Periodontal Dressing Research Articles

Bone tissue reactions to periodontal dressings.

78 rats weighing 180–200 g were used to assess the bone tissue responses to three periodontal dressings (Coe‐pak, Peripac and Ward's Wondrpak). The dressings were implanted subscutaneously on periosteal covered and denuded bone. Sham operated animals served as controls and a comparison btween the responses produced by the three dressngs were made.In one series the dressings remained in situ for 3, 7, 14, 30 and 90 days. Osteocyte damage of varying extent was recorded for all materials. Remodelling of the bone surface adjacent to the dressing was observed. Bone resorption was never foud in the gournd defect produced to denude the bone tissue, but repair of the defect by bone formation was observed after long observation periods. This repair was retarded in some animals were Ward's Wondrpak had been implanted.In another seiries Ward's Waondrpak was implanted against bone for three days, then re‐operated to remove the dressing and the defect allowed to heal for 30 days. The test group exhibited empty bone lacunae and the repair of the defect was retarded or lacking.

Periodontal dressing materials

A detailed review of periodontal dressings is presented, covering physical, chemical and biological aspects. Areas requiring further research are outlined, particularly in the physico-chemical sphere; and some contra-indications to particular substances are described. It is concluded that there is a definite place for dressings, but that more knowledge is required before optimal properties can be developed.

Methods for evaluation of working and setting times of periodontal dressings

Three different methods were used to determine working and setting times of periodontal dressings. The Gillmore needle and the rheometer employed were not suitable for recording setting reactions. A penetration test was found applicable for determination of working and setting times for all three dressings although they exhibited different setting characteristics.

Chlorhexidine‐Induced Lingual Keratosis and Dysplasia in Rats

CHLORHEXIDINE IS an antibacterial agent that has been used extensively in recent years outside of the United States as a mouthwash for the prevention of periodontal disease. The observations of diminished plaque for­ mation and decreased severity of gingival inflammation have been confirmed in studies on monkeys.' Chlor­ hexidine also has been reported to increase the gingival healing rate following periodontal surgery, when incor­ porated into the periodontal dressing. Inflammatory and ulcerative lesions have been described in some pa­ tients using therapeutic doses of the drug as a mouth­ wash. However, the safety of the drug in humans has been emphasized in a number of reports, in which var­ ious medical parameters were found to be normal after 2 years of continuous daily use of the agent. Keratinization of palatal mucosa was found to be normal, the metabolism of oral epithelium, as determined by the activity of oxidative enzymes, was normal, and there was no evidence of inflammation or premalignant changes. The drug has been reported to be relatively nontoxic in experimental animals. Rats were able to tolerate 0.2% aqueous solutions as the only source of drinking water for periods of 6 months, with no obvious interference in growth and reproduction. Tissue culture studies, on the other hand, have demonstrated a high degree of toxic­ ity. 4 Exposure of human gingival fibroblasts, human newborn fibroblasts and HeLa cells to Chlorhexidine at concentrations as low as 0.004% resulted in impaired cellular function or cell death. Exposure of cells to 0.2% Chlorhexidine for 30 seconds produced suppression of protein synthesis as evidenced by release of radioactive chromium. Chlorhexidine was also found to be toxic to polymorphonuclear leukocytes, using the trypan blue dye technique. In view of the wide use of Chlorhexidine, the fact that some oral changes have been reported in humans and the absence of oral mucosal studies in experimental animals, the present study was undertaken to investigate the effect of Chlorhexidine ingestion on rat oral mucosa. The tongue was selected as the oral mucosal site of interest for several reasons. The tongue would be most likely to come in contact with the compound if delivered via the drinking water. In addition, the histol­ ogy of normal tongue in laboratory rats has been well described, and the organ presents two different surfaces for study. The dorsal surface is well keratinized and composed of highly specialized papillary structures, while the ventral surface is smooth and relatively nonkeratinized.

