Closed curettage of periodontal pockets without gum incision. Indications and contraindications for the procedure. Innovative methods of conducting

Serious ailment periodontitis develops in many people who ignore regular and good hygiene oral cavity. The disease causes a lot of problems and complications, and some of them require curettage or patchwork operations on soft tissues. In this article, we will consider what kind of “curettage of teeth” procedure is, the need for it, all the pros and cons of the event.

Due to inadequate hygiene, hereditary factors, anatomical features or the patient's diet in the mouth appears a soft layer of microbial plaque, protein deposits, dark and hard stone. Actively multiplying in them, bacteria trigger inflammatory processes in the teeth and surrounding soft tissues.

The patient begins to complain of bleeding gums, gropes for swollen areas of soft tissues, touching which is accompanied by severe pain.

In case of absence effective treatment periodontal disease leads to tooth mobility, a change in their position and even loss, and inflammatory processes are characterized by the appearance of pus from under the gums, a general deterioration in the condition.

Curettage - cleaning periodontal pockets

Against the background of all these processes, the patient develops two critical conditions.

Surgical treatment in this case will clean the channels and granulation tissue, contributing to the improvement of 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, ultrasonic, hygienic, etc.). Even if you sign up for a stone and plaque removal procedure, the dentist will not physically be able to clean periodontal pockets using standard equipment. And if there are deposits, then inflammation remains, and further destruction of the bone and teeth.

Even if you managed to empty your pockets and suspend inflammatory process, anatomical changes remain in the body that contribute to regular relapses of periodontitis.

So, curettage of the periodontal pocket remains the only way guaranteeing a complete cure for the disease.

It promotes:

removal of voids filled with pathological contents;
cleansing the teeth from subgingival stones and deposits;
cleansing periodontium and bones from replacement tissue.

There are 2 methods of curettage: open and closed.

Closed technique

It is prescribed to remove subgingival microbial plaque, as well as granulation tissue from pockets.

The technique is effective only when the depth of voids does not exceed 3 mm(initial forms of periodontitis). If the disease has progressed to severe forms, private method will only help to stop the process.

This type is performed in clinics where there is no qualified periodontal surgeon. The operation is undertaken by dentists-therapists who do not have sufficient experience and qualifications to perform more complex manipulations (open curettage or patchwork operations on the gums).

Closed curettage

How is the procedure carried out? The nurse administers local conduction anesthesia and the doctor proceeds to clean the pockets with 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 saline based on sodium chloride. Then the doctor polishes the tooth roots.

After the event, the doctor recommends wearing special dressings (for example, stomalgin, zincoplast, dentol and others). Within 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 of them disappear, and the deep ones are reduced.

Open method

An open curettage of periodontal pockets is prescribed to eliminate inflammatory processes, remove subgingival deposits, and replacement tissue. This procedure also allows you to completely remove periodontal pockets and promotes the restoration of natural bone tissue, for which the doctor "plants" artificial material.

Before the operation, the doctor performs necessary training . Held professional cleaning the entire oral cavity from plaque, tartar and pus, teeth are splinted (if necessary), a course of therapy with antibiotics and anti-inflammatory drugs is prescribed.

At the appointed time, the patient is given local conduction anesthesia. The operation is performed on a specific area, including no more than 8 teeth.

Open curettage

An open procedure involves the periodontal surgeon exfoliating the mucous tissue of the gums.. To do this, the doctor performs small incisions in the area of the dental necks. The resulting flaps are taken away from the bone, exposing the dental roots and areas of destroyed bone. At this stage, the doctor fully sees all subgingival stones and plaque, as well as granulation tissue. He removes these pathological formations(including pockets) using surgical curettes. Modern clinics allow scraping replacement tissue and stones with an ultrasonic scaler. In the same way, a periodontal pocket can be removed (photo below).

Such an artificial material stimulates the restoration of its own tissue, which will significantly reduce the depth of the cavities.

Curettage by ultrasound

The last step is suturing in the area where the interdental papillae are located. Also, a special bandage is attached to the area, which protects the wound from infection and promotes tissue regeneration. The doctor removes the stitches after 10 days.

For several days after the operation, the patient is forbidden to perform standard hygiene procedures(cleansing with a toothbrush, interdental brush, floss, irrigator) in the intervention area. The specified area should be treated with a swab moistened with an antiseptic or anti-inflammatory agent.

A month later, the dentist conducts a control probing depth of bone pockets and may prescribe a second procedure.

Pros and cons of the procedure

Curettage has collected both positive and negative feedback doctors and their patients, which we will give below.

The closed technique has several advantages.: the doctor can remove deep subgingival deposits, clean the pockets from the pathological mass, which may help to reduce their volume.

Also, manipulations take little time, and rehabilitation is quite fast. In addition, the procedure is available for the middle strata of the population.

The operation also has many disadvantages:

it is not prescribed in case of moderate or severe periodontitis;
in 99% of cases causes relapse and progression of the disease;
the procedure is carried out blindly (the doctor does not see the depth of the pockets, the surface of the roots), so some pockets may not be completely cleaned, and deposits and granulations are not removed.

