Open and closed curettage. What is curettage and how does it happen? The course of the open curettage procedure

Missed a couple scheduled inspections at the dentist and overlooked inflammation of the gums? It can happen to anyone, because at first periodontitis is asymptomatic. When the gums swell, start to hurt and bleed, appears bad smell from the mouth and teeth turn yellow from plaque - everyone runs to the doctor.

At such stages of gum inflammation, curettage of periodontal pockets is indicated - mechanical removal of subgingival deposits. Held open and closed ways. Read more about each in our article.

Description of the procedure

Curettage of the periodontal pocket is carried out using a special tool - a dental curette (the second name is a curettage spoon).

The curette is inserted into the gum pocket and all the plaque accumulated in the pocket is scraped off. The procedure is painful, so it is performed under local anesthesia.

With advanced periodontitis, granulation tissues are also removed. They replace atrophied bone tissues, which have been resorbed under the action of toxins secreted by the bacteria "living" in the pocket.

It is worth noting that scraping subgingival deposits does not replace a full-fledged professional teeth cleaning. This is only one of its stages, along with the removal of tartar and soft touch with enamel, as well as polishing the surface of the teeth.

When to do gum pocket curettage

The most important indication is gingival inflammation, in which periodontal pockets are formed with a depth of more than 3 mm. This means that the gum "lags behind" the tooth, and as a result, a cavity is formed between them, into which microbes penetrate.

This can happen against the background of the following diseases:

periodontitis;
periodontal disease;
gum injury.

Contraindications

The presence of periodontal abscess (purulent tumor);
copious excretion pus from gum pockets;
thinned gums;
fibromatosis of the gums;
pathological tooth mobility III-IV degree;
acute infectious diseases of the oral mucosa;
other acute infectious diseases(tonsillitis, flu, etc.);
general contraindications to surgical procedures.

Methods

Vacuum curettage

Closed curettage, which uses a vacuum device that instantly removes scraped plaque from the pocket.

Laser curettage

Instead of a curette, a laser device is used, under the action of which the plaque evaporates.

Cryo curettage

A special cryo-probe destroys plaque with ultra-low temperatures.

Chemical curettage

Before removing plaque, it is softened with lactic or citric acid.

In most dental clinics, closed and open methods are used - they are considered traditional when removing subgingival deposits.

The technique is justified if the depth of periodontal pockets does not exceed 5 mm - at the mildest stages of periodontitis. Its peculiarity is that the doctor performs the procedure virtually blindly, since there is no opportunity to look under the gum. At the same time, delicacy is very important, with inaccurate work, healthy gum tissue can be damaged and the surface of the tooth can be scratched.

This surgical procedure carried out in cases where the depth of the gum pockets is more than 5 mm. Using a scalpel, the surgeon makes incisions in the gum and peels off a flap of its mucous membrane from the teeth.

Exposed roots are carefully cleaned from plaque and granulation tissues, and then polished. The plot is being processed antiseptics, after which an osteogenic preparation is placed in the periodontal pockets, which stimulates the restoration of bone tissue.

Then the gingival flap is returned to its place, sutures are applied in the area of the interdental papillae, then a protective gingival bandage is applied. The sutures are removed ten days after the operation.

After the procedure, you can not:

stop oral care (microbes can get into tissues weakened after surgery and cause inflammation);
touch the gum area on which the procedure was performed with a brush;
eat in the first two or three days solid food;
spit.

give up hot food and drinks before healing;
use antiseptics - wipe your teeth with solutions of Chlorhexidine, Miramistin, rinse your mouth with these and similar preparations after eating;
if necessary, apply cold, which will help relieve inflammation after surgical procedures;
drink only through a straw in the first hours after open curettage so as not to cause bleeding.

What is the price

The average price of closed curettage is 100-200 rubles for cleaning the gum pocket in the area of one tooth.
Open - in the area of \u200b\u200bone tooth costs from 2,000 rubles, for a quadrant (six to seven teeth) - from 9,000 rubles.

Pros and cons

Advantages of the procedure:

the possibility of eliminating pathological gingival pockets. Open curettage is the only method to achieve such a result);
restoration of bone tissue due to the replanting of osteopreparations using an open technique;
getting rid of pathological tooth mobility. With the restoration of bone tissue, the teeth hold stronger;
low cost of closed curettage.

There are also many disadvantages. First of all, the low efficiency of closed curettage for moderate and severe periodontitis (in 99.98% of cases the disease recurs) and the high cost of the open method (in addition to the doctor's work, the total amount includes suture material, osteogenic preparations).

the duration of the open curettage procedure.

Approximately 2 hours to work in the area of 6-7 teeth;

high requirements for the qualification of a doctor.

Otherwise, there may be mucosal injury and damage to the teeth.

Open curettage of periodontal pockets should only be performed by surgeons with a specialization in periodontics. On our website you can find clinics that successfully cope with the treatment of periodontitis with a similar technique.

Open curettage of periodontal pockets is a dental operation, the main indication for which is the cleaning of gum pockets. Normally, their dimensions do not exceed 0.5 mm, and food that gets there can be removed by hygiene procedures.

At what degree of periodontitis is open curettage possible? Is it possible to independently determine the degree of periodontitis?

With a depth of periodontal pockets of more than 5 mm., Approximately possible.

Is anesthesia mandatory during open curettage?

Yes, definitely

Are there breaks during the operation? (3 hours is very long, for example to call)

After intervention on 1 jaw, it is possible to take a break

Those. Do you need regular follow-up with a periodontist?

Yes, as long as there are teeth

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If their depth is more than 1-2 mm, food debris cannot leave the intergingival recesses without assistance. Gradually accumulating, they serve as an ideal place for further development microbes. Completely clean periodontal pockets in this case is possible only with the help of open curettage.

Stages of the procedure

The operation begins with a vertical incision in the gums. Next, the specialist folds the tooth flap and cleans the pocket. To improve osteogenesis, special medications, after which the gum is sutured.

The cost of this procedure is quite affordable and fully justifies itself. This is evidenced by numerous positive reviews patients left on the website of our dental clinic Roott in Moscow.

Payment for treatment:

Turnkey payment

no hidden fees

Tax deduction

Staged payment

for your comfort

Free

initial doctor's consultation

anxiety symptoms

Treatment with open curettage is recommended in the presence of tooth mobility of 2-3 degrees, which is the result of developed inflammatory process. If the pocket depth is less than 5 mm, closed curettage is possible, which is less traumatic and lower in price.

Causes of this symptom complex

The most common indication for open curettage is periodontal disease (periodontitis, parodontosis), in which part of the gum exfoliates from the tooth.

Inflammatory processes in the oral cavity, in particular gingivitis, also serve as an obligatory reason for contacting a specialist. The doctors of our clinic will quickly and efficiently perform the procedure, regardless of the cause of the changes.

Preventive actions

Avoiding the symptoms described above is easier than you think. It is enough to visit the dentist at least once every six months. A specialist can not only detect diseases on initial stages, but also to perform a number of measures to prevent the development of inflammation.

It is also necessary to regularly observe oral hygiene and eat foