Laser curettage of periodontal pockets. Curettage - instrumental cleaning of gum pockets. Development of the pathological process

CURETTAGE

The task of curettage is the elimination of periodontal pockets due to the formation of a scar. To do this, it is necessary to remove dental deposits, granulation tissue, the epithelium of the inner surface of the gums. As a result of the formation of a blood clot, cicatricial wrinkling of the periodontal pocket occurs.

When performing curettage, the following requirements must be observed:

Complete anesthesia of the operated area;

Careful attitude to the processed fabrics;

Compliance with the rules of hygiene in the postoperative period;

Protection of the blood clot.

When performing curettage, sterile sharp commensurate instruments are used: scalers, curettes, etc. The operation can be performed simultaneously on half of the jaw.

According to Nikitina T.V. and Danilevsky N.F. in the literature, simple and subgingival curettage are distinguished.

Simple curettage is limited to the circular epithelium and is carried out within the periodontal junction in the absence of a periodontal pocket. With subgingival curettage, periodontal pockets are eliminated or reduced.

A. A. Storm points out that according to the US Dictionary of Special Terms, the term "scaling" is defined as "instrumental processing of the surface of the crown and root of the tooth to remove plaque, calculus, stains."

The term "periodontal debridement" is considered an alternative to the terms "scaling" and "root planning". The decisive difference between these procedures is the different treatment of the root. While scaling does not consider cement removal necessary, and sometimes even undesirable, to achieve periodontal health, rootplaning is the primary concern.

Curettage in the classical sense (curettage of the contents of the 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. A contraindication 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 with fibrous gums, explaining this by the fact that the fibrous-modified wall of the periodontal pocket adheres poorly to the surface of the tooth root.

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 the epithelium are removed from the walls and bottom of the periodontal pocket. To do this, a finger is placed on the outer surface of the gingival wall of the pocket and, with the help of instruments (curettes), pathological granulations are removed “along the finger”. If necessary, refresh the edge of the gums and the alveolar process. The curettage is completed with antiseptic treatment of the surgical wound, hemostasis, tight pressing of the gum to the tooth and the application of a gum bandage.

Scheme of subgingival curettage according to A. A. Storm (1997):

a - removal of 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 "coupling" to the root of the tooth (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 the 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, with scarring of which a hypothetical result of the operation is provided: attachment of the gum to the root of the tooth, or rather, restoration of the epithelium of the gingival sulcus with close adaptation of the gingival sleeve to the root of the tooth (probable result of the operation).

A number of specialists do not recommend introducing drugs into the pocket before completing curettage, so as not to disrupt the process of organizing connective tissue. There is a positive experience with the use of lyophilized powder of animal polysaccharide chonsuride in pockets before completion of 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 building connective tissue, and also provides sufficient anti-inflammatory and hemostatic effects.

Healing of the surgical wound after curettage occurs within a week. However, probing of the gingival groove should not be carried out after curettage for up to 3-4 weeks. (the period of formation and maturation of fibrous structures in the connective tissue, including collagen fibers).

However, closed curettage in the 90s. of the last century, the conciliation commission of periodontists in the United States was recognized as irrelevant on the basis of long-term multicenter randomized studies. Due to the fact that this manipulation is carried out with curettes (such as the Gracie curette), the effectiveness of which does not exceed 5 mm, the indications for this event are limited to a periodontal pocket up to 4 mm. However, with the normalization of oral hygiene and adequate removal of dental deposits, a periodontal pocket of such a depth completely eliminates itself. Thus, the method of curettage is part of the manipulation in cases with a deeper lesion of periodontal structures.

The presented technique of classical curettage according to N. N. Znamensky was improved by T. I. Lemetskaya, who proposed the technique of “open” curettage, which improves visual control over the thoroughness of cleaning the tissues of the surgical field. This technique is recommended to be performed with a periodontal pocket depth of 5 mm (mainly in the interdental space), the presence of gingival proliferation and significant ingrowth of granulations into periodontal pockets, leading to deformation and loose fit of the gingival papillae to the tooth.