A Comparison of a Periodontal Dressing and Chlorhexidine Gluconate Mouthwash After the Internal Bevelled Flap Procedure

A group of 15 patients requiring comparable bilateral internal bevelled flap procedures took part in a study to compare the clinical results achieved when a dressing or chlorhexidine mouthwash was used during the first postoperative week. Initial preoperative conditions were comparable. At the end of the first postoperative week, significantly more plaque accumulated and the sulcus bleeding index was significantly higher on the dressing treated side. At 1 month and 3 months postoperatively the sulcus bleeding indices were below preoperative levels for both treated sides with no significant differences between the sides. A significant and comparable reduction in pocket depths occurred following the two postoperative treatments. Subjectively recorded pain scores demonstrated that more pain was experienced on the dressing treated side, particularly during the first 4 postoperative days. More patients preferred the mouthwash as a postoperative treatment.

The Incidence of Transient Bacteremia During Periodontal Dressing Change

Twenty patients undergoing treatment for periodontal disease and not receiving antibiotics, volunteered to donate blood for culture studies to determine the incidence of transient bateremia during the dressing change and suture removal 1 week after periodontal surgery. Each patient contributed 20 ml of blood prior to the dressing change and an additional 20 ml during suture removal. The samples were cultured both aerobically and anaerobically. Bacteria were demonstrated in five out of 20 postoperative cultures (25%). This incidence approached statistical significance at the 0.05 level using Chi-square analysis with a Yates correction. All species were identified as belonging to the genus streptococcus. None of the blood specimens obtained prior to dressing change exhibited bacterial growth. Although the incidence of bacteremia in this study was not statistically significant at the 0.05 level, it may be clinically significant that five out of 20 patients demonstrated transient bacteremia. Commercial materials and equipment are identified in this report to specify the investigative procedures. Such identification does not imply recommendation or endorsement or that the materials and equipment are necessarily the best available for the purpose. Furthermore, the opinions expressed herein are those of the author and are not to be construed as those of the Army Medical Department.

Subcutaneous implants for assessments of dental materials with emphasis on periodontal dressings.

Polyethylene tubes filled with various dental materials were placed as subcutaneous implants in rats. A scoring system for no, slight, moderate and severe reaction was established on the basis of the tissue response to a variety of materials for the evaluation of long term implants (30 or 90 days). Short term implants (7 or 14 days) were evaluated by deciding whether or not an effect from the material could be found in addition to the operative trauma.The scoring system was used to evaluate the reactions to three periodontal dressings. Tissue from the short term implantation periods exhibited marked reactions to most implants. Long term implantation revealed that a difference in the tissue response to the three dressings was present, For two of the materials the initial irritation was followed by an innocuous state, but from the third dressing a continuous irritation of the tissue was observed.

In vitro cytotoxicity of periodontal dressings.

The cytotoxicity of three periodontal dressings was evaluated by two in vitro cell culture techniques. Fresh and stored materials were found to be cytotoxic by both techniques and it appeared that the mechanism of cytotoxicity was different for the three dressing materials tested.

Clinical assessment of periodontal dressings

Forty-one patients requiring gingivectomy in one or more areas were used for a clinical evaluation of three different periodontal dressings. Sixty-five operations were performed. Whenever possible different dressings were tested in the same patient. The type of dressing was chosen randomly, applied by one operator and left in place for 1 week. The patients were supplied with analgetic tablets. At day 7 the condition of the dressing was evaluated before removal. The patients' subjective experiences of pain, swelling, bleeding and fever, as well as use of pain relieving tablets, were recorded. The wound was evaluated with regard to the degree of epithelialization, presence of denuded bone and granulation tissue. The tendency to bleeding and the sensitivity of the teeth to a water spray (15 degrees C) were tested. At day 14 and 21 the same evaluation procedure was repeated. In addition the presence of plaque in the operated area was assessed. One of the dressings more frequently induced pain and swelling than the others. Tablet consumption was also higher when this dressing had been used. No statistically significant differences were found in the clinical assessment of wound healing, tendency to bleeding and the sensitivity of teeth.

Dimensional Changes of Periodontal Dressings

The linear dimensional changes of three commercial periodontal dressings were measured during 24 hours. The dressings revealed different degrees of dimensional changes, which may indicate that exhibit variations in adaptation to wound surfaces.

