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Journal oj Clinical Periodontoiogy: 1979: 6: 3-14

Key words: Periodontal dressings - composinon - iherapeulic efjects - lisme irriiation.

Accepted for publication: September 4, 197S.

Review Article

Periodontal dressing materials


Department of Oral Medicine and Dental Materials Science Unit,

Turner Dental School, University of Manchester,
Abstract. A detailed review of periodonta) dressings is presented, covering physical,
chemical and biological aspects. Areas requiring further research are outlined, particularly
in the physico-chemical sphere; and some contra-indications to particular substances are
described. It is concluded that there is a definite place for dressings, but that more knowledge is required before optimal properties can be deveioped.

Rationale for Usage

A wide variety of reasons has been given

for the use of periodontal dressings. These
reasons fall into two principal groups: a
dressing may be employed as a physical
adjunct to periodonta! surgery, or it may
be used therapeutically with or without
Physical effects
Opinions vary as to the desirable physical effects of a dressing. Prichard (1972)
states that a dressing is used to prevent
postoperative haemorrhage and to protect
the wound area from contact with food,
concluding that a dressing "has no other
virtue". Manson (1975) however, considers
that a dressing is to protect a healing wound
from saliva and trauma, thus producing
comfort and speedier heahng, to prevent
the proliferation of granulation tissue and
to control haemorrhage. Held (1967), in
addition, feels that the surgical wound must
be protected from bacteria by the dressing
which wiU also have an analgesic and anti-

haemorrhagic effect; whilst Goldman &

Cohen (1973) emphasize the need for a
"secure and rigid surgical dressing" with
good adhesive properties. The advent of
isobutyl cyanoacrylate has also led Bhaskar
et al. (1966b) to consider instant haemostasis one of its main advantages. No other
dressing material has this adhesion - dependent effect. Finally, the advent of flap
repositioning led Ariaudo & Tyreli (1957)
to state that the dressing should act as a
stent. Many other writers have also stated
the above points in textbooks and research
papers, including some whose work is
quoted elsewhere in this review. Thus we
may conclude that wound protection and
comfort, and some degree of hacmostasis
and tissue stasis are generally considered
to be desirable effects in a dressing.
Therapeutic effects
Dressings have been used in the absence of
surgery for two principal effects: tissue
destruction and tissue shrinkage. In the
austere days of World War II, Orban (1943)
described a technique of chemosurgery by

0303-6979/79/010003-12$02.50/0 1979 Munksgaard, Copenhagen


using paraformaldehyde in a dressing.

Gingival necrosis occurred in 4-8 days. It
was noted that contact with bone would
cause sequestration. This technique does
not seem to have achieved much popularity.
As regards tissue shrinkage, the limited use
of saline and astringent packs for 20 minutes following scaling has been reported by
Padgett (1959); this is a variation on the
once popular technique of packing periodontal pockets with an inert substance
(usually a paraffin wax formulation) for
1-2 days following subgingiva! scaling
(Pincus 1944, Christensen 1944, McTntosh
1947). Isolation from tooth roots led to a
rapid shrinkage of the gingiva, an effect
which is produced today by the somewhat
slower techniques of plaque control. The
use of special pressure packs to produce
gingival shrinkage has also been advocated
in cases where surgery is medically or
psychogically inadvisable (Weinreb & Shapiro 1964).
Therapeutic effects after periodontal
surgery have been the goal of many who
have incorporated specific agents in dressings. These agents may be classified as
having a primary effect eitber on oral bacteria or upon periodontal tissues.
Eugenol has been shown to have antibacterial properties in several studies in
vitro (Linghorne & O'Connell 1949, CoU
man 1962, Persson & Thilander 1968a,
O'Neil 1975, Haugen et al. 1977); in vivo,
it has been noted that plaque composition
is definitely altered, presumably as a result
of selective inhibition (Coppes et al- 1967,
Heaney et al. 1972). Pihlstrom et al. (1977)
considered that the total number of microorganisms was not noticeably reduced by
eugenol. None of the quoted authors has
suggested that the antibacterial properties
of eugenol in any way enhance healing.
However, other antibacterial substances
have been added to dressings with this object, notably tetracycHne (Fraleigh 1956,

