Soft Pack)
Developed in 1950s
Asbestos was found to have the potential 1. Basic Ingredients
for causing asbestos lung cancer and tannic acid a. base
cause liver damage when absorbed systemically b. Accelerator
2. Brand names
Baer et al 1960 described the use of a non - Coe-Pak Dr Gene Moinar of coe –
eugenol dressings containing zinc oxide, laboratories one paste-
bacitracin and hydrogenated fat. The material did
not set to hard consistency as do eugenol
dressings, and bacitracin was believed to aid in
healing.
TYPES OF DRESSINGS
A. Zinc oxide Eugenol Dressing (hard pack)
Popular following gingivectomies .
Eugenol has an obtudent effect on exposed
dentine and connective tissue . Eugenol has an
antiseptic property which can affect bacterial
growth. ?
Oxides of various metals – zinc oxide Oil-
plasticity
Brand Names: Wonder-Pak , by Ward 1923 ?
Gum – cohesiveness
Powder ?
Lorothidol –fungicide
ZnO- Resin- improve setting
Tannic acid- improve setting Other paste –
Cellulose fibers- improve setting ? Liquid coconut fatty acids
Zinc acetate – accelerator, better working time. ? Resin or rosin
Asbestos – binder and filler ? Chlorothymol - bacteriostatic
The re action between a metallic oxide and Haugen measured dimensional changes of freshly
fatty acids is the basis of Coe-Pak Automix prepared samples of Coe-Pak, Peripac, wonder-
Noneugenol Surgical Dressing and Periodontal pak expansion seen in Peripac, others contracted.
Pack Comes in Two-Pack: Two Double Barrel Haugen et al tested the adhesive properties of
Cartridges Coe-Pak, Peripac, wonder-pak- better adhesion in
Coe-Pak than wonder-pak and Peripac did not
have any adhesive strength at all. Hence
mechanical inter locking was necessary to hold
the dressings in place.
PERIOCARE
Perioputty Two paste, highly elastic periodontal
Methyl and Propyl parafens –bactericidal dressing which sets resiliently hard does not chip
and fungicidal property Benzocaine – topical or fall apart in the mouth.
anesthetic
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After mixing, PerioCare is ready to be picked
Peripac up with wet fingers in about 75-90 seconds.
Eberic and Muhlemann in 1959, ready mix ?
It has a 7 minute working time and sets in 15
minutes.
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It is patient pleasing, and has a neutral odor
and taste.
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Contains no eugenol or asbestos
Cyanoacrylate
N-BUTYL Cyanoacrylate (1965)
? DROPS/ SPRAYS
? SOLIDIFIES IN 5-10 SEC
? ADHESION FOR 2-7 DAYS
A P I C A L LY P O S I T I O N E D , F U L L ?
Excellent compatability with the wound site
THICKNESS AND SPLIT THICKNESS FLAPS ?
Stiffness by zinc oxide powder
WERE PERFORMED on 16 patients with one of
the 3 dressings applied post surgically. Clinical CARRIER FOR MEDICATION
and histological evaluations were made for 21 I R W I N W AT T E R S C O P S - O R A L
days. It was found that Cyanoacrylates produced ADHESIVE BANDAGE- well tolerated and non
better healing presumably because they prevent irritating. Safe to be used in oral cavity which gives
the accumulation of plaque and debris by sealing protection to the wounds.
the wound site .
BAUER & BLACK ,1954 –TEFLA facilitate healing
Forrest, 1974 , compared clinically in traumatic wounds .
Cyanoacrylate dressing to Suturing without
dressing , using Split mouth approach in 30 SCHLUTZ- viscous filament impregnated with
surgical cases . No significant difference was water in oil emulsion , effective in preventing
found between the two with regard to healing mechanical trauma . oil of bergamot used instead
responses. Cyanoacrylate dressing produced of eugenol causes less inflammation with greatest
Rapid hemostasis, Absence of discomfort and bactericidal activity
better patient acceptance.
