It is impossible to cure periodontal diseases without removing tartar. The fact is that dental plaque is the main source pathogenic bacteria. They will immediately infect the periodontium. Therefore, any treatment will be ineffective. The best way getting rid of hard dental deposits - curettage of periodontal pockets. What is it? This will be discussed in this article.
When there is a lot of dental plaque, it triggers inflammatory processes in the gums. Because of this, the mechanism of destruction of periodontal and inert tissue is triggered. As a result, a periodontal pocket is formed,
An experienced doctor only needs to look at the gums to determine the degree destruction periodontal The deeper and wider the visible gap, the further the decay process has gone.
In severe forms of the pathology, the sockets of the teeth may be destroyed, which leads to the loss of the latter.
On early stages this pathology can only be detected using an x-ray.
At first, the formation of a periodontal pocket does not manifest itself in any way. But the further the disease develops, the more acute and varied the symptoms:
If any of these symptoms appear, it is better for the patient to immediately consult a dentist. Otherwise, the disease can lead to tooth loss.
As mentioned above, this disease appears due to the penetration of bacteria into the cervical area of the dental crown. Microbes form an invisible film with the naked eye on the surface of the enamel and begin to actively multiply. Their waste products provoke severe inflammation.
Microbial growth is accelerated by the following factors:
A periodontal pocket is not a simple tissue deformation. That's enough dangerous pathology, which needs to be treated as early as possible. Otherwise, the patient may face quite serious complications.
The most common complication is acute abscess. If the patient ignores it, it will become chronic.
A periodontal pocket, among other things, very often causes mobility of the dentition. Loose teeth often cause severe pain. And sometimes they simply fall out of the alveolar sockets.
Inflammatory the process in the periodontium causes lymphadenitis and very often leads to general intoxication of the patient.
If the patient does not receive quality treatment, then the pathology will most likely affect the jaw bones.
In the treatment of this pathology, both therapeutic and surgical treatment methods can be used. Dentists resort to one method or another based on the severity of the pathology and the results analyzes.
At the very beginning of the development of pathology, it can be dealt with using conservative treatment. We are talking about hygienic teeth cleaning with ultrasound and the use of antiseptics: Chlorhexidine or Miramistin.
These procedures effective only in cases where the depth of the periodontal pocket has not reached 2 mm. If the pocket depth is more than 2 mm, then surgical intervention is necessary.
All surgical methods for treating periodontal pockets are called curettage. Curettage is a direct instrumental impact on the subgingival space. Depending on the severity of the pathology, doctors resort to open or closed curettage.
Currently more effective There is simply no way to treat periodontal pockets. After it, the patient’s periodontium is completely restored. It is worth considering that each treatment method has its own indications and contraindications.
The main task of the surgeon with closed curettage is to remove subgingival deposits and granulation tissue that has replaced the destroyed periodontium. Main disadvantage closed curettage - the surgeon is forced to work blindly. He does not see the surface of the roots and cannot assess the condition of periodontal pockets. For this reason, some of the granulation formations and deposits on the teeth may remain in place.
TO closed Doctors resort to curettage when the depth of the periodontal pocket does not exceed 3 millimeters. This allows us to more or less guarantee complete cure patient. If the pocket is deeper, the effect of this procedure will be temporary. Pretty soon, periodontitis will return with renewed vigor.
This procedure has several contraindications:
Closed curettage of the periodontal pocket is carried out in several stages:
After curettage of the periodontal pocket to the patient for three days prohibited eat solid food.
Often, after closed curettage, the patient encounters complications such as: pulpitis, bleeding, suppuration of the gums. This is not an indicator of the quality of the surgeon's work. The final results of the procedure can only be announced after the scar has formed. This will happen no earlier than in a few weeks.
Because of its simplicity, closed curettage is often practiced in small dental clinics that cannot afford experienced periodontal surgeons. In expensive clinics, when treating moderate and severe periodontal disease, they always resort to open curettage.