Regarding open gum curettage, then here good points much more: the doctor not only cleans the periodontal pocket, but also removes it, which allows you to stop periodontitis without the possibility of recurrence. The implantation of artificial tissue allows to reduce the depth of defects-voids in the bone, which will also eliminate tooth mobility.

Open curettage takes about 2 hours

The disadvantages of the technique, unfortunately, are:

the qualification of a periodontal surgeon must be high enough to perform a complex operation;
the procedure is expensive: the work of the surgeon and the nurse is paid, as well as consumables, which include expensive artificial bone and monofilament for suturing;
possible after the procedure unpleasant consequence- gingival prolapse, which leads to exposure of the tooth roots and related complications;
the gingival papillae become flatter for several months, which makes the interdental spaces deeper;
the operation takes enough time (about 2 hours) and requires rehabilitation (limited hygiene of the area, care with special anti-inflammatory drugs, soft food diet, etc.);
the event is ineffective in the presence of pathologies: thin gum tissue, deep pocket or large pocket volume, abnormal structure of the dentition, pocket festering, etc.

When choosing between 2 types of procedure, remember that only open curettage makes it possible to permanently stop the disease and try to restore the lost bone tissue.

Periodontal disease cannot be cured without tartar removal. The fact is that it is dental deposits that are the main source of pathogenic bacteria. They will infect the periodontium at once. Therefore, any treatment will be ineffective. The best way getting rid of hard dental deposits - curettage of periodontal pockets. What it is? This will be discussed in this article.

What is a periodontal pocket?

When there are a lot of dental deposits, they trigger inflammation in the gums. Because of this, the mechanism of destruction of periodontium and bone tissue is launched. As a result, a periodontal pocket is formed,

An experienced doctor just needs to look at the gum to determine the degree destruction periodontal. The deeper and wider the visible gap, the further the decay process has gone.

At severe forms pathology, the sockets of the teeth can collapse, which leads to the loss of the latter.

In the early stages, this pathology can only be detected using an x-ray.

The main symptoms of pathology

At first, the formation of a periodontal pocket does not manifest itself in any way. But the further the development of the disease goes, the sharper and more diverse the symptoms:

If any of these symptoms appear, the patient should immediately consult a dentist. Otherwise, the disease can lead to loss of teeth.

The main causes of the appearance of a periodontal pocket

As mentioned above, this disease appears due to the penetration of bacteria into the cervical region of the dental crown. Microbes form an invisible film with a simple eye on the surface of the enamel and begin to multiply actively. Their metabolic products provoke severe inflammation.

Microbial growth is accelerated by the following factors:

What are the consequences of pathology?

A periodontal pocket is not an easy tissue deformation. This is enough dangerous pathology which should 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, then he will go into a chronic form.

Periodontal pocket, among other things, very often causes mobility of the dentition. Loose teeth often cause severe pain. And sometimes they just fall out of the alveolar sockets.

Inflammatory process in the periodontium causes lymphadenitis and very often leads to general intoxication patient.

If the patient does not receive quality treatment, then the pathology big share likely to affect the jaw bones.

What is the treatment of periodontal pocket?

In the treatment of this pathology, both therapeutic and surgical methods treatment. Dentists resort to one method or another based on the neglect of the pathology and the results. analyzes.

At the very beginning of the development of pathology, it can be dealt with with the help of conservative treatment. It's about about hygienic cleaning teeth 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 without surgical intervention not enough.

Surgical treatments

All surgical methods for the treatment of 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 type curettage.

Currently more efficient there is simply no way to treat periodontal pockets. After it, the patient's periodontium is completely restored. It should be borne in mind that each method of treatment 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 makes it possible to more or less guarantee a complete cure for the patient. If the pocket is deeper, then the effect of this procedure will be temporary. Pretty soon, periodontitis will return with renewed vigor.

This procedure has several contraindications:

Pus is released from the periodontal pocket.
An abscess is suspected.
There are pockets in the bone tissue.
Thinning gum tissue.
Mobility of teeth of the 3rd degree.

Closed curettage of the periodontal pocket is carried out in several stages:

The doctor performs antiseptic treatment of the mouth. Then, he administers anesthesia with local anesthetics.
Using curettes and scalers, the doctor removes deposits from the surface of the tooth and darkened root cement. After that, the surface of the teeth is polished with a special tool.
Using an excavator or rasp, the doctor cleans out the contents of the periodontal pocket: granulations, epithelium, softened deposits.
The treated pocket is washed with an antiseptic and hemostatic drugs. It is very important to fix blood clot, blocking access to the holes of the teeth.
At the final stage, a protective bandage is applied.

After the curettage of the periodontal pocket to the patient for three days prohibited eat solid food.

Often, after closed curettage, the patient is faced with complications such as: pulpitis, bleeding, suppuration of the gums. This is not an indicator of the quality of the surgeon's work. About final results procedures can be said only after the formation of the scar. It won't happen until a few weeks later.

