+ Nontowe Advantages + Hasty manipulated Disadvantages ‘Materia isvry sticky (Vaseline must be ase on gloves whan rolling into a ope to avo it king) Indica ns and contraindications for use Indicotions 2 To promote healing ater periodoseal restment, ingvectonics and surgical procedures 1 To prec the wound aes To hold 2 peiolotal fap in pasion + To improve the poten omor troindicat 1 Some patients have rpporte a sensicty tthe material va Git al Metre Step 2 + Spatulite the material together witha woodhandledspatala oe the spatla supplied by the marfactueruntla homogenassmie (se the raceris as x uniform color) achieves Siep 3 + Using the edge ofthe spatula, arbor the material cogethor and for 8 «rlndreal or rape shape Stew «+ roe handling, beso lowes with Vaseline or lanolin an test the peviodontal desing for ackines (usually takes 2-3 minutes) Steps + Pass the operator some serie gauze to wipe an dey the aca gently Step 6 «+ Form dhe perioootal dressing inc small rope (or desire shapes) for the operator sigh} large ham the arco ofthe woud) sep? + Receive the gue roe tac operator and extend the poiodntal dss ing material on the paper mixing padStep 5 ‘+ Pass the operator some sterile gnuze to wipe and dry the area gently Stop 6 «+ Form the periodontal dressing inca stall ropes jor desired shapes) for the operator (slightly larger than the area of the wound) Step 7 «Receive the gtuze from the operator anid extend the periodaneal dress: ing meterial on the paper mixing pad Step 8 + The opecator will apply the periodontal dressing so thar appeosimately ‘one-thied of the cliical crown is covered as well as the wound Prepare and pass the opetaior a damp cotton tipped applicator, The foperatos may use ieto apply slight pressure 0 the dressing vo adapt i to the interproximal areas Pass the operator 2 hand instrament to removeitrim the excess material | The periodontal dressing mast not he over-packed as excess material tends to break away, causing dislodgement ofthe dressing. Stop 9 4 Wipe excess matesial from che spatula and dispose af the paper mixing pad and excess material into the contaminated waste binStep 5 «+ Pass the operator some sterile gauze to wine and dry the area gently Stop 6 «+ Form the periodontal dressing inca stall ropes jor desired shapes) for the operator (slightly larger than the area of the wound) Step 7 «Receive the gauze from the operator and extenel the periogmneal dress ing meterial on the paper mixing pad Step 8 + The opecator will apply the periodontal dressing so thar appeosimately ‘one-thied of the cliical crown is covered as well as the wound + Prepare and pass the operaior a damp cotton tipped applicator, The foperatos may use ieto apply slight pressure 0 the dressing vo adapt i te the interproximal areas ‘+ Pass the operator 2 hand instrament co removeitrim the excess material | The periodontal dressing mast not he over-packed as excess material tends to break away, causing dislodgement ofthe dressing. Stop 9 4s Wipe excess matesial from che spatula and dispose of the paper mixing pad and excess material into the contaminated waste bin Fesiodonta hesings va 6) 8) © ie@ figure 102 a) Perot tesing sop) Sep 1~Feodral dag digmmnd (Sep 7° Cormencan lS =a oth ine Soe SittinStep 40 Post-operative iestructions (ire relation to the jreriodontad dressing): + Explain to the patient that the dressing is intended ro stay in place until their next appointment where if will be remeweels andl ifi¢ ts displaced prematurely, they should telephone the sirgery + Tey to eat on the opposite side of the deessing and avold hard foods hae may cause the dressing ro be displaced Mixing times, working times and setting times will vary dependings on the constituents and type af tacerial chosen: the following tines are in relation to | tworpaste non-cugenol zine oxide paste (regular 3). Mixing tome + 35-40 seconds Working me 210-15 minutes Setting time = 30 minutes Instruments and materials used in s: uP > yoestotsnnal ctacesian eaves = Wooden-handled spatula or manufacturer's supplied spacula = Paper mixing padtheit next