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After performing the laboratory/clinical exercises in this chapter, the student will be able to do the following:
1. Correctly dispense and mix a periodontal dressing.
2. Properly apply the dressing.
3. Differentiate between four types of periodontal dressings.
Periodontal dressings are physical barrier that is placed on surgical sites to protect the healing tissues from the forces produced during mastication, thereby providing patient comfort. These dressings also provide some splinting of mobile teeth during healing. After periodontal surgery, they help shape newly forming tissues by maintaining close adaptation of mucosal flaps and gingival grafts to the underlying tissues. Periodontal dressings help prevent postsurgical bleeding by keeping the initial blood clot in place. At present, no periodontal dressings are manufactured that contain therapeutic agents to aid in healing.
The dental hygienist may be given the responsibility of placing a periodontal dressing when assisting the dentist during surgery, when performing postoperative care, or when a patient returns to the practice with a postsurgical emergency. Necessary items for placing a periodontal dressing are listed in Table 33.1.
TABLE 33.1. Armamentarium for Placement of a Periodontal Dressing
II. Dressing Types
A. Zinc Oxide–Eugenol (ZOE) Dressing
Early periodontal dressings were made by mixing zinc oxide with eugenol. These are described in Chapter 7, Dental Cements. Because some patients experience adverse reactions to the eugenol, these dressings are seldom used today.
B. Noneugenol–Zinc Oxide Packs
Coe-Pak (G.C. America, Inc.) is one of the most commonly placed periodontal dressings. Its clinical preparation and application are discussed in this chapter. Compared to the ZOE dressings, this is a more pliable and smoother dressing. However, it must be prepared at the time it is used. Postoperative instructions for patients with a noneugenol–zinc oxide dressing are listed in Table 33.2.
TABLE 33.2. Postoperative Instructions for Patients with a Noneugenol–Zinc Oxide Dressing
C. Visible Light–Activated Surgical Packs
A urethane dimethacrylate resin-based material (e.g., Barricaid, Dentsply International, Inc.) is available in a syringe carrier for direct placement. There is no mixing of pastes or powder required. The material is activated by a visible light, giving the operator control over manipulation and setting time. On activation, a nonbrittle, protective, tasteless, translucent, elastic covering is formed. This dressing is especially useful in the anterior region, where esthetics are a concern.
D. Cyanoacrylate Dressing
N-Butyl cyanoacrylate is a liquid that polymerizes shortly after contact with the moisture of the oral tissues. An example of this dressing is PeriAcryl (GluStitch, Inc.), which is available in single-dose applicators (Fig. 33.1) or multiuse kits with a dispensing tray and applicator pipettes. This clear dressing adheres to the tissues and is hemostatic, bacteriostatic, and biodegradable. It does not need to be removed at a postsurgical follow-up. It is useful for securing the gingival margin after placement of intrasulcular local delivery antimicrobials and as a dressing for postbiopsy sites. Although it has many applications in periodontal surgery, it is not widely used at present.
FIGURE 33.1. Single-dose applicator of PeriAcryl (GluStitch, Inc.), a cyanoacrylate dressing.
III. Preparation and Placement of the Noneugenol–Zinc Oxide Pack
1. Coe-Pak is supplied as two pastes, which are mixed immediately before placement.
2. The larger tube, containing the base paste, is composed primarily of petrolatum, rosin, and fatty acids.
3. The smaller tube, containing the accelerator, is a mixture of zinc and magnesium oxides and vegetable oils.
4. Equal lengths of base and accelerator are expressed onto the mixing pad, as shown in Figure 33.2A. The diameters of the expressed pastes (but not the lengths) will differ, corresponding to the size of the tube orifice. Usually, strips equal in length to the span of the surgical site are adequate to provide coverage.
5. Coe-Pak is also packaged as an automix material similar to impression materials. Simply express the mixed material onto a pad and allow mixed material to develop the proper consistency for use as described below.