The method of "open" curettage involves dissection of the tops of the interdental papillae in the region of several teeth with a scalpel or gingival scissors, followed by blunt delamination of the interdental gingiva to the bottom of the pockets. After that, curettage is carried out according to the described method. It should be emphasized that with “open” curettage, it is sometimes expedient and technically possible to perform de-epithelialization of the flaps with gingival scissors and even partial (up to 1.5 mm) excision of the gingiva in cases of its proliferation while maintaining the scalloped gingival margin. At the end of the operation and careful hemostasis, a gingival bandage is applied. There are reports of the advisability of suturing in the interdental spaces of the gums.

Contraindications for the operation of "open" curettage are periodontal pockets with a depth of more than 5 mm, the presence of bone pockets, a sharp thinning of the gums in the area of the proposed intervention, as well as suppuration and abscess formation.

A more radical removal of factors that support inflammation in periodontal tissues, with "open" curettage, reasonably guarantees a longer remission of the inflammatory process. A.P. Bezrukova believes that it is more correct to consider the method of “open” curettage not as a modification of curettage, but as a kind of patchwork operation.

The group of open curettage also includes several subgingival curettage interventions that are very similar in essence. This is a modified Widman flap, Ramfjord and Nisle techniques.

INDICATIONS

Horizontal type of bone atrophy.

Deep gingival and periodontal pockets (up to 6 mm) when quality blind treatment is not possible.

The location of the attached gingiva is apical to the bottom of the pockets.

CONTRAINDICATIONS

The location of the bottom of the pockets is coronal to the border of the attached gingiva. This is studied before planning the operation using special marker tweezers.

Intraosseous pockets.

Furcation lesions.

It cannot 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% solution of lactic acid or a 5% solution of citric acid is currently usually used. Acid is injected into the periodontal pocket on a cotton turunda or with a syringe under slight pressure. A number of foreign scientists believe that "chemical" curettage provides a predictable uniform removal of the inner wall of the pocket, no need for tissue anesthesia, and a decrease in bleeding due to the hemostatic effect of a chemical agent.

Solutions of sulfuric, hydrochloric or trichloroacetic acid for the purposes of chemical curettage are not used because of their adverse effect on the surrounding periodontal tissues.

Known technique of vacuum curettage, in which curettage of pathological periodontal pockets is carried out under vacuum using special equipment. The authors recommend performing vacuum curettage with a periodontal pocket depth of more than 5-7 mm, single and multiple abscess formation. For a better view of the surgical field, it is possible to pre-perform a gingivotomy.

Stages of vacuum curettage:

1. Anesthesia (application, injection).

2. Instrumental removal of subgingival tartar and destroyed cement on the surface of the tooth root up to the bottom of the periodontal pocket, followed by polishing of the treated surface of the tooth root.

3. Instrumental scraping of granulations and strands of the epithelium from the outer wall of the pocket (the inner wall of the gum).

4. Treatment of the bottom of the periodontal pocket and alveolar ridge using sharp hollow nozzles for a vacuum apparatus. The alveolar margin is smoothed with cutter-like instruments, and the surface of the interdental septa is freed from the bone that has undergone destruction.

As a result of the treatment, congestion in periodontal tissues decreases, blood and lymph circulation improves.

The authors specially designed hollow hooks for vacuum curettage and an apparatus-compressor, which, when connected to the network in one of the containers, creates a vacuum after 3-5 s, capable of sucking out blood, mucus, plaque, the smallest particles of tartar, granulations, alveoli. At the same time, a low overpressure is created in the second tank, which makes it possible to supply and irrigate the surgical field with an antiseptic solution.

Vacuum curettage is simultaneously carried out in no more than 3-4 single-rooted or 2-3 multi-rooted teeth. After the operation, it is recommended to fill deep pockets with an emulsion or liquid paste with proteolytic enzymes, antibiotics, vitamins, etc.; followed by the imposition of a hardening bandage for 2-3 days.