This is a type of closed procedure. Its main difference from classic closed curettage is that during the operation the doctor uses curettes connected to a vacuum apparatus. This allows you to not only scrape off deposits, but also remove them immediately. This can significantly reduce the risk of complications. But this is the only advantage of this method. Otherwise, it has the same disadvantages as classic closed curettage.
During operations the surgeon removes all deposits from the surface of the teeth, removes granulation formations from under the gums, completely eliminates periodontal pockets and implants artificial bone tissue.
The main indication for this operation is the depth of the periodontal pocket of more than 3 millimeters. This procedure is also carried out when pathological deformation of the interdental papillae is detected and a loose fit of the gum to the tooth is detected.
This operation it is forbidden carried out in the following cases:
The operation is preceded by a thorough Preparation:
Surgery performed under local anesthesia. At one time, the doctor treats an area covering no more than 8 teeth.
Open Curettage consists of the following stages:
This is a type of open curettage. Its main difference from the classical procedure is that to access the contents of the pocket, the surgeon creates a completely mobile flap. That is, a section of the gum is simply thrown aside. This allows you to better see the bone pockets and the surface of the tooth roots.
The operation should refuse, If:
Patchwork The operation is carried out in several stages:
The main disadvantage of flap surgery is that it can provoke pathological mobility of teeth and cause exposure of their necks.
Closed and open curettage, as well as all varieties of these operations, have one common goal - removing deposits and eliminating periodontal pockets. Without these procedures, it is impossible to achieve stabilization of advanced periodontitis.
Any gum disease is a very long and unpleasant process. Increasingly, patients are turning to dental clinics with problems such as gingivitis, or a more complex form. inflammatory disease– periodontitis.
Although these types of diseases seem harmless at the beginning, they can lead to serious problems, up to the loss of teeth.
That is why in dental practice one of the most effective methods Treatment of gum disease is curettage of periodontal pockets. About what methods modern technology uses to carry out this procedure surgical dentistry, and how they differ will be discussed in this article.
Treatment of periodontitis involves a whole range of procedures aimed at eliminating the cause and the possibility of reoccurrence. If the disease is mild or moderate severity, then curettage will be part of this complex.
At its core curettage is the cleaning of periodontal pockets that form between the gum and tooth. Sometimes it is called differently - dental, periodontal, gingival pocket.
If its dimensions exceed 3 mm, then cleaning using conventional methods is ineffective. Therefore, surgical ones are used.
In order to understand this, you need to know general information about the course of periodontitis.
The need for this operation is explained, first of all, by the fact that the process of atrophy, destruction and replacement of healthy tissue with granulate becomes almost irreversible when gum pockets form.
Anti-inflammatory and local therapy, together with superficial cleaning and antibiotics, have only a short-term effect.
Therefore, a method is needed, which is curettage, which allows you to immediately eliminate the entire list of problems:
There are several surgical methods that serve the same purpose. It is the elimination of altered and diseased tissues to eliminate pathogenic factors. They differ from each other only in the degree of intervention and the method of performing the operation.
If the patient is found easy stage periodontitis, when the depth of the pockets is small - about 3-4 mm, then the first type of closed curettage is often used.
Its purpose is to remove granules, deposits located under the gum, affected dental root cement, decomposed tissue and particles.
The main feature of the technique is that the manipulations are carried out by the dentist blindly, without excision of the gums and full access to the affected cavity. The lack of visualization requires the surgeon to be extremely meticulous, have great patience and professional skills. After all, in addition to removing altered diseased tissues, healthy ones cannot be damaged.
Necessary for mild to moderate types of the underlying disease. In this case, the depth of the cavity should not be more than 4 mm, otherwise there will be no expected effectiveness. The presence of so-called bone pockets is also unacceptable, and the gum tissue itself must be of normal density.
Like all surgical procedures, closed curettage also has contraindications.
There are several mandatory stages of the operation, the sequence of which must be followed.
The effectiveness of the operation can only be judged after sufficient time for scar formation to occur. connective tissue time. This usually takes about 2-3 weeks.
