PERIODONTAL DRESSING perio pack - JC.pptx

periodontics, periodontal dressing, coe pack, periodontal surgery

1. To pack or not to pack? –CURRENT STATUS OF PERIODONTAL DRESSINGS

2. CONTENTS Introduction Definition Rationale for Use Ideal Properties Types of Dressings Application of Dressing Removal and Replacement Controversial Articles Conclusion References

3. The main objectives following periodontal surgery, are to obtain optimal healing and to ensure minimum amount of discomfort to the patient. Periodontal dressings are being used to aid in these objectives since the early 1920s. Since the introduction of first practical periodontal dressing by Dr. A.W Ward in 1923, numerous investigations on all aspects of the effects have been carried out. INTRODUCTION

4. Periodontal dressing is defined as a surgical dressing applied over and protecting the surgical wound produced by periodontal surgical procedures. DEFINITION - American Academy of Periodontology 1986

5. RATIONALE FOR USE Maintenance of debris free area. Protection of newly exposed root surfaces from temperature changes and protection of sutures. Protection of the wound area. Enhancement of patient comfort. Control of bleeding. Prevent salivary contamination. Prevent coronal displacement of an apically positioned flap. Bernier & Kaplan 1947

6. IDEAL PROPERTIES… The dressing should be soft , but still have enough plasticity and flexibility to facilitate its placement in operated area and to allow proper adaptation. Should harden within a reasonable period of time. After setting the dressing should be sufficiently rigid to prevent fracture and dislocation. The dressing should have a smooth surface after setting to prevent irritation to cheeks and lips. It should not interfere with healing. Jan Lindhe ; 1995

7. …IDEAL PROPERTIES 6. The dressing should preferably have bactericidal properties to prevent excessive plaque formation. 7. The dressing should have dimensional stability to prevent salivary contamination. 8. It should not induce possible allergic reactions. 9. It should have an acceptable taste . 10. It should be economical and easily available. 11. The material should have a good shelf life.

8. TYPES OF DRESSINGS

9. COMMERCIALLY AVAILABLE PERIODONTAL DRESSINGS

10. S. No. Name Type Composition 1. Ward’s Wondrpak Eugenol Powder: ZnO , Powdered pine resin, talc and asbestos Liquid: Isopropyl alcohol 10%, clove oil, pine resin, pine oil, peanut oil, camphor and coloring material 2. Kirkland formula Eugenol ZnO , resin, Zinc acetate, eugenol, tannic acid and olive oil 3. Coe- pak Non-Eugenol First paste – ZnO , added oils, gums and lorothidol Second paste – Unsaturated fatty acids and chlorothymol 4. Cross Pack Non-Eugenol Colophony powder, ZnO , tannic acid bentonite and powdered neomycin sulphate 5. Peripac Non-Eugenol Calcium sulphate, ZnO , ZnS, acrylic type of resin and glycol solvent 6. Septopack Non-Eugenol Amyl acetate, dibutyl phthalate, butyl polymetacrylate , ZnO , ZnS 7. PerioCare Non-Eugenol First paste – paste of metal oxides in vegetable oil Second paste – gel of rosin suspended in fatty acids

11. S. No. Name Type Composition 8. Perio Putty Non-eugenol Methylparabens, propylparabens, benzocaine 9. Periogenix TM Non-eugenol Perfluorodecalin , purified water, glycerin , hydrogenated phosphatidylcholine, cetearyl alcohol, polysorbate 60, tocopheryl acetate, benzyl alcohol, methylparaben, propylparaben and oxygen 10. Cyanoacrylate dressings Other N-Butyl cyanoacrylate 11. Light cure dressings Other Silicon dioxide crystalline – quartz, hydrophobic amorphos fumed silica, urethane dimethacrylate resin 12. Collagen dressing Other Type I collagen derived from bovine tendon mixed with cancellous granules 13. Stomato adhesive dressing Other Gelatin pectin, sodium carboxymethylcellulose and polusio polysiobutylene

12. COMPOSITION AND INGREDIENTS OF COE-PAK AND THEIR FUNCTIONS

13. Lesher 1949; Zwemer TJ 1993; Haugen E 1978; Newman, Takei, Carranza 2006; Philstorm , Thorn 1977

14. Ensure that the bleeding from operative area has ceased before the dressing material is applied. Carefully dry teeth and soft tissues before the application for optimal adherence of dressing. Moisten the surgical gloves to avoid the material sticking to finger tips. Zinc oxide packs are mixed with eugenol or non eugenol liquids on a wax paper pad with a wooden spatula. APPLICATION

15. REMOVAL OF DRESSING

16. REPLACEMENT OF DRESSING

17. Clinical trials supporting the use of periodontal dressings

18. Increasing the Amount of Attached Gingiva Using a Modified Apically Repositioned Flap Year of Publication : 1957 Name of the Journal : The Journal of Periodontology Results : They supported the use of a periodontal pack incorporated with Terramycin (or any brand of tetracycline Hydrochloride) 125 mg to 6 drops of liquid) Reason : Protection of wound from mechanical trauma, and stability of the surgical site during healing process.