The method of cryocuretage of periodontal pockets is also used, 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 with a periodontal pocket depth of up to 3 mm and with a thinned gingival wall.

Stages of cryocuretage:

1. irrigation of the oral cavity with an antiseptic solution, anesthesia of the surgical field and removal of supra- and subgingival tartar;

2. cryocurethage: the working part of the device is inserted into the periodontal pocket and the cryoprobe is turned on. The cooling time (3-15 s) depends on the amount of tissue to be destroyed. At the end of cryotherapy, the working part of the device after electric thawing is removed from the periodontal pocket;

3. care of the surgical wound, which consists in careful oral hygiene and the use of solutions of proteolytic enzymes with antibiotics during dressings, and as tissues are rejected after cryodestruction, drugs that improve regeneration. After cleansing the surgical wound, a medical bandage is used.

Cryonecrosis after surgery occurs in 24-48 hours, and the regeneration of the damaged area - after 3-6 days.

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 the same direction as the vertical axis of the tooth around it, avoiding contact with the tooth, since the temperature of the tissues directly under the electrodes usually reaches 80-90 ° C . The duration of tissue coagulation in one periodontal pocket at a current of 10-15 mA is 2-4 s. In order to avoid burns of the cement of the tooth root, it is recommended to cover the active electrode with insulating varnish, leaving free an insignificant part of the electrode in contact with the tissues to be coagulated (Danilevsky N. F. [et al.], 1993). In hypertrophic gingivitis, active electrodes are used in the form of a thin blade, with which the gingival papillae are cut off from their base from the vestibular and lingual (palatal) side.

"Diseases, injuries and tumors of the maxillofacial region"

ed. A.K. Jordanishvili

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 gums, which is first manifested by 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 the teeth in a person without concomitant periodontitis (X-ray 3a) and in a person with moderate periodontitis (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 simply 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 diseases, in contrast to therapeutic treatment, allows:

So, when deep periodontal pockets from 3-4 mm were formed, there was a partial replacement of the 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 of surgical interventions for 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. the mildest degree of 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: to 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 the granulation tissue, antiseptic treatment of the surface of the roots of the teeth and bone tissue, a synthetic bone is “planted” into the 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 the X-rays BEFORE and 3 months AFTER the operation. 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 Russian drugs such as Kolapol and Kollapan, which are several times cheaper.

Curettage, patchwork operation: reviews

I briefly summarize the feedback from patients after different types of 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.

Rating:

Associated with periodontal pockets. Usually, it is not possible to solve the problem without surgical intervention in the course of complex treatment. Curettage allows you to remove the pocket between the tooth and the gum. The procedure involves: removal of tartar, scraping of granulations from the walls of the gums and the bottom of the formed cavity, treatment of tissues with antiseptic preparations, application of protective dressings.

Indications

There are a number of indications that require curettage of the periodontal pocket:

inflammation of the gums;
the formation of cavities between the wall of the tooth and gums;
the occurrence of abundant deposits of tartar;

Curettage of gum pockets should not be considered as an alternative to professional cleaning of enamel. In the latter case, only the removal of plaque and polishing of surfaces is carried out. Comprehensive treatment of pockets in the gums not only allows you to get rid of deposits, but also to eliminate the course of pathological processes in tissues and avoid their decay.

Contraindications

Curettage treatment is contraindicated in case of purulent discharge, suspected tissue abscess, presence of pockets in the bone structure, expansion of periodontal cavities to a depth of more than 5 mm. It is forbidden to carry out the procedure with extreme thinning of the gums, their fibrous change, tooth mobility of the 3rd degree.

