PEDAGOGY

ON
PERIODONTAL DRESSINGS

Contents
Introduction
Classification
Uses of periodontal dressing
Indications of periodontal dressing
Clinical trails supporting periodontal dressing
Clinical trails not in favour of periodontal dressing
Composition of various dressings
Repacking
Conclusion
References

Date

Presented by

22-8-15

R.Uday bhaskar
2nd mds

Introduction
A 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 for proper
adaptation to gingival tissues
These periodontal dressings are applied around the necks of tooth and surrounding gingival
tissues to protect the surgical wound after periodontal surgery
ZENTLER in 1918 first reported the use of periodontal dressing in the form of iodoform gauze
1st commercial periodontal dressing is wondr pak developed by A.M.WARD in 1923
Classification
Periodontal dressings are generally grouped into 3categories:
(i) those containing zinc oxide and eugenol,
(ii) those containing zinc oxide without eugenol
(iii)those containing neither zinc oxide nor eugenol.

NAME, TYPE AND COMPOSITION OF EACH COMMERCIALLY AVAILABLE

DRESSING
1 Wards Wondrpak Eugenol dressing Powder zinc oxide, powdered pine resin, talc & asbestos
Liquid isopropyl alcohol 10%, clove oil, pine resin, pine oil, peanut oil,
camphor & coloring materials
2 Kirkland formula Eugenol dressing Zinc oxide, resin, zinc acetate, eugenol, tannic acid and
olive oil.
3 Coe-Pak Noneugenol dressing Two pastes
First paste zinc oxide, added oils, gums & lorothidol
Second paste unsaturated fatty acids & chlorothymol
4 Cross Pack Noneugenol dressing Colophony powder, zinc oxide, tannic acid bentonite &
powdered neomycin sulphate

5 Peripac Noneugenol dressing Calcium sulphate, zinc oxide, zinc sulphate, acrylic type of resin
& glycol solvent
6 Septopack Noneugenol dressing Amyl acetate, dibutyl phthalate, butyl polymetacrylate, zinc
oxide, zinc sulphate
7 PerioCare Noneugenol dressing Two pastes
First paste paste of metal oxides in vegetable oil
Second paste gel of rosin suspended in fatty acids
8 Perio Putty Noneugenol dressing Methylparabens, propylparabens, benzocaine
9 PeriogenixTM Noneugenol dressing Perfluorodecalin, purified water, glycerin, hydrogenated
phosphatidylcholine,cetearyl alcohol, polysorbate 60, tocopheryl acetate, benzyl alcohol,
methylparaben, propylparaben, & oxygen
10 Cyanoacrylate dressings Other n-Butyl cyanoacrylate
11 Light cure dressings Other Silicon dioxide crystalline quartz, hydrophobic amorphous
fumed silica,urethane dimethacrylate resin
12 Collagen dressing Other Type I collagen derived from bovine tendon mixed with cancellous
granules
13 Stomato adhesive dressing Other Gelatin, pectin, sodium carboxymethylcellulose and polysio
polysiobutylene

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

Ideal requirements of dressings

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

CLINICAL TRIALS SUPPORTING THE USE OF PERIODONTAL DRESSINGS

Ariaudo and Tyrell - Protection of wound from mechanical trauma, stability of the surgical site
during healing process
Prichard -Patient comfort during healing, good adaptation to underlying gingival and bony tissue,
prevention of postoperative hemorrhage or infection, decreasing tooth hypersensitivity,
protecting the clot from forces applied during speaking or chewing, preventing gingival
detachment from the root surface
Wikesjo et al -Prevention of flap displacement in apically repositioned flaps, additional support
in free gingival grafting procedures
Sigusch et al - Periodontal wound dressing has a positive effect on clinical long-term results

CLINICAL TRIALS NOT IN FAVOR OF USE OF PERIODONTAL DRESSINGS

Loe and Silness

- Dressing has little effect

Stahl et al

-Dressing accumulates plaque

Harpenau

- No difference in clinical parameters

Greensmith

- No differences in healing

Kidd and Wade

- Greater pain experience,Plaque accumulation,Subsequent microbial

invasion Nonpack areas showed better wound healing,Lesser pain

Jones and Cassingham

- Irritates healthy tissue increases chances of infection

Allen and Caffesse

-No difference in PD, CAL and gingival inflammation

Checchi and Trombelli

- No statistical differences in pain scores and number of analgesics

consumed between the pack and nonpack groups.

Bose et al

- Pronounced swelling increases plaque accumulation

Increases inflammation and GCF,Difficult in eating

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

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
REMOVAL OF THE PACK
1. By inserting a surgical hoe along the margin and exerting gentle lateral pressure
2. Pieces of pack retained interproximally and particles adhering to the tooth surfaces
are removed with scalers
3. The entire area is rinsed with peroxide to remove superficial debris
4. After removal of pack the gum will most likely bleed

REPACKING
1. Low pain threshold
2. Extensive periodontal involvement
3. Slow healing
CONCLUSION
Whether or not to give the pack is entirely the opinion of the clinician. Good adapted flap itself
acts as a barrier
REFERENCES
1. Clinical periodontology and implant dentistry. Jan Lindhe.
2. Carranza's clinical periodontology-10th edition
3. Sachs H.A. Fanroush A. Current status of periodontal dressings, J Periodontal 55:689,
1984.
4. Levin MP. Bhaskar SN: Cyanoacrylate as a periodontal dressing. J. Oral. Med 30:40,
1975.
5. J Periodontal 1974,45.619
6. J Periodontal 1989,60.(8) 429
QUESTIONS
1. Indications for repacking
a) Low pain threshold,
b) Extensive periodontal involvement,Slow healing
2 contraindications of periodontal dressing
a) patient known allergic to any of ingredients
guided bone regeneration
3) How much time dressing should be placed
a)3-14 days