PERIODONTAL PACK

SANGHAMITRA GHOSH ET AL
SOUTH ASIAN JOURNAL OF ORAL AND DENTAL SCIENCES
JANUARY 2020
CONTENTS:
• Introduction
• Classification of periodontal pack
• Ideal characteristics
• Rationale
• Controversy on periodontal dressing
• Conclusion
• References
INTRODUCTION:
• Periodontal surgeries cause tissue injury, triggering hemorrhage & leading to blood clot

• Blood clot- important factor in wound healing

• For protection of wounds various dressings have been suggested in the past

• 1st intraoral wound dressing- Iodoform gauze by Zentler in 1918

• Wonder pack by AW Ward in 1923- Zinc oxide eugenol based

• Dressing allows- uninterrupted healing, protection of area, prevention from infection

CLASSIFICATION OF PERIODONTAL PACK:
• 3 types- 1. Eugenol based 2. Non-eugenol based 3. Others

Eugenol based
Name Composition

Ward’s Wondrpack • Powder - Zinc oxide, powdered pine resin, talc & asbestos
• Liquid - Isopropyl alcohol 10%, clove oil, pine resin, pine oil,
peanut oil, camphor & colouring materials

Kirkland formula Zinc oxide, resin, zinc acetate, eugenol, tannic acid and olive oil.

Irritation to mucosa,
Reduced allergic reactions,
pain & sensitivity, retardedtissue necrosis-
bacterial Delayed
growth wound
(Waerhug healing
& Loe-
High conc of eugenol- Cytotoxic
1957) (Alpar B et al- 1999)
 Non-eugenol based
Name Composition
Coe-pack Two pastes
• Catalyst paste – zinc oxide, added oils, gums, magnesium oxide & lorothidol
• Base paste – unsaturated fatty acids, rosin, zinc acetate & chlorothymol

Cross pack Colophony powder, zinc oxide, tannic acid, bentonite & powdered neomycin sulphate

Peripac Calcium sulphate, zinc oxide, zinc sulphate, acrylic type of resin & glycol solvent
Septopack Amyl acetate, dibutyl phthalate, butyl polymetacrylate, zinc oxide, zinc sulphate
PerioCare Two pastes
• Catalyst paste – paste of metal oxides in vegetable oil
• Base paste – gel of rosin suspended in fatty acids

Perioputty Methylparabens, propylparabens, benzocaine

Periogenix Perfluorodecalin, purified water, glycerin, hydrogenated phosphatidylcholine, cetearyl alcohol,
polysorbate 60, benzyl alcohol, methylparaben, propylparaben

Name
Cyanoacrylate dressings
Light cure dressings (Barricaid)
Collagen dressing
Stomato adhesive dressing
Other Dressings
Composition
n-Butyl cyanoacrylate
Silicon dioxide crystalline – quartz, hydrophobic amorphous fumed
silica, urethane dimethacrylate resin
Type I collagen derived from bovine tendon mixed with cancellous
granules
Collatape, collcote, collaplug
Gelatin, pectin, sodium carboxymethylcellulose and
polysiobutylene
 Modifications
Dressing + CHX Addy & Douglas (1975) CHX + methacrylate gel

Plus et al (1975) CHX + Peripac- Significant reduction in plaque

Zyskind et al CHX varnish application before dressing

CHX mouthrinses postsurgically

Dressing + Antibacterial agents Fraleigh Tetracycline in dressing

Baer et al Zinc Bacitracin in dressing

• Sensitization & allergy

• Emergence of resistant
organisms
• Opportunistic infections
IDEAL CHARACTERISTICS:

• Should be soft enough to facilitate the placement of material in operative site & to prevent
distortion and displacement of the material

• Should have adequate setting time

• Should have antimicrobial properties- To prevent excessive plaque formation

- To prevent secondary infections

• Should aid in hemostasis and facilitate healing

 Bandage
over site

Supporting Holding flap

mobile teeth in place
RATIONALE
Of
PERIODONTAL
PACK
Reduce
Protection
pain,
from trauma
infection
Haemostasis
Fast wound
healing
CONTROVERSY ON PERIODONTAL DRESSING: To pack or not to pack?
Matter of individual preference
&
Judgement of operator
CONCLUSION:
• 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

• Although, Post-surgical healing is probably not affected by the periodontal dressing but it shows
numerous beneficial effects like reduction in post-operative pain, swelling, aids in hemostasis,
prevent secondary infections, also protect suture thread from irritation

• Further, no periodontal dressing material has been shown to exhibit all of the ideal properties –
both physical and biologic

• Authors believe that further research will introduce newer material and improvement in
biomaterial properties that may lead it to universally acceptable
REFERENCES:
• Ghosh S, Chaturvedi SS, Bagde H. History of Periodontal Dressing.
• Kathariya R, Jain H, Jadhav T. To pack or not to pack: the current status of periodontal
dressings. Journal of applied biomaterials & functional materials. 2015 Jul;13(2):73-86.
• Carranza’s clinical periodontology (10th edition)
• Loe H, Silness J. Tissue reactions to a new gingivectomy pack.Oral Surg Oral Med Oral
Pathol. 1961; 14(11): 1305-1314.
• Stahl SS, Witkin GJ, Heller A, Brown R Jr. Gingival healing: Part 3: the effects of
periodontal dressings on gingivectomy repair. J Periodontol. 1969; 40(1): 34-37.
• Harpenau LA. Periodontal dressings. In: Prichard JF, ed. Advanced periodontal disease.
2nd ed. Philadelphia, PA: W.B. Saunders; 1972:280.
• Greensmith AL, Wade AB. Dressing after reverse bevel flap procedures. J Clin
Periodontol. 1974; 1(2): 97-106.
THANK YOU