Curettage of the periodontal pocket - types

There are several types of procedures:

Open curettage - required when opening pockets to a depth of 4 to 5 mm. During the event, the affected area occurs, which makes it possible to gain open access to the preparation of the roots of the tooth and perform a deep cleaning of the tissues.
Closed curettage of periodontal pockets is performed with a shallow canal depth. The procedure does not require a gum incision.
Patchwork gum - not only pockets are cleaned, but also deep surfaces,. To restore the structure of the tooth, artificial materials can be used that stimulate the growth of new tissue.

Flap surgery on gums

Open curettage

The operation is relevant when the depth of pathologies is more than 5 mm. In addition, the method is resorted to if the treatment of gum pockets with a closed method has not brought results.

A prerequisite for carrying out is a surgical dissection of the affected gum. Open curettage of periodontal pockets is carried out in several successive stages:

The condition of the gums is diagnosed.
Local anesthesia is performed.
The gums are dissected in the area of the interdental papillae, which facilitates access to the base of the pockets.
The fabric is cleaned using a specialized tool.
In order to restore the bone pocket is treated with osteogenic stimulating drugs.
At the end of the operation, the gums are sutured.

It is carried out if the pocket in the gum between the teeth has a depth of up to 5 mm. The operation is performed without surgical intervention and consists of the following activities:

General diagnostics of tissue condition.
Local anesthesia.
With the help of a special tool, the periodontal pocket is cleaned without disturbing the structure of the gums.
The tissues of the roots of the tooth are polished.

The closed method allows you to reduce the deep periodontal pocket and completely eliminate the small one. The operation causes less discomfort for the patient compared to the open method of preparation. Therefore, closed curettage looks preferable if there is an opportunity for its implementation.

Closed

Flap operation

The method involves cutting out the periosteal surface of the gums, followed by processing of the root and internal soft tissue. Flap surgery for periodontitis provides good visual control, which contributes to the convenient removal of pathological material.

During the recovery phase, a number of complications may occur. First of all, this is an increase in the likelihood of exposure of the necks of the teeth, a change in the alveolar processes, dentin hypertension and aesthetic defects in the outer tissues.

Features of the patchwork operation and its consequences

Periodontal treatment in this way involves the sanitation of the oral cavity, local anesthesia and the use of antiseptics. Further to the transitional fold, starting from the edge of the gum, several vertical incisions are made. Two more incisions are created on the vestibular and oral sides with a 2.5 mm indent. The cut pieces of tissue are removed. In order to preserve the natural material, one horizontal section is allowed, similar to open curettage.

The prepared gum is exfoliated, the periosteal flap is folded back to the transitional fold - the movable area of the mucous membrane. Pathological root cement is removed. The gum pockets are cleaned. Tooth roots are polished with periodontal burs and rasps.

Pocket cleaning

Upon completion of the treatment of hard surfaces, soft tissues are prepared. Subsequently, the ingrown epithelium is removed, granulation tissues are truncated. Alveolar osteoporotic processes are processed, the surgical wound is washed with antiseptic solutions.

If the dissection of the gums has exposed bone defects, the anatomical structure of the tissues is restored using artificial transplant material. The flaps are placed in place, after which surgical sutures are applied. Finally, the prepared tooth is covered with a protective dressing.

For several weeks after the operation, tooth mobility is noted. Then the effect gradually disappears. Additionally, there may be an increase in the sensitivity of tissues to temperature and chemical irritants. Discomfort may persist for up to a month.

As practice shows, brushing your teeth with a desensitizing paste helps to eliminate discomfort after the operation. The consequences of the procedure may be bruising and swelling, which disappear naturally after 2 weeks.

Closed and open curettage at first does not allow you to open your mouth wide. The functions of the jaw muscles are restored within 5-10 days.

Postoperative period

In order not to open the prepared periodontal pockets, after the operation, you should refuse to eat and drink. During the first 10 hours it is forbidden to brush your teeth, rinse your mouth, actively spit saliva.

In order for gum surgery to give the expected result, it is necessary to gently brush your teeth using a brush with soft bristles. Cleaning the oral cavity should be carried out bypassing the problem area.

