|Year : 2020 | Volume
| Issue : 4 | Page : 204-208
Comparative evaluation of gingival response following the placement of light-cured dressing and noneugenol dressing after periodontal flap surgery: A clinical study
Saransh Srivastava1, Priyanka Tandon2, Himani Sharma1, Stuti Gupta1
1 Department of Periodontology, School of Dental Sciences, Sharda University, Greater Noida, Uttar Pradesh, India
2 Department of Periodontology, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India
|Date of Submission||18-Mar-2020|
|Date of Decision||10-Aug-2020|
|Date of Acceptance||26-Jul-2020|
|Date of Web Publication||13-Oct-2020|
C-Block, House No-608, Sarojini Nagar, New Delhi - 110 023
Source of Support: None, Conflict of Interest: None
Aim: The aim of the study was to compare light-cured dressing with most widely used noneugenol pack in the perspective of esthetics, acceptance, and healing following periodontal flap surgery. Materials and Methods: Fifty-eight patients suffering from generalized chronic periodontitis, requiring periodontal flap surgery on contralateral sides of the arch, were selected and divided randomly into Group I (control) and Group II (test). In Group I, a noneugenol dressing and in Group II light-cured dressing were applied after flap surgery. Clinical parameters such as debris index, plaque index, and modified gingival index were recorded at baseline (day 0) and 10 days postoperatively (after removal of the dressing). The data were collected and statistically analyzed. Results: Group II showed better results than Group I when debris index, plaque index, and modified gingival index scores were compared though the differences were not statistically significant. Patients found no unpleasant taste/smell and perceived the light-cured dressing to be better. Conclusion: The noneugenol dressing retained more plaque on its undersurface than light-cure dressing. However, this did not have much influence on the healing outcome and clinical gingival parameters, which were optimal and comparable in both groups. The greater number of patients showed a preference for light-cure dressing, based on its superior esthetics and taste.
Keywords: Barricaid, Coe-Pak, periodontal dressing
|How to cite this article:|
Srivastava S, Tandon P, Sharma H, Gupta S. Comparative evaluation of gingival response following the placement of light-cured dressing and noneugenol dressing after periodontal flap surgery: A clinical study. Indian J Dent Sci 2020;12:204-8
|How to cite this URL:|
Srivastava S, Tandon P, Sharma H, Gupta S. Comparative evaluation of gingival response following the placement of light-cured dressing and noneugenol dressing after periodontal flap surgery: A clinical study. Indian J Dent Sci [serial online] 2020 [cited 2021 Jun 20];12:204-8. Available from: http://www.ijds.in/text.asp?2020/12/4/204/298031
| Introduction|| |
Wound healing is a complex and dynamic process of restoring cellular structures and tissue layers. This biologic process can be broadly divided into three distinct phases, i.e., inflammatory, proliferative, and remodeling. Within these three phases, a complex and coordinated series of events takes place. The culmination of wound healing results in the restoration of normal structure and formation of the injured tissue.
A surgical dressing allows for uninterrupted healing to occur and also contributes to the protection of the surgical area and prevention of wound damage and infection. The first surgical dressing was patented by Lesher and Wareham in 1953.
Surgical dressing is also utilized after periodontal surgical procedures. These dressings are applied around the necks of the teeth and adjacent tissue to cover and protect the surgical wound after periodontal surgery. They are applied to serve as a bandage over the surgical site with the objective of holding the flap in place; protecting newly formed tissue; minimizing postoperative pain, infection, and hemorrhage; protecting the surgical site from trauma during eating and drinking; and finally, supporting mobile teeth during the healing process.
Types of periodontal dressings
Periodontal dressings are generally grouped into three categories: (i) zinc oxide and eugenol dressings, (ii) noneugenol dressings, and (iii) those containing neither zinc oxide nor eugenol.
Coe-Pak™ is one of the most widely used dressings today and offers a standard to which new dressings can be compared. It has two components, i.e., accelerator and base, and it also contains bacteriostatic agents. Apart from having the effects common to all periodontal dressings, it is free from tissue irritating properties of eugenol dressings. It is known to possess good adhesive properties and adapts closely to the teeth and soft tissue, preventing detachment of postsurgical flap from the root surface. Coe-Pak™ has a number of disadvantages such as poor appearance, ill-defined setting time, and poor flow properties during manipulation. Its bulky in nature and poor esthetics have always been a concern for patients after surgery.
