2. • PART-1
• Introduction
• History
• Ideal requirements of periodontal
dressing
• Rationale of using periodontal
dressing
• Classification of periodontal
dressing
• Eugenol dressing
• Non eugenol dressing
• Retention of dressing
• Removal of dressing
• Redressing and failures of
dressings
PART –2
•Dressings without zinc oxide eugenol
•Modifications of periodontal dressing
•Benefits of dressing
•Physical properties
•Biological properties
•Studies of periodontal dressing
•Periodontal dressing for all
techniques?
•Conclusion
•References
3. Introduction
• Wound healing is a complex and dynamic process of
restoring cellular structures and tissue layers.
• Favorable environment for wound healing can be, created by
a surgical dressing.
• A surgical dressing allows for uninterrupted healing to occur
and also contributes to the protection of the surgical area and
prevention of wound damage and infection.
4. • Dressing n. protective covering for a wound. (Oxford
Dictionary)
• Periodontal dressing is a surgical dressing used postoperatively
to cover and protect the surface of surgical wound created by
periodontal therapy.
5. • Dr. H . Winnett Orr first advocated (1923) the closed plaster
technique for compound fractures.
• The first surgical dressing was patented by E. P. Lesher in
1953.
• A surgical dressing is also utilized after periodontal surgical
procedures by Zentler in 1918 by using iodoform gauze and
Dr. Ward in 1923, used fast setting cement on the surgical
area.
• Dressings are applied around the necks of the teeth and
adjacent tissue to cover and protect the surgical wound after
periodontal surgery.
6. • Serve as;
1. Bandage over the surgical area holding the flap
2. Protecting newly formed tissue
3. Minimizing postoperative pain infection and hemorrhage
4. Protecting the surgical site from trauma during eating and
drinking
5. Supporting mobile teeth during the healing process.
7. History
• 1918, Zentler-
First reported the use of a periodontal dressing in the form of
iodoform gauze.
• 1923, Ward-
Invented the Wondrpak
• 1942 , Box and Ham-
Use of zinc oxide-eugenol dressing to perform chemical
curettage in treatment of necrotizing ulcerating gingivitis
8. • 1943 , Orban –
Zinc oxide Eugenol + Paraformaldehyde to perform
Gingivectomy by chemosurgery
Dressing caused extensive necrosis of the gingival and bone
and abscess formation.
• 1947 ,Bernier and Kaplan –
For wound healing protection was the primary concern
9. • Ariaudo and Tyrell 1957-
Dressing to position and stabilize apically positioned flap.
• 1962, Blanquie – Fundamental and technique for periodontal
dressing.
Control post operative bleeding
Splint loose teeth
Prevent re-establishment of pocket – desensitize cementum
10. • 1964, Gold-
Splint teeth, as it was cement dressing that set hard.
• 1964 ,Weinreb and Shapiro
Zinc oxide eugenol impregnated cords into periodontal pockets
,but found to be less effective than gingivectomy.
11. • 1969 - Baer et al
Stated that primary purpose of a dressing
1. Patient comfort
2. Protect wound from further injury during healing
3. Hold flap in position.
4. To immobilize a gingival graft by dissipating the pull from
alveolar mucosa and lip
5. They pointed that the dressing should not be used to control
post-operative bleeding, nor to splint teeth .
12. • Antibacterial periodontal dressing
Ramanov 1964 – antibotics in periodontal dressings
encouraged the growth of candida albicans and yeast.
Absoe Jorgerson et al 1974 found that a dressing containing
Chlorhexidine promoted healing
Plyss et al 1975 evaluated the efficacy of CHX when used with
a dressing,
• Light cured periodontal dressing
• Resorbable periodontal dressing
13. Properties of periodontal dressing
• Soft
• Enough plasticity and flexibility
• Set within a reasonable time.
• Sufficient rigidity
• Smooth surface after setting
• Bactericidal properties
14. • Not interfere with healing
• Dimensional stability
• Not induce possible systemic detrimental effects and
allergic reactions
• Acceptable taste
• Economical and easily available
• Good shelf life
15. Rationale of using periodontal dressing
• Protection of the wound area
• Enhancement of patient comfort
• Maintenance of a debris free area
• Control of bleeding: from trauma
• Periodontal dressings also protect newly exposed root surfaces
from temperature changes and protect sutures.
• Protects surgical healing areas from irritants such as hot or
spicy foods.