Prepared gum pockets should be periodically rinsed with salted water or chlorhexidine solution. It is acceptable to apply cold compresses to the outside of the postoperative area during the first hours after the procedure.

Salted water

At first, liquid, pureed and soft food is taken. Cold and hot drinks are prohibited. For a week, after the curettage of periodontal canals has been performed, it is worth giving up physical activity, contact sports, sauna visits.

In the postoperative period, it is necessary to resort to the use of special oral care products for sensitive teeth. Additionally, you can contact your dentist for a number of activities that will reduce the sensitivity of the necks of the teeth.

Quality Criteria

Cleansing the cavities from granulation material stops the processes of resorption of damage. The use of restorative bone-forming substances stimulates the growth of the missing tissue. In general, the operation should close the tooth pocket, relieve tissue inflammation, and remove hard deposits.

Price

The price of curettage is on average from 200 to 500 rubles for the procedure by the closed method and from 300 to 1000 rubles for the open method of preparation. The specified range varies slightly depending on several factors.

Technical capabilities, the level of equipment, the availability of materials, and the quality of anesthesia come first. The human factor is also important - the characteristics and nature of the disease in a particular patient. The cost of service is affected by the class and experience of the specialist, the status of the clinic, feedback on curettage from regular customers.

More expensive is laser curettage of periodontal pockets, which does not use traditional surgical instruments, and the procedure is performed quickly and painlessly.

laser

Such an important procedure for health and future well-being is best performed by contacting a dentist with a good reputation, regardless of the financial background.

Finally

As can be seen, despite the different approaches to the operation and methods of gaining access to the area of development of pathological processes, methods that have common features allow eliminating the pocket in the gum. The described methods are primarily aimed at removing granulations, dental and subgingival deposits, ingrown oral epithelium, cement of an infected tooth root. In other words, in all cases, the formed pocket is eliminated, the same tissues are truncated, but using different approaches.

Any dental disease in the absence of adequate treatment sooner or later leads to serious complications.

You can avoid them only by consulting a doctor in time.

But even in this case, standard treatment is not always enough, so you have to use more complex techniques, for example, one of the curettage methods.

Periodontal pocket refers to the space that is formed due to the destruction of the dentogingival junction. In other words, due to infections and improper oral care, gums are damaged, resulting in the formation of so-called pockets.

The danger of their appearance lies in the fact that it is very difficult to clean the space with an ordinary brush, therefore, over time, a serious inflammatory process begins. And it, in turn, leads to the destruction and loss of teeth. Therefore, at the first symptoms of the disease, it is necessary to consult a dentist.

In order to prevent inflammation and receding gums, you should devote enough time to caring for the oral cavity. Unfortunately, modern tools used at home are not able to cope with the task. Therefore, it will be useful to visit a dentist for professional cleaning.

Indications for the procedure

The dentist prescribes curettage only if the patient has indications for the procedure. If the development of the disease is in the initial stages, then other methods are used as treatment.

Curettage is prescribed in the following cases:

moderate periodontitis;
lack of bone pockets;
deposits of tartar on the gums;
inflammation and bleeding of the gums.

Diagnosis of the disease is a prerequisite before determining the method of treatment. If a number of complications are detected, the procedure is prohibited.

Contraindications

Direct contraindications include:

discharge from the periodontal pocket of pus;
suspected abscess;
the formation of bone pockets;
strong tooth mobility;
thinning gums;
other infectious diseases of the oral cavity;
pocket depth over 5 mm.

open way

There are several types of curettage, and the open method among them is one of the most effective. The method is used even if the depth of detachment of the gums from the tooth is more than 5 mm.