The disadvantage of this technique is that without filigree precision, which only experienced professionals possess, healthy tissue can be damaged. This sometimes leads to complications in the form of pulpitis, prolonged bleeding, and suppuration.
One of the types of surgery. Here the curettes are connected to the apparatus to create a vacuum. The main advantage of the technique is that pathological tissues are not simply scraped off, but are immediately removed from the cavity. This helps to significantly reduce the occurrence of all kinds of complications.
How to perform closed curettage of periodontal pockets - see the following video:
The purpose of the operation is the same as in the case of closed curettage. But, unlike him, here the periodontal pocket itself is also removed, as a probable source of bacteria and a factor of possible relapse.
As in the closed method, there are certain stages of the operation.
How to perform open curettage of periodontal pockets - see the following video:
The cost of both methods will be different and it does not depend on the clinic. The fact is that open curettage is not only the most effective for complex forms of the disease, but also requires great effort from the doctor.
The average cost of a closed type operation for one tooth is about 800–1000 rubles, and an open type operation is about one and a half to two times higher - up to 1,700 rubles.
This amount includes anesthesia, treatment with all kinds of drugs, and the work itself. Depending on the complexity of the operation, the price may be higher, but without an examination, the doctor is unlikely to be able to give the exact cost.
Also, prices may vary slightly depending on the region and clinic. Popular large dental centers that have a name and invite only experienced specialists can charge 30–40% more for the same operations.
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A serious disease, periodontitis, develops in many people who ignore regular and high-quality oral hygiene. The disease causes a lot of problems and complications, and some of them require curettage or flap operations on the soft tissues. In this article we will look at what this “dental curettage” procedure is, the need for it, all the pros and cons of the event.
Due to poor hygiene, hereditary factors, anatomical features or the patient’s diet, a soft layer of microbial plaque, protein deposits, and dark and hard stone appear in the mouth. By actively multiplying in them, bacteria trigger inflammatory processes in the teeth and surrounding soft tissues.
The patient begins to complain of bleeding gums, feels swollen areas of soft tissue, touching which is accompanied by severe pain.
In case of absence effective treatment periodontal disease leads to tooth mobility, changes in their position and even loss, and inflammatory processes are characterized by the appearance of pus from under the gums and a general deterioration of the condition.
Curettage – cleaning periodontal pockets
Against the background of all these processes, the patient develops two critical conditions.
Surgical treatment in in this case will cleanse the canals and granulation tissue, helping to improve your well-being.
Large voids (starting from 4 mm), once appeared in the body, do not go away on their own, even after effective treatment with anti-inflammatory drugs, antibiotics, dental procedures(laser, ultrasound, hygienic, etc.). Even if you sign up for a tartar and plaque removal procedure, the dentist will not physically be able to clean periodontal pockets using standard equipment. And if deposits remain, then inflammation and further destruction of bones and teeth remain.
Even if it was possible to clean the pockets and stop the inflammatory process, anatomical changes remain in the body that contribute to regular relapses of periodontitis.
So, curettage of the periodontal pocket remains the only method that guarantees a complete cure for the disease.
It promotes:
There are 2 curettage techniques: open and closed.
It is prescribed to remove subgingival microbial plaque, as well as granulation tissue from pockets.
The technique is effective only when the void depth does not exceed 3 mm (initial forms periodontitis). If the disease has progressed to severe forms, the closed method will only help to stop the process.
This type is performed in clinics where there is no qualified periodontist surgeon. The operation is undertaken by dental therapists who do not have sufficient experience and qualifications to carry out more complex manipulations (open curettage or patchwork operations on the gums).
Closed curettage
How is the procedure carried out? The nurse administers local anesthesia and the doctor begins cleaning the pockets using manual or ultrasonic instruments. The dentist carefully removes subgingival soft and hard deposits, looks deep into each pocket, removing replacement tissue and pathological masses from its cavity. The cleaned cavity is washed isotonic solution based on sodium chloride. The doctor then polishes the tooth roots.
After the event, the doctor recommends wearing special dressings (for example, stomalgin, zincoplast, dentol and others). For 4-5 hours after the session, the patient should not eat or drink aggressive liquids. It's better to limit yourself plain water without gas at room temperature.
