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REVIEW ARTICLE

PERIODONTAL DRESSING
Muthukumarasamy1,Nazargi Mahabob2

CORRESPONDING ADDRESS
Dr.Muthukumaraswamy, M.D.S.,
Asst.Professor, Dept of Periodontia
TNGDC,Chennai-3
Ph.no:9840994822

ABSTRACT
The 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 close adaptation.

HISTORY OF PERIODONTAL PACKS ? of a dressing – patient comfort, protect


? 1923 – Dr A W Ward- Wonder pak,consist of - wound from further injury during healing –
Zno Eugenol mixed with - Alcohol , pine oil, hold flap in position. They pointed that the
Asbestos fibers dressing should not be used to control post-
? 1942 – Box and Ham –use of Zno Eugenol operative bleeding, nor to splint teeth .
dressing to perform chemical curettage in
treatment of NUG – tannic acid was included USES OF PERIODONTAL DRESSING
for haemostasis and astringency- thymol ? Provide mechanical protection for the
was used as an astringent . surgical wound and therefore facilitate
? 1943 – Orban - Zno Eugenol + healing .
Paraformaldehyde to perform Gingivectomy ? Enchancement of patient comfort .
by chemosurgery. This dressing caused ? Prevents post operative bleeding by
extensive necrosis of the gingival and bone maintaining the initial clot in place.
and was left to promote abscess formation ? Maintainance of debris free area.
by blockage of exudate. ? Control of bleeding
? 1947 – Bernier and Kaplan – for wound ? Supports mobile teeth during healing
protections. ? Helps in shaping or molding the newly
? 1962 - Blanquie – control post operative formed tissue
bleeding- splint loose teeth – prevent re- ? Provide patient comfort by isolating area
establishment of pocket – desensitize from external irritations or injuries.
cementum
? 1964 – Gold – splint teeth, as it was cement Physical Properties of Dressing
dressing that set hard. ? The dressing should be soft but have enough
? 1964 - Weinreb and Shapiro - Zno Eugenol plasticity and flexibility to facilitate its
impregnated cords into periodontal pockets placement in operated area and to allow
,but found to be less effective than proper adaptation.
gingevectomy. ? The dressing should Set within a reasonable
? 1969 - Baer et al stated that primary purpose time

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PERIODONTAL DRESSING

?
After setting it should have sufficient rigidity Liquid
?
The dressing should have Smooth surface Eugenol, vegetable oil, added to dissolve
?
The dressing should have bacteriocidal Eugenol thymol, a weak antiseptic. colour
property additives the setting involves both chemical and
?
The dressing should not interfere with physical properties and is influenced by moisture,
healing proportions of powder and liquid used ,mixing time
?
The dressing should have Dimensional and temperature . Eugenol can induce an allergic
stability reaction that produces reddening of the area and
?
The dressing should not induce reaction burning pain in some patients .
?
The dressing should have acceptable taste.
Disadvantages:
? Unpleasantness
Zinc oxide eugenol dressing contain 40 -50 % ? Spicy taste
eugenol, increases in amounts as zinc eugenate ? Burning sensation
decomposes. It has been shown to cause tissue ? Lack of smoothness
necrosis and delayed healing. ? Difficulty with adaptation
? Frequency of fracture
Radden 1992 found that free eugenol ? Crazing of acrylic materials
caused a marked inflammatory reaction , delayed
healing and tissue necrosis. Non-Eugenol Dressings (Soft Pack)
Developed in 1950s
Asbestos was found to have the potential 1. Basic Ingredients
for causing asbestos lung cancer and tannic acid a. base
cause liver damage when absorbed systemically b. Accelerator
2. Brand names
Baer et al 1960 described the use of a non - Coe-Pak Dr Gene Moinar of coe –
eugenol dressings containing zinc oxide, laboratories one paste-
bacitracin and hydrogenated fat. The material did
not set to hard consistency as do eugenol
dressings, and bacitracin was believed to aid in
healing.

