Periodontal dressing

PERIODONTAL DRESSINGS

Definition
Periodontal dressing or periodontal packs is a productive materials applied over the wound created by periodontal surgical procedures

Uses

To protect the wound postsurgically
To obtain and maintain a close adaptation of mucosal flaps to underlying bone
Comfort to the patient
Prevents post-operative bleeding
Prevents formation of excessive granulation tissue

Properties

1. The dressing should be soft, but still have enough plasticity and flexibility to facilitate its placement in operated area and to allow proper adaptation
2. Should harden with in a reasonable period of time
3. After setting the dressing should be sufficiently rigid to prevent fracture and dislocation

4.The dressing should have a smmoth surface after setting to prevent irritation to cheeks and lips
5.The dressing should preferably have bactericidal properties to prevent excessive plaque formation
6.Dressing must not detrimentally interfere with the healing


TYPES
packs based on reaction of znoZno eugenol packs & eugenol include – wondr pak developed by Ward
The addition of accelerators such as Zinc acetate gives the dressing a better working time
It is supplied as a liquid and a powder thet are mixed prior to use.
Eugenol may produce allergic reaction
(reddening of area and burning pain )

Non eugenol packs

Reaction between metallic oxide and fatty acid is basis for coe-Pak
Supplied in two tubes
One tube contains oxides of various metals
(Mainly zinc oxide) and lorothidol (a fungicide) and second tube contains non ionized carboxylic acids and chlorothymol (bacteriostatic agents)
Equal parts of both mixed together immediately prior to insertion
Setting time is prolonged by adding a retarder

Other non eugenol packs

Light curing dressing e.g Barricaid
Useful in anterior tooth region and particularly following mucogingival surgery because it has favorable appearance and it can be applied without dislocating soft tissues age

Disadvantage

It is not the choice of dressing to be used in situations where flap has to be apically retained due to its soft state before curing


2. Cyanoacrylates
It is applied in a liqiud directly on to the wound or spread over the wound
3.Tissue conditioners ( methacrylate gel)
Retention of packs
Periodontal dressing are kept usually in place mechanically by interlocking the interdental spaces
&
Joining lingual and facial portions of pack
In isolated teeth or when several teeth in arch are missing --- retention of pack may be difficult
So numerous reinforcement and splints and stents placement of dental floss tied loosely around the teeth enhances retention of packs

Application techniques

Ensure that the bleeding from operated tissues has ceased before the dressing material is inserted
Carefully dry teeth and soft tissues before the application for optimal adherence of dressing

Moistened the surgical gloves to avoid the material sticking to finger tips

Zinc oxide packs are mixed with eugenol or non eugenol liquids o a wax paper pad with a wooden tongue depressor
The powder is gradually incorporated with the liquid until a thick paste is formed

Coe-pack is prepared by mixing equal length of paste from tubes containing the accelerator and the base until the resulting paste is a uniform colour
The pack is then placed in a cup of water at room temperature in 2-3 minutes the paste loses its tackiness and can be handled and molded


The pack is then rolled into two strips and placed on the surgical wound
the dressing should not be covered more than the apical third of tooth surface
Excess pack irritates the mucobuccal fold and floor of mouth and interfere with the tongue

Pack that interfere with the occlussion should be trimmed away failure to do this cuases discomfort and jeopardized the retention of pack
The pack is kept on for one week after surgery

Instructions for the patients after the packs are placed

1. The pack should remain in place until it is removed in the office at the next appointment
2. For the first three hours after the operation avoid hot foods to permit the pack to harden
3. Do not smoke
4. Do not brush over the pack