A month after the closed procedure, the doctor examines the depth of the pockets. As a rule, the shallowest ones disappear, and the deepest ones shrink.
Open curettage of periodontal pockets is prescribed to eliminate inflammatory processes, remove subgingival deposits and replacement tissue. This procedure It also allows you to completely remove periodontal pockets and promotes the restoration of natural bone tissue, for which the doctor “plants” artificial material.
Before performing the operation, the doctor performs the necessary preparations. Conducted professional cleaning the entire oral cavity is removed from plaque, tartar and pus, the teeth are splinted (if necessary), and a course of antibiotic and anti-inflammatory drugs is prescribed.
At the appointed time, the patient is given local local anesthesia. The operation is performed on a specific area, including no more than 8 teeth.
Open curettage
An open procedure involves the removal of the mucous membrane of the gum tissue by a periodontist surgeon.. To do this, the doctor makes small incisions in the area of the dental necks. The resulting flaps are removed from the bone, exposing the tooth roots and areas of destroyed bone. At this stage, the doctor fully sees all subgingival stones and plaque, as well as granulation tissue. He deletes these pathological formations(including pockets) using surgical curettes. Modern clinics allow you to scrape out replacement tissue and stones with an ultrasonic scaler. The periodontal pocket can be removed in the same way (photo below).
This artificial material stimulates recovery own fabric, which will significantly reduce the depth of the cavities.
Ultrasound curettage
The last step is suturing to the area where the interdental papillae are located. A special bandage is also attached to the area, protecting the wound from infection and promoting tissue regeneration. The doctor removes the sutures after 10 days.
For several days after surgery, the patient is prohibited from performing standard hygiene procedures (cleaning with a toothbrush, interdental brush, floss, irrigator) in the intervention area. This area should be treated with a swab moistened with an antiseptic or anti-inflammatory agent.
A month later, the dentist performs a control probing depth of the bone pockets and may prescribe a repeat procedure.
Curettage collected both positive and negative reviews doctors and their patients, which we present below.
The closed method has several advantages: the doctor can remove deep subgingival deposits, clean the pockets from the pathological mass, which may help reduce their volume.
Also, manipulations take little time, and rehabilitation is quite fast. In addition, the procedure is available to the middle segments of the population.
The operation also has many disadvantages:
Regarding open gum curettage, then here positive points much more: the doctor not only cleans the periodontal pocket, but also removes it, which makes it possible to stop periodontitis without the possibility of relapse. Replanting artificial tissue can reduce the depth of defects-voids in the bone, which will also eliminate tooth mobility.
Open curettage takes approximately 2 hours
Unfortunately, the method has some disadvantages:
When choosing between 2 types of procedures, remember that only open curettage makes it possible to permanently stop the disease and try to restore lost bone tissue.
The simplest and most common surgical method is curettage of periodontal pocket(“curettage” - curettage, i.e. removal of pathological granulations and treatment of the surface of the tooth root without the formation of a mucoperiosteal flap), which is isolated in independent method from the century before last (Junger-Sachs method). Curettage was first performed by Rigg in 1867, and the authors and developers of this method were Younger (1880-1892), N. N. Znamensky (1899) and Sachs (1909-1910). Junger introduced curettage into clinical dentistry as the main method of treatment for periodontal diseases. Zaks understood curettage as a technique for removing dental plaque and scraping granulations, and also proposed a set of tools for these purposes. N. N. Znamensky in his work “ Radical treatment cellular suppuration" (1899), and then in the dissertation "Alveolar pyorrhea and its pathological anatomy"(1902) not only theoretically substantiated the curettage technique, but also analyzed the long-term results of the use of curettage in large number patients with periodontal diseases.
In the literature, a distinction is made between simple and subgingival curettage (Nikitina T.V., 1982; Danilevsky N.F. [et al.], 1993; and others).