TYPES OF DRESSINGS
A. Zinc oxide Eugenol Dressing (hard pack)
Popular following gingivectomies .
Eugenol has an obtudent effect on exposed
dentine and connective tissue . Eugenol has an
antiseptic property which can affect bacterial
growth. ?
Oxides of various metals – zinc oxide Oil-
plasticity
Brand Names: Wonder-Pak , by Ward 1923 ?
Gum – cohesiveness
Powder ?
Lorothidol –fungicide
ZnO- Resin- improve setting
Tannic acid- improve setting Other paste –
Cellulose fibers- improve setting ? Liquid coconut fatty acids
Zinc acetate – accelerator, better working time. ? Resin or rosin
Asbestos – binder and filler ? Chlorothymol - bacteriostatic

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PERIODONTAL DRESSING

The re action between a metallic oxide and Haugen measured dimensional changes of freshly
fatty acids is the basis of Coe-Pak Automix prepared samples of Coe-Pak, Peripac, wonder-
Noneugenol Surgical Dressing and Periodontal pak expansion seen in Peripac, others contracted.
Pack Comes in Two-Pack: Two Double Barrel Haugen et al tested the adhesive properties of
Cartridges Coe-Pak, Peripac, wonder-pak- better adhesion in
Coe-Pak than wonder-pak and Peripac did not
have any adhesive strength at all. Hence
mechanical inter locking was necessary to hold
the dressings in place.

Watts & Combe compared Coe-Pak,


Peripac , and wonder-pak for their effects on
composite filling material & GIC ,result in softening
of composite, but had little effect on glass ionomer
cement .

PERIOCARE
Perioputty Two paste, highly elastic periodontal
Methyl and Propyl parafens –bactericidal dressing which sets resiliently hard does not chip
and fungicidal property Benzocaine – topical or fall apart in the mouth.
anesthetic
?
After mixing, PerioCare is ready to be picked
Peripac up with wet fingers in about 75-90 seconds.
Eberic and Muhlemann in 1959, ready mix ?
It has a 7 minute working time and sets in 15
minutes.
?
It is patient pleasing, and has a neutral odor
and taste.
?
Contains no eugenol or asbestos

Cyanoacrylate
N-BUTYL Cyanoacrylate (1965)
? DROPS/ SPRAYS
? SOLIDIFIES IN 5-10 SEC
? ADHESION FOR 2-7 DAYS

IDEAL TO BE USED AS PERIODONTAL


?
Calcium sulphate DRESSING
?
Zinc oxide ? Decreases time required for suturing
?
Acylate ? Provides rapid haemostasis due to
?
Zinc sulfate polymerization in the presence of moisture
?
Poly methyl methacrylate ? Accerlerate early periodontal healing
?
Di methoxy tetra ethylene glycol ? Aids in presice positioning of the flap/ free
?
Ascorbic acid an organic solvent as a gingival graft
flavoring agent
?
Red dye – coloring agent OCHSTEIN, 1969, COMPARED THE
EFFECTS OF Cyanoacrylate, an eugenol & non
Setting takes place when it comes in eugenol dressing on surgical wound healing.
contact with water or the saliva. Gjerdet &

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PERIODONTAL DRESSING

A P I C A L LY P O S I T I O N E D , F U L L ?
Excellent compatability with the wound site
THICKNESS AND SPLIT THICKNESS FLAPS ?
Stiffness by zinc oxide powder
WERE PERFORMED on 16 patients with one of
the 3 dressings applied post surgically. Clinical CARRIER FOR MEDICATION
and histological evaluations were made for 21 I R W I N W AT T E R S C O P S - O R A L
days. It was found that Cyanoacrylates produced ADHESIVE BANDAGE- well tolerated and non
better healing presumably because they prevent irritating. Safe to be used in oral cavity which gives
the accumulation of plaque and debris by sealing protection to the wounds.
the wound site .
BAUER & BLACK ,1954 –TEFLA facilitate healing
Forrest, 1974 , compared clinically in traumatic wounds .
Cyanoacrylate dressing to Suturing without
dressing , using Split mouth approach in 30 SCHLUTZ- viscous filament impregnated with
surgical cases . No significant difference was water in oil emulsion , effective in preventing
found between the two with regard to healing mechanical trauma . oil of bergamot used instead
responses. Cyanoacrylate dressing produced of eugenol causes less inflammation with greatest
Rapid hemostasis, Absence of discomfort and bactericidal activity
better patient acceptance.
Light-cure Periodontal Dressings
Dis advantages – difficulty in application Brand names
around posterior teeth and rapid polymerization Barricaid
upon contact with small amount of moisture. Characteristics
a) Non brittle & very elastic
?
Binnie & Forrest,1974 clinical & histological b) No mixing
healing in 2 beagle dogs using ? Single-component, light-activated
Cyanoacrylate dressings verses suturing periodontal dressing eliminates time-
following periodontal surgery.. after 2 weeks consuming mixing of pastes.
healing was superior in Cyanoacrylate ? Curing with a visible light-curing unit to form
dressing
a non-brittle, but firm, protective elastic
?
Levin et al 1975 Cyanoacrylate dressing -
covering.
close to ideal dressing material
? Incremental additions of the material, which
bond adherently, can be made in the mouth
It cannot dissipate the pull of the lip or
immobilize a flap for the time required for it to without any special prior surface preparation.
attach to the underlying tissue . ? The dressing is tinted pink, is tasteless, and
has a translucent character which allows for
Zinc Oxide & Glycol Alcohol (Peridres) superior esthetics
Powder- Zinc oxide & rosin ? Designed for both Direct and Indirect
tannic acid Placement. If the syringe is used in direct
Kaolin intra-oral placement, the syringe must be
Liquid- ethelene glycol discarded to avoid any potential patient
Butyl alcohol cross-infection.
? For Direct Dispensing - Using a sterile, dry
TISSUE CONDITIONERS 2 x 2 gauze, dry the buccal or lingual tooth
? Methacrylic gels with modifications to surfaces adjacent to the surgical site.
increase adhesion & rigidity, addition of ? Remove the tip from the disposable syringe.
antibacterial substances Dispense the material at the juncture of the
? Close adaptation & constant flow for 3 days cervical one-third of the teeth