Ariaudo & Tyreil 1957, 1960), zinc bacitracin (Baer et al. 1958, 1960, 1969) noneugenal phenol derivatives such as chlorothymol (Molnar 1962), oil of bergamot
(Schach 1968), and chlorhexidine (AsboeJorgensen et al. 1974, Addy & Douglas
1975, Pliiss et al. 1975). It should be noted
that chemical inactivation may occur: Baer
et al. (1958) report that eugenol and tannic
acid both affect bacitracin.
Apart from haemostatics such as tannic
acid, there have been two attempts to improve postoperative healing by means of
substances with a primary effect on the
tissues. Saad & Swenson (1965) reported
on steroids; and Swann et al. (1975) reported on diiantin. The latter agent had
been previously reported to increase the
rate of healing in skin wounds of rats and
humans, but neither agent showed any
advantage in these periodontal studies.
It is unlikely that the present periodontai
climate will be conducive to the widespread use of therapeutic agents other than
antibacteriats in dressings. Emphasis on
plaque control by the patient has largely
replaced the earlier philosophies based on
professional intervention.
Material Aspects

The literature on periodontal dressings as

materials is so sparse that Mjor (1977) was
quite justified in complaining of its paucity.
It is clear that manufacturers want to be
free to vary the composition of their products and Smith (1970) gives Just such an
example in relation to the reports of Persson & Thilander (1968 a, b) concerning
Coe-Pak. The limited factual information
available will now be described and will
highlight areas where knowledge is deficient.
Setting systems
With the exception of the zinc bacitracin/


hydrogenated fat dressing described by
Baer et al. (1960), most dressings are intended to set, though not necessarily to
the point of rigidity. At least five different
systems are discernible in presently available materials: (1) The reaction of zinc
oxide with eugenol to form zinc eugenolate.
The reaction is slow, and even with the use
of accelerators such as zinc acetate, there
will always be free eugenol available during the normal life of a periodontal dressing (Molnar 1967). The significance of this
free eugenol will be discussed below (Biological side-effects). (2) Organic solvent
loss is the basis of setting in Peripac
(Eberle & Miihlcniann 1959), and a physical
hardening results. (3) The reaction between
a metallic oxide and fatty acids is the
basis of Coe-Pak (Molnar 1962). A requirement of water insolubility and suitable melting points limits the typs of
acids which may be used. (4) Tissue
conditioners have formed the basis for
certain dressing materials (Frisch et al.
1968 b, Levin et al. 1969, Addy & Douglas
1975). Their setting is usually a physical
process (Combe 1977), with an elastic gel as
the result. (5) Cyanoacrylate tissue adhesives set by polymerisation in the presence
of anions, such as OH- (Combe 1977). (6)
In addition, an experimental polycarboxylate system was used on a limited basis by
Smith (1970). These setting systems may
therefore be categorised as chemical or
physical, and at present there is no clear
basis for choice of one or the other, except
for individual preference in the clinical situation. If a particular system were acknowledged to be advantageous in other respects
(for example, by not inactivating a useful
antibacterial agent), then these factors
would help determine choice.

A considerable amount of ingenuity has
been expended on the problem of how peri-

odontal dressings may be kept in place.