• Supports mobile teeth during healing
16. Classification or types
(Hall 2003)
Containing zinc oxide and eugenol
Containing zinc oxide without eugenol
Containing neither zinc oxide nor eugenol
17. Eugenol dressing
• Ward’s Wondrpak (1923)
• It was a 2-component system comprising-
Powder
• Zinc oxide
• Powdered pine resin
• Talc
• Asbestos
Liquid
• Isopropyl alcohol 10%
• Clove oil
• Pine resin
• Pine oil
• Peanut oil
• Camphor
• Coloring materials
18. Powder
• Zinc oxide-antiseptic and astringent
• Resin- Improve setting
• Tannic acid- Improve setting
• Cellulose fibers- Improve setting
• Zinc acetate – Accelerator, better working time
• Asbestos – Binder and filler
19. Liquid
• Eugenol - Anesthetic, antiseptic and obtundent.
• The oil of cloves or the eugenol can be reduced to a very low point
• Alcohol- Germicidal property
• Pine oil- Dissolve resin and rosin
• Pine resin- Adhesive quality
• Peanut oil- Regulates the setting time (Hastens)
• Camphor - Tissue preservative and cuts the bite of the eugenol
20.
21. • Tube 1 base –
87% zinc oxide
13% fixed vegetable or mineral oil
• Tube-2 accelerator –
12% oil of clove or eugenol
50% gum or polymerized rosin
20% filler (silica type)
8% lanolin
22. • These are mixed together on a waxed paper pad using a
wooden tongue depressor or spatula.
• The powder or paste is gradually incorporated into the liquid
until it reaches a dough-like consistency.
• Sets to brittle state like cement
• The dressing may be used immediately or wrapped in
aluminum foil and refrigerated for use for up to 1 week.
23. • A modified of a eugenol dressing was introduced by Kirkland,
called the Kirkland formula.
• Contains-
Zinc oxide
Resin
Zinc acetate
Eugenol
Tannic acid
Olive oil.
24. Role of eugenol
• Popularly used in gingivectomy- obtunding pain
• Prevent or retard bacterial growth based on their antiseptic
properties
25. Disadvantages
• Found to irritate oral mucosal tissues
• Induce allergic reactions
• Cause tissue necrosis of bone
• Difficulties in manipulation and has a rough surface after
setting
• Histological evidence showed-
Destruction with more inflammatory cell infiltration and
connective tissue response
26. • Cytotoxic at higher concentrations
• Adverse effect on fibroblasts and osteoblast-like cells
• Unpleasantness
• Spicy taste
• Burning sensation
• Frequency of fractures
Due to all these reasons lead to noneugenol
dressing in 1950s
27. Non eugenol dressing
• Currently most widely used
• Various-
• Coe-Pak,
• Cross Pack,
• Peripac,
• Septo-pack,
• PerioCare,
• Periogenix
• Vaco pack
28. Coe pak
• Coe-Pak is the most widely used noneugenol intraoral dressing
in the United States
• Manufactured by-
Coe Laboratories (Alsip, IL, USA)
It consists of 2 pastes-
Smith D C 1970
30. • The setting time can be altered by
Adding a few drops of warm water during mixing or by
immersing the pack into a bowl of warm water just after
mixing.
Increased by adding vasaline or lubricant
31. • The Coe-Pak is available in regular set and hard and fast set
formulations, based on its setting time and consistency, and it
is supplied commercially both in manual mix and automix
varieties.
• Automix promotes -
Cleanliness and healing.
33. Cost and shelf life
• Rupees 2600/-
• Shelf life is of 2 years
34. Cross Pack
• Cross Pack was formerly the powder part of a zinc oxide– eugenol
dressing in use in the late 1940s
• W.G. Cross, personal communication, 1974
• It consists
• Colophony powder
• Zinc oxide
• Tannic acid
• Bentonite
• Powdered neomycin sulphate.
35. • Cross Pack is added as a filler to Coe-Pak to give more body
to the material.
• Zinc oxide alone can be used instead of Cross Pack if desired
37. • Reacts on exposure to air
• Indicated as a dressing in-
Gingivectomies and papillectomies,
Deep curettage,
Reattachment surgery
Gingival repositioning
• Treatment of necrotic gingivitis and ulcers
• Protection of nonspecific lesions or sutured margins
• Fixation of desensitizing medicaments to cervical areas
• Temporary rebasing of immediate dentures in periodontal
surgery
38. • To use this material, a small quantity should be taken from the
jar with a dry sterile spatula and deposited on a paper napkin.