The patient's oral cavity is treated with antiseptics and an anesthetic. Only after that the dentist starts the procedure.
The gum in the region of the interdental papillae is stratified using several vertical incisions. This is the so-called flap operation.
To remove granulation tissue and tartar, the dentist uses scalers or curettes.
The roots of the teeth are necessarily polished and disinfected in the process..
In order for the tissue to grow together faster, the doctor uses special tools that accelerate regeneration..
After cleansing and applying all the necessary medications, the incisions are sutured. A special dressing impregnated with anti-inflammatory agents is applied to the place of the seam. If the incision site is bleeding, the dentist may refuse to use a bandage to prevent a bruising.
The sutures are removed after 10-12 days.

Until the operated gum area heals, the patient should gently brush their teeth and avoid solid foods.

See in the video how the open curettage procedure is performed.

Closed

If the pocket depth is small and does not exceed the permissible norm, then the dentist can apply the closed curettage method.

The difference between these two methods of dental treatment is that during closed curettage, the doctor performs all manipulations blindly. That is, the pocket is cleaned without cutting the gums.

The method is less effective and in difficult cases improves the condition of the patient's oral cavity only temporarily, but the procedure is practically painless, it is possible to use local anesthesia:

First, a specialist with ultrasound or dental instruments cleans all deposits.
Then he carefully polishes the roots of the tooth and treats everything with antibacterial agents.
With heavy bleeding, the doctor's task is to stop it, but a small clot should remain in the periodontal pocket to protect the pocket from bacteria getting inside.
Then a special bandage is applied to the gum.

In practice, the cleaning method allows you to clean the pocket well and reduce its depth. It is important that the dentist be extremely attentive and careful, as rough work can lead to complications, increase the healing time of the gums and lead to new inflammatory processes.

The video popularly talks about the closed method.

Using a vacuum

Often, when conducting closed curettage, various additional techniques are used. Modern dentists successfully use vacuum curettage, which allows you to clean the pocket much more thoroughly.

During the procedure, a special vacuum apparatus with nozzles is used, with the help of which impurities are sucked out even from deep pockets.

Treatment of the problem area with disinfectants is carried out automatically.

The advantage of the method is that it stimulates tissue regeneration and improves blood circulation.

Innovative methods of conducting

Progress has also affected the field of dentistry, so modern specialists most often prefer to use various innovative methods of treatment. This also applies to the treatment of periodontal pockets.

laser

Laser radiation has long been used both in cosmetology and medicine. During curettage, the laser beam evaporates all impurities, disinfecting the oral cavity.

The procedure is practically painless and excludes a long postoperative period. Moreover, there is no need to wear a bandage after applying the laser.

Depending on the indications, diode and erbium lasers are used.

Cryo

The essence of the method lies in the impact on the periodontal pocket of low temperatures. The procedure is carried out under the influence of anesthesia.

With the help of a special cryoprobe, all gum tissues are destroyed. After the session is completed, a bandage is applied to the gum.

It is necessary for the operated tissue to heal as quickly as possible. In addition, it is necessary to reliably protect the oral cavity from the occurrence of new infections.

Chemical

For curettage, mechanical means and devices are not always used. There is another chemical type of treatment, which is based on the use of various active agents.

With their help, the dentist softens the gums and removes all deposits. Most often, citric or lactic acids are used as chemicals. Therefore, chemical curettage is the most gentle procedure.

During the period of any oral treatment, some time is required to eat very carefully or brush your teeth.

After open curettage, doctors recommend applying cold compresses and making sure that bleeding does not open.

In addition, after the treatment of the periodontal pocket, it is recommended not to stop brushing your teeth, but try not to touch the diseased gum.

Dentists advise:

avoid hot food and alcohol;
stop smoking;
rinse your mouth with antiseptic;
the first 1 - 2 days drink drinks with a straw.

All actions are necessary so as not to damage the operated gum area and not cause bleeding.

Any intervention from the outside will lead to the fact that the periodontal pocket will not be able to tighten normally. And then its depth will only increase, which will eventually lead to tooth loss. Over time, the inflammatory process will move to neighboring teeth.

In cases with serious complications, it is very difficult to save the teeth, and the dentist can only offer prosthetics to the patient.