Effect of Soluble Extracts from Periodontal Dressings on Human Granulocytic Leukocytes in Vitro

Purified populations of human polymorphonuclear granulocytic leukocytes were exposed in vitro to solubilized material(s) extracted from two commerical periodontal dressings. The composiitonof one dressing contained eugenol while that of the other lacked it. Extracts were prepared by placing each mixed dressing in isotonic saline for 18 to 24 hours. Granulocytic leukocytes received serial dilutions of each extract and were then evaluated at 15 minutes and at 3 hours of culture for changes in viability and elaboration of cyto-plasmic and lysosomal enzymes. High concentrations of extract from each dressing were toxic to the cultured granulocytes. Measurements for cell viability and release of cytoplasmic enzyme revealed that the toxic potential in the eugenol-free dressing was greater. With cell damage, extracellular release of the lysosomal enzymes was found to occur. Serially increased dilutions of either extract to nontoxic concentrations failed to selectively release lysosomal enzymes.

The Remodeling of Human Gingival Tissues following Gingivectomy

A total of 30 facial gingivectomies were carried out for reduction of suprabony pockets (mean +/- S.D. preoperative pocket depth 2.8 mm +/- 0.3 mm). Remodeling of the gingival margin was monitored by clinical measurements. The following techniques were utilized: A polyvinyl stent was constructed for each surgical quadrant. This stent covered the occlusal margins of the involved teeth and contained the fixed point of reference. Preoperatively, the following measurements were taken: the distance from the fixed point to (a) the height of the free gingival margin, and (b) the base of the clinical pocket. For control purposes similar measurements were taken at the facial surface of an adjacent tooth. A standard gingivectomy to the base of the clinical pocket was then performed and a periodontal dressing was applied for 1 week. Utilizing the stent (fixed point of reference), measurements were taken of the healing margin and control sites inn the same manner as preoperatively; 1,4,8 and 12 weeks after surgery. Our findings indicate that 12 weeks after gingivectomy, the newly formed free gingival margin was located coronally to the line of incision in all cases. The mean pocket depth at 12 weeks after surgery was 0.7 mm +/- 0.2 mm. However, the mean gain in coronal marginal height was 1.2 mm +/- 0.3 mm. Thus, a clinical coronal pocket closure of about 0.5 mm seemed to have taken place at the soft tissue-tooth interface. Measurements at the nonoperated control site showed no significant variations in crevicular depth during the experimental period. We therefore conclude that the excisional reduction of a crevice to 0 mm depth was altered by gingival remodeling during the healing phase. In our experience, this remodeling took place within 3 months after surgery and clinically appeared as a limited coronal pocket closure and gain of marginal height.

Some antibacterial properties of periodontal dressings

Three commercial periodontal dressings were tested for antibacterial activity against salivary microorganisms after having been stored dry or in liquid for 1 and 2 days. Inhibition of growth of mixed salivary flora was evaluated on blood agar dishes. Also, the ability of Strep. mutans to colonize the surface of the dressings was tested. The surface contact test indicated antibacterial activity against salivary microorganisms by freshly made Coe-pak and Wondrpak. Some activity could also be observed after 2 days' storage in about half the experiments. The initial bacteriostatic effect of Peripac was limited to the setting phase. The plaque accumulation test revealed single cells only on the surfaces of Coe-pak and Wondrpak whereas Peripac seemed to be colonized by the test bacteria.

Vital Root Amputation: A Clinical and Histological Study

An investigation was designed to study the clinical and histological effects of delaying endodontic therapy for a period of 2 weeks without dressing of the exposed pulp, after vital intentional root amputation had been carried out on periodontally involved teeth. From the results obtained it was possible to conclude that: 1. Endodontics, prior to surgical root amputation, remains the treatment of choice. 2. When preoperative endodontics is not possible, the approach used in this study will provide good results without severe, adverse clinical or histological effects. 3. The altered periodontal condition and tooth form do not interfere with the performance of definitive endodontics 2 weeks after surgery. 4. Definitive preparation of the cut tooth surface at the time of root amputation facilitates maintenance of oral hygiene after removal of the periodontal dressings. 5. The high percentage of involvement of the distobuccal root of the first maxillary molar in periodontal situations requiring correction by root amputation, may be due to the anatomy of this root.

The effect of periodontal dressings on the healthy periodontium.