• Hardening of Peripac begins as soon as it comes into contact
with water and is complete in about 20 minutes.
• Dough like consisitency
• Application of the dressing should not take more than 2-3
minutes.
• A correctly applied dressing remains with no change for 8-10
days.
42. • Working time- 2-3 minutes
• Setting time- 30 minutes
• Self-hardening plastic paste
• It can also be combined, as a neutral medium, with some
medicines so that they can be kept in place easily on the
gingiva or tooth or at the alveolar ridge level.
• No antibacterial properties
44. PerioCare
• Pulpdent Corp., Watertown, MA, USA
• Highly elastic periodontal dressing
• Sets resiliently hard
• 2 paste system-
• Equal amounts of the pastes are dispensed, mixed and applied.
1
• Paste of metal
oxides in
vegetable oil
2
• Gel of rosin
suspended in fatty
acids
45. • After mixing, PerioCare is ready to be picked up with wet
fingers in about 75-90 seconds.
• It has a 7 minute working time and sets in 15 minutes.
• It is patient pleasing, and has a neutral odor and taste.
contains no eugenol or asbestos
• Does not support the growth of bacteria
• Tissues are clean upon removal or the dressing
• Cost rupees 3000/-
46. Periogenix
• A noneugenol dressing manufactured by OroScience (New
Line Medical Inc., Lafayette, LA, USA).
• It contains
• Perfluorodecalin
• Purified water
• Glycerin
• Hydrogenated phosphatidylcholine,
• Cetearyl alcohol,
Polysorbate 60,
Tocopheryl acetate,
Benzyl alcohol,
Methylparaben,
Propylparaben
Oxygen
47. • Accelerates healing of postoperative surgical wounds.
• Wounds treated with Periogenix demonstrated an up-
regulation
• Vascular endothelial growth factors
• Collagens I and III
• Matrix metalloproteinase levels.
48. • Promote wound healing by stimulating several processes
• Neovascularization,
• Collagen production,
• Epithelization,
• Phagocytosis neutrophil-mediated oxidative microbial killing,
• Degradation of necrotic wound tissue
49. Voco pack
• Manufactured by: Voco, Cuxhaven, Germany
• It is supplied as two pastes (base and catalyst) that chemically
51. Advantages
• Remains elastic in the patient's mouth
• Not brittle
• Causes no gingival irritation.
• Adheres excellently to teeth and promotes healing
52. Contraindicated
• In patients,
Who are allergic to these ingredients
Contact with the bone should be avoided as well.
Slight discoloration of synthetic materials may also occur
53. Advantages of non eugenol dressing
• Minimal irritation of the mucous membrane
• Pleasant odor
• Neutral taste
• Ease of manipulation
• Pliability which facilitates easy removal
• Neither the analgesic nor antibacterial properties of eugenol
dressings
• Form a closely adapted adhesive barrier to saliva and oral
bacteria
58. Characteristics of well placed
periodontal pack
• Whether secured and rigid
• Has little bulk
• Locks mechanically interdentally
• No overextension
• Covers the treated area
• Posses a smooth surface
59. Removal of dressing
Syringe with a gentle stream of warm water
Use scaler or curete to remove the pack on the tooth surfaces
Observe the issue
Remove the fragments gently
Watch for sutures
Insert a scaler or plastic instrument under the border applying
lateral pressure
60. Redressing
• For additional week due to -
Low threshold pain and uncomfortable when the dressing is
removed
Unusually sensitive root surface postoperatively
Open wound were flap edges are necrosed
61. Failures of periodontal dressing
• Failure to pack in interproximal space leads to -
Postoperatively pain
Discomfort
Growth of granulation tissue
Thereby defeating the purpose of pocket eradication or objective
of surgery.
• Should not be bulky and rough
63. Summary of part 1
• A.W. Ward - Wondrpak in 1923
• Eugenol pack showed irritation
• Non eugenol periodontal dressing
• Coe pak
Two equal pastes
Spatulate it for 30-40 seconds
Working time is 15 to 20minutes
Setting time according to Rubinoff
66. • PART –2
Dressings without zinc oxide eugenol
Modifications of periodontal dressing
Benefits of dressing
Physical properties
Biological properties
Studies of periodontal dressing
Periodontal dressing, is it necessary for all periodontal techniques?
Conclusion
References
68. Cyanoacrylate
• Obtained by A.E. Ardis in alkyl form.
• In 1959, Coover et al., suggested their possible use as surgical
adhesives.