appointment where it will be removeds and if itis displaced ‘prematurely they should telephone the surgery «+ Tey to eat on the opposite side of the dressing and avoid hard foods that may cause the dressing to be displaced Mixing times, working times and setting times will vary depending on the constituents and type of material chosen; the following times are in relation to a two-pasts non-cugenol zinc oxide paste (regular st). Mixing time + 35-40 seconds Working time + 10-15 minutes Setting time + 30 minutes Instruments and materials used in set-up ‘© Periodontal dressing material ‘» Wooder-handled spatula or manufacturer's supplied spatula ‘© Paper mixing pad '* Lubricant (Vaseline or lanolin) ‘+ Sterile gauze Cotton-tipped applicator Hand instrament used for trimming the materialPART 18 Miselaneous sues, Problems, and Weetrenis 1 40 Periodontal Dressings ea A Harpomae Peron resins were is inoue 1925 by Dr A. ‘ac who ommended ibe se ofa packing materi lowing faneiva uryery the dressing mater. Was Wanda. ok fade nf rh exide a even lee phe eae asesn {hes ts rity pases nlc! pare conor and wound Froncclon, Tae cmpostian of dressings a change ver the ‘eas crane poral caste roduc (uch a5 asbeses) Aint adding ethers Krak mete nd ean ABT thon of drowngs tae nokicton of Tearhope ad fpratne tec cnn of ranula tise gris eer ‘en ot apkalypstioned as by prevenangeofonat esac ‘em. atineral sabizaton cl 2 sot-sve zr petecton of emu tore dng ean. ana sping of pssungealy tate ech One the rosin Renee the peo Ingxal cern prvi the ae ater sige Pennoni dressings are generally vied nto the follow: Inuiew cng Theseeatanne ose an eee {Gh tho cntaeang rn side WEnOUT eugeree 2 (3) thse ‘omatning nner ne xe or ego. ‘A tine oxite ant eugene dressings ate sup 363 hd contamingengenol and peat andor reseed rein fu.a poder coming wre ove. powaeted een and Taneic nt The tv components ae Med together et» waked paper Pat using 3 wanden Tenge depressor TNE “containing ether sine oxide nor upon (A. Gin one arn agen drosngs ase supple Hd fontasingcuycaol aad peanut aalor reseed roe Ghd powder colt auc owe. powered Festa a tani ni. Fhe tw coronene mixed wot tt & Imated oper pal wing 2 seein trate dere. Te Darley ibeororted ao the uid ul 2 Aloughine Consbtetey forms. The desing may be used imaedtly oF wrapped in alana il an ekigerat lor up 01 mock. The aanloie o hs type uf Gs husuce spbouny (ice aderes tothe tee) ae nenpnia e's peed by Me ante a. The sade ‘vantages indade "ough surface on stone tat as 10 pine scrnulaion and tacit poieranon: 2 hark. feting cnssenc that may comic remoal engaged ‘he dine tate of eugene While the pack etm poe: and posse slg ream to exe that may pasha 1B rancenie thou exgonoldesings const of t40 pases: ue, emetile ander neal oder Bsety, and ‘agnetiom oekle andthe tae nay cones of petatin, fe denature aleaol The setng sci sus Hem the tection bese the metaiconie ar th ty ace Fae Acelerator aid base ate eopersed in tae. El eng St mate ae paced en 3 weed paper pad nd kod song a wooden tongue depress un a tack constency ‘and uaiirm cole reacted. tse seuing ume can be fede! yada ew drops of en) wate eng Inger by immersing the pork ita a bow! warm water Jt afer xing Once pave es stakes a he anaes and moked Ushg snes lubed ih ater pectlatum. the packs ten formed ini pence os fst aethen mechanically erick neat a Be fu interpimatonay Working iene apoconiately 15 {020 mines, The aGvariapes of ths desing ewe less cohor an hela: pag, wn fates Fepval fom undercut areas and ihe absence of eupe dint aiteses The dsuvamtages indude the wat "0 Sater coe: rematire es he packing HE 1 not firth ttervontmaiy: mal eng aay eve tos sot rbery consistency ar the aber of ee sexiinthe matera. © Addhionst nemosiass may te requied for palatal donor Stes. Surpeal aporbable Renosst (Surpeel, Colyer dene maybe apie ever the wou Hed. over Which ‘he eso desing ra palatal sen cane be placed 1D Some surgeons report the ue a 4 Somahesve mandage nen mete cs cere reqitement fra sha © Addhonat Remnais may be rogues for patel donor Stes. Surgical sboxbale Benes (Sump, calycte, fsiene ey Be eped ewer the oud fxd, Over whic ‘he peso droing alta set ea en be ace 1D Some surseons report ihe use of a Siemahesve bandage wwe thee ha cna overage rule fra ahr Unt (241036 hours. Stomahesve ya yelaalike match ‘with an aces sua petectedLy a peber com. Ale (ne pepe removed, te pred tay be pled nc ssfaes and are is gy warmed Tyaloved hasan the warn of be orl envionment ‘he knovty chs adage mina however sme sorgeers and ts shore ime adequate lor petting he fone and repent shes ea sas grat 9 gh lay procedure ‘Additional Readings ny: tap 781 HL WH Deen bing perahnrogy Sel St Lak Moby ‘aad: WR Saunders 2903 9729-91 Sues HA Farncunh A Cec L Jeng CE Cran a el ‘sonal dors Persona (984568 ‘aT Combe Coolest Cha einePaint fr PERIODONTAL OREEEING ‘toa PostTIONED or aupeD ee Cownectve ‘CoRONALLyPosirCneD TISSUE “anata Tissue Ae SUEGEEY AESENERATION art ower Sounueg eect Sinnng ect singe site ‘eced rat ede ‘ae ide amet desing Moe ses ' Zee aide wtnoxt “The application ofthese matenalsis controversially siscuned inthe litsrature, Some authors found beter lineal results alr pesiontal surgery wing such Gressngs [1 104], whereas others fond that rinsing twith 02% chlorhoridine solution was mote effective [sce so periodentology textbooks) 11.3.1. Basic Material Properties 11.3.1.1 Composition Wid Sesings are Fequetly david as eaxenoksoniaiing sd eopenocfree mai. he Dondero the white pat of ger: contaiing t= fel const of che oxi, sia leat, ol phony. an are sek. The hui He ng pte contain wogena! with anise adives such {5 thyal sept The set te shied by the iin tne acest and nine sara. Eagen fice materiale contd, for instance, ane oxide with aaiuives of vara sand trctdoy a ang Sabance ted to heachlonophoae The the paste ontans uate ty ah with ade coro imo ay antimerial satan (Cee-Fak). Another Commonly weed dressing consi of calcio sl, dine oid, sine wl, a res ad gle slvent (Gerigac)Alighcursie pris pack esis rl I ona of polyter-athane- dietary O [senna 1 Nate for shore Appation in Oral Cavity 1 Fig. 114 Appleton of gt crble pdt reson with subsequent formation of gypsem (81). Anotber ‘eogenol-tee product tht contains unsaturated fay acids (Coe-Pak) sets by soap formation (91), Light curable periodontal dressings set, lke equnvlent tetia-bated composite, vin «polymerization ae ie adit mith sb ight (Hg 11) The relense cate and solubility of « eugeaol-free fPetiontal dressing (Peripas) was high using the Ini 24h and decrease over time. The solubity of another eugeaol free product (Coe Pak) iseressed alter 6 h. Furthermore, the solullty of « eageaot Ccontining mural (Wards WNondrpab) was consi teal low and dd not change ote ae 10). Itmay befoe materials contin, for stance, sine oxide with aaties of varius cil nd lovathidaly an sntifngal Substance related to hexachloropcae. The other paste oataas unsaturated fay ace with aed cloeathy- ‘ol as sntimicobil substance (Coe-Pal). Anotber commonly used dies consists of eallum sult, dine onde, sine sulate, a rsin, adm gly ment (Pesipt) light curable periodontal pock savaable 25 well It css of polyether uretae-cethucry Uae silane SiO, ight initiators, accelerators, and father alditives [I]. A number of products previously contained asbestos flrs, 2, PPP [29], Sepo-pack TPS), and Warde Wondrpat [4 Cyanoneyltes were wed oe, locas an alternate Yo suture materials forthe Sxaton ‘ftlape These males are reviewed in Chap 65 ‘Antinicroliel adtives are applied av well but notes ae no longer use 38) Chlorhebine a8 Aikydrochleride 79] ora acetate [26] was ocason ally recommended Detd infortation about sone ominon med rots sowie a Tahle 13 a the Append [3 1.3.1.2 Setting Reaction and Release of Substances ugpno- containing prodact sc via a compl forme tion and the kinetics of sebstance release are equa lent to those of other ZOE materials (See Chap. 7) Eugenol-fce periadantal dressings based on clei saline (Petipa) set abou 2 glycol-water exchange cxtensre iterate shout ebestoe bers cannot be od Aremesta ths pont (fr details ac textbooks on toxi= cology) Nocestrafashesiosecamsed seas (ge ‘conta in denial personnel dae to the aplieation {asbestos omtatning peioontaldessngsbaveteen Socumeniod. Asbestos hes ol been sed for commer- lel periodontal dressings ince the 1960s [90] 11.3.3, Local Toxicity ond Tissue Compatibility 113..1. Cytotonicity Eogonat-tre pevietal dresinge have been deel- ‘oped to prevent eugenol-associted toxicity [17,52] However various im wo stues have revealed that sugeno containing ‘ressiogs may cause Jess growth inhibition of permanent ells and psary Ihuman lukaeytes than some engens-tiee prodacte 53,85), On the other hand, a eugenol-fres materiel tac cin cakum sulfate (Pepe) way the Fas el slamaging product when compared wits evgencl-con taining mesial and some other eugene: fee prod vets (91 Sel specimens of «ight curabe peridoalal dross: Ang were not eytoteae In varous cell caltures and dt erent call ypes. Other eugene dressing materials towed modersttooeverecytonicityin these studies Unpolymenzed light-cerable material, however, vas cylotie [51- Light curing sharpened due to ier rsiacbated composies, vin a polymerization ate ie radiation with visible ight (ig, 1) The reese cate and solublty of a eugenol fe (erspse) wa high ding the Initia 24 eed decreed ver time, The solubility ‘of another eaenol-fiee product (Goe-Pak) locreased aitee i'hTurthermare, the soltty of a eagendt containing material (Weed Wondspek) wan conse: teal iow and dd not change ove ave 0) tay be ‘cli from these dala thal slubitytime- and product dependent A clasication bated on cugenol ‘comayaing and eagenl-ree products does no elect the diferent elabily pattern. 11.3.2. systemic Toxicity ‘A sxdy nesting the ssemic sey of nm- ts of MBSE aay: (Coe a Perf, Wack ‘Wondrpal dovarented an (De 22000 mlb body vreh [4 Irmay be concede tse on thes dat nserver mpc sof penal dreingr das no ose» ym tlh isk for pation The pevotsadtion of asbestos fiers ome profs waa Fak for dent porand [21 the ‘ipo ef petal cui sYehof a poe tos-conianing periodontal desing cused lung al tons inthe terminal bronchi that were eat to the Ssbestoncontent [97]. Such asbeson-cased ertons conresult in brosisand emphysema 29th dhe tal dressings woe abcerved [28], Alter eubcutencour Implantation in rain « cupenol-contaning product cased a more severe reaction than aengeneltree me terial (PDC, Coe Pak) ar an observation period of 7-14 days (72). Wands Wondspak (eugenot- Scape blades and demand bur 9 Sealers ae cites Seft ave rongeurs and surgical cixors > Hemost > Suture nede and tend > Peredentl dressing materials PROCEDURE STEPS (Fallow aseptic procedures) 1. The aesthetic is administered to anesttize the Uavor and reduce the bleed fw tote area, 2. The periodontist examines the patient's Ute ond Wie a ee eben lee ‘periodontal probe. operative Treatment Following Surgery 9 Oral hygiene. Norms brushing and fis Should Be completed in ares nt involve nthe Surgery. Brash any the iting suroces of he teeth involved in surgery. Gent rise the mouth ith ‘arm saltrater alter erty four hours. Diet. Acid ot. 11 Yoods and ius fod: ea St foods and dew on the healthy side of the frouth 30 that the periodontal ese not tured » ain, The patent can expect mito mocerate ‘Sicemfor and meat soul be presebed 9 Swelling and bleeding. Some sneing may ‘cut Place an ke pack ovr te oe or ten in tes and remeve for ten. minutes. Repeat a5 ‘eeded. Some seepage and bleecing may occur Spd fs norma, however, HH pers, cal the Seni Periodontal Flap Surgery Perlodootal flap surgery Involves surgically separating the gingiva from the underlying tise. The ylngva Is Inclzed with a scalpel and then separated with periosteal elavator. Once the tissue is retracted, the periodontist has good visibility and access to bone, tooth, and the toot roots, “The design ofthe Map depends on the objectives of the surgery and the periodannist The amount of expo sure necessary for the surgery and the repositioning of the lap are Important considerations. The periodontist Sind planes the root sudaces atonts ae removed and the surfaces are smoothed to promote heal: Jing. Continue to pass instuments and evacuate