Simple curettage limited by the circular epithelium and carried out within the periodontal junction in the absence of a periodontal pocket. With subgingival curettage, periodontal pockets are eliminated or reduced. It was believed that the success of the intervention depends on how thoroughly supra- and subgingival dental plaque and granulation are removed, resulting in pocket scarring (Dolinnik K., 1967; Storm A.A., 1997). At the same time, there is evidence that careful mechanical treatment and control of subgingival infection, and not simply the presence or absence of periodontal pockets, are the main component of success (Matulyan A. A., 1992). Even with careful individual oral hygiene, subgingival dental plaque may not only not disappear, but also not decrease, which necessitates professional intervention under the gum. Therefore, at present, subgingival curettage is usually performed with the removal of supragingival dental plaque.
Considering the above, it becomes clear why curettage in its classical understanding a method rarely performed today. Its modern modifications and additions have made this a multi-stage procedure, pursuing various purposes. Previously, in foreign, and now in domestic literature (Isidor F., 1981; Storm A. A., 1997; Fedosenko T. D., Prokhorova O. V., 2002; etc.) this intervention began to be called “scabbing” - scraping; “rootplaning” - leveling the root surface, as well as “periodontal debridment” - periodontal removal of deposits.
Analyzing these terms, A. A. Storm (1997) points out that according to the US Dictionary of Special Terms (1996), the term “scaling” is defined as “instrumental treatment of the surface of the crown and root of a tooth to remove plaque, stone, stains.” This procedure initially aims to remove visible and easily accessible tartar. However, scraping performed in the usual way, has an incomplete effect in removing dental plaque and bacterial toxins from affected surfaces. That is why scraping is suggested to be performed only in those places where tartar is easily identified. "Rootplaning" is defined as " medical procedure", designed to remove cementum or dentin surfaces that are "impregnated" with deposits or contaminated with toxins and/or microorganisms.
Therefore, when “root planning” is combined with “scaling”, the result of the intervention is a more extensive treatment of the root surface, at the cost of removing a significant amount of cement, for more complete removal sediments of any kind (Woodall I.R., 1993).
The term "periodontal debridement" is considered an alternative to the terms "scaling" and "root planning", which are more traditionally used to refer to the treatment of the root surface of a tooth. The decisive difference between these procedures is considered to be different conduct root treatment. If with “scaling” the removal of cement is not considered necessary, and sometimes even undesirable for achieving periodontal health, then with “rootplaning” it is priority(Storm A.A., 1997).
Curettage in the classical sense (scraping out the contents of a periodontal pocket in order to eliminate it) is indicated in the presence of periodontal pockets up to 5 mm deep (preferably single) and can be carried out simultaneously in the area of 2-3 teeth. Repeated curettage on the same teeth is possible only after 12 months. Contraindications to curettage should be considered the presence of bone pockets, thin gingival walls of the periodontal pocket, as well as profuse suppuration from it. Some experts do not recommend performing curettage in fibrotic-changed gums, explaining this by the fact that the fibrous-changed wall of the periodontal pocket does not adhere well to the surface of the tooth root. This fact is confirmed in clinical periodontology.
To perform curettage, complete anesthesia in the area of the surgical field is required, compliance with the rules of asepsis and antisepsis, careful attitude to the operated tissues, protection blood clot and careful adherence to the rules of individual oral hygiene in the postoperative period (Krekshina V. E., 1973).
Curettage technique(closed, according to N. N. Znamensky) is as follows. After antiseptic treatment of the surgical field and local anesthesia, the tooth root is cleaned of supragingival and subgingival dental deposits and polished, and then granulations and strands of epithelium are removed from the walls and bottom of the periodontal pocket. To do this on outer surface A finger is placed in the gingival wall of the pocket and, using instruments (curettes), pathological granulations are removed “finger by finger”. If necessary, refresh the edge of the gums and alveolar process. Curettage is completed with antiseptic treatment of the surgical wound, hemostasis, tight pressing of the gum to the tooth and application of a gingival bandage.