• Chemical formula- n- butyl cyanoacrylate
69. • Biocompatible
• Has been evaluated clinically and histologically, in periodontal
procedures and for oral ulcers
• Advantages-
Rapid hemostasis in presence of moisture due to
polymerization.
Accelerates initial healing
Maintain the precise position of flap
Antimicrobial properties
71. Studies
1. Ochstein 1969,
Compared the effects of
Cyanoacrylate
Eugenol
Non eugenol dressing
On surgical wound healing.
Clinical and histological evaluationd were made on 21 days
Concluded that, cyanoacrylate showed better healing
because…..
72. 2. Forrest 1974, a split mouth study;
Compared clinically
Cyanoacrylate dressing
Without dressing
No significant differences found between the two with
healing responses.
Cyanoacrylate dressing produced,
Rapid hemostasis
Absence of discomfort and better patient acceptance
73. 3. Levin et al 1975,
• Concluded that cyanoacrylate is close to ideal dressing
material.
74. Disadvantages
1. Difficulty in application around posterior teeth
2. Rapid polymerization upon contact with small amount of
moisture
76. Light cure dressing
• Novel concept for protection of periodontal surgical sites
• Single component
• Light activated dressing material supplied in a syringe for
direct placement
• Cured in increments with a visible light curing agent
77. • Characteristics -
Non brittle
Very elastic
No mixing is required
• Advantages-
Tinted pink
Tasteless
Superior esthetics
78. Placement
• Direct Placement
Dispense the material at the junction of cervical
one third of the teeth
Remove the tip from disposable syringe
Sterile gauze, dry the buccal and lingual tooth
surfaces adjacent to it
79. Indirect placement
Repeat the exposure as needed; until the entire dressing is cured
Uncured material to be detected with an explorer
Expose the dressing to a visible light curing unit for atleast 10 seconds per tooth per
side
Remove any uncured material that has been extended onto occlusal contact areas
Contoured with a plastic instrument or by finger pressure
With Lightly lubricated gloved hand roll the ribbon of the dressing off of the pad
Place a thin layer of lubricant on the mixing pad
Dispense the dressing on the pad
80. Studies
1. Gilbert et in 1994,
Demonstrated the effect of light cured periodontal dressing on
HeLa cells and fibroblast cells
Uncured material produces a zone of inhibition and and the
cell death on direct contact
Partly cured material containing free monomer in contact
with the healing gingival site could delay rapid repair.
The fully cured material is compatible with cells and has no
effect on the either of cells
81. 2. Smeekens et al.
Examined histological tissue responses of surgical areas
covered during 7 days with either;
Barricaid }
Wonder pack }
Bio-inert control gel Carboxyl Methyl Cellulose
Results after 7 days, acute inflammatory reactions in test group
without significant differences between periodontal dressing
materials.
• From biological point of view, no contraindication for light
cured periodontal dressing
Test group
83. Perio Putty
• Cadco Dental Products Inc., Los Angeles, CA USA
• Containing
Methylparabens and propylparabens-effective fungicidal
properties
Benzocaine-topical anesthetic
• Introduced in 1978
• Expired in 7th March 2000
84. Collagen dressing
• Biological wound dressing which create a interface between
wound and the environment and encourage the wound
healing by deposition of the fibers in granulation tissue
formed freshly in the wound bed.
85. • Advantages over the other dressings-
Ease of application
Non-immunogenic
Non pyrogenic
Hypoallergenic
Promote hemostasis
Strengthening the blood clot
Comes in three forms-
CollaTape
CollaCote
CollaPlug
89. Mucoadhesive dressing
• Adhesive and non sensitizing wound dressing
• Multilayered dressing including
• Contacts with the wound
Layer of curative
and absorbent
material
• To remove unpleasant smell
Layer of
deodorizing
material
• Secures bandage to tissues
Outer layer
90. Contents
• Gelatin
• Pectin
• Sodium carboxymethylcellulose
• Polyisobutylene
•Indicated whenever mucosal coverage is required for a short
period of time
•As its longevity is less or minimal that is dissolves in 8- 24
hours.
•Donor site for soft tissue graft and for gingivectomy
procedures
91. Methacrylic Gel
• Used as tissue conditioners or as denture liners
• Advantages
1. Soft and resilient, flows under pressure hence ideal for use in
dentures.
2. Adapt closely to tissues,
3. Comfortable to wound,
4. Act as a vehicle for medicaments (Chlorhexidine) to soft
tissues.
