Periodontal Dressings

Periodontal Dressings

In most cases after the surgical periodontal procedures are completed the area is covered with a surgical pack which is known as periodontal pack or periodontal dressing.

The dressing has no curative properties, they assist the healing by protecting the tissue rather than providing healing factors.

Advantages of Periodontal Dressings

Periodontal Dressings minimizes likelihood of postoperative infection and bleeding.
Periodontal Dressings facilitates healing by preventing surface trauma during mastication.
Periodontal Dressings protect against pain induced by contact of wound with food or with tongue during mastication.

Periodontal Dressings Types of Packs

Zinc oxide eugenol packs
Non-eugenol packs

Read And Learn More: Periodontics Question And Answers

Periodontal Dressings Zinc Oxide Eugenol Packs

Example is Wonder-pack.
Supplied in liquid and water form which is mixed before use.
These packs are based on reaction of zinc oxide and eugenol
Apart from zinc oxide, they also consists of zinc acetate which act as accelerator; asbestos which act as binder and filler and Tannic acid.
Addition of zinc acetate provides the dressing a better working time.
In some of the patients eugenol produces allergic reaction which leads to erythematous area combine by burning sensation.

Periodontal Dressings Non-eugenol Packs

Example is Coe-pack
It is based on the reaction between metallic oxide and fatty acid.
It is supplied in two tubes, contents of which get mixed immediately before use till uniform color is obtained.
One tube contains zinc oxide, oil for plasticity, a gum for cohesiveness and lorothidol as fungicide.
Other tube contains liquid coconut fatty acid thickened \with resin and chlorothymol—a bacteriostatic agent.
Other non-eugenol packets consists of boric acid, a light curing dressing, cyanoacrylates and tissue conditioner.
Fracture strength is good compared to eugenol packs.

Preparation and Application of Periodontal Pack

Zinc oxide packs are mixed with eugenol or non-eugenol liquids on a wax paper pad with a wooden tongue depressor. The powder is gradually incorporated with the liquid till 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 of uniform color.
The pack is then placed in a cup of water at room temperature for 2–3 minutes so that the paste loses its tackiness and can be molded. It remains workable for 15–20 minutes.
The pack is then rolled into two strips of approximately the length of the treated area. The end of one strip is bend into a hook shape and fitted around the distal surface of the last tooth, approaching it from the distal surface.
The remainder of the strip is brought forward along the facial surface to the midline and gently pressed into place along the gingival margin and inter-proximally.
The second strip is applied from the lingual surface. It is joined to the pack at the distal surface of the last tooth, and then brought forward along the gingival margin to the midline.
The strips are joined inter-proximally by applying gentle pressure on the facial and lingual surfaces of the pack. For isolated teeth separated by edentulous spaces, the pack should be made continuous from tooth-to-tooth covering the edentulous areas.
When split flaps have been performed, the area should be covered with the tin foil to protect the sutures before placing the pack.
Pack should cover gingiva but overextension in an uninvolved mucosa is avoided. Excess pack irritates the mucobuccal fold as well as floor of the mouth and interferes with the tongue.
Overextension jeopardizes remainder of pack because the excess tends to break-off, taking pack from the operated area with it. Pack which interferes with occlusion is trimmed before relieving the patient.
Clinician should ask the patient to move the tongue out forcibly to each side and cheek and lips should displace in all the directions to mold the pack while it is still soft. As pack is set, it is trimmed to eliminate all the excess material.
As per the general rule, pack is kept for 1 week after surgery. But this is not the rigid requirement. The time can be extended or area is repacked for additional one week.

Instructions for the Patient when Periodontal Pack is Placed After Surgery

Pack should remain in place till it is removed in office in next appointment.
Hot foods are avoided for first three hours after operation to permit pack to harden.
Avoid smoking and brushing over the pack.
During first day ice is applied on the face over the operated area which decreases the inflammation and swelling.
Carry on the daily activities but without exertion.

Removal of Pack and Return Visit

As patient returns after the one week, periodontal pack should be taken off by inserting a surgical hoe along the margin and exerting gentle lateral pressure.
Scalers should be used to remove the pieces of pack retained interproximally and particles adhering to the tooth surfaces. Complete area should be rinsed with peroxide to remove the debris.