Visits to the dentist are mandatory for the patient. And it is necessary to do this not only while the gum is healing.

Often, doctors prescribe a course of antibiotics as an additional treatment, but even this approach does not guarantee a final recovery. Since previously damaged gums can easily become inflamed again, preventive examinations can help prevent or detect the appearance of a problem in the early stages.

Prices

The cost of dental curettage depends on many factors. Most often, the formation of prices is influenced by the use of various painkillers and antiseptics.

Closed curettage of one tooth will cost 200-300 rubles, while an open operation will cost about 2 thousand rubles.

Such a big difference arises from the fact that open curettage is a full-fledged surgical operation.

Vacuum curettage in a dental clinic will cost 1,200 rubles, and an average of 1,500 rubles will have to be paid for laser treatment.

Cryo-curettage will become available after payment of its cost in the amount of 2000 - 2500 rubles. The price for chemical curettage starts from 300 rubles. Naturally, we mean prices for one tooth.

At the first symptoms of periodontitis or other diseases of the oral cavity, you should consult a doctor. It does not matter that there is no pain, and the inflammatory process does not interfere. Over time, even a small inflammation can lead to serious complications, and then you will have to resort to surgical intervention.

A periodontal (dental) pocket is a cavity in the gum, which is formed due to the destruction of the tissues surrounding and holding the tooth in the gum. Its walls are lined with connective tissue, and a large number of leukocytes, bacterial colonies and food particles are found in the fossa itself, which leads to infection and the development of inflammation.

Causes of occurrence:

periodontitis;
gingivitis;
poor oral hygiene;
hereditary predisposition;
smoking.

periodontal pocket

There are also a number of factors contributing to the progression of this defect:

altered bite;
eating only liquid or soft foods;
endocrine diseases (diabetes mellitus, hypothyroidism);
hormonal disorders in the body;
immunodeficiency states in various diseases (HIV, tuberculosis, malignant neoplasms);
errors in the installation of filling material in the treatment of caries, leading to trauma to the gums;

When is periodontal canal curettage indicated?

Indications for this dental procedure include:

the depth of the periodontal gap is more than 3 millimeters;
abundant deposition of tartar;
inflammation of the gums;
pronounced layer of plaque;

Professional cleaning of teeth by a dentist is not an alternative to curettage of periodontal pockets in the treatment of gum disease.

Curettage techniques

The choice of a scraping technique is carried out by a dentist and depends on the depth of the periodontal pocket, the amount of tartar and the degree of destruction of the periodontium. There are three types of this procedure: closed, open and laser curettage.

Closed curettage of the periodontal pocket

The method of closed curettage is used with a depth of the periodontal fissure up to 5 millimeters and slight deposits of tartar. The first stage of the procedure is the diagnosis of the general condition of the gums, then local anesthesia is performed and the oral cavity is treated with disinfecting solutions (rinsing the mouth with chlorhexidine or miramistin).

Further, dental deposits and granulation tissue are scraped off with special dental hooks and curettes, the mucous membranes are re-irrigated with an antiseptic, and a special dressing is applied to protect the injured mucous membranes. This procedure is relatively painless and well tolerated by patients.

Curettage of the periodontal pocket

Open curettage of the periodontal pocket

It is a more complex procedure due to greater trauma to the gums. The open method is used when the depth of the periodontal pocket is more than 5 millimeters, massive deposits of tartar, the inefficiency of the previous closed curettage. Such an intervention is also carried out under local anesthesia, but a course of antibiotic therapy is added to the preparation.

During one visit to the dentist, an average of 5-7 teeth are subjected to cleaning of periodontal pockets. The difference between this method and the closed one is the surgical incision of the gums in the area of the interdental papillae to provide the necessary access with suturing at the end of the intervention.

Laser curettage of the periodontal pocket

It consists in the introduction of a special laser light guide into the periodontal cavity, with the help of which pathological growths of the connective tissue are coagulated, microorganisms in the cavity are killed. After the procedure, the gingival pocket is sterile clean and closed, an antiseptic ointment is applied to the affected area. Laser curettage is recommended for the initial stages of periodontal disease and allows you to cure the disease in 1-2 sessions.