92. • Disadvantage
1. Can’t be used alone as a dressing,
2. Poor retention
3. More stiffness with Zinc oxide powder
95. • Chlorhexidine is an,
Antibacterial agent
Inhibits plaque growth
Long term activity
Substantivity and slow release properties
• In 1989, commercial periodontal dressing had lost its
antimicrobial activity shortly after application.
• Thus, proposed the addition of chlorhexidine to dressing to
improve their properties.
96. Studies
1. Addy and Douglas in 1976; a in vitro and in vivo study,
Concluded that methacrylate gel is a good medium for
carrying chlorhexidine to the wound area and its releasing it
slowly.
2. Plṻss et al. in 1975 incorporated 15 – 20 mg of chlorhexidine
dihydrochloride in Peripac
Concluded that significant reduction in plaque formation and
attributed to direct contact of powder with the tooth.
97. 2. Othman et al found that surgical dressing with antimicrobial
agents are advantageous due to its,
High retention
Slow releasing properties
3. Newman and Addy in 1978,
Used chlorhexdine as mouthwash to swish the oral cavity
following a periodontal flap surgery
Concluded that, less plaque accumulation and less sulcular
bleeding
Patient’s preferred for chlorhexidine rinse than dressing.
98. 5. Zyskind et al. in 1992
Chlorhexidine varnish prior to the application of a periodontal
dressing
Significantly less plaque found on the teeth precoated with the
slow release varnish.
99. Disadvantages
• Toxicity to cells-
Delayed healing of sutured skin incisions was reported
Human gingival fibroblasts in tissue culture exposed to
chlorhexidine 0.04% altered cell function and death
Toxic to polymorpho-neutrophils
• Systemic implications-
Chlorhexidine can penetrate intact mucosa and can become
deposited elsewhere in the body
100. Trials supporting use of periodontal
dressing
Clinical trials Reason
Ariaudo and
Tyrell (1957)
•Protection of wound from mechanical trauma
• Stability of surgical site during healing process
Prichard
(1967)
•Patient comfort during healing,
•Good adaptation to underlying gingival and bony
tissue
•Prevention of postoperative hemorrhage or
infection,
•Decreasing tooth hypersensitivity,
•Protecting the clot from forces during speaking
•Preventing gingival detachment from root surface.
101. Clinical trial Reason
Wikesjo et. al (1992) •Prevention of flap displacement
•Additional support in free gingival
grafting procedures
Sigusch et al (2005) Positive results on clinical long term
results
102. Clinical trials not in favor of
periodontal dressings
Clinical trial Reason
Loe and Silness (1961) Dressing has little effect
Stahl et al (1969) Dressing accumulates plaque
Harpenau (1972) No differences in clinical
parameters
Greensmith (1974) No differences in healing
Kidd and Wade (1974) •Greater pain experience
•Plaque accumulation
•Subsequent microbial invasion
•Non pack areas showed better
wound healing
•Lesser pain scores
103. Clinical trial Reason
Jones and Cassingham
(1979)
Irritates the tissues and increases the
chances of infection
Allen and Caffesse
(1983)
No differences in probing depth, clinical
loss of attachment and gingival
inflammation
Checchi and
Trombelli (1993)
Postoperative pain with the dressing
group
Bose et al (2013) •Pronounced swelling
•Increases the plaque accumulation
•Increases inflammation and gingival
crevicular fluid
•Difficulty in eating
104. Studies assessing the antibacterial properties of
periodontal dressing against microorganisms
found at the surgical sites
Clinical trial Reason
Coppes et al
(1967)
•Compared non-eugenol and eugenol dressings
•Revealed that, frequency of Bacteroides
melaninogenica to be higher under non-eugenol
dressing
Heaney et al
( 1972)
•Took bacterial samples from the areas under the
dressing
•Revealed that microorganisms under Coe Pak were
gram negative bacteria while yeasts under the
eugenol dressing
O’Neil
(1975)
•Tested Coe Pak, Cross Pak, Peripac, Septo Pak and
eugenol dressing
•Revealed that, no antibacterial activity a while
eugenol dressing has little antifungal effects
105. Clinical trial Reason
Heaney et al
(1976), in vitro
study
Showed inconsistent antibacterial properties in
the periodontal dressing against bacterial plaque
Haugen and
Gjermo (1978)
Tested Coepak, wonderpak and Peripac,
Revealed that had antibacterial effects on
salivary microorganisms
Volozhin et al
(2004)
Showed that frequency of aggressive
microorganisms in periodontal pockets of
patients with chronic generalized periodontitis
reduced when the periodontal dressing
consisting of collagen and Lactobacillus casei
37 cell suspension
106. Clinical trial Reason
Ikeda T et al
(1984) and
Woodcock et al
(1988)
Revealed that polyhexamethylene biguanide
have better phsical properties than
chlorhexidine
Romanow
(1964)
Found that clinical signs of candidiasis occurred
when using tetracycline in dressing and that
bacitracin was found to enhance the growth of
yeast
Breloff and
Caffesse (1983)
•Tested effect of Achromycin applied
underneath the periodontal dressing
•Showed no beneficial effect on healing
Note- Antibiotics in periodontal dressing should not be used for
every periodontal treatment.