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PERIODONTAL DRESSING

For Indirect Placement and cell death on direct contact. Inhibition is


? Place a thin layer of lubricant on a clean caused by the release into the medium of
mixing pad.. If the application will be delayed substances toxic to cells. It is suggested that
more than 1 or 2 minutes, cover the partly-cured material containing residual free
dispensed dressing to prevent premature monomer in contact with a healing gingival site
curing by light. With gloved finger, lightly could impede rapid repair.Increasing the exposure
lubricated , roll the ribbon of dressing off the to the curing light will prevent (or minimize) the
pad. presence of partly-cured material; the fully-cured
material being compatible with the cells.
? The material may be muscle molded.
contoured with a plastic instrument, carver, or
SMEEKENS JP et al. examined
finger pressure. Remove any uncured
histologically the tissue responses of surgical
material that may have extended onto
areas covered during 7 days with either Barricaid,
occlusal contact areas. the eugenol-containing dressing Ward's
? Expose Barricaid to a visible light-curing unit Wondrpak or the bionert control gel Carboxyl
for at least 10 seconds per tooth per side Methyl Cellulose.
(buccal or lingual). Uncured material can be
detected with an explorer or a blunt Results after 7 days indicate acute
instrument. Repeat exposure, as needed, inflammatory reactions in the test areas without
until the entire dressing is cured. (A segment significant differences between the 2 periodontal
of approximately four teeth requires 40 dressing materials.
seconds per side, buccal or lingual).
? Check occlusion and coverage of material. From a biological point of view, these
The material may be curved and contoured findings suggested no contra-indication for
with finishing burs in a low-speed handpiece. application of this photocuring dressing material
? Additional material may be added to cure after periodontal surgery.
dressing at any time during the placement
appointment and incrementally cured for an Application of Hard and Soft Periodontal
additional 40 seconds. Dressing
? Check the dressing coverage and the A. Hard Pack
occlusion prior to dismissing the patient. ? Mix maximum amount of powder into the
liquid to achieve a putty mix
Thorstensen Ae etal demonstrated the ? Consistency is firm and thick
effect of adding two bisguanide antimicrobial
agents (chlorhexidine and polyhexamethylene B. Soft Pack
bisguanide )on physical properties of the light- ? Extrude equal lengths & quickly mix together
cured periodontal dressing material. The addition with tongue blade until blended
of both chlorhexidine and PHMB solutions reduced ? Use vaseline on gloves to form pack
the elastic modulus. Tear stress was also reduced ? If there are open embrasures with missing
by the addition of water and the chlorhexidine and papillae or recession, use small sections of
PHMB solutions. the dressing to mold into wedge shapes to
press interproximally.
Gilbert AD et al J Periodontol. 1994 ? Apply 1 U-Strip starting from distal and
demonstrated the effect of a light-cured placing on the facial & lingual
periodontal dressing material on HeLa cells and ? Press interproximally and with a plastic
fibroblasts in vitro. Fully-cured material has no instrument adapt around the gingival surface
effect on either cell type. Uncured material and interproximal areas to gain retention and
produces a surrounding zone of growth inhibition

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PERIODONTAL DRESSING

create festooning ?
Placement of dental floss
?
For protection & promotion of healing, the ?
Wire ligation
dressing should not exceed 1-2 mm beyond
the surgical site Anti Bacterial Properties of Packs
?
Any edentulous areas can be filled in to make ? Bacitracin
dressing continuous ? Oxytetracycline
? Neomycin
Muscle trim cheeks, lips and tongue to ? Nitrofuranzone
prevent movement or dislodgement dressing
should not interfere with muscle, cheek and frenum Waehaug & Loe – EUGENOL PACKS prevent or
attachments;overextension causes irritation retard bacterial growth.

