Periodontal dressing ppt

Periodontal dressing, PERIODONTAL - PAC
COE-PAK

1. P ERIODONTAL - DRESS ING . DR.MD.SHADAB ANWAR PERIODONTOLOGIST & IMPLANTOLOGIST

2. I NTRODUCTION 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.

3. . . . . . These dressings are applied around the necks of the teeth and adjacent tissue to cover and protect the surgical wound after periodontal surgery ( Zwemer TJ et al in 1993)

4. . . . I deal requisites of periodontal dressings soft , but still have enough plasticity and flexibility to facilitate its placement in the operated area and to allow proper adaptation. set within a reasonable time . sufficient rigidity to prevent fracture and dislocation. smooth surface after setting to prevent irritation to the cheeks and lips. bactericidal properties to prevent excessive plaque formation.

5. . . . Not interfere with healing. dimensional stability to prevent salivary leakage. not induce possible systemic detrimental effects and allergic reactions. acceptable taste. economical and easily available. good shelf life.

6. . . .   Protection of the wound area Enhancement of patient comfort Maintenance of a debris free area Control of bleeding: from trauma. Protect newly exposed root surfaces from temperature changes Protect sutures. Protects surgical healing areas H. A. Sachs, A. Farnoush . Current Status of Periodontal Dressings. J. Periodontol . December, 1984; 55; 689-696 RATIONALE

7. . . . U SES OF P ERIODONTAL DRESSING Provide mechanical protection for the surgical wound and therefore facilitate healing Enchancement of patient comfort . Prevents post operative bleeding by maintaining the initial clot in place. Maintainance of debris free area. Control of bleeding Supports mobile teeth during healing

8. Helps in shaping or molding the newly formed tissue Provide patient comfort by isolating area from external irritations or injuries.

9. TYPES OF PERIODONTAL DRESSINGS 3 categories Those containing zinc oxide and eugenol , Those containing zinc oxide without eugenol and Those containing neither zinc oxide nor eugenol

10. 1 . Z inc oxide eugenol dressing ( hard pack) Brand Names: - Wonder Pack, Kirkland- Kaiser Pack, Box Pack, Peridress , Ppc The first periodontal dressing introduced was containing eugenol (Ward AV in 1923)

11. A modified form of a eugenol dressing was introduced by Kirkland . It consists of zinc oxide, resin, zinc acetate, eugenol , tannic acid and olive oil. Kirkland Formula

12. Evolution of ZOE Dressing Products such as asbestos and tannic acid eliminated. Asbestos- asbestosis, lung cancer (Dyer MRY in 1967) Tannic acid- potential liver damage .(Baer PN 1969) Products-Added : Zinc acetate.

13. Obtundant property & make the sites less sensitive . ( O Neil 1975) Prevent or retard bacterial growth (Antiseptic properties ). ( Waerhaug and Loe in 1957)

14. Irritate oral mucosal tissues. May cause allergic reactions which can lead to tissue necrosis ( Sarrami et al 2002) Difficult manipulation. Rough surface after setting.

15. Currently the most widely used periodontal dressings. Commercially available non eugenol dressings include: Coe-Pak, Cross Pack, Peripac , Septopack , PerioCare , Perio Putty and Periogenix . NON-EUGENOL DRESSINGS

16. Advantages Of Noneugenol - Dressings Minimal irritation of the mucous membrane, Pleasant odor, Neutral taste, Ease of manipulation, Pliability -easy removal from undercut areas

17. Elimination of the objectionable taste of eugenol . Th ey a r e less i r r i ta t ing Form a closely adapted adhesive barrier to saliva and oral bac t er i a ( Sin g er and Thod e 20 4 )

18. The most common and widely used non- eugenol dressing is Coepak (Coe Laboratories Inc., Chicago, IL), which is supplied as two tube (1. Base tube & 2. catalyst tube or accelerator) or as an automixing system contained within a syringe. COE-PAK