Visible light-cured periodontal dressing material, commercially available as Barricaid® (DENTSPLY International Inc., Milford, DE, USA), based on polyether urethane dimethacrylate resin is stated to be an advanced concept in the protection of periodontal wound sites. Its superior physical properties such as easy manipulation, better surface smoothness, interdental retention, and translucent pink color have been claimed to favor its clinical application. Due to these superior properties, this material is gaining wide popularity among periodontists and patients.
The aim of this study was to compare gingival tissue response following placement of a light cure and a noneugenol periodontal dressing after periodontal flap procedure.
| Materials and Methods|| |
A total number of 58 patients having chronic periodontitis requiring periodontal flap surgery were selected for this study from the outpatient department of periodontology. The study was approved by the institutional ethical committee before the commencement of the study. All the patients were explained about the procedure, and an informed consent was obtained from every patient. The sites were randomly divided into two groups:
- Group I was applied with Coe-Pak postoperatively [Figure 1]
- Group II was applied with Barricaid postoperatively [Figure 2].
|Figure 2: Barricaid visible light cure periodontal wound dressing (Dentsply)|
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The participants were selected on the basis of following inclusion criteria: (1) age group of 20–55 years of either sex, (2) systemically healthy and cooperative participants, (3) similar periodontal involvement bilaterally as determined by the clinical and radiographic assessment, (4) probing pocket depth of ≤6 mm, and (5) the presence of bilateral horizontal bone loss as determined by orthopantomograph.
The exclusion criteria were: (1) participants hypersensitive to polyacrylic acid, (2) smokers and tobacco chewers, (3) pregnant or lactating women and those using oral contraceptive pills, (4) participants on antibiotics or anti-inflammatory drugs in the past 3 months, (5) participants with a history of any gingival and/or periodontal surgical treatment in the past 6 months, and (6) patients with hematological disorders.
Presurgical and surgical procedure
Both the groups received a full diagnostic workup that included clinical examination and case history recording. Phase I therapy was performed for all the patients. At day 0 (baseline), both groups were subjected to the recording debris index (OHI, Greene and Vermillion, 1960), plaque index (Silness and Loe, 1964), and modified gingival index (Lobene RR, 1986).
In Group I [Figure 3], following sulcular incisions, a full-thickness mucoperiosteal flap was reflected both facially and lingually. After thorough debridement and root planing of the exposed root surface, the flap was placed in its original position and sutured using nonresorbable silk thread. The surgical site was dried using gauze, and Coe-Pak was then applied [Figure 4]. A similar surgical procedure was adopted on the contralateral side, and photocured dressing (Barricaid) was applied thereafter in Group II.
Application of photocured dressing
The photocured dressing was dispensed at the juncture of the cervical one-third of the teeth and the margin of the surgical site on the facial aspect. It was exposed to a visible light-curing unit for 10 s per site per tooth until the entire dressing was cured. Occlusal clearance over the dressing coverage was checked before dismissing the patient [Figure 5] and [Figure 6].
Data were summarized as mean ± standard deviation (SD). Groups were compared by independent student's t-test. A two-tailed P < 0.05 (P < 0.05) was considered statistically significant.
| Results|| |
The mean increase in the debris index score of Group I was 2.60 ± 0.57, whereas in Group II, it was 1.70 ± 0.67 [Table 1]. The debris index score of two groups showed a significant difference and lower (34.6%) debris index score of Group II as compared to Group I [Graph 1].
|Table 1: Debris index score (mean±standard deviation, n=10) of two groups|
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The mean increase in plaque index score of Group I was 1.87 ± 0.22, whereas in Group II, it was 1.19 ± 0.39 [Table 2]. Comparing the mean of both groups, it showed a significant difference and lower (36.7%) plaque index score of Group II as compared to Group I [Graph 2].
|Table 2: Plaque index score (mean±standard deviation, n=10) of two groups|
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Modified gingival index
The mean increase in modified gingival index score of Group I was 1.83 ± 0.10, whereas in Group II, it was 1.28 ± 0.28 [Table 3]. Comparing the mean modified gingival index score of two groups, the result suggested a significant difference and lower (30.0%) modified gingival index score of Group II as compared to Group I [Graph 3].
|Table 3: Modified gingival index score (mean±standard deviation, n=10) of two groups|
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| Discussion|| |
The rationale for the use of periodontal dressings has always been debatable as their effects on periodontal wound healing have been questioned over the years, and they are said to be associated with more plaque accumulation when compared to no dressing. The effect of various dressings on wound healing, the amount of plaque accumulation beneath dressings, their biocompatibility with postsurgical tissue are the most important parameters, based on which these materials can be critically assessed and a preference established.