the area. A sete alte solution may be tned 10 innate the area sutures are needed, they are placed at this Ue Prepare the suture need tnd trerd and have them postioned ina emextat or needle holder joey pasts Gee, etches a needa ‘er the sures are placed and the aren ine pce th ae auton» rd a dread prepueet ire faerie Ae pevodotat wth te wae pcemen, vacate the mee ard prepare he petodontl deg. 2. Ater the placement of the dressing is completed, ‘the patents gen postoperative instructions ard ‘lmisied, Make sute tne palon: does not have ny debris on his or her ce, ghie postoperative instctions and dismis the patient Ay FACURE 23.22 a aingeciry sacecue ( 8) Marr he pct depth win the pie marke. (Cnking the ‘arte ise wath[TIGURE 28-25 Cingia ort. (A) Grghalreceson shows ned for a ra (8) aaa tie gti postoned rd suture a place (©) Gat ter eng period. (Courtesy of ary Shell DOS) Frenectomy ‘The fremectomy Isa complete removal ofthe irenum, focluding the attachment to the underlying bone. The fem may be removed if 1s atachell (00 close to the marginal gingiva. The procedure involves incising the trenum and removing a ttangular section, The pert ‘odontal fibers are separated and cut to the bone. The labial mucosa is then sutured tothe apeal periosteum. The personal dressing is prepared and paced over suture site. [Pemovowrat Daessinc Periodontal dressings or packs are placed alter pest ‘odontal surgeal procedures, The dressings do not have ‘any medicinal qualities; they are bandages used to pro. {ect the tissue during the Healy process. ‘The purposes ofthe periodontal dressing include Minimizing postoperative infection and hemorrhage Protecting the tissues during mastication 9 Covering the surgical sits inorder to reduce pan due {otraurnaer tration 9 Provicing support for teeth that are mobile 2 Helping to hold flaps in postion ‘Types of Periodontal Dressing “There.re diferent materais used fo periociontaldiress- lings. The most common types are the zinc orde- feugenol materials, the noneugerol materlals, the light-cured dressings, and the gelain-based materials, Zinc Oxidefugenol Materials. The zinc oxide: ‘geno! materials are supped in a powder (upc oxide) Preparation and Placement of the Non-Eugenol Periodontal Dressing elles [ile The periodontist routinely poces the desing. but in some sttes the denial esssiont allowed to place acd remove the peracortt ies. The Gessing 1s paced iter the surgery to protect the tasves and promote the heating process. EQUIPMENT Basic setup: mouth mio, explorer, and cotton pls » Gouze sponges » Non-eugenol periodontal dressing material dase and accelerator) Paper pad and tonave depressor > Lubricant > Instrument to contour dresing (spoon excavator, side sale) PROCEDURE STEPS (Folow aseptic procedures) 1. Alter the hemorrhaging is contaied, the patent's lips ao coated ight with Vasaine, 2. The desing materials ore dpensed into equal lengths and mixed with a tongue blade until homogeneous. (Using a paper pad and tongue blade make cleanup easier). The material is slowed to set for two to three minutes unt the twckiness is gne Figute 23-264). 3. Lubricate gloved tingors with vaseline so the patty the material can be handled easiy. 4. The dresiing comes with a retardant to slow the setting time, necessary: it can be molded easly for eee to five minutes and worked for Maen to Ibventy minutes. 5. The desing is molded into a thin strip stichtly foniger than the length of the surgical ste. Divide the ep into two equal lengths, one forthe facia surface and one for the lingual surface (Figure 3.268). 6, To begin the placement, fir the end of one sip Into’s hook shape Wrap this hook around the dt: {al ofthe mott posterior tooth (gure 23-260).SE Paper pad and tonave depressor » Lubricant » Instrument to contour. (spoon excavator, sickle taler) ae PROCEDURE STEPS (Follow aseptic procedures) | aterthebemorhagng conte the patent's fpsareceac ght) oh alae secing ime, # necenary: 1 cm ve mowea exsry for three to five minutes and worked for fleen to twenty minutes, 5. The desing is molded into @ thin strip slighty Jonger than the length ofthe surgical ste. Divide ‘he stnp into two equal lengths, one forthe facia surface and one for the lingual surface (Figure 23-268). 