Because of its simplicity closed curettage often practiced in small dental clinics who cannot afford experienced periodontal surgeons. AT expensive clinics in the treatment of periodontal disease of moderate and severe always resort to open curettage.

This is a kind of closed procedure. Its main difference from the classic closed curettage is that during the operation the doctor uses curettes connected to a vacuum apparatus. This allows not only to scrape off deposits, but also to remove them immediately. This can significantly reduce the risk of complications. But this is the only plus of this method. Otherwise, it has the same disadvantages as the 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 more than 3 millimeters. Also, this procedure is carried out when a 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 be carried out in the following cases:

The depth of the pocket exceeds 5 mm.
The gums are too thin.
Necrotic processes are visible to the naked eye along the edge of the gums.
infectious diseases oral cavity.

The operation is preceded by a thorough preparation:

All surface deposits are removed from the teeth.
Therapy is carried out to relieve inflammation from the gums.
If there are indications, then groups of teeth are splinted.

Surgery is carried out under local anesthesia. At one time, the doctor treats an area that captures no more than 8 teeth.

Open curettage consists of the following steps:

Flap operation

This is a type of open curettage. Its main difference from the classical procedure is that in order to access the contents of the pocket, the surgeon creates a fully mobile flap. That is, the gum area is simply thrown aside. This allows you to see better bone pockets and surface of the roots of the teeth.

From the operation follows refuse, if:

Resorption is noted alveolar process down to the middle of the root of the tooth.
Resorption of bone tissue is detected in close proximity to a multi-rooted tooth
The patient has a serious somatic pathology.

Patchwork The operation is carried out in several stages:

The surgeon or his assistant performs the sanitation of the oral cavity and processes it antiseptic solutions. Local anesthesia is followed.
The doctor forms a flap and folds it back.
The surgeon completely removes all deposits from the surface of the tooth, dark cement from the root, and polishes their surfaces with special tools. After that, all granulation formations and excess epithelium are removed from the soft tissues.
The flap is applied in place and sutured. In this case, the edges of the flap are pulled up with suture material to the necks of the teeth.
The operation ends with the application of a protective bandage.

The main disadvantage of flap surgery is that it can provoke pathological tooth mobility and cause their necks to be exposed.

Conclusion

Closed and open curettage, as well as all varieties of these operations, have one common task - the removal of deposits and the elimination of periodontal pockets. Without these procedures, it is impossible to achieve stabilization of advanced periodontitis.

Gum disease is a fairly common problem in dentistry. Gingivitis, periodontitis are a concern for many patients, advanced cases require surgical intervention for effective treatment. The most common procedure is curettage of periodontal pockets.

The operation is a deep cleansing of the formed pockets, disinfection of cavities to prevent the re-formation of tartar. Curettage helps to speed up recovery, generally improve the condition of the oral cavity.

What is this procedure and why is it carried out

To fully understand why it is necessary to carry out curettage, you need to understand the reasons for the appearance, possible complications periodontitis. The disease is characterized by bleeding gums, further development inflammatory process, the result is tissue edema, suppuration, mobility of the dentition, their further displacement.

The root cause of the disease is poor sanitation of the oral cavity. As a result of the accumulation of a large number soft plaque, consisting of microbes, provokes the formation of tartar, which can no longer be cleaned off regular brush and pasta.

Hard deposits on the teeth are the root cause of periodontitis. The absence of any medical measures leads to the following complications:

bone atrophy. Due to the inflammatory process, the active life of pathogenic bacteria, the bone tissue begins to dissolve, it does not easily disappear, gradually turns into granulation formations. It is they who sharply negatively affect the deterioration of the situation;
formation of periodontal pockets. Under the influence of hard dental deposits, not only the bones are destroyed, but also the periodontium (microconnections between the root of the tooth and the bone). In periodontium, the cumulative effect negative factors on the gum tissue provokes the formation of gaps between it and the tooth (dentists call these formations periodontal pockets).

Read the page about the causes and methods of treatment of apical peri-implantitis.

When the formations between the tooth and the gum reach 3–4 mm, the process becomes irreversible. Granulation tissue is not amenable to treatment, it is removed exclusively by surgery. local, general therapy antibiotics, laser treatment cope with periodontal disease only at the beginning of its development, then curettage is used, There are several reasons for operations:

it is almost impossible to completely clean the periodontal gum canals; with the help of a laser, the doctor works blindly, removing only visible deposits. The remaining microorganisms continue their vital activity, resuming the inflammatory process. The process itself is costly, painstaking, inefficient in advanced cases, spending time on it, money is not rational;
the formation of deep periodontal pockets, even after their complete cleaning, anti-inflammatory therapy still remains an excellent environment for the development of bacteria. The oral cavity is constantly exposed external factors, it is impossible to completely exclude the ingress of pathogenic bacteria.