107. Other medicaments and dressings
Clinical studies Reason
Saad and Swenson
(1965) and
Swann et al (1975)
•Added steroids and Dilantin to dressings
•Reported healing rate in skin wounds
•But showed no any advantage in
periodontal studies
Srakaew et al
(2011)
Concluded that, sodium-phosphorylated
chitosan could be used as a reaction rate
modifying agent in periodontal dressing
108. Substitute for dressings
• Steer PL in 1990,
Aim of the study was to evaluate the effect of Solcoseryl
dental adhesive paste in comparison with grafts covered with
Peripac
Concluded that, adhesive pastes also can be considered as a
substitute for conventional periodontal dressing
109. Benefits of a periodontal dressing
Benefits
Physical
effects
Therapeutic
effects
110. Physical effects
Clinical trial Reason
Ariaudo and
Tyrell 1957,
Established that periodontal dressing can be
used as stent.
Prichard (1972) Used to prevent postoperative hemorrhage
and protect the wound
Mason (1975) Protect the wound from saliva and trauma
thus enhancing comfort and healing
Ramfjord (1980) •Closed curettage can cause wide dehisence of
buccal and lingual papillae
•So after the completion of the treatment, the
area should be closed by interproximal sutures
or by a firm dressing for better postoperative
results
111. Clinical
trial
Reason
Plagman
(1998)
•Recommended the covering of the wound area for
3-4 days with a periodontal dressing in addition to
suturing
•Prevented the accumulation of food debris from
impacting in the interdental spaces
•Coagulaum was stabilized so that movements of
the healing epithelium were prevented
•An untroubled attacment to hard tissues
Genovesi et
al (2012)
•Use of periodontal dressing improved the
periodontal parameters after scaling and root
planning
112. • To summarize the physical effects of periodontal dressing
Protection of postsurgical wound from trauma, saliva, and
food debris
Stabilization of blood clot
Limits the entry of bacteria and other microorganisms
Acts as splint for loose teeth
To immobilize the newly positioned grafts and flap
May control postoperative discomfort in early stages of
healing
113. Therapeutic effects
Clinical
trials
Effect
Ward
(1923)
•To bypass the pain, infection and root sensitivity
•To prevent formation caseous deposists on the root
surface
•Dressing act as a temporary support after
gingivectomy
Orban
(1941)
•Used zinc oxide eugenol dressing and observed
better healing after gingivectomy
•If the dressing was changed every 2 to 4 days for 10
to 14 days
•If the dressing was left in place in excess of 12 days,
delayed the healing
114. Clinical trials Effects
Box and Ham
(1942)
•Described the use of zinc oxide eugenol
dressing after performing a chemical curettage
for the treatment of necrotizing ulcerative
gingivitis
•Improved the clinical parameters
Bernier and
Kaplan (1947)
Dressing facilitated healing
Blanqui (1962) Purpose of periodontal dressing was to
Control postoperative discomfort
Allowing tissue healing under aseptic
conditions
Preventing reestablishment of periodontal
pocket
115. Clinical trials Effects
Loe and Silness
(1961)
•Reported that the exposed tissue will heal
irrespective of application of a protective
dressing
•Dressing provided an environment more
favorable for optimum healing
Bhaskar et al
(1966)
•Used isobutyl cyanoacrylate,
•Concluded that hemostasis was its main
advantage.