Check Occlusion Persson & Thilander- tested antibacterial


? Dressing should extend only to the height of property of 5 periodontal dressings, against
contour of the teeth staphylococcus aureus & candida albicans. coe-
pac had the greatest antibacterial property &
? It should not be in occlusal contact during
tissue irritation ,peripac had the least .the zinc
closure
oxide dressings showed a diminishing effect over
time which was felt to br due to its setting into non
reactive eugenate. Coepac and peri-pac produced
more inflammation in the tissues than the zinc
oxide eugenol products.

Fraleigh evaluated the effect of


Oxytetracycline containing packs, on gingival
wounds of 50 patients revealed more rapid
healing ,comfortable, less odour &
unpleasentness .12 patients developed
allergic reactions.
Preparation & application of periodontal
dressings Baer ,1958 effect of Bacitracin , on 200
patients experienced less odour& unpleasent
Repacking taste and dressing was cleaner than
After the pack is removed, it is usually not dressings without Bacitracin.
necessary to repeat it. However in some condition
it is advisable to repack for additional 1 week. The 3000units /gm of Bacitracin, was
conditions are- recommended , but hydrogenated fat was
? A low pain threshold value patients who are used instead of eugenolin the dressing with the
particularly uncomfortable when the pack is following formula
removed.
? Unusual extensive periodontal involvement Zinc oxide 42%
? Slow healing. Hydrogenated fat 58%
Ramanov 1964 – antibotics in periodontal
RETENTION OF PACKS dressings encouraged the growth of candida
? MECHANICALLY INTERLOCKING in albicans and yeast.
interdental spaces
? Splints O Neill 1975- antibacterial effect of 5
? Stents periodontal dressing, on 430 patients as well as in

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PERIODONTAL DRESSING

vitro against 9 strains of bacteria . ?


Human gingival fibroblasts in tissue culture
? Peripac-greatest antibacterial effect exposed to CHX at concentration as low as
? Coe –pac –none 0.04% result in altered cell function or death.
?
Toxic to PMNS
Breloff & caffesse 1983- Achromycin
applied underneath the dressing in a single blind SYSTEMIC IMPLICATIONS
study involving 12 patients .- no beneficial effect on ? When placed on the hamster cheek pouch,
healing . CHLX glyconate brought about an increase
of flow of velocity in the sub epithelial
Saad & Swenson- corticosteroid in venules.
dressing and its effect in 22 cases. The difference ? When labelled and applied to intact cheek
in result between corticosteroid treated and
pouch, it was found to accumulate in the liver
experimental dressing were statistically
and kidneys.
insignificant.
? Therefore drug can penetrate intact mucosa
and become deposited elsewhere in the
CHLORHEXIDINE AS AN ADDITIVE TO
DRESSING body.
Absoe Jorgerson et al 1974 found that a
dressing containing CHX promoted healing Plyss Allergy to a Periodontal Dressing
et al 1975 evaluated the efficacy of CHX when Fraleigh – noted allergic reactions due to
used with a dressing, PERIODONTALLY terramycin in a dressing
HEALTHY SUBJECTS AND instructed to rinse Pulsion – reported an anaphylactic reaction after
with 0.2% CHLX for 5 days . no significant application of eugenol containing dressing
reduction in plaque formation was observed Lysell –– reported a case of contact allergy to
compared to control. In another experiment , rosin , urticaria on the abdomen, swelling on
dressings rolled in 15 -20 mg of.CHLX dichloride, dorsum of the hand, involvement of
significant reduction in plaque formation.because interphalangeal joints
CHLX did not have access to the teeth due to the Haugen & Hensten Petterson- demonstrated
dressing whereas powder was in direct contact that coe –pac, peri-pac & wonder-pak were all
with the teeth and thus able to inhibit plaque . capable of producing sensitization in guinea
pigs .wonder-pak-exhibited the strongest
Addy and douglas 1975, found that effect ,Peri-pac- exhibited weakest effect.
methacrylate gel is a good medium for carrying
CHX to the wound area and releasing it slowly ( CARE AFTER PERIODONTAL PACK
conc of 2%) in vitro and in vivo Split mouth ? A periodontal pack placed over your gums to
approach following gingivectomy, patients protect them from irritation. The pack
experienced less pain with dressing (coe-pac) . prevents pain, aids healing, and enables you
to carry on most of your usual activities in
Newman and Addy 1978, flap surgery comfort.
.patients preferred for CHLX rinse than dressing , ? The pack will harden in a few hours, after
less plaque accumulation and less sulcular which it can withstand most of the forces of
bleeding with CHLX rinse. chewing without breaking off; it may take a
little while to become accustomed to it.
DISADVANTAGES OF USING ? The pack should remain in place as long as
CHLORHEXIDINE possible. For the first 3 hours
? Toxicity to Cells:- ? After the operation avoid hot foods in order to
? Delayed healing of sutured skin incisions was permit the pack to harden
reported after a brief exposure to the drug. ? Do not brush over the pack. Brush and floss