Based on all of the above, we can conclude: to cope with periodontitis completely, irrevocably is possible only with complete removal periodontal canals, granular tissue, all dental deposits. Curettage helps to cope with all problems in one operation.

Types of curettage

Subgingival deposits are removed in two ways: using open and closed curettage. Both operations are aimed at solving the same problem, but there are some differences, dentists use different techniques based on the clinical situation of each patient.

Closed

It is carried out in order to remove granulations, affected root cement, periodontal pockets. The procedure is indicated for mild to moderate periodontitis. Mandatory conditions: the depth of the gaps in the gum does not exceed 4 mm, the tissue has a dense structure. It is forbidden to carry out such manipulations if there is purulent discharge, suspicion of an abscess, depressions up to 5 mm. Fibrous changes tissues, tooth mobility of the third degree are also contraindications for closed curettage.

A significant disadvantage of the procedure is the lack of direct visibility, which increases the risk incomplete removal ingrown periodontal tissue, granulations. The technique of manipulation requires special skill and patience from the specialist. Removing pathological tissues blindly, the doctor must not damage healthy areas, completely eliminate pathogenic formations.

Open

The purpose of the manipulations is to excise the epithelium that has grown into the pocket, the affected areas of the teeth and gums. The technique allows you to cope with large granulations, pockets up to 5 mm deep, full fit of the gingival margin to the dentition.

It is forbidden to carry out open curettage during acute diseases in the oral cavity with infectious nature, necrotic formations of the gums, severe suppuration. It is also impossible to plunge the patient into surgery in this way with too thin gum tissues, depressions of more than 5 mm.

Preparation for the operation is serious, it requires powerful therapy with antibiotics, splinting of all groups of teeth (if necessary), and other important manipulations. Usually, 7-8 teeth are put in order in one approach, the whole procedure takes place under local anesthesia.

There is a third way to overcome the disease - to use a patchwork operation. The intervention technology is similar to open curettage, it is carried out in very advanced cases, the affected tissue is not only removed, but also stretched over the neck of the tooth. The process increases the effectiveness of surgical intervention, prevents the "omission" of the gum tissue.

Characteristic

To accept the right decision comparing the advantages and disadvantages of each type of manipulation will help.

Advantages of the open method:

low cost;
no need for a highly qualified doctor;
short duration of surgery;
easily tolerated.

Cons of open curettage:

it is used exclusively for periodontitis of mild, moderate severity;
low efficiency (in almost 99% of cases progression of the disease is observed).

The procedure is not popular, due to the almost complete uselessness, with its help, the patient's condition improves only for a while.

Advantages of closed curettage:

the only way to fully restore the chewing function, to achieve stabilization of the periodontium, to completely remove the formed pockets.

Disadvantages of flap surgery:

high price. The operation requires a decent payment for the doctor, nurses, Supplies;
required qualified specialist, not all clinics have experienced doctors;
there is a risk of exposure of the roots of the tooth, which causes significant aesthetic damage to the patient;
interdental papillae are eliminated, gingival tissue changes appearance;
the duration of the operation on teeth 7–8 is approximately two hours.

Advantages last method Obviously, it is better to walk with a healthy mouth, but a little modified, than to stay with a beautiful gum for a while, but soon periodontitis will return, bringing with it even more problems.

How to stop in a child? find out effective methods treatment.

In what cases is it necessary to panoramic shot teeth and what can be seen on it? Reply page.

See an overview of effective medicines from periodontitis.

Contraindications

It is forbidden to carry out any kind of procedures:

course of acute infectious diseases(flu, tonsillitis);
the presence of oncology;
blood diseases;
sharp allergic reactions for anesthesia, any other material that is used during the operation;
weakened immunity;
Availability diabetes, hepatitis, tuberculosis;
constant disregard for the rules of oral hygiene, occlusion pathology without the possibility of correction, destruction of bone tissue by more than half, tooth mobility of 3-4 degrees, the presence of ulcers.

Important! Only an experienced doctor determines the need for surgical intervention. Do not trust little-known clinics, amateur doctors. The operation requires high professionalism, a considerable amount, approach this issue seriously.

Classic operation

Until recently, periodontal pockets were an almost unsolvable problem. With the development of technology, doctors have come up with techniques to cope with severe form periodontitis. closed, open operation carried out according to classical technology, includes the following aspects:

disinfection of the operating field;
anesthesia of the operation site;
by using special devices solid deposits are crushed into fine dust;
procedures for collecting ground stones, plaque, precipitation on the roots of the tooth and other harmful substances are carried out;
the doctor polishes, grinds, levels the cured planes;
with the help of tools, the affected areas of tissues, waste products of microorganisms, spotting are removed;
complete disinfection of the oral cavity;
pressing the gum tissue to the base of the tooth, the maximum approximation of the tissues to healthy state periodontal.

During the procedure, the dentist gives Special attention normalization of blood circulation, removal of all injured tissues. After the operation, the doctor carefully monitors the patient, checks normal process tissue scarring, monitors general condition person.