Scheme of subgingival curettage according to A. A. Storm (1997):
a - deletion subgingival calculus; b — curettage of the wall of the gingival pocket; c — hypothetical result: attachment of the gum to the root of the tooth; d - restoration of the epithelium of the gingival sulcus and close adaptation of the gingival “muff” to the tooth root (probable result)
Curettage is carried out using a special set of tools, which includes excavators of various sizes and shapes, periodontal curettes, rasps, hooks, etc.
Upon completion of curettage, the periodontal space is filled with blood, due to which a blood clot is formed. It is the basis for the formation of connective tissue, the scar change of which provides the hypothetical result of the operation: attachment of the gum to the root of the tooth, or rather the restoration of the epithelium of the gingival sulcus with close adaptation of the gingival coupling to the root of the tooth (the probable result of the operation).
A number of specialists do not recommend inserting into the pocket before completing curettage. medicines so as not to disrupt the process of organizing connective tissue (Kuryakina N.V., Kutepova T.F., 2000). There is positive experience with the use of lyophilized powder of the animal polysaccharide honsuride in pockets before completing the curettage operation. Experience has shown that this drug not only does not disrupt, but also optimizes the process of tissue regeneration in the marginal periodontium by creating a depot of glycosaminoglycans necessary for the construction of connective tissue, and also provides sufficient anti-inflammatory and hemostatic effects.
Healing of the surgical wound after curettage occurs within a week. However, you should not probe the periodontal groove after curettage for up to 3-4 weeks. (the period of formation and maturation of fibrous structures in connective tissue, including collagen fibers).
The presented method of classical curettage according to N. N. Znamensky was improved by T. I. Lemetskaya (1981), who proposed the “open” curettage technique, which allows for improved visual control over the thorough cleansing of the tissues of the surgical field. Therefore, this technique is recommended to be performed when the depth of the periodontal pocket is 5 mm (mainly in the interdental space), the presence of proliferation of the gums and significant ingrowth of granulations into the periodontal pockets, leading to deformation and loose fit of the gingival papillae to the tooth (Tsepov L. M., Nikolaev A. I. ., 2002).
Methodology "open" curettage involves dissecting the tops of the interdental papillae in the area of several teeth with a scalpel or gum scissors, followed by blunt delamination of the interdental gum to the bottom of the pockets. After this, curettage is performed according to the described method. It should be emphasized that with “open” curettage, it is sometimes advisable and technically possible to perform de-epithelialization of flaps using gingival scissors and even partial (up to 1.5 mm) excision of the gum in cases of its proliferation while maintaining the scalloped gingival margin. Upon completion of the operation and thorough hemostasis, a gingival dressing is applied. There are reports on the advisability of suturing the buccal and lingual papillae of the interdental gum.
Contraindications for “open” curettage surgery include periodontal pockets with a depth of more than 5 mm, the presence of bone pockets, sharp thinning of the gums in the area of the intended intervention, as well as suppuration and abscess formation.
More radical removal of factors that support inflammation in periodontal tissues with “open” curettage reasonably guarantees longer remission inflammatory process. It seems that one should agree with the opinion of A.P. Bezrukova (1987) that the technique of “open” curettage is more correctly considered not as a modification of curettage, but as a type of flap operation.
It must be said that during curettage, in addition to the mechanical removal of dental complications, chemical agents are used to dissolve them. For this purpose, a 20% lactic acid solution or a 5% citric acid solution is currently usually used. The acid is injected into the periodontal pocket on a cotton pad or using a syringe under slight pressure. A number of foreign scientists believe that “chemical” curettage provides predictable, uniform removal inner wall pocket, no need for tissue anesthesia, reduced bleeding due to the hemostatic effect of the chemical. All this makes chemical curettage simple and accessible to use (Kenneth L., 1981; Ithal J. S., 1983). We also emphasize that the combined use of chemical and mechanical curettage techniques provides optimal conditions for organizing a blood clot and optimizing the regeneration of gingival sulcus tissue and their attachment to the cement surface of the tooth root.
Solutions of sulfuric, hydrochloric or trichloroacetic acid are not used for the purposes of chemical curettage due to their adverse effect on the surrounding periodontal tissue (Bezrukova A.P., 1987).