Light-cure Periodontal Dressings
Dis advantages – difficulty in application Brand names
around posterior teeth and rapid polymerization Barricaid
upon contact with small amount of moisture. Characteristics
a) Non brittle & very elastic
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Binnie & Forrest,1974 clinical & histological b) No mixing
healing in 2 beagle dogs using ? Single-component, light-activated
Cyanoacrylate dressings verses suturing periodontal dressing eliminates time-
following periodontal surgery.. after 2 weeks consuming mixing of pastes.
healing was superior in Cyanoacrylate ? Curing with a visible light-curing unit to form
dressing
a non-brittle, but firm, protective elastic
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Levin et al 1975 Cyanoacrylate dressing -
covering.
close to ideal dressing material
? Incremental additions of the material, which
bond adherently, can be made in the mouth
It cannot dissipate the pull of the lip or
immobilize a flap for the time required for it to without any special prior surface preparation.
attach to the underlying tissue . ? The dressing is tinted pink, is tasteless, and
has a translucent character which allows for
Zinc Oxide & Glycol Alcohol (Peridres) superior esthetics
Powder- Zinc oxide & rosin ? Designed for both Direct and Indirect
tannic acid Placement. If the syringe is used in direct
Kaolin intra-oral placement, the syringe must be
Liquid- ethelene glycol discarded to avoid any potential patient
Butyl alcohol cross-infection.
? For Direct Dispensing - Using a sterile, dry
TISSUE CONDITIONERS 2 x 2 gauze, dry the buccal or lingual tooth
? Methacrylic gels with modifications to surfaces adjacent to the surgical site.
increase adhesion & rigidity, addition of ? Remove the tip from the disposable syringe.
antibacterial substances Dispense the material at the juncture of the
? Close adaptation & constant flow for 3 days cervical one-third of the teeth
create festooning ?
Placement of dental floss
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For protection & promotion of healing, the ?
Wire ligation
dressing should not exceed 1-2 mm beyond
the surgical site Anti Bacterial Properties of Packs
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Any edentulous areas can be filled in to make ? Bacitracin
dressing continuous ? Oxytetracycline
? Neomycin
Muscle trim cheeks, lips and tongue to ? Nitrofuranzone
prevent movement or dislodgement dressing
should not interfere with muscle, cheek and frenum Waehaug & Loe – EUGENOL PACKS prevent or
attachments;overextension causes irritation retard bacterial growth.
normally the areas of the mouth not covered No statistically significant difference
by the pack. Use chlorhexidine mouth rinses was found between Wondrpak and Nobetec
after brushing regarding mean pain score
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After the pack is removed the gums most
likely will bleed more than they did before the Effects on Cell Cultures
operation. This is perfectly normal in the early Kreth et al 1966, tested 4 periodontal
stage of healing dressings on Hela cell cultures, and found
eugenol dressings slightly inhibitory to cell growth.
Effects of Wound Healing
Comparison of Eugenol and Non-Eugenol Hildebrand and De Renzis 1974 tested 2
Dressings:- eugenol and 2 non-eugenol dressings on
Studies have shown that eugenol fibroblasts , greatest cell toxicity was with wonder
dressings are more irritating than non-eugenol –pak
dressings.
Hanger & Hensten Petterson 1978
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Recently, Early irritating effects of dressings compared cytotoxic effects of coe-pak, peri-pac &
may contribute to postoperative pain and wonder-pak , all exhibited high degree of
swelling whether or not it contains eugenol. cytotoxicity .
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Peripac was shown to be more irritating than
wonder-pak due to dimensional changes, Present Status and Value of Surgical Dressing
which caused tissue irritation. Whether or not to use a dressing?
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Materials such as Tefla or other fabrics may ? Loe and Silness 1961, concluded that
be interposed between dressings tissues to dressing has little influence on the healing
prevent such harmful effects. provided that the surgical area is kept clean.
? Stahl et al 1969 showed that the presence of
Disadvantage of Eugenol Dressings:- inflammation at the wound site had more to
? They set hard often with sharp edges and do with the rate of healing than whether or not
leave a bad taste in the mouth which make a dressing is placed.
them less popular ? Wampole et al 1978, found 24% incidence of
transient bacteremia in patients during post
Jorkjend L , et al examined the incidence operative dressing change.
and severity of postoperative pain after ? Greensmith and Wade 1974 , effects of coe-
gingivectomy, Coe-pak and 2 eugenol- pak & without dressing on GCF flow ,gingival
containing periodontal dressings, Wondrpak index & pocket depth,following reverse bevel
and Nobetec flap procedures. They reported no significant
differences between any of these parameters
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Patients were subjected to gingivectomy and found that the use of the , dressing
using 1 type of local anaesthesia (lidocaine + caused more pain & swelling but less
adrenalin) only and covering the surgical sensitivity & eating difficulty , also healing
areas with either of the 3 different dressings was rapid , but patients expressed a
in a randomized study preference for no dressing.