If any complications occur, contact your doctor immediately repeated inflammatory process threatens total loss dentition.

Prevention of periodontal diseases

It is possible to avoid curettage, follow the rules of personal hygiene, if you find problems in the oral cavity, visit the dentist. Precisely because of untimely appeal to a specialist, letting periodontitis take its course, there is a need for surgical intervention.

Remember: any operation is a huge stress for the body, there is a risk of complications, other troubles, postoperative period does not please anyone. Be vigilant, take care of your health, avoid deplorable situations, a smile is the visiting card of any person!

Video. Technology of open curettage of periodontal pockets:

Periodontitis treatment methods: essence, features, reviews
This article was written by a periodontist with more than 20 years of experience.
Here you can find out:

the nature and characteristics of such a disease as periodontitis;
reasons why surgical treatment is necessary;
existing methods of surgical control of periodontitis;
advantages and disadvantages of the presented methods;
feedback from patients on the effectiveness of each type of operation;
the answer to the question, what is the best way to treat periodontitis.

For a complete understanding of the need surgical treatment periodontitis, it is necessary to consider the process of its occurrence.

Causes, features and consequences of periodontitis

If a person does not pay enough attention to oral hygiene, plaque can form on the teeth, as well as hard deposits - these are obvious factors in the development of periodontitis. Inflammation of the gums begins, and, at first, this manifests itself through their bleeding, and later the mobility of the teeth occurs, they can shift, pus can come out from under the gums.

Thus, initially soft plaque due to mineralization becomes tartar, the microorganisms of which produce toxins. These toxins induce an inflammatory process in the gums, which results in various adverse effects.

First, the bone tissue around the tooth begins to gradually dissolve. It does not just disappear, in its place there is another - granulation - tissue containing many microbes that also dissolve the bone. Thus, bone tissue atrophy occurs many times faster.
Secondly, periodontal pockets are formed. Inflammation causes the destruction of the attachment of the tooth to the bone (the so-called periodontium). With the help of periodontium, the tooth is securely attached to the bone tissue with microligaments.

As for the periodontal pocket, it is an area where the bone tissue is destroyed, and the cavity itself is filled with pus, granular tissue and dental deposits. In the people, the periodontal pocket is also called gingival or dental. Such a disease can be detected in a patient using an x-ray or by probing.

If, as a result of the examination, deep gum pockets(from 3-4 mm), then no therapy and antibiotics in this case are unable to help, since the process of destruction becomes irreversible.

There are several reasons for this.

Not even the most highly qualified specialist is able to give a 100% guarantee that with the introduction of an ultrasonic nozzle under the gum, all subgingival deposits will be removed. This is due to the fact that the doctor cannot see what exactly is happening in the gum pockets. Therefore, in almost all cases, there remains a lot of destructive deposits.
Moreover, such a procedure is very expensive and painstaking, it takes a lot of time, effort and money, and guarantees complete cure- No.
Even if we assume that subgingival deposits have been completely removed from the pocket, periodontitis will still progress, since there are all conditions for favorable development infections.

The only way out that can guarantee improvement is surgery. Only it can completely remove all deposits, granulation tissue and periodontal pockets.

Types of periodontitis treatment with surgery

There are three main methods of operations for this disease: open and closed curettage of gingival pockets and flap surgery. Consider the features of each of the methods in more detail.

Closed curettage of periodontal pockets

The purpose of closed curettage is to get rid of granulation in periodontal pockets, as well as subgingival dental deposits. But the technique has a significant drawback - during the curettage, there is no overview of the root surface and periodontal pockets, so granulations and deposits can remain in their original places, and in a considerable amount.

Effective this technique only if the patient has periodontal pockets up to 3 mm. it mild degree periodontitis. With more complex stages of the development of the disease, curettage can give only short-term relief, and in any case, the progression of periodontitis is inevitable.

As a rule, such operations are performed in clinics where there are no highly qualified periodontal surgeons and operations are performed by ordinary dentists.

It is worth saying a little about the specialty of a periodontist to make it clear how important such a specialist is in the treatment of periodontitis.
A periodontist is essentially a dentist who treats teeth, in most cases it is from periodontitis.

Also this specialist treats gingivitis. This disease is much less dangerous, but gives the "owner" a lot of problems. With gingivitis, the gum changes color and swells, bleeds, and pain(burning, itching, sore gums) and bad breath.

It is important to timely diagnose both periodontitis and less dangerous gingivitis. The periodontist conducts visual inspection and also uses special professional methods diagnostics. Thanks to them, he can timely identify the signs of an incipient disease and provide qualified assistance in a timely manner.

On the early stage gingivitis, the doctor removes plaque, cleans stones in the gum pockets and smoothes the surface of the tooth root.
On average or late stage there is a need for surgical intervention.

In general, a periodontist treats periodontal diseases, studies the periodontal tissues. In general, his work directly depends on the goal of the patient. Someone may need to check in preventive purposes and receive recommendations to help prevent the occurrence of diseases of the teeth and gums, observe proper hygiene oral cavity.