Hirschfeld & Wasserman (1958) listed a
whole battery of techniques, including the
use of wire, floss, acrylic, adhesive tin foil
and copper bands. At the other extreme.
Gold (1964) preferred a cement type pack
because, in his estimation, it could even
splint mobile teeth. When flap repositioning techniques were established, Ariaudo &
Tyreil (1957) wanted the dressing to act as
a stent; but Seibert (1961) clearly had no
faith in any dressing to achieve this, and
advocated the use of cobalt-chromium
tacks to hold flaps in place. Numerous
splints and stents have been described, employing latex (Munns 1952), acrylic resin
(McKenzie 1951, Gottsegen 1954, Hileman
1957, Holmes 1962, Reader 1970, Glcn^
dinning 1976) and a vinyl polymer (Frisch
et al. 1968a, Kalkwarf et al. 3974). Some of
these have been related to repositioning
and grafting techniques. Other means of
increasing retention which have been advocated include wiring (Cowan 1965, Larato 1967), interproximal usage of spiral
saws and lengthwise cotton thread (Waerhaug & Aanerud 1953), foil (Berman et al.
1961, Nelson et al. 1977), and cotton tapes
with interdental sutures if necessary
(Castenfelt 1962). There is no experimental
evidence that objects placed within a dressing are likely to contribute to its retention;
on the contrary, they are likely to weaken
the dressing material since they decrease
its cross-sectional area and contribute to
stress concentration phenomena, thus rendering it more liable to fracture. External
retention with splints and stents is free
from this criticism, but they are inconvenient to both patient and operator. Ideally the dressing should be sufficiently retentive without the need for extra devices.
Smith (1970) reported on preliminary trials
with polyacrylate dressing materials, and
Addy & Douglas (1975) also attempted to
incoiporate some degree of adhesion into


their chlorhexidine-carrying material, by
employing polyacrylic acid. Two other
research groups, Asboe-Jorgensen et al.
(1974) and Pluss et al. (1975), decided to
employ auxiliary methods of retention for
their chlorhexidine-containing dressings.
Other attempts at improving dressing retention have used frankly adhesive materials. The use of cyanoacrylate tissue adhesives is well attested to in the literature
(Bhaskar et al 1966, Ewen 1967, Forrest
1974, Levin et al 1975). The production of
haemostasis, flap immobilisation and possibly quicker healing are described as the
principal advantages of the technique. No
problems of removal have been described
in the literature, since cyanoacrylates are
apparently biodegradable and are gradually
depolymerised and phagocytosed (CDA
Council for Dental Materials and Devices
From the variety of ideas, it is apparent
that retention of dressings presents numerous problems. This is to be expected, since
a periodontal dressing is intended to be
removed after a short period of time. If
retention were too good, removal might
become a problem; therefore, an optimum
level of retention should be specifiable.
Biological and therapeutic compatibility
Biological side-effects of dressings are considered below; certain authors have sought
to ensure biological compability by using
intermediate materials under dressings.
Stern (195S) reported the use of Telfa,
the inner layer of which was a thin, perforated polyester film which was non-adherent and could be used to cover bone.
The use of specially prepared fabrics has
been advocated by Schultz (1962) and
Chasens & Marcus (1963). These fabrics
must be carefully cut to size and adapted
to furcation and embrasure regions. Sullivan & Atkins (1968), referring to free mucosal grafts, suggested that rubber dam be

used under any zinc oxide and eugenol

dressing for the first 6 days. Cleariy it
would be simpler if intermediate materials
were not needed; it is also possible that
they might adversely affect retention of
the, dressing.
Therapeutic compatibility is important
if an active pharmacological agent is incorporated in a dressing. It would seem from
the results of Addy & Douglas (1975) that
their dressing did not substantially interfere with chlorhexidine activity. The warning of Baer et al. (1960) regarding bacitracin has already been mentioned.
Restorative material compatibility
It is important that periodontal dressings
should not damage permanent restorations
in teeth. There are two possible problems
which could arise. First, an interaction
might take place between dressing and
restoration leading to physical breakdown
of the latter. The authors have heard one
such report from a reliable periodontologist.
Second, anterior restorations might be
stained at their margins by substances such
as chlorhexidine in dressings. Protection
by a separating agent would be possible,
but might affect retention. Further experimental data are required on this subject.