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PERIODONTAL DRESSING

normally the areas of the mouth not covered No statistically significant difference
by the pack. Use chlorhexidine mouth rinses was found between Wondrpak and Nobetec
after brushing regarding mean pain score
?
After the pack is removed the gums most
likely will bleed more than they did before the Effects on Cell Cultures
operation. This is perfectly normal in the early Kreth et al 1966, tested 4 periodontal
stage of healing dressings on Hela cell cultures, and found
eugenol dressings slightly inhibitory to cell growth.
Effects of Wound Healing
Comparison of Eugenol and Non-Eugenol Hildebrand and De Renzis 1974 tested 2
Dressings:- eugenol and 2 non-eugenol dressings on
Studies have shown that eugenol fibroblasts , greatest cell toxicity was with wonder
dressings are more irritating than non-eugenol –pak
dressings.
Hanger & Hensten Petterson 1978
?
Recently, Early irritating effects of dressings compared cytotoxic effects of coe-pak, peri-pac &
may contribute to postoperative pain and wonder-pak , all exhibited high degree of
swelling whether or not it contains eugenol. cytotoxicity .
?
Peripac was shown to be more irritating than
wonder-pak due to dimensional changes, Present Status and Value of Surgical Dressing
which caused tissue irritation. Whether or not to use a dressing?
?
Materials such as Tefla or other fabrics may ? Loe and Silness 1961, concluded that
be interposed between dressings tissues to dressing has little influence on the healing
prevent such harmful effects. provided that the surgical area is kept clean.
? Stahl et al 1969 showed that the presence of
Disadvantage of Eugenol Dressings:- inflammation at the wound site had more to
? They set hard often with sharp edges and do with the rate of healing than whether or not
leave a bad taste in the mouth which make a dressing is placed.
them less popular ? Wampole et al 1978, found 24% incidence of
transient bacteremia in patients during post
Jorkjend L , et al examined the incidence operative dressing change.
and severity of postoperative pain after ? Greensmith and Wade 1974 , effects of coe-
gingivectomy, Coe-pak and 2 eugenol- pak & without dressing on GCF flow ,gingival
containing periodontal dressings, Wondrpak index & pocket depth,following reverse bevel
and Nobetec flap procedures. They reported no significant
differences between any of these parameters
?
Patients were subjected to gingivectomy and found that the use of the , dressing
using 1 type of local anaesthesia (lidocaine + caused more pain & swelling but less
adrenalin) only and covering the surgical sensitivity & eating difficulty , also healing
areas with either of the 3 different dressings was rapid , but patients expressed a
in a randomized study preference for no dressing.
?
Mean pain score after Coe-pak was higher ? Heaney and Appleton 1976,tested the
than after Nobetec effect of periodontal dressings when placed
?
Mean pain score after Coe-pak was higher in periodontally healthy mouths,using either
than after Wondrpak coe-pak or wondr –pak . They found that
while the dressing caused little damage to the
periodontium, they were associated with