Twenty-seven proprietory periodontal dressings were applied to the lower labial segments of 18 subjects showing low levels of gingival inflammation when assessed by the Gingival Index system at the time of application. Specimens of each dressing type were subsequently removed at intervals ranging from 3 h to 5 days. The material adhering to the deep surface of the dressing was examined by light, transmission and scanning electron microscopy and was shown to be a complex heterogeneous structure consisting of large intact epithelial cell sheets and oral bacteria in a proteinaceous matrix. Possible mechanisms which could contribute the epithelial cell and protein components to this structure were discussed. It was concluded that the dressings themselves caused little damage to the normal periodontium but could be associated with increased levels of inflammation at longer time intervals because of bacterial growth. The significance of these findings to current clinical practice is discussed.

A Chlorhexidine‐containing Methacrylic Gel as a Periodontal Dressing

The modification of a methacrylic gel for use as a periodontal dressing was attempted. The increased adhesion and rigidity of the resultant material appeared consistent with the clinical findings. Satisfactory retention of the dressing was found in 85% of those placed on a group of patients attending for periodontal surgery. The potential value of the methacrylic gel for carrying and releasing pharmacological agents useful in the management of lesions of the oral mucosa was assessed by incorporating chlorhexidine acetate into the dressing. In vitro and in vivo studies demonstrated effective release of the chlorhexidine from the dressing throughout the period of time a periodontal dressing is normally in situ. In conclusion the results suggested that the modified methacrylic gel fulfills the requirements of a periodontal dressing. Study to assess further the potential for this material to carry other pharmacological agents used in the topical treatment of lesions of the oral mucosa is indicated.

Antibacterial Properties of Periodontal Dressings

The relationship between the build-up of bacterial plaque at the dento-gingival junction and the development of gingivitis is well established. The susceptibility of patients requiring periodontal surgery to the pathogenic potential of plaque would seem to necessitate the protection of the surgically treated area by a periodontal dressing until adequate plaque control by the patient is possible. In the light of clinical experience, an investigation was undertaken into the antibacterial properties of certain proprietary periodontal dressings and a zinc oxide/eugenol material. None of these materials showed any marked degree of antibacterial activity. One of these materials, Coe-Pak, had been used alone or combined with Cross Pack for all the patients in the clinical survey with very satisfactory results, and it is concluded that this material is successful because of its physical properties and not its antibacterial ones. Careful attention to asepsis, gentle and controlled tissue handling, correct technique, and thorough removal of plaque and calculus are the prerequisites for successful periodontal surgery. The protection of the surgical wound by a dressing of adequate physical properties aids in ensuring uneventful healing. The use of potent antibacterial agents in the dressing is not necessary; a physical barrier to salivary/bacterial contamination and food impaction may be the most important factor.

An anaphylactoid reaction to periodontal surgical dressing: report of case

At the second periodontal surgical procedure, the patient had an anaphylactoid reaction immediately after the periodontal dressing had been applied. This report illustrates the potential antigenicity of periodontal surgical dressing. The dressing was applied at two separate times after periodontal surgical procedures were performed two weeks apart. The patient had an anaphylactoid reaction immediately after the administration of the surgical dressing for the second surgery. The administration of drugs to counteract the symptoms elicited by the anaphylactoid reaction is mentioned. The patient’s history of allergies is discussed. This report is intended to alert dentists to the possible antigenicity of periodontal surgical dressing. At the second periodontal surgical procedure, the patient had an anaphylactoid reaction immediately after the periodontal dressing had been applied. This report illustrates the potential antigenicity of periodontal surgical dressing. The dressing was applied at two separate times after periodontal surgical procedures were performed two weeks apart. The patient had an anaphylactoid reaction immediately after the administration of the surgical dressing for the second surgery. The administration of drugs to counteract the symptoms elicited by the anaphylactoid reaction is mentioned. The patient’s history of allergies is discussed. This report is intended to alert dentists to the possible antigenicity of periodontal surgical dressing.

Clinical study of fungal growth on tissue conditioners

This study was conducted to determine if tissue conditioners, when used as periodontal dressings, encouraged the growth of Candida albicans . The results suggest that they are useful as surgical dressings.

Effect of periodontal dressings on tissue culture cells.

Effect of periodontal dressings on tissue culture cells.