Greensmith and
Wade (1974)
•Evaluated healing in with and without
dressing
•Concluded that application of a dressing led to
statistically slight better results,
•Lower gingival index
116. Clinical trial Effect
Asboe-
Jorgensen et al
(1974)
Improved patient comfort after periodontal surgery
Linsky et al
(1981)
Closed wounds had less inflammatory response
than open wounds
Eaglstein (1991) Wounds with dressing healed faster
Eaglstein (1991) Improved the periodontal clinical parameters after
non surgical periodontal therapy
117. • To summarize the therapeutic effects of periodontal
dressing-
• Control of bleeding or hemostasis
• Improvement in clinical periodontal parameters
• Desensitization of denuded root surface
• Prevention of reestablishment of periodontal pockets
119. Clinical
trial
Material
s used
Properties
von
Fraunhof
er and
Argryopo
ulos
(1990)
Coe Pak,
Periocare
and
Barricaid
•Coe Pak and periocare absorbed water and acted similar in
manner at 23°C
•Periocare absorbed more water at 37°C
•Barricaid had little effect on its water sorption or solubility
•When immersed in 0.09% KCl solution,
Barricaid showed no effect on conductivity or pH
Coe pak and periocare increase in conductivity slightly and
increase in pH
•Adhesion to a single tooth was noted
Coe Pak
At 1 hour was 7kg, at 24 hours was 6.5kg and at 5 days was
5kg
Periocare
2 kg at 1hour, 8.5 kg at 24 hours and 7.5kg at 7 days
Barricaid
5 kg at 1hour, 3.5 kg at 24 hours and 1.5 at 7days.
Mechanism of adhesion of Barricaid was mechanical
interlocking
Differs from Coe pak and PerioCare
120. • Another study,
Chemomechanical lock between tooth surface and Barricaid
Barricaid gave adhesion value of
43.94 MPa at 1 hour
37.17MPa at 7 days
43.23MPa at 1 hour
19.32MPa at 7 days
Etching
Without etching
121. • Watts and Combe (1979) compared Coe pak, Peripac and
Peripac improved
Concluded that,
None of the dressing exhibited ideal flow properties during
manipulation and adaptation,
None of the dressing exhibited an adequetely well defined set.
123. Effects on wound healing
• Eugenol based dressing had adverse effects and inflammatory
reaction
• Eugenol dressing can cause
Less growth inhibition of permanent cells and primary human
leukocytes than some non-eugenol dressings
Wondr Pak produced greater tissue destruction, more
inflammatory cell infiltration and connective tissue response
Wondr Pak involved wider reaction in adjacent tissues
124. Comparison between eugenol and non
eugenol dressings
• Recently, early irritating effects of dressing may contribute to
postoperative pain and swelling whether or not it contains
eugenol.
• Peripac shown to more irritating than wondrpak
• Tefla may be interposed between tissues to prevent such
harmful effects
125. Studies assessing periodontal dressing
cytoxicity
• Haugen et al (1978) concluded
Wondr pak is most irritating followed by Coe pak and peripac.
• Haugen et al (1979) concluded
Cytotoxicity of Coe-pak increases with time
• Wennberg (1983) concluded that
Peripac is more severe tissue reaction than wondrpak
• Baer and Wertheimer (1961)
Inflammatory reaction is greater when dressing is placed directly on
the bone compared with time when placed on the periosteum
126. Therapeutic effects of antimicrobial
agents in dressing
• Eugenol based dressing were bacteriostatic effect in vitro
• Antimicrobial activity was greatest in Coe-pak while it was
least in peripac
• None of the periodontal dressing showed any mark degree of
antibacterial activity
127. Postoperative pain and dressing
• Jorkjend L (1990) examined the incidence and severity of
postoperative pain after gingivectomy
Comparing Coe pak, wondr pak and Nobetec
Mean pain score after Coe pak was higher than Nobetec
Mean pain score after Coe-pak was higher than after
Wondrpak
No statistically difference found between Wondrpak and
Nobetec
128. Periodontal dressing for all?
• Complete healing can occur without giving a periodontal pack.
• There is no difference in healing between dressed and
nondressed wounds
• Use of dressing accumulates plaque causing inflammation
• Irritates the healing tissues and produces transient bacteremia
during postoperative dressing change
• Causes more pain and swelling but less sensitivity and
difficulty in eating
129. • Healing appears to slightly more rapid in dressed segments.
• Use chlorhexidine mouth rinse instead of dressing was patients
preference while it showed to reduce plaque accumlation
postoperatively and surgical inflammation
• Many patients experienced discomfort when periodontal
dressing was used and preferred mouth rinse
• Some patients exhibited psychological feeling of protection
and well being when a periodontal dressing was put in place
130. • The answer for this question is still controversy and a topic to
debate.
