This document discusses different types of periodontal dressings used after periodontal surgery. It begins by describing the purpose of periodontal dressings in protecting healing tissues from forces during chewing. It then discusses the key properties dressings should have and lists three categories: those containing zinc oxide and eugenol, those containing zinc oxide without eugenol, and those containing neither. The document focuses on the composition, advantages, and application techniques of various common dressing types, including zinc oxide eugenol dressings, non-eugenol zinc oxide dressings like Coe-Pak, and alternatives like collagen dressings.

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DR.MD.SHADAB ANWAR
PERIODONTOLOGIST & IMPLANTOLOGIST

2. 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.

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These dressings are applied around the necks of the teeth
and adjacent tissue to cover and protect the surgical wound
after periodontal surgery (Zwemer TJ et al in 1993)

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o soft, but still have enough plasticity and flexibility to
facilitate its placement in the operated area and to allow
proper adaptation.
o set within a reasonable time.
o sufficient rigidity to prevent fracture and dislocation.
o smooth surface after setting to prevent irritation to the
cheeks and lips.
o bactericidal properties to prevent excessive plaque
formation.

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o Not interfere with healing.
o dimensional stability to prevent salivary leakage.
o not induce possible systemic detrimental effects
and allergic reactions.
o acceptable taste.
o economical and easily available.
o good shelf life.

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o Protection of the wound area
o Enhancement of patient comfort
o Maintenance of a debris free area
o Control of bleeding: from trauma.
o Protect newly exposed root surfaces from temperature changes
o Protect sutures.
o Protects surgical healing areas
H. A. Sachs, A. Farnoush. Current Status of Periodontal Dressings. J. Periodontol.
December, 1984; 55; 689-696

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USES OF PERIODONTAL DRESSING
o Provide mechanical protection for the surgical wound and
therefore facilitate healing
o Enchancement of patient comfort .
o Prevents post operative bleeding by maintaining the initial clot
in place.
o Maintainance of debris free area.
o Control of bleeding
o Supports mobile teeth during healing

8. o Helps in shaping or molding the newly formed tissue
o Provide patient comfort by isolating area from external
irritations or injuries.

9. 3 categories
(i) Those containing zinc oxide and eugenol,
(ii) Those containing zinc oxide without eugenol and
(iii) Those containing neither zinc oxide nor eugenol

11. 1.Zinc oxide eugenol dressing (hard pack)
Brand Names: -
o Wonder Pack,
o Kirkland- Kaiser Pack,
o Box Pack,
o Peridress, Ppc
The first periodontal dressing introduced was containing eugenol
(Ward AV in 1923)

13. A modified form of a eugenol dressing was introduced by
Kirkland.
It consists of zinc oxide, resin, zinc acetate, eugenol, tannic
acid and olive oil.
Kirkland Formula

14. Evolution of ZOE Dressing
o Products such as asbestos and tannic acid eliminated.
o Asbestos- asbestosis, lung cancer (Dyer MRY in 1967)
o Tannic acid- potential liver damage.(Baer PN 1969)
o Products-Added : Zinc acetate.

15. Obtundant property & make the sites less sensitive.
(O Neil 1975)
Prevent or retard bacterial growth (Antiseptic properties).
(Waerhaug and Loe in 1957)

16. o Irritate oral mucosal tissues.
o May cause allergic reactions which can lead to tissue necrosis
(Sarrami et al 2002)
o Difficult manipulation.
o Rough surface after setting.

17. Currently the most widely used periodontal dressings.
Commercially available non eugenol dressings include:
i. Coe-Pak,
ii. Cross Pack,
iii. Peripac,
iv. Septopack,
v. PerioCare,
vi. Perio Putty and
vii. Periogenix.

18. Advantages Of Noneugenol- Dressings
o Minimal irritation of the mucous membrane,
o Pleasant odor,
o Neutral taste,
o Ease of manipulation,
o Pliability -easy removal from undercut areas

19. o Elimination of the objectionable taste of eugenol.
o They are less irritating
o Form a closely adapted adhesive barrier to saliva and
oral bacteria (Singer and Thode 2004)

20. The most common and widely used non-eugenol dressing is Coepak
(Coe Laboratories Inc., Chicago, IL), which is supplied as two tube
(1. Base tube & 2. catalyst tube or accelerator) or as an automixing
system contained within a syringe.
COE-PAK