Biological Side-effects

It is essential that no risk should accompany the use of dressing materials. The
patient should not suffer any side-effects,
the surgical procedures should in no way
be compromised, and there should be no
health risks to the operator and his staff.
In general, three methods of testing materials are used: tissue culture, animal experiments and human trials.
Tissue irritation
Culture studies with eugenol and noneugenol dressings show that with minor


variations, both types of material can be
cytotoxic when tested against HeLa cells
(Kreth et al. 1966), fibroblasts (Hildebrand
& DeRenzis 1974) and polymorphs (RiveraHildalgo et ai. 1977). It is possible that in
vivo dilution may occur, as toxic substances
leach into saliva (Rivera-Hidalgo et ai.
1977), and therefore these dressings may be
better tolerated by a patient who is using
frequent mouthrinses. Culture studies of
cyanoacryiates (DeRenzis & Aleo 1970)
on mouse fibroblasts show that a short
side-chain molecule (methyl cyanoacrylate)
is considerably more toxic than one with a
long side chain (isobutyl or n-octyl cyanoacrylates). However, all substanees tested
showed definite cytotoxicily.
Certain problems arise when experimental animals are used for tests of dressing
materials. Most important of these is the
animal's natural tendency to remove the
dressing as an extraneous object. Thus
Englcr et a!. {1966) decided no dressing
was needed in their gingivectomy healing
studies in rhesus monkeys, and Loe & Silness (1961) used acrylic splints as dressing
retainers in mongrels. Other workers have
used subdermal or paraperiosteal implantation (e.g. Mitchell 1959, Baer & Wertheinier 1961, Frisch & Bhaskar 1967).
Eugcnol has been implicated as an irritant
in some animal studies (e.g. Waerhaug &
Loe 1957), though this is a relative effect
For instance Mitchell (1959) found croton
oil to be a more severe tissue irritant and
Gugliani & Allen (1965) rated several materials to be more irritant, including bacitracin-containing dressings. Neither Triadan
(3 965) nor Yokoyama (1976) could detect
unfavourable effects of eugenol histologically, and Persson & Thilander (1968b)
felt that the strong antibacterial substances
in Coe-Pak at that time (but see Smith
1970) were also responsible for its greater
tissue irritation. However, a recent study
using a standardized technique of com-

parison is in agreement with these results

(Haugen & Mjor 1978), even though the
composition of Coe-Pak is now believed
to be different. On the other hand, Baer
& Wertheimer (1961) compared several
dressings above and below periosteum, and
concluded that a non-eugenol dressing was
better, and that if possible the periosteum
should be left intact. Ochstein ct al. (1969)
agreed with the desirability of split flaps
and the inferiority of eugenol dressings,
but recommended isobutyl cyanoacrylate to
Coc-Pak (presumably of the older formulation). This study involved actual gingival
surgery on beagles, and was therefore closer to the clinical situation than that of
Frisch & Bhaskar (1967) which found no
difference in the response in rats to subperiosteai implants of eugenol and noncugenoi dressings.
As regards cyanoacrylates, other studies
have shown a generally moderate tissue
response to the longer-chain molecules
(Bhaskar et al. 1966a, Bhaskar et al. 1967,
Binnie & Forrest 1974). If sub-epithehal
leakage occurs, there is however a swift
foreign body response (Miller et al. ]974,
Ericksson 1976). Miller et al. (1974) also
noted some bone resorption in response to
cyanoacrylates, and considered that heat of
polymerisation migbt also affect tissues.
In human beings, Bernier & Kaplan
(1947) studied the healing process after
gingivectomy, and stated that surface contact of tbe dressing was of primary imporiance during the first 10 days, and that
constituents were only of secondary importance. Orban & Arcber (1945) considered
the blood clot of prime importance in the
immediate post-operative period, a view
shared by Radden (1962) with regard to
extraction sockets. The latter author also
pointed out the delayed healing associated
with eugenoi contact in rhesus monkey experiments. Stahi et al. (1969) followed up
a study of gingivectomy healing (Stah! et