Hence, a randomized split-mouth study was conducted to compare the tissue response and patient acceptability for this periodontal dressing as compared to Coe-Pak in chronic generalized periodontitis patients. A split-mouth study was used to allow each patient to act as their own control. Random allocation reduced the risk of bias to the selection of periodontal dressing.
To evaluate the effect of periodontal dressing on patient oral hygiene performance and more plaque retention, plaque index was recorded at baseline and after 8 days. In each group, there was a significant change in plaque index from baseline to 8th day; however, after 8th days, absolute change in plaque score in Group II was slightly less as compared to Group I, which was not statistically significant [Table 2]. An increase in plaque score was due to increased plaque accumulation beneath the periodontal dressings, which can be attributed to difficulty in maintaining oral hygiene postsurgically.
A modified gingival index was recorded to evaluate the healing response of the tissue after application of periodontal dressings. Both groups show intragroup significant increase of MGI after 8 days, which might be related to inflammatory response after periodontal flap surgery [Table 3]. No ulceration, erythema, or any untoward reaction was observed in either of the groups.
The debris index by Greene and Vermillion (1960) was assessed pre- and post-operatively, and an increase was noted. On comparing, the mean increase in Group II (Barricaid) was found to be slightly less in comparison with Group I (Coe-Pak) due to better retentive properties of Barricaid [Table 1].
The presence of silk suture within the tissue may act as foreign material that can lead to provoked tissue reaction and also lead to trauma during suturing and increase in plaque accumulation at the surgical site.
Another important consideration is the preference of the operator in terms of handling, manipulation, and the working time of each dressing. Light-cure dressing includes a single paste, therefore eliminating the time required for mixing as with noneugenol pack. However, direct application technique by syringe could also raise issues of cross infection, unless the syringe is discarded after every surgery. Light-cure dressing has the advantage of total control over the placement and setting time as well as incremental additions, whereas setting time of noneugenol dressing is fixed, limiting the working time. While manipulation, both of these dressings need to be handled with moistened gloves; however, after complete setting, light-cured dressing has an advantage of being firm in consistency, whereas noneugenol dressings become brittle.
The translucency of Barricaid® allows for superior esthetics as well as monitoring of surgical site without removal of dressing. As far as cost-effectiveness is concerned, noneugenol dressing is a more economically viable option. Therefore, both the clinician's personal preference and the patient acceptance are important while deciding the periodontal dressing of choice for specific clinical situations. The clinical performance of both the dressings in terms of healing, plaque, and bleeding scores was found to be acceptable.
The microbial analysis would clarify the nature of plaque under each dressing.
| Conclusion|| |
The present study concluded that visible light-cured periodontal dressing, Barricaid, is esthetically pleasing, easily applied, and offers a perfect color match with no unpleasant taste or smell. It is biocompatible and offers good retentivity, and only a thin layer is required to be applied. However, the higher cost of dressing is a mere illusion, and it does not limit its application in clinical practice. Although noneugenol dressing retained more plaque on its undersurface than light-cure dressing, this did not have much influence on the healing outcome. A greater number of patients showed a preference for light-cure dressing, based on its superior esthetics.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Lesher EP. Wareham, MA. Surgical Dressing. US Patent 2632443. Filing Date April, 18 1949. Issue Date March 24, 1953.
Zwemer TJ. Boucher's Clinical Dental Terminology. 4th
ed.. St. Louis, MO: Mosby; 1993. p. 218.
Kakar A, Lamba AK, Tandon S, Faraz F, Ahad A. Gingival tissue response following placement of a light cure dressing and a non-eugenol dressing after periodontal flap procedure: A comparative clinical study. J Nat Sci Biol Med 2018;9:65-71.
Watts TL, Combe EC. Rheological aspects of non-eugenol periodontal dressing materials. J Oral Rehabil 1982;9:291-300.
Wikesjö UM, Nilvéus RE, Selvig KA. Significance of early healing events on periodontal repair: A review. J Periodontol 1992;63:158-65.
Watts TL, Bertenshaw BW, Combe EC. Initial physical tests of aluminoborate cements in the context of periodontal dressing development. J Oral Rehabil 1983;10:393-8.
Nalmas S, Prakash S, Mehta DS. Periodontal dressings in periodontal therapy – An update. J Indian Dent Assoc 2000;71:174-9.
Sachs HA, Farnoush A, Checchi L, Joseph CE. Current status of periodontal dressings. J Periodontol 1984;55:689-96.
Madan E, Bharti V, Chaubey KK, Vipin KR, Thakur RK, Nirwal A. Light-cured resin “Barricaid”-An aestheticand biocompatible dressing: A step ahead. J Indian Soc Periodontol 2013;17:753-6.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
[Table 1], [Table 2], [Table 3]