19. Significance of early healing events on periodontal repair: a review Year of Publication : 1992 Name of the Journal : The Journal of Periodontology Reason : Prevention of flap displacement in apically repositioned flaps, additional support in free gingival grafting procedures.

20. Periodontal dressing ( Vocopac ) influences outcomes in a two-step treatment procedure Year of Publication : 2005 Name of the Journal : The Journal of Clinical Periodontology Reason: Periodontal wound dressing has a positive effect on clinical long-term results.

21. The etiology, diagnosis and treatment of the intrabony defect. Year of Publication: 1967 Name of the Journal: The Journal of Periodontology Reason: 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 applied during speaking or chewing, preventing gingival detachment from the root surface.

22. Clinical trials NOT IN FAVOR OF the use of periodontal dressings

23. CLINICAL TRIALS: AUTHORS REASONS Loe and Silness ; 1961 Dressing has little effect Stahl et al.; 1969 Dressing accumulates plaque Harpenau ; 1972 No difference in clinical parameters Greensmith ; 1974 No differences in healing Kidd and Wade; 1974 Greater pain experience; Plaque accumulation; Subsequent microbial invasion; Nonpack areas showed better wound healing; Lesser pain scores Jones and Cassingham ; 1979 Irritates healthy tissue increases chances of infection Allen and Caffesse ; 1983 No difference in PD, CAL and gingival inflammation Checchi and Trombelli 1993 No statistical differences in pain scores and number of analgesics consumed between the pack and non-pack groups. Postoperative pain with dressing Bose et al.; 2013 Pronounced swelling increases plaque accumulation; Increases inflammation and GCF; Difficult in eating

24. STUDIES ASSESSING ANTIBACTERIAL PROPERTIES OF PERIODONTAL DRESSING AGAINST MICROORGANISMS FOUND AT THE SURGICAL SITES

25. STUDIES ASSESSING PERIODONTAL DRESSING CYTOTOXICITY

26. CONCLUSION The question of whether we need to use a dressing for all surgical procedures still remains open !!! According to patients’ preference and comfort point-of-view: Many patients experienced discomfort when a periodontal dressing was used and preferred to use a mouth rinse. Conversely, some patients exhibited a psychological feeling of protection and well-being when a periodontal dressing was put in place.

27. THE CHOICE OF USE OF A PERIODONTAL DRESSING IS A MATTER OF INDIVIDUAL PREFERENCE AND THE JUDGMENT OF THE OPERATOR. However, it is prudent to use a dressing for stabilization of free gingival grafts and protection of donor site, retention of an apically positioned flap, protection of the denuded bone from further injury, protection of the graft site in periodontal regeneration and to facilitate retention of drugs delivered locally in the sub-gingival sites. There appears to be no consensus regarding the absolute indication for the use of periodontal dressings after a surgical procedure. However, the literature does elaborate on the benefits of application of a dressing postsurgically .

28. REFERENCES To Pack or Not to Pack: The Current Status of Periodontal Dressings – Dr. Rahul Kathariya , Hansa Jain and Tanya Jadhav (Journal of Applied Biomaterials and Functional Biomaterials) Antibacterial properties of periodontal dressings – T. C . A . O 'NEIL Periodontal Dressing: A Review Article – Zahra Baghani and Mahdi Kadkhodazadeh Sigusch BW, Pfitzner A, Nietzsch T, Glockmann E. Periodontal dressing ( Vocopac ®) influences outcomes in a two‐step treatment procedure. Journal of clinical periodontology. 2005 Apr;32(4):401-5. Wikesjö UM, Nilvéus RE, Selvig KA. Significance of early healing events on periodontal repair: a review. Journal of periodontology. 1992 Mar;63(3):158-65. Genovesi AM, Ricci M, Marchisio O, Covani U. Periodontal dressing may influence the clinical outcome of non‐surgical periodontal treatment: a split‐mouth study. International journal of dental hygiene. 2012 Nov;10(4):284-9. Soheilifar S, Bidgoli M, Faradmal J, Soheilifar S. Effect of periodontal dressing on wound healing and patient satisfaction following periodontal flap surgery. Journal of Dentistry (Tehran, Iran). 2015 Feb;12(2):151. Sachs HA, Famoush A, Checchi L, Joseph CE. Current status of periodontal dressings. Journal of periodontology. 1984 Dec;55(12):689-96. Bose S, Gundannavar G, Chatterjee A, Mohan RR, Viswanath RA, Shetty S. Comparison Of The Early Wound Healing Following Periodontal Flap Surgery In Periodontitis Patients With And Without Periodontal Dressing. Indian Journal of Dental Sciences. 2013 Mar 1;5(1). Nezwek RA, Caffesse RG, Bergenholtz A, Nasjleti CE. Connective tissue response to periodontal dressings. Journal of periodontology. 1980 Sep;51(9):521-9. Kumar MV, Narayanan V, Jalaluddin M, Almalki SA, Dey SM, Sathe S. Assessment of clinical efficacy of different periodontal dressing materials on wound healing: A comparative study. J Contemp Dent Pract . 2019 Aug 1;20(8):896-900.