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Mean pain score after Coe-pak was higher ? Heaney and Appleton 1976,tested the
than after Nobetec effect of periodontal dressings when placed
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Mean pain score after Coe-pak was higher in periodontally healthy mouths,using either
than after Wondrpak coe-pak or wondr –pak . They found that
while the dressing caused little damage to the
periodontium, they were associated with
more inflammation than undressed areas. and without surgical dressing. J Perio.
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Jones and Cassingham 1979,TESTED 54:470.1983
THE POST OPERATIVE DIFFERENCES 3. Binnie WH and Forrest JO. A study of tissue
BETWEEN USING NO DRESSINGS AND response to cyanoacrylate adhesive in
USING COE-PAK IN 7 PATIENTS, WHO periodontal surgery. J Perio,45:619,1974
HAD PERIODONTAL SURGERY. patients 4. Checchi L, Trombelli L. Postopeative pain and
R E P O R T E D M O R E PA I N A N D disconfort with and without periodontal
DISCOMFORT WHEN DRESSING WAS dressing in conjunction with 0.2%
USED and expressed a preference for no chlorhexidine mouthwash after apically
dressing . other disadvantages are, positioned flap procedure. J Periodontol, 64
possibility of displacing a flap, entrapping (12):1238-42.1993
sutures beneath the dressing & FORCING 5. Gilbert AD, Lloyd Ch, Scrimgeour SN. The effect
DRESSING MATERIAL UNDER THE of a light-cured periodontal dressing material
FLAP during the placement . on HeLa cells and fibroblasts in vitro. J
Newman & Addy 1982 ,compared a
? Periodontol. 65(4): 324-9 1994
dressing plus a saline mouth rinse to o.2% 6. Glendinning D. A method for retention of
CHLX rinse following internal bevel flap periodontal pack. J Perio,47:236,1976
procedures in 9 patients .they suggested that 7. Greensmith AL and Wade AB. Dressing after
the use of a dressing post operatively is reverse bevel flap procedures J Clin
undesirable as it promote bacterial Perio,1:97.1974
contamination of the surgical site, increases 8. Haugen E, Gjermo P. Clinical assessment of
post operative surgical inflammation. CHLX periodontal dressings . J Clin Perio. 5: 50,1978
reduced postoperative plaque 9. Jones TM, Cassingham RM. Comparison of
accumulation and surgical inflammation. healing following periodontal surgery with and
Allen &coffesse 1983 ,examined clinical
? without dressing in humans. J Perio.
effects of perio-putty on periodontal healing, 49:387,1979
following modified widman flap procedures , 10. Jorkjend L , Skoglund LA. Effect of non-eugenol
concluded that no significant differences and eugenol containing periodontal dressings
exisits no pack philosoph on the incidence and severity of pain after
?
Modified home care procedure during periodontal soft tissue surgery. J Clin Perio.17:
immediate postoperative time period. The 341,1990
patient is asked to employ to a very soft 11. Kafrawy AH. Connective tissue reactions to an
brush and to work the brush bristles down to experimental periodontal dressing. J Dent
the tooth to the gingival margin but not onto Res,69:1825.1989
the soft tissue . 12. Levin MP, Cutright DE, Bhaskar SN.
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Cautious flossing so as not to disturb the Cyanoacrylate as a periodontal dressing J Oral
sutures is also encouraged ,to remove Med,30: 40.1975
bacterial plaque and ensure reduced 13. O'Neill TCA. Antibacterial properties of
inflammatory reaction during initial healing. periodontal dressings. J Perio,46:469,1975
14. Othman S, Haugen E, Gjermo P. The effect of
REFERENCES chlorhexidine supplementation in periodontal
1. Addy M, Douglas WH. A chlorhexidine- dressing. Acta Odont Scand. 47:361,1989
containing methacrylic gel as a periodontal 15. Philstrom BL, Thorn HL , Folke LEA.
dressing. J Perio,46: 465,1975 16. Richards, Caffesse RG, Smith BA. Light cured
2. Allen DR,Caffesse RG. Comparison of results periodontal dressing: a clinical evaluation. J
following Modified Widman flap surgery with Dent Res.68: 1824.1989