al. 1968) by considering the effects of
dressings. They concluded there was no
detrimental effect detectable in either dressing used (Coe-Pak, Peripac), on the ground
of biopsy examination. They also gave a
figure of 7-14 days for complete epithelialisation to occur, and it is interesting
that Ramfjord & Costich (1963) gave a
figure of 6 days for epithelialisation after
gingivectomy, but using Wondrpak (Ward
1923, 1929), a eugenol-containing material.
Finally, Levin et al. (1975) biopsied 350
out of 725 patients in whom isobutyl
cyanoacrylate had been used after a variety
of surgical procedures, and found that healing was excellent.
On the basis of these studies, it would
be reasonable to say that whilst eugenol
and other strong antibacterials do have
some irritant effect on healing tissues, it
has yet to be shown that this effect damages the overall healing process. Tissue irritation is not a ground for the definite exclusion of any materials, except the short sidechain cyanoacrylates. However, factors
such as patient comfort will play some
part, and the irritant effects of eugenol are
perhaps countered to some extent by its
obtundent action.
Tissue disturbance
It is important that tissue flaps and grafts
should remain precisely adapted and be
undisturbed by dressing materials. Sutures
are used for tissue retention with most
dressing materials, but it is claimed that
cyanoacrylates make sutures unnecessary.
Binnie & Forrest (1974) observed more inflammation with sutures than cyanoacrylate,
but Ericksson (1976), utilising the buccal
mucosa, preferred sutures to adhesive, because of fistula formation and cyanoacrylate inclusion in wounds. Without
doubt, the introduction of cyanoacrylate
under a flap could impair healing, and in
the case of a free graft prevent revas-

cularisation, but in the largest reported

study (Levin et al. 1975), this did not seem
a problem. However, these authors did note
that overextension of the adhesive into the
vestibule led to mucosal ulceration, and a
tissue adhesive cannot be moulded like a
conventional dressing.
Contact ailergy differs from tissue irritation in several respects, such as the need
for previous exposure to an antigen, a
latency period following this, and the low
antigen dose required to elicit a response
in the subject (Magnusson et al. 1970).
Where tissue is damaged, a very low dose
of antigen may sensitize a person. It is
therefore of great importance to minimise
the antigenicity of periodontal dressings.
Antibiotics are a well-known source of
allergic reactions, but neither Fraleigh
(1957) nor Baer et al. (1960) detected any
true allergies in their respective studies with
tetracycline and bacitracin. It is interesting
that both of these studies used agents
which have been implicated as allergens in
later work: eugenol and colophony (rosin:
abietic acid). Koch et al. (1971) were able
to sensitize guinea pigs to both agents, and
tested 18 patients who had clinical manifestations suggestive of allergy after periodontal surgery. Of these, about two-thirds
were sensitive to eugenol and/or colophony.
Subsequently, Koch et al. (1973) were able
to produce a 10 % incidence of allergy to
eugenol or colophony in a group of patients
from which previously sensitized persons
were excluded. Case reports of other workers have also appeared in the literature:
Romanow (1957) may have been the first
to indict eugenol and colophony: Lysell
(1976) described a reaction to colophony
alone, and Poulsom (1974) gave details of
a severe reaction which occurred on the
application of Coe-Pak 1 week after a
eugenol-containing dressing. The trigger


substance in this case appears to have been
tannin (Poulsom 1977), which was incorporated in both dressings.
In view of the possibility of rare and
very serious allergic reactions, it seems wise
to exclude substances with a well-known
sensitizing potential from periodontal dressings. Indeed, it seems desirable to work
with pure and fully-identified materials, in
view of their application to wound areas.
In this connection, it is of interest that bay
oil has been suggested as a constituent of
eugenoi-free materials (Molnar 1962): yet
according to the Merck Index (Windholz
et al. 1976) this oil contains 40-55 % eugenol.
Asbestos-related disease
Asbestos has been incorporated into numeous dressing materials as a binder and filler
(Mcintosh 1947, Linghorne & O'Connell,
1949, Blanquie 1962, O'Neil 1975), but
increasing knowledge regarding its possible
side-effects has led to warnings that it
should be avoided. Dyer (1967) pointed
out that asbestos had not only been incriminated in chronic destructive lung disease,
but also in carcinoma of the lung and
mesothelioma. Otterson & Arra (1974)
showed that it was possible to mix asbestos
into a dressing and not infringe the stringent U.S. Department of Labor regulations,
but advised against use of asbestos on the
grounds that the patient would have a reservoir of the substance in any periodontal
Liver toxicity
Tannic acid was also used in some dressings (e.g. Box & Ham 1942) but absorption
of this substance may lead to liver damage
(Baer et al. 1969, CDA Council for Dental
Materials and Devices 1977).
Bacterial ecology
In the complex oral microflora, variations