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PERIODONTAL DRESSING

more inflammation than undressed areas. and without surgical dressing. J Perio.
?
Jones and Cassingham 1979,TESTED 54:470.1983
THE POST OPERATIVE DIFFERENCES 3. Binnie WH and Forrest JO. A study of tissue
BETWEEN USING NO DRESSINGS AND response to cyanoacrylate adhesive in
USING COE-PAK IN 7 PATIENTS, WHO periodontal surgery. J Perio,45:619,1974
HAD PERIODONTAL SURGERY. patients 4. Checchi L, Trombelli L. Postopeative pain and
R E P O R T E D M O R E PA I N A N D disconfort with and without periodontal
DISCOMFORT WHEN DRESSING WAS dressing in conjunction with 0.2%
USED and expressed a preference for no chlorhexidine mouthwash after apically
dressing . other disadvantages are, positioned flap procedure. J Periodontol, 64
possibility of displacing a flap, entrapping (12):1238-42.1993
sutures beneath the dressing & FORCING 5. Gilbert AD, Lloyd Ch, Scrimgeour SN. The effect
DRESSING MATERIAL UNDER THE of a light-cured periodontal dressing material
FLAP during the placement . on HeLa cells and fibroblasts in vitro. J
Newman & Addy 1982 ,compared a
? Periodontol. 65(4): 324-9 1994
dressing plus a saline mouth rinse to o.2% 6. Glendinning D. A method for retention of
CHLX rinse following internal bevel flap periodontal pack. J Perio,47:236,1976
procedures in 9 patients .they suggested that 7. Greensmith AL and Wade AB. Dressing after
the use of a dressing post operatively is reverse bevel flap procedures J Clin
undesirable as it promote bacterial Perio,1:97.1974
contamination of the surgical site, increases 8. Haugen E, Gjermo P. Clinical assessment of
post operative surgical inflammation. CHLX periodontal dressings . J Clin Perio. 5: 50,1978
reduced postoperative plaque 9. Jones TM, Cassingham RM. Comparison of
accumulation and surgical inflammation. healing following periodontal surgery with and
Allen &coffesse 1983 ,examined clinical
? without dressing in humans. J Perio.
effects of perio-putty on periodontal healing, 49:387,1979
following modified widman flap procedures , 10. Jorkjend L , Skoglund LA. Effect of non-eugenol
concluded that no significant differences and eugenol containing periodontal dressings
exisits no pack philosoph on the incidence and severity of pain after
?
Modified home care procedure during periodontal soft tissue surgery. J Clin Perio.17:
immediate postoperative time period. The 341,1990
patient is asked to employ to a very soft 11. Kafrawy AH. Connective tissue reactions to an
brush and to work the brush bristles down to experimental periodontal dressing. J Dent
the tooth to the gingival margin but not onto Res,69:1825.1989
the soft tissue . 12. Levin MP, Cutright DE, Bhaskar SN.
?
Cautious flossing so as not to disturb the Cyanoacrylate as a periodontal dressing J Oral
sutures is also encouraged ,to remove Med,30: 40.1975
bacterial plaque and ensure reduced 13. O'Neill TCA. Antibacterial properties of
inflammatory reaction during initial healing. periodontal dressings. J Perio,46:469,1975
14. Othman S, Haugen E, Gjermo P. The effect of
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containing methacrylic gel as a periodontal 15. Philstrom BL, Thorn HL , Folke LEA.
dressing. J Perio,46: 465,1975 16. Richards, Caffesse RG, Smith BA. Light cured
2. Allen DR,Caffesse RG. Comparison of results periodontal dressing: a clinical evaluation. J
following Modified Widman flap surgery with Dent Res.68: 1824.1989

JIDENT ISSUE 1 VOLUME 1 OCTOBER 2012 32


PERIODONTAL DRESSING

17. Rubinoff CH, Greener EH, Robinson PJ.


Physical properties of periodontal dressing
materials, J Oral Rehab,13: 757.1986
18. Sachs HA, Farnoush A, Checchi L, Joseph CE.
Current status of periodontal dressings. J
Periodont,55:689 1984
19. Skoglund LA Jorkjend L. Postoperative pain
experience after gingivectomies using different
combiantions of local anesthetic agents and
periodontal dressings. J Clin Perio.
18:204,1991
20. Smeekens JP, Maltha JC, Renggli HH.
Histological evaluation of surgically treated oral
tissues after application of photocuring
periodontal dressing material. An animal study.
J Clin Perio. 19:641,1992
21. The effect of periodontal dressings on
supragingival microorganism. J Perio
48:440,1977
22. Watts T Combe E. Adhesion of periodontal
dressing to enamel in vitro. J Clin
Perio,51:521.1980 NezwekRA, Caffesse RG,
Bergenholtz A Nasjleti CE. Connective tissue
response to periodontal dressings J Periodont.
51: 521.1980
23. Watts TLP and Combe EC. Periodontal
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