Other patients need complete diagnostics oral cavity, identifying the causes of periodontal disease and developing effective ways treatment and advice.

Be that as it may, a specialist periodontist is necessary in any highly qualified dental clinic, and in the event of a periodontal disease, one should contact this kind of doctor.

Open curettage of dental pockets

The purpose of open curettage is to get rid of granulation in periodontal pockets, subgingival dental deposits, elimination of gum pockets and stimulation of bone tissue regeneration by implanting synthetic tissue.

The operation is usually performed under local anesthesia. Before its start, a serious and careful preparation. Dental deposits are removed, anti-inflammatory therapy is carried out, etc. As a rule, one segment (7-8 teeth) is operated during one operation.

Consider the course of such an operation

Around the necessary tooth necks, the specialist makes an incision, after which the flaps of the mucous membrane of the gums exfoliate from the teeth. Thus, the root surface and bone defects become visible. The surgeon can now visually observe all pockets and subgingival deposits. Using ultrasound, it removes granulation tissue and all tartar. Then, the roots of the teeth and bone tissue are treated with an antiseptic and the grafting of synthetic bone tissue begins. This procedure is not able to completely restore the tissue, but it helps to significantly reduce the depth and width of the pockets.

A little should be said about synthetic bone tissue. It is an artificial raw material of a powdered form, completely replacing the bone. It is not dangerous for allergy sufferers because it is hypoallergenic.

After bone grafting, a periodontal surgeon in the area of interdental papillae sutures, then a bandage is also applied to the operated area. The sutures are removed after 10 days.

Flap operation

With regard to flap surgery, it helps to achieve the following goals: remove granulation tissue from under the gums, clean out subgingival dental deposits, remove gum pockets, and finally, stimulate bone regeneration by implanting its synthetic analogue. As you can see, these goals are fully consistent with the goals achieved with open curettage.

However, there are differences between these methods. It consists in the fact that during a patchwork operation, the incision is made 1-1.5 mm from the edge of the gums. In the future, this strip of gums is cut out, because being inflamed for a long time, the gum changes and loses its ability to fit snugly against the tooth surface. At the end of the procedure, the flaps of the gingival mucosa are stretched to the tooth necks. This "tension" helps to prevent the "drooping" of the gums.

Flap operations are used both for generalized periodontitis and for the purpose of closing the gingival prolapse in the area of 1-2 teeth and exposing the roots.

We offer for consideration the feedback of patients after testing by them different methods surgical interventions.

Review of closed curettage

This procedure is very short-lived, it is tolerated without special problems. For such an operation, an experienced periodontist surgeon is not needed, a regular dentist or periodontist will do. Moreover, in terms of price, this is the cheapest of all the presented methods of surgical treatment. And perhaps these are the only advantages of closed curettage.

There are more cons.

First, the operation can only help with mild stage periodontitis. The presence of deep periodontal pockets, i.e. with moderate and severe periodontitis, closed curettage is ineffective. You can also say with almost 100% certainty that the disease will certainly develop after such an operation.

Feedback on open curettage and flap surgery

The indisputable advantage of these methods is that they are the only way to destroy gum pockets and stabilize periodontitis. In addition, such operations reduce bone tissue atrophy by replanting its synthetic analogue. This helps to partially cope with the mobility of the teeth.

It is important to say about the disadvantages that are present in most surgical interventions.
Firstly, to carry out such operations, a special specialist is needed - a periodontist-chiropractor, who can currently not be found in every dental clinic.

Secondly, the prices for these operations "bite", and this is not an exaggeration. The patient must pay, in addition to the work of the doctor, his assistant or nurse, also the purchase of expensive materials (monofilament - suture material, synthetic bone tissue others).

During the operation, when the doctor removes granulation tissue and inflamed gums, there is a risk of gingival recession (that is, the gum, as it were, "falls", exposing the roots). The scale of such exposure of the roots fully depends on the size of the bone tissue atrophy.

In addition, a few months after the operation, the gingival papillae are flattened and cannot fill the entire interdental space. And only after a long time period they accept their former form eliminating cavities between teeth.
Finally, the last disadvantage of such operations is the duration of their implementation. Working with one segment (7-8 teeth) takes about 2 hours.

The choice of method of surgical treatment of periodontal disease

As can be seen from the presented article and from the reviews of the operated patients, each method of surgical intervention has advantages and disadvantages. On the initial stage The development of periodontitis can be helped by closed curettage, but such an operation is ineffective and its result is short-lived - in the future, it will need to be repeated repeatedly.

For moderate and severe periodontal disease, it is better to choose other methods. The most reliable and viable option can be called patchwork surgery and open curettage, since only they are able to cope with the middle and severe stages of periodontitis, while guaranteeing the cessation of the progression of the disease in the future.

In any case, it is not worth neglecting examination and treatment in specialized clinics, since dental health is a very valuable gift, which must be preserved in adulthood succeeds not for everyone.