may easily occur where antibacterial dressings are used (Heaney et al. 1972). If an
antibiotic is employed, two possible problems may occur: emergence of resistant
organisms, and opportunistic infection. In
the study quoted, organisms resistant to
certain antibacterials predominated under
the dressings used, but led to no adverse
effect. However, Romauow (1964) found
that clinical signs of candidiasis occurred
when using tetracycline in dressings, and
that bacitracin enhanced the growth of
yeasts, though without clinical signs in this
Gruber et al. (1966) showed in vitro
that Candida would grow on tissue conditioners, but Frisch et al. (1968c) found no
signs of candidiasis in patients using tissue
conditioners as periodontal dressings. Thus,
evidence suggests that antibacterials may
lead to this problem, but not tissue conditioners.
Critical Assessment

It has been asked whether periodontal

dressings are necessary. The answer to this
question surely depends on the type of
surgery employed. For instance, Stahl et al.
(1969) in a post-gingivectomy biopsy study
found no marked differences between
dressed and undressed sites; Greensmith
& Wade (3974), using carefully sutured
flaps in a controlled trial, found that patients healed more easily and more comfortably without dressings; but Prichard
(1977) clearly considered the dressing an
important and not-so-simiple aspect of the
interdental denudation procedure. Furthermore, a dressing will play some part in the
retention of an apically positioned flap,
preventing undesirable coronal movement.
As regards comfort, opinions are in conflict as to whether a dressing is required
(e.g. Greensmith & Wade 1974, Addy &
Dolby 1976), and this problem is not easily



studied because of the subjective phenomena involved.

Comfort is at least partly involved in the
question of whether biological agents
are needed in dressings. Haugen .& Gjermo
(1978) found that Peripac was less comfortable than either Coe-Pak or Wondrpak.
However, O'Neil (1975) found that Peripac
had better antibacterial properties than
Coe-Pak, although the former has no
specific antibacterial agent, and concluded
that the physical properties of Coe-Pak
were responsible for its clinical success.
Oliver & Heaney (1970) on the other hand
found that though a eugenol dressing was
more easily fractured than Coe-Pak, there
was no difference in comfort between the
two. (This finding also highlights the difficulty of assessing materials for which the
detailed formulation is not available: Did
Oliver & Heaney (1970) use the low antibacterial post'Persson & Thiiander (1968b)
formulation of Coe-Pak, or did they use
the older formulation?) It seems that there
is a dearth of evidence showing any definite
advantage to biological agents. Of the three
chlorhexidine studies quoted, two utilised
auxiliary retention for the dressings as noted
above, and one of these (Pliiss et al. 1975)
used Peripac because it permitted a relatively large plaque accumulation. Only the
study of Asboe-Iorgensen et al. (1974) concerned the direct tissue effects, and a high
degree of professional attention yielded a
moderate difference only. An effect was
certainly demonstrated, but would it be
worth-while under the normal conditions
of periodontal practice? And to what extent was it related to the surgical techniques
No doubt the cyanoacrylates will continue to have their enthusiastic adherents,
but they have two problems - difficulty in
application in certain areas (Forrest 1974)
and the impossibility of adjusting the dressing after application, leading for instance

to the ulceration observed by Levin et al.

Many authors have indicated a need for
specific physical properties in periodontal
dressings, including Gottsegen (1954) Ariaudo & Tyreil (1957, 1960), Loe & Siiness
(1961), Berman et al. (1961), Castenfelt
(1962), Gold (1964), Kalkwarf et al. (1974),
Addy & Douglas (1975), Heaney & Appleton (1976). This area is overdue for research, and new questions of chemical and
biological compatibility will probably arise
as a consequence.
In conclusion, it appears that there are
definite surgical indications for the use of
periodontal dressings; that certain materials
should be excluded because of toxic or
other side-effects, that there is no definite
indication for the use of biological agents;
and that there is a need for research on the
chemical and physical aspects of dressing