6, To begin the form the end of one sip Into a hook shape: Wap this hook around the ds. tal ofthe most posterior tooth (gure 23.260). [FIGURE 23.26 Prepration and pracement ofthe perodon! desing. A) Ming the materials. 8) Preparing the materials {ar plcerss(ontrae) qh the rest of | along the facial surface, fee Aen pel erat cc fries ; '8, The second strip is applied to the linaual surface ier ravecte mek waorel ceed eect tes oe ce ingal ooea eee ee meron Fi pe ee eae el ata Battie wih Sclucie ee nee Pe ee ee eau cclueemetn ln mserecnan ‘scaler. Gently press the instrument into the dress- Ing to detach the extta material, Snooth the pock Eee ee eet ae 11. Ak te pant ho he peck fea ate the Cr en Wl eineielaet ee 10, Check the +12. Give the patent nsructions abou the peiodon- coe. 1 The packs pt on fone wes a sre Th pack wi ato no nos and hen _withstand normal chewing stresses, » The pack nay chip and break off BEA pA ac acl Ray bie. # there is pain vinen pices of the come off or the pack becomes rough, the ‘patient should call the office. 1 The patent sou bh the och utace tre athinehedin he age and cote Inthand fon hereof tah sealfor liquld eugenoD) form that can be mixed before the procedure and stored fr later use. Some offices x the ‘material, wrap in wax paper, and then freeze it unt needed, ‘The presence ofeugenclinthis dressing can eausean allergic reaction. The area becomes red and a buraing sensation ls experienced by the patient. Non-fugenol Materials. The non-sugenol materials come in-a tworpaste system: one tube of base material ‘and one tube of accelerator: The two pastes are dis- Densed In equal portions on a paper pad and mixed {together prior to placement “The non-eugencl dressings do not cause sensitivity problems, and come non-ugene! dressing materiale ‘have bacterostatic agents added. Light-Cured Periodontal Dressing. Ligh-cured perio- ‘dontal dressing material comes in syringes It can be placed directly on the sureal ste oF placed on a mx Removal of the Periodontal Dressing fal | This procedice is performed by the periodontist or the etal assistant (7 the expanded tureons. Thepatint has wom the desing fer week te ten days. The patients mouth is exenined before removing the resing 9 creck for ares where the desig ray have core oe ar come off completly come bore or come of completely. equiewenr 1 csp: mouth no expos nd cation lars ¥ Sala ecto HVE, aater singe > Gove pong ae ue > tnsoumens to remove te desig (spoon exc tor, sickle explorer, surgical hoe), PROCEDURE STEPS flow seeped) 1 -Atersenng the pater, the suas _ated and the cressing is removed. 2 saat exerts exceed Seger muir Uae cole ayite ts py the tein anny tom ete Genre 23-27, 3. The pack may come off in large pieces and ther {esky sh fos canbe ted rove ty por Ailes from the interproximal areas and tooth sur faces. Cotton pliers are used to remove particles of desing that are embedded inthe sural te. 4. Genty rings the entire area with warm veater to remove any debris. The a-nater syringe can be lied caret, ‘ng pad its placed recy on the tissues it can be ceontoured tnto desired position, then light cured. The material may also be dispensed onto 2 paper pad, ‘manipulated to the required shape and slze, placed ‘over the tissues, then light cured, Gelatin Base Dressings. Gcatintase dressings offer ‘f00U stably and dissave ta 24 co 48 hours, Tey are fexcllent for ure n such procedures as tha ater sot- ‘ssue augmentation, designed therapy. Perldntal disease is an ongoing process. bu eomtinual are mainais the status bet= ‘odonil health ater surgery. Dedicated home oral hygiene rutaee apd periodic vite to the dent re ‘eecsnary for sucesso periodontal eae. ‘Once the pellet has accepted the eaten pl plaqusconinl techaqucs re tautht by the deatel Assistant andj the hygienist As the patient conte through treatment. the patient's hyepene Sl and pete sonaliaed intraoral aids are evaluated snd sds