Periodontal dressings are materials placed over wounds created by periodontal surgery. They protect the wound, help maintain close adaptation of tissue flaps, and provide patient comfort by preventing bleeding and excessive tissue growth. Effective dressings are soft but become rigid, have a smooth surface to prevent irritation, and preferably have antibacterial properties. Common types include zinc oxide eugenol packs and non-eugenol packs. Dressings are typically kept in place for one week following surgery.

1. PERIODONTAL DRESSINGS

2. Definition Periodontal dressing or periodontal packs is a productive materials applied over the wound created by periodontal surgical procedures

3. Uses To protect the wound postsurgically To obtain and maintain a close adaptation of mucosal flaps to underlying bone Comfort to the patient Prevents post-operative bleeding Prevents formation of excessive granulation tissue

4. Properties 1. The dressing should be soft, but still have enough plasticity and flexibility to facilitate its placement in operated area and to allow proper adaptation 2. Should harden with in a reasonable period of time 3. After setting the dressing should be sufficiently rigid to prevent fracture and dislocation

5. 4.The dressing should have a smmoth surface after setting to prevent irritation to cheeks and lips 5.The dressing should preferably have bactericidal properties to prevent excessive plaque formation 6.Dressing must not detrimentally interfere with the healing

6. TYPES Zno eugenol packs  packs based on reaction of zno & eugenol include – wondr pak developed by Ward The addition of accelerators such as Zinc acetate gives the dressing a better working time It is supplied as a liquid and a powder thet are mixed prior to use. Eugenol may produce allergic reaction (reddening of area and burning pain )

7. Non eugenol packs Reaction between metallic oxide and fatty acid is basis for coe-Pak Supplied in two tubes One tube contains oxides of various metals (Mainly zinc oxide) and lorothidol (a fungicide) and second tube contains non ionized carboxylic acids and chlorothymol (bacteriostatic agents) Equal parts of both mixed together immediately prior to insertion Setting time is prolonged by adding a retarder

8. Other non eugenol packs Light curing dressing e.g Barricaid Useful in anterior tooth region and particularly following mucogingival surgery because it has favorable appearance and it can be applied without dislocating soft tissues age

9. Disadvantage It is not the choice of dressing to be used in situations where flap has to be apically retained due to its soft state before curing

10. 2. Cyanoacrylates It is applied in a liqiud directly on to the wound or spread over the wound 3.Tissue conditioners ( methacrylate gel)

11. Retention of packs Periodontal dressing are kept usually in place mechanically by interlocking the interdental spaces & Joining lingual and facial portions of pack In isolated teeth or when several teeth in arch are missing --- retention of pack may be difficult So numerous reinforcement and splints and stents placement of dental floss tied loosely around the teeth enhances retention of packs

12. Application techniques Ensure that the bleeding from operated tissues has ceased before the dressing material is inserted Carefully dry teeth and soft tissues before the application for optimal adherence of dressing

13. Moistened the surgical gloves to avoid the material sticking to finger tips Zinc oxide packs are mixed with eugenol or non eugenol liquids o a wax paper pad with a wooden tongue depressor The powder is gradually incorporated with the liquid until a thick paste is formed

14. Coe-pack is prepared by mixing equal length of paste from tubes containing the accelerator and the base until the resulting paste is a uniform colour The pack is then placed in a cup of water at room temperature in 2-3 minutes the paste loses its tackiness and can be handled and molded

15. The pack is then rolled into two strips and placed on the surgical wound the dressing should not be covered more than the apical third of tooth surface Excess pack irritates the mucobuccal fold and floor of mouth and interfere with the tongue

16. Pack that interfere with the occlussion should be trimmed away failure to do this cuases discomfort and jeopardized the retention of pack The pack is kept on for one week after surgery

17. Instructions for the patients after the packs are placed 1. The pack should remain in place until it is removed in the office at the next appointment 2. For the first three hours after the operation avoid hot foods to permit the pack to harden 3. Do not smoke 4. Do not brush over the pack

18. References Periodontics-medicine surgery and implants by Louis F Rose and Brian L Mealey 2. clinical Periodontology and implant dentistry by Jan Lindhe