19. Rosin – TO REDUCES BRITTELNESS C ellulose , N atural gums - ( for cohesiveness) and W axes , F atty acids - FOR LUBRICATION Chlorothymol - (Bacteriostatic agent), Z inc acetate- STRENGTH, DECREASE STTING TIME,ACCELARATOR Ethyl Alcohol – luting agent,viscosity,micromechanical adhesion Base Tube: contains

20. Z inc oxide- PRINCIPAL INGREDIANT ANTISEPTIC,ASTRINGENT(ACCELARATOR,MODIFIER,FILLERS) Vegetable oil (for plasticity), Chlorothymol - Bacteriostatic agent Magnesium oxide - HELPS IN SETTING REACTION Silica - B inder,filler Synthetic resin - PLASTICITY Coumarin - ANTICOAGULANT Lorothidol - a fungicide Accelerator Tube: contains (CATALYST PASTE)

21. PREPARATION OF COE-PAK APPLICATION TECHNIQUE Moistening of gloves to avoid sticking of material. Teeth and soft tissue to be dried for adherence of dressing. For Coe-Pak the interproximal areas are filled first, thin rolls of dressing to cover entire field of operation are then placed against the buccal and lingual surfaces of the teeth and pressed against the tooth surfaces, into the interproximal areas.

22. Surface of the dressings is smoothened and excess material is removed ensuring non displacement of dressing during function . Should not cover more than apical third of the tooth surface.

23. APPLICATION - STEPS

24. Insert a scaler or plastic instrument under the border of the dressing and apply lateral pressure. Watch for sutures that can get lodged in the dressings. Remove fragments of dressing gently with cotton pliers to avoid scratching the thin epithelial covering of the healing tissue. Use a scaler for removal of fragments adhering to tooth surfaces. REMOVAL OF THE PACK

25. For the first 3 hours after the operation avoid hot foods in order to permit the pack to harden Do not brush over the pack. Brush and floss normally the areas of the mouth not covered by the pack. Use chlorhexidine mouth rinses after brushing After the pack is removed the gums most likely will bleed more than they did before the operation. This is perfectly normal in the early stage of healing. Care after periodontal pack

26. Cyanoacrylate dressing, Light cure dressing (BARRICAID) Collagen dressing and Mucoadhesive dressing Modification( chlorhexidine dressing) DRESSINGS CONTAINING NEITHER ZINC OXIDE NOR EUGENOL

27. Cyanoacrylate dressing, Maintaining precise positioning of a flap or free gingival graft

28. Collagen dressings (e.g., Colla products from Zimmer Dental, Carlsbad, CA, USA) are biological dressings which create a physiologic interface between the wound and the environment and encourage healing . The advantages over other dressings include ease of application, non-immunogenic, non-pyrogenic, hypoallergenic properties . COLLAGEN DRESSINGS

29. Commercially available collagen dressings have three forms: 1. Tape ( CollaTape ; Zimmer Dental, Carlsbad, CA, USA), 2. Cote ( CollaCote ; Zimmer Dental, Carlsbad, CA, USA) 3. Plug ( CollaPlug ; Zimmer Dental, Carlsbad, CA, USA).

30. COLLA-Tape is used for localized ridge defects, socket grafting, subantral augmentations and protection of soft tissue donor sites.

31. Colla -Cote is used in procedures like Soft tissue recontouring Sinus graft containment, Guided bone regeneration and Sinus membrane perforations, whereas, a plug is used as a dressing for biopsy sites. (Steer PL 2002)

32. Colla -Plug Used As Dressing For Biopsy Sites (Steer and Mathews).

33. Mucoadhesive / Stomahesive Dressing An adhesive, nonsensitizing wound dressing U sed whenever mucosal coverage is required for a short period of time.

34. I t i s a mult il a y e r ed d r essing i- a l a y er of cu r at i v e and absorbent material contact with the wounds, a layer of deodorizing material and an ou t er l a y er w hich secu r es th e b a n d a g e t o the tissues.

35. It includes Gelatin Pectin Sodium Carboxymethylcellulose Polyisobutylene . The longevity -is minimal (dissolves in 8-24 hours).

36. THANKS