The cost of curettage of periodontal pockets

Closed curettage of a periodontal pocket in the area of one tooth 1210 rubles
Open curettage of a periodontal pocket in the area of one tooth 2680 rubles

From this article you will learn:

surgical methods for the treatment of periodontitis - reviews of dentists,
flap surgery, curettage of periodontal pockets - price 2019.

The article was written by a periodontal surgeon with more than 19 years of experience.

Why do you need to do curettage?

To understand why you need to do curettage or flap surgery, you need to go a little deeper into the details of the development and course of periodontitis. Periodontitis develops against the background of poor oral hygiene, the presence of a large amount of soft microbial plaque and hard dental deposits. The latter trigger an inflammatory process in the gum, which first manifests itself as bleeding when brushing the teeth, pain and swelling of the gums, and later these symptoms are also accompanied by tooth mobility, their displacement, suppuration from under the gums, etc.

So, in the dentogingival sulcus, it turns into a hard tartar, which is very tightly attached to the surface of the neck of the tooth (Fig. 1.2). Tartar microorganisms produce toxins that trigger inflammation in the gums.

In the process of inflammation occurs:

Bone atrophy around the tooth –
those. the bone begins to gradually dissolve. Compare the level of bone tissue in relation to the roots of teeth in a person without concomitant periodontitis (X-ray 3a) and in a person with periodontitis medium degree severity (X-ray 3b). The distance between "a" and "b" is the level of complete destruction of the bone tissue, which can be seen from the absence of bone trabeculae in this area.
Moreover, it should be noted that bone tissue does not easily disappear without a trace, but is replaced by the so-called granulation tissue, which contains a large number of microbial cells, bone resorbing cells (osteoclasts), etc. The appearance of granulation tissue contributes to an even faster subsequent destruction of the bone.
Formation of periodontal pockets –
under the influence of inflammation caused by dental deposits, not only the bone is destroyed, but also the periodontal attachment of the tooth to the bone (Periodont). Periodontium is such microligaments between the root of the tooth and the bone, with the help of which the tooth is securely attached to the bone tissue.
In Figure 4, you can see the differences between diseases such as Gingivitis (in which there is no bone destruction, there are no periodontal pockets) and Periodontitis (in which there is active destruction of the bone and the formation of periodontal pockets). With periodontitis, the cumulative destruction of bone tissue and periodontal ligaments leads to the formation of periodontal pockets (Fig. 4).
A periodontal pocket is such an area, to the width and depth of which the bone tissue has been destroyed, there is no attachment of the gum to the surface of the root of the tooth, and the defect itself is filled with granulation tissue, dental deposits, and pus. Patients often refer to periodontal pockets as dental pockets, gum pockets, or gum pockets. Such gingival pockets can be identified by probing with special periodontal probes, or radiographically.
In Figures 4-6 you can see the clinical situation in one patient regarding a deep periodontal pocket in the interdental space between the canine and premolar:
→ in Fig. 4 you can see that the periodontal probe penetrates under the gum by 5-6 mm, at a rate of 1-2 mm.
→ Figure 5 shows a radiograph of this tooth. It shows that there is a bone defect. Destruction of bone tissue radiographically manifests itself in the form of darkening (indicated by black arrows).
→ Figure 6 shows a view of a bone defect in the process of gingival detachment. The granulation tissue from the periodontal pocket has already been practically removed and hard tartar on the root surface is clearly visible, which caused the destruction of the bone and the formation of the periodontal pocket.

Surgical treatment of periodontal disease as opposed to therapeutic treatment allows:

So, when deep periodontal pockets from 3-4 mm were formed, there was a partial replacement of bone tissue with granulation tissue - the process essentially becomes irreversible, despite any local and general anti-inflammatory therapy, treatment with antibiotics, laser, removal of dental plaque, etc. d. Why?

Firstly- it is almost impossible to completely remove dental deposits from deep periodontal pockets. The fact is that the doctor inserts the ultrasonic nozzle under the gum “blindly”, i.e. he makes movements without seeing what exactly is happening in the periodontal pockets. Therefore, as a rule, a large amount of subgingival deposits remain, which continue to have a destructive effect.
In addition, the removal of subgingival dental deposits is an extremely painstaking, long process, and the patient will never know if something remains there. Therefore, in the conditions of a paid commercial reception, it is not very profitable to spend precious time looking for small subgingival pebbles.
Secondly- if deep periodontal pockets have formed, then in them, even after the removal of dental plaque and anti-inflammatory therapy, conditions are created for the development of infection and the further progression of periodontitis.
Therefore, the only way to treat periodontitis that guarantees improvement is one that will eliminate:
→ periodontal pockets,
→ remove all subgingival deposits,
→ remove the granulation tissue that replaced the resorbed bone.
This can only be done using surgical methods for the treatment of periodontitis.

Surgical methods for the treatment of periodontal diseases

There are several methods surgical interventions with periodontitis:

curettage of periodontal pockets - "open" and "closed".
patchwork operations.

