140 Periodontal Dressings Lisa A.

Harpenau PART 15 Miscellaneous Issues, Problems, and Treatments Periodontal dressings were first introduced in 1923 by Dr A.W. Ward, who recommended the use of a packing material following gingival surgery. The dressing material, Wards Wondrpak, was made of zinc oxide and eugenol, alcohol, pine oil, and asbestos fibers. Its primary purposes included patient comfort and wound protection. The composition of dressings has changed over the years, eliminating potentially caustic products (such as asbestos) and adding others for added retention and healing. Additional benefits of dressings include reduction of hemorrhage and postoperative infection, control of granulation tissue growth, retention of apically positioned flaps by preventing coronal displacement, additional stabilization of a soft-tissue graft, protection of denuded bone during healing, and splinting of postsurgically mobile teeth. One of the most important benefits is the psychological comfort provided to the patient after surgery. Periodontal dressings are generally divided into the following three categories: (1) those containing zinc oxide and eugenol; (2) those containing zinc oxide without eugenol; and (3) those containing neither zinc oxide nor eugenol. A Zinc oxide and eugenol dressings are supplied as a liquid containing eugenol and peanut and/or rose oil, and resin and a powder containing zinc oxide, powdered resin, and

tannic acid. The two components are mixed together on a waxed paper pad using a wooden tongue depressor. The powder is gradually incorporated into the liquid until a doughlike consistency forms. The dressing may be used immediately or wrapped in aluminum foil and refrigerated for up to 1 week. The advantages of this type of dressing include splinting (since it adheres to the teeth) and the hemostatic effects produced by the tannic acid. The disadvantages include a rough surface on setting that adds to plaque accumulation and bacterial proliferation; a hardsetting consistency that may complicate removal if engaged in an undercut; the inability to adhere to mucosal surfaces; the distinct taste of eugenol while the pack is in place; and possible allergic reaction to eugenol that may produce burning pain and reddening of the treated area. B Zinc oxide without eugenol dressings consist of two pastes: an accelerator and a base. The accelerator may contain zinc oxide, vegetable and/or mineral oil (for plasticity), and magnesium oxide, and the base may consist of petrolatum and denatured alcohol. The setting action results from the reaction between the metallic oxide and the fatty acids. The accelerator and base are dispensed in tubes. Equal lengths of material are placed on a waxed paper pad and mixed using a wooden tongue depressor until a thick consistency and uniform color is reached. The setting time can be

reduced by adding a few drops of warm water during mixing or by immersing the pack into a bowl of warm water just after mixing. Once the paste loses its tackiness, it can be handled and molded using gloves lubricated with water or petrolatum. The pack is then formed into pencil-sized rolls that are then mechanically interlocked in the facial and lingual interproximal areas. Working time is approximately 15 to 20 minutes. The advantages of this dressing include pleasant color and neutral taste; pliability, which facilitates removal from undercut areas; and the absence of eugenol and asbestos. The disadvantages include the inability to adhere to mucosa; premature loss of the packing if it is not firmly locked interproximally; minimal splinting ability due to its soft, rubbery consistency; and the absence of tannic acid in the material. C Additional hemostasis may be required for palatal donor sites. Surgical absorbable hemostat (Surgicel, Colycote, Avitene) may be applied over the wound bed, over which the periodontal dressing or a palatal stent can then be placed. D Some surgeons report the use of a Stomahesive bandage when there is a mucosal coverage requirement for a short time (24 to 36 hours). Stomahesive is a gelatinlike material with an adhesive surface protected by a paper coating. After the paper is removed, the product may be placed on mucosal surfaces, and it will adhere if it is slightly warmed

by gloved hands and the warmth of the oral environment. The longevity of this bandage is minimal; however, some surgeons find this short time adequate for protecting the donor and recipient sites of a soft-tissue graft or a gingivoplasty procedure. Additional Readings Grant DA, Stern IB, Listgarten MA. Periodontics. 6th ed. St. Louis: Mosby; 1988. p. 7312. Hall WB. Decision making in periodontology. 3rd ed. St. Louis: Mosby; 1998. p. 254. Newman MG, Takei H, Carranza FA Jr. Clinical periodontology. 9th ed. Philadelphia: WB Saunders; 2002. p. 72931. Sachs HA, Farnoush A, Checchi L, Joseph CE. Current status of periodontal dressings. J Periodontol 1984;55:689. Watts TL, Combe EC. Periodontal dressing materials. J Clin Periodontol 1979;6:3.