• Choice of periodontal dressing depends on the experience and
judgment of the operator
• Moreover none of the dressing showed ideal properties
131. Additional information regarding Coe
Pak
Base paste
Dangerous components
Components Percentage
Luaric acid 25-50%
Elemi resin 1-5%
6- cholorothymol 1-5%
Zinc di acetate <0.5%
134. Conclusion
• No absolute indication for periodontal dressing after
periodontal surgery
• Literature elaborates the benefits of periodontal dressing after
surgery
• We believe that future research to improve the biomaterial
properties may lead to a more universal applicability
• As far now, periodontal dressings for all? maybe yes, may
not!
135. References
• Orsted HL, Keast D, Forest-Lalande L, Megie MF. Basic
principles of wound healing. Wound Care Canada. 2011; 9(2):
4-12.
• Lesher EP. Wareham, MA. Surgical dressing. US patent
2632443. Filing date April, 18 1949. Issue date March
24,1953.
• Zentler A. Suppurative gingivitis with alveolar involvement. J
Am Med Assoc. 1918; 71(19): 1530.
136. • Ward AW. Inharmonious cusp relation as a factor in periodontoclasia.
J Am Dent Assoc. 1923; 10(6): 471-481.
• Dyer MRY. The possible adverse effects of asbestos in gingivectomy
packs. Br Dent J. 1967; 122(11): 507.
• Sachs HA, Farnoush A, Checchi L, Joseph CE. Current status of
periodontal dressings. J Periodontol. 1984; 55(12): 689-696.
• O’Neil TC. Antibacterial properties of periodontal dressings. J
Periodontol. 1975; 46(8): 469-474.
• Waerhaug J, Loe H. Tissue reaction to gingivectomy pack. Oral Surg
Oral Med Oral Pathol. 1957; 10(9): 923-937.
•
137. • Sarrami N, Pemberton MN, Thornhill MH, Theaker ED.
Adverse reactions associated with the use of eugenol in
dentistry. Br Dent J. 2002; 193(5): 257-259.
• Hall WB. Critical decisions in periodontology. Harpenau, LA:
PMPH; 2003.
• Checchi L, Trombelli L. Postopeative pain and disconfort with
and without periodontal dressing in conjunction with 0.2%
chlorhexidine mouthwash after apically positioned flap
procedure. J Periodontol, 64 (12):1238-42.1993
138. • Greensmith AL and Wade AB. Dressing after reverse bevel
flap procedures J Clin Perio,1:97.1974
• Haugen E, Gjermo P. Clinical assessment of periodontal
dressings . J Clin Perio. 5: 50,1978
• Jorkjend L , Skoglund LA. Effect of non-eugenol and eugenol
containing periodontal dressings on the incidence and severity
of pain after periodontal soft tissue surgery. J Clin Perio.17:
341,1990
139. • Levin MP, Cutright DE, Bhaskar SN. Cyanoacrylate as a
periodontal dressing J Oral Med,30: 40.1975
• Othman S, Haugen E, Gjermo P. The effect of chlorhexidine
supplementation in periodontal dressing. Acta Odont Scand.
47:361,1989
• Philstrom BL, Thorn HL , Folke LEA,Richards, Caffesse RG,
Smith BA. Light cured periodontal dressing: a clinical
evaluation. J Dent Res.68: 1824.1989
140. • Sachs HA, Farnoush A, Checchi L, Joseph CE. Current status
of periodontal dressings. J Periodont,55:689 1984
• Skoglund LA Jorkjend L. Postoperative pain experience after
gingivectomies using different combiantions of local
anesthetic agents and periodontal dressings. J Clin Perio.
18:204,1991
• Smeekens JP, Maltha JC, Renggli HH. Histological evaluation
of surgically treated oral tissues after application of
photocuring periodontal dressing material. An animal study. J
Clin Perio. 19:641,1992
141. • Watts T Combe E. Adhesion of periodontal dressing to enamel
in vitro. J Clin Perio,51:521.1980
• NezwekRA, Caffesse RG, Bergenholtz A Nasjleti CE.
Connective tissue response to periodontal dressings J
Periodont. 51: 521.1980
• Watts TLP and Combe EC. Periodontal dressing Materials J
Clin Periodont, 6:3.1979
142. • Dr. Bhusari et al. Periodontal dressing,International Journal of
Current Research Vol. 7, Issue, 07, pp.18578-81, 2015