21. i. Rosin – TO REDUCES BRITTELNESS
ii. Cellulose,
iii. Natural gums - (for cohesiveness) and
iv. Waxes,
v. Fatty acids - FOR LUBRICATION
vi. Chlorothymol - (Bacteriostatic agent),
vii. Zinc acetate- STRENGTH, DECREASE STTING TIME,ACCELARATOR
viii. Ethyl Alcohol – luting agent,viscosity,micromechanical
adhesion
Base Tube: contains

22. i. Zinc oxide- PRINCIPAL INGREDIANT
ANTISEPTIC,ASTRINGENT(ACCELARATOR,MODIFIER,FILLERS)
ii. Vegetable oil (for plasticity),
iii. Chlorothymol - Bacteriostatic agent
iv. Magnesium oxide - HELPS IN SETTING REACTION
v. Silica - Binder,filler
vi. Synthetic resin - PLASTICITY
vii. Coumarin - ANTICOAGULANT
viii. Lorothidol - a fungicide
Accelerator Tube: contains
(CATALYST PASTE)

23. PREPARATION OF COE-PAK
APPLICATION TECHNIQUE
Moistening of gloves to avoid sticking of material.
Teeth and soft tissue to be dried for adherence of dressing.
•For Coe-Pak the interproximal areas are filled first, thin rolls of dressing to cover entire field of
operation are then placed against the buccal and lingual surfaces of the teeth and pressed against the
tooth surfaces, into the interproximal areas.

24. Surface of the dressings is smoothened and excess material is removed
ensuring non displacement of dressing during function.
Should not cover more than apical third of the tooth surface.

25. APPLICATION - STEPS

26. o Insert a scaler or plastic instrument under the border of the
dressing and apply lateral pressure.
o Watch for sutures that can get lodged in the dressings.
o Remove fragments of dressing gently with cotton pliers to avoid
scratching the thin epithelial covering of the healing tissue.
o Use a scaler for removal of fragments adhering to tooth surfaces.
REMOVAL OF THE PACK

27. o For the first 3 hours after the operation avoid hot foods in order to permit the
pack to harden
o Do not brush over the pack.
o Brush and floss normally the areas of the mouth not covered by the pack.
o Use chlorhexidine mouth rinses after brushing
o After the pack is removed the gums most likely will bleed more than they did
before the operation. This is perfectly normal in the early stage of healing.
Care after periodontal pack

28. i. Cyanoacrylate dressing,
ii. Light cure dressing (BARRICAID)
iii. Collagen dressing and
iv. Mucoadhesive dressing
v. Modification( chlorhexidine dressing)
DRESSINGS CONTAINING NEITHER ZINC
OXIDE NOR EUGENOL

29. I. Cyanoacrylate dressing,
⚫ Maintaining precise positioning of a flap or free
gingival graft

30. Collagen dressings (e.g., Colla products from Zimmer Dental, Carlsbad, CA,
USA) are biological dressings which create a physiologic interface
between the wound and the environment and encourage healing.
The advantages over other dressings include ease of application, non-
immunogenic, non-pyrogenic, hypoallergenic properties.
COLLAGEN DRESSINGS

31. Commercially available collagen dressings have three
forms:
1. Tape (CollaTape ; Zimmer Dental, Carlsbad, CA, USA),
2. Cote (CollaCote ; Zimmer Dental, Carlsbad, CA, USA)
3. Plug (CollaPlug ; Zimmer Dental, Carlsbad, CA, USA).

32. COLLA-Tape is used for
o localized ridge defects,
o socket grafting,
o subantral augmentations and
o protection of soft tissue donor
sites.

33. Colla-Cote is used in procedures like
•Soft tissue recontouring
•Sinus graft containment,
•Guided bone regeneration and
•Sinus membrane perforations,
whereas, a plug is used as a dressing for biopsy sites.
(Steer PL 2002)

34. Colla-Plug Used As
o Dressing For Biopsy Sites (Steer and Mathews).

35. Mucoadhesive / Stomahesive Dressing
o An adhesive, nonsensitizing wound dressing
o Used whenever mucosal coverage is required
for a short period of time.

36. o It is a multilayered dressing i- a layer of curative and
absorbent material
o contact with the wounds, a layer of deodorizing material
and an outer layer which secures the bandage to the
tissues.

37.  It includes
o Gelatin
o Pectin
o Sodium Carboxymethylcellulose
o Polyisobutylene.
⚫ The longevity -is minimal (dissolves in 8-24 hours).

38. THANKS