1. Closed curettage of periodontal pockets -

The purpose of the operation: to remove granulation from periodontal pockets, subgingival dental deposits. Disadvantages of the technique: curettage is carried out blindly, there is no visual review of the surface of the roots, periodontal pockets, which is why both granulation and dental deposits massively remain in their places.

Closed curettage can be more or less effective only for shallow periodontal pockets up to 3 mm, i.e. most mild degree periodontitis. With periodontitis of moderate and severe degree, closed curettage (due to a temporary decrease in the mass of granulations) can only temporarily improve the condition of the gums, but this phenomenon will only be short-term, and periodontitis will definitely progress further. In Fig.7 (a,b) you can see the instruments used for closed curettage.

This type of curettage is popular in dental clinics that do not have an experienced periodontist surgeon, and therefore the operation is performed by a regular dentist or even a periodontist. These specialists have neither the skills nor the experience to perform complex surgical interventions in the oral cavity, which include open curettage and patchwork operations.

2. Open curettage of periodontal pockets -

The purpose of the operation: remove all subgingival dental deposits, remove inflammatory granulation tissue from under the gums, eliminate periodontal pockets, stimulate the restoration of bone tissue with the help of "replanting" synthetic bone tissue.

Thorough preparation must be carried out before the start of the operation -

After removal of granulation tissue, antiseptic treatment the surface of the roots of the teeth and bone tissue - a synthetic bone is “planted” into deep bone pockets (Fig. 10). This is necessary for the restoration of bone tissue. Naturally, it is impossible to restore it in full, but it is quite possible to reduce bone pockets.
In Fig.11 (a, b) you can see x-rays BEFORE and 3 months AFTER surgery. On a radiograph taken a few months after the operation (Fig. 11b), one can easily see an increase in bone mass in the periodontal pocket.
Suturing. Sutures are placed in the area of the interdental papillae (Fig. 12). At the end of the operation, a gum bandage is also applied, which will protect the area of the operation and promote faster healing. The stitches are removed 10 days after the operation.

3. Flap surgery for periodontitis -

The difference is that the incision during flap surgery is made 1-1.5 mm from the edge of the gums. This thin 1.5 mm gum line is further removed. This is done because with prolonged inflammation, the marginal gum changes in such a way that it can never fit snugly against the surface of the teeth, and therefore it must be removed. Since the mucosal flaps are mobile, at the end of the operation they are stretched to the necks of the teeth, which in most cases prevents the “dropping” of the gums.

There are methods of patchwork operations not only for generalized periodontitis, but also to, for example, close gum recession. Recession is the omission of the gums in the area of 1-2 teeth, accompanied by exposure of the roots.

Curettage of periodontal pockets: price 2019

How much does curettage of periodontal pockets cost - the price for 2019 in Moscow will be depending on the type of technique, as well as the cost of the materials used (primarily bone material).

closed curettage of periodontal pockets - the price for 1 tooth will be from 500 rubles.
open curettage of pockets - the price for 1 tooth will be from 1500 rubles.
patchwork operation - the price for 1 tooth is from 2500 rubles, and a segment of 6-8 teeth - from 10,000 rubles.

This cost, as a rule, does not include the price of bone material. Can be used as high-quality expensive bone material Bio-Oss (Switzerland) - 6500 rubles. for a package of 0.5 g, and costing several times cheaper Russian drugs such as Kolapol and Kollapan.

Curettage, patchwork operation: reviews

Briefly summarize, patient reviews after different types interventions.

Closed curettage –
it is worth doing only with the initial form of periodontitis, when there are only shallow periodontal pockets up to 2-3 mm. With moderate and severe periodontitis, in the presence of deep periodontal pockets, it is absolutely ineffective. However, the operation takes little time, is easily tolerated, does not require a highly qualified doctor (usually dentists who do not have the skills of major operations like to do it), and is relatively inexpensive. This is the only positives.

Open curettage and flap surgery –
Pluses - these are the only techniques that allow you to eliminate periodontal pockets and achieve stabilization of periodontitis, as well as reduce the amount of bone tissue atrophy due to bone tissue grafting (which can also reduce tooth mobility). Therefore, if you want to chew with your own teeth as long as possible, then the choice of the operation method is obvious.

Minuses -

Requires a highly qualified doctor, should only be performed by dental surgeons with a specialization in periodontics.
Operations are expensive: they require not only the payment of a doctor, a nurse, but also the purchase of expensive consumables, such as synthetic bone tissue, expensive suture material (it must be monofilament), etc.
Removal of inflammatory granulation tissue and inflamed gingiva may be accompanied by gingival “drooping” (i.e. root exposure). The amount of root exposure will directly depend on the initial amount of bone tissue atrophy.
Also, after the operation, the appearance of the gingival papillae temporarily changes, which are flattened and do not occupy the entire space between the teeth. After a few months, the gingival papillae return to their normal shape and the interdental spaces are thus eliminated.
The operation is long in time: a segment of 7-8 teeth takes about 2 hours.

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