Known technique vacuum curettage, in which curettage of pathological periodontal pockets is carried out under vacuum conditions using special equipment. IN former USSR such a technique and equipment to ensure it were proposed by N. F. Danilevsky, A. P. Grokholsky and V. Ya. Datsenko (1968). The authors recommend performing vacuum curettage for periodontal pocket depths greater than 5-7 mm, single and multiple abscess formation. For better review surgical field, it is possible to perform a gingivotomy first.
Stages of vacuum curettage:
The authors specially designed hollow hooks for vacuum curettage and a compressor apparatus, which, when connected to the network in one of the containers, creates a vacuum in 3-5 seconds, capable of sucking out blood, mucus, plaque, tiny particles of tartar, granulations, etc. during the curettage operation. alveoli. At the same time, a low excess pressure is created in the second container, allowing the supply and irrigation of the surgical field with an antiseptic solution.
Vacuum curettage is simultaneously carried out on no more than 3-4 single-rooted or 2-3 multi-rooted teeth. After surgery, it is recommended to fill deep pockets with an emulsion or liquid paste with proteolytic enzymes, antibiotics, vitamins, etc.; followed by application of a hardening bandage for 2-3 days. (Danilevsky N.F. [et al.], 1968).
Found it practical application methodology cryocuretage(Danilevsky N.F., Proteven N.F., 1977) of periodontal pockets, which is recommended for pocket depths of 5-7 mm, abundant growths of granulation tissue, periodontal abscesses, as well as for symptomatic papillitis and hypertrophic gingivitis. Cryocuretage is contraindicated when the periodontal pocket depth is up to 3 mm and when the gingival wall is thinned.
Cryodevices make it possible to provide temperatures of up to 60-140 °C on the working part.
Stages of cryocuretage:
Note that cryoblowing techniques can be used in the treatment of papillitis, persistent hypertrophic gingivitis and increased desquamation of the epithelium of the oral mucosa.
Gingivectomy can be used using a physiosurgical treatment method, namely using laser surgery. The laser installation "Szhalpel-1", simultaneously with tissue dissection, provides a coagulation effect and asepticity of the wound surface, as well as the course of postoperative period without complications (Bezrukova A.P., 1987). The disadvantage of the Scalpel-1 installation, like all CO2 lasers operating at a wavelength of 10.6 microns and a power of 20-25 W, is the inability to use a fiber light guide.
IN recent years The use of pulsed radiation from a neodium-yttrium-aluminium-garnet laser with a wavelength of 1.064 microns, the energy of which can be transmitted through a 320-micron silicon fiber, has been tested. This allows this type of laser to be used in periodontology for tissue dissection when performing gingivoplasty, gingivectomy and other purposes. In addition, along with traditional methods laser radiation can remove subgingival dental plaque and effectively carry out the procedure of laser curettage (Guk A. S., 1998), which is indicated for the depth of periodontal pockets (PC) from 3 to 7 mm. To do this, a silicone light guide is inserted into the PC and simultaneously moved to the contours of the tooth root, trying to irradiate the epithelial lining of the pocket wall with cross movements, which ensures its evaporation. The light guide is then removed from the PC. In this case, anesthesia is usually not required, the operation is bloodless, and sometimes the existing hyperesthesia of the hard tissues of the tooth is eliminated, which allows the use of lasers for these purposes after surgical interventions on the periodontium (Myers T.D., 1991; Guk A.S., 2002).
Diathermocoagulation is widely used in the treatment of periodontal diseases - coagulation or curdling of tissue under the influence of currents. high frequency using devices DKS-2M, DKG-1, DK-3 and special electrodes in the form of a needle, scalpel, loop (Danilevsky N. F. [et al.], 1993). It is indicated for the destruction of overgrown epithelium and granulations of the periodontal pocket, enlarged interdental papillae, i.e., with hypertrophic gingivitis, gingival fibromatosis, periodontitis with pocket depths of more than 3 mm, and periodontal abscesses.