Curettage Laser Guide

Advantages and disadvantages of periodontal pocket curettage

Curettage shows good results in the treatment of periodontal disease and is a mandatory procedure in the treatment of many gum diseases. The positive aspects of this method include:

a good degree of cleaning of the periodontal fissures from food particles and dental deposits;
reduction of bleeding of mucous gums;
reduction of the inflammatory process;
prevention of loosening and loss of teeth in periodontal disease;
removal of pain.

The disadvantages include the relative invasiveness of the intervention, the additional load on the body with antimicrobial drugs, the increased sensitivity of teeth to temperatures and acidic foods, and the cost ranging from 900 rubles to 2 thousand for the treatment of one gum cavity, depending on the chosen technique.

Alternative Treatments for Periodontal Pocket

Ultrasonic cleaning

It is produced by special devices with nozzles penetrating into the pocket area, which generate ultrasonic waves. Ultrasound has a detrimental effect on microorganisms, and also destroys plaques of hard plaque on the tooth wall and in the depth of the fossa. It takes from one and a half to two hours to process all the teeth. The procedure is painless and causes only discomfort.

Flap operation

Surgery is usually combined with open curettage and is an invasive procedure requiring antibiotic support. It is performed under local anesthesia by a highly qualified dental surgeon, and a segment consisting of 5-7 teeth is processed in one visit to the clinic.

The meaning of the intervention is to excise the gums, remove deposits and granulation tissue and hem the mucous membranes in such a way that the gingival pocket decreases relative to its original size. In case of periodontal disease, the doctor, before filing the gums, can treat the root of the tooth with special preparations that stimulate the restoration of bone tissue.

Flap surgery on the gums

Treatment at home

In the presence of prolonged inflammation or abundant deposits of tartar, treatment should be carried out in a dental clinic.

Treatment of gum disease at home is possible only in the initial stages of the disease and is aimed at strengthening the mucous membranes, preventing inflammation and reproduction of pathological flora in the oral cavity and is reduced to the use of various rinsing liquids for the oral cavity.

In case of inflammation localized in the area of the periodontal fissures, it is necessary to add to the usual hygiene procedures the use of rinses containing antiseptics that normalize the natural microflora and have an astringent effect. If there is a large amount of dental plaque, special solutions against gingivitis and plaque are recommended, which include sodium citrate.

A good anti-inflammatory effect has the use of rinses based on medicinal herbs (chamomile, oak bark, tea tree oil, sage).

Rinsing the mouth

After a curettage procedure of any kind, for the next few days, it is necessary to spare the gums, to prevent rough mechanical action on them, to use mouth rinses based on antiseptics and wound healing agents.

The consequences of the formation of a periodontal pocket in the gum

Pathological processes localized in the area of the periodontal fissures entail a number of serious consequences, since with the deepening and inflammation of the periodontal pockets, the tissues surrounding the tooth are destroyed.

Without timely started proper treatment, development is possible:

hypersensitivity to low and high temperatures, sweet or sour food due to exposure of dental roots;
pathological mobility and loosening of teeth;
deformities of the dentition and malocclusion;
tooth loss;
development of inflammatory diseases of the oral cavity (periodontitis, stomatitis and gingivitis);
the appearance of bad breath;

To prevent the occurrence and deepening of periodontal pockets, you must follow a number of simple rules:

Regularly carry out oral hygiene procedures using a brush, dental floss, irrigator.
Use mouth rinses that help soften hard deposits on the surface of the enamel and prevent their further occurrence.
Use abrasive toothpastes that polish tooth enamel.
To resort to professional cleaning of teeth in a dental clinic at least twice a year.
Visit the dentist regularly for preventive check-ups.
Give up bad habits (smoking, drinking too much sweets).