Parodontale Wundverbdnde. Eine Ubersicht

Es wird eine eingehende Ubersicht tiber parodontale Wundverbande vermittelt, in der physikalisehe, chemiscbe und biologiscbe Ge.sichtspunkte beriicksichtigt werden. Weiterbin werden Gebiete umri^sen die weiterer Eorscbung
bedurfen - vor allem handelt es sich hierbei
um physikalisch-chemische Fragestellungen.
Kontraindizierte Substanzen werden bescbrieben. Es wird gefolgert, dass der Wundverband
seinen Platz in der parodonto-chirurgischen
Bebandlung behauptet. Es ist jedoch eingehenderes Wissen erforderlich bevor Verbande mit
optimal en Eigenschaften entwickelt werden

Pansements parodontaux. Mise-au-point sur les

On trouvera iei une mise-au-point detaillee sur
les pansements parodontaux et ieurs aspects
physiques, chimiques et biologiques. Apergu
de questions pour lesquelles des recherches
ulterieures sont necessaires, particuli^remenl
dans le domaine physico-cbimique; description


de quelques eontre-indications concernant certaines subsiances particulieres. En eonciusion,
les pansements parodontaux ont sans aueun
doute un role a jouer, mais certaines connaissances necessaires manquent encore pour pouvoir realiser des produits ayant des proprietes
Addy, M. & Douglas, W. H. (1975) A chlorhexidine containing metbacrylic ge! as a
periodontal dressing. Journal of Periodontoiogy 46, 465-468.
Addy, M. & Dolby, A. E. (1976) The use of
chlorhexidine mouthwash compared with a
periodontai dressing following the gingivectomy procedure. Journal of Clinical Periodonlology 3, 59-65.
Ariaudo, A. A. & Tyreil, H. .\. (1957) Repositioning and increasing the zone of attacbted
gingiva. Journal of Periodonlology 28, 106-

Ariaudo, A. A. & Tyreil, H. A. (1960) Elimination of pockets extending to or beyond the
mucogingival junction. Dental Clinics of
North America, 4, 67-74.
Asboe-Jdrgerisen, V., Attstroni, R., Lang, N. P.
& Loe, H. (1974) Effect of a chlorbexidine
dressing on the healing after periodontal
surgery. Journal of Periodontoiogy 45, ]3-17.
Baer, P. N. & Wertheimer, F. W. (1961) A
histologic study of the effects of several
periodontal dressings on periosteal-covered
and denuded bone. Journal of Dental Research 40, 858.
Baer, P. N., Goldman, H. & Scigliano, J. (1958)
Studies on a bacitracin periodontal dressing.
Oral Surgery, Oral Medicine and Oral Pathology 11, 712-720.
Baer, P. N., Sumner, C. F. & Scigliano, J.
(1960) Studies on an bydrogenated fat-zinc
bacitracin periodonta] dressing. Oral Surgery,
Oral Medicine and Oral Pathology 13, 494498.
Baer, P. N., Sumner, C. E. & Miller, A. (1969)
Periodontal dressings. Dental Clinics of
North America l3, 181-191.
Berman, C, Beube, E., Odrich, R. & Kutscher,
A. (1961) A new adhesive foil dressing for
periodontal surgery. Journal of Periodontology 32, 14.
Bernier, J, L. & Kaplan, H. (1947) Tbe repair
of gingival tissue after surgical intervention.
Journal of the American Dental Association
35, 697-705.
Bhaskar, S. N., Jacoway, J. R., Margetis, P. M.,

Leonard, F. & Pani, K. C. (1966a) Oral tissue response to chemical adhesives (cyanoacrylates). Oral Surgery, Oral Medicine and
Oral Pathology 22, 394-404.
Bhaskar, S. N., Frisch, J., Margeds, P. M. &
Leonard, F. (1966b) Application of a new
chemical adhesive in periodontai and oral
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Trevor L. P. Watts
Department of Oral Medieine
Turner Dental School
Bridgeford Street
Manchester M15 6FH