G. N. Varava (1974) proposed a bioactive method of diathermocoagulation for the treatment of periodontal diseases using the Electroknife and UDL-200 devices.
With a monoactive method of electrocoagulation of a periodontal pocket, an active electrode in the form of a needle is inserted to its entire depth, after which the device is turned on and the needle is moved in a co-directional manner vertical axis the tooth around it, avoiding touching the tooth, since the temperature of the tissue directly under the electrodes usually reaches 80-90 °C. The duration of tissue coagulation in one periodontal pocket at a current strength of 10-15 mA is 2-4 s. To avoid burns to the cement of the tooth root, it is recommended to cover the active electrode with an insulating varnish, leaving free a small part of the electrode in contact with the tissues to be coagulated (Danilevsky N. F. [et al.], 1993). For hypertrophic gingivitis, active electrodes in the form of a thin blade are used, with the help of which the gingival papillae are cut off from their base on the vestibular and lingual (palatal) side.
With the bioactive method (Varava G.N., 1974), the electrodes are placed on the sides of the operated tissue area at a distance of 1 cm from each other. This allows you to concentrate the high-frequency current lines between the electrodes and to ensure the required effect, you need to use less current than with the monoactive technique, reducing the risk of thermal effects on the tooth tissue.
Necrotic tissue is removed with an excavator or a small surgical spoon, the wound is washed with antiseptics and 1-2% tincture of iodine, and a non-hardening protective medical dressing with vitamins, hormones, enzymes, etc. is applied for 24-48 hours. The healing process is completed in 10- 14 days, sometimes with scar formation (Danilevsky N.F. [et al.], 1993).
A. I. Grudyanov et al. (1996) at surgical treatment periodontal diseases used high-frequency waves to destroy tissue cells, and A. S. Guk (1999) used various types lasers, including yttrium garnet laser.
"Diseases, injuries and tumors maxillofacial area"
edited by A.K. Iordanishvili
Open curettage of periodontal pockets is dental surgery, the main indication for which is to cleanse gum pockets. Normally, their size does not exceed 0.5 mm, and food that gets there can be removed by hygienic procedures.
At what degree of periodontitis is open curettage possible? Is it possible to independently determine the degree of periodontitis?
If the depth of periodontal pockets is more than 5 mm, it is approximately possible.
Is anesthesia required for open curettage?
Yes, definitely
Are there any breaks during the operation? (3 hours is a very long time, for example to make a call)
After intervention on 1 jaw, it is possible to take a break
Those. Do you need constant observation by a periodontist?
Yes, all the time, as long as you have teeth
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If their depth is more than 1-2 mm, food debris cannot leave the intergingival grooves without outside help. Gradually accumulating, they serve as an ideal place for further development microbes In this case, it is possible to completely clean the periodontal pockets only with the help of open curettage.
The operation begins with a vertical incision in the gum. Next, the specialist folds back the dental flap and cleans the pocket. To improve osteogenesis, special medications are placed in the surgical area, after which the gum is sutured.
The cost of this procedure is quite affordable and fully justifies itself. This is evidenced by numerous positive reviews patients left on our website dental clinic Roott in Moscow.
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Treatment with open curettage is recommended for cases of tooth mobility of 2-3 degrees, which is the result of a developed inflammatory process. If the pocket depth is less than 5 mm, closed curettage is possible, which is less traumatic and lower in price.
The most common indication for open curettage is periodontal disease (periodontitis, periodontal disease), in which part of the gum is peeled off from the tooth.
Inflammatory processes in the oral cavity, in particular gingivitis, are also a mandatory reason to consult a specialist. Doctors at our clinic will quickly and efficiently perform the procedure, regardless of the cause of the changes.
Avoiding the symptoms described above is easier than you think. It is enough to visit the dentist at least once every six months. A specialist can not only identify diseases on initial stages, but also take a number of measures to prevent the development of inflammation.
It is also necessary to regularly maintain oral hygiene and eat foods containing sufficient amounts of vitamins and minerals. Follow these simple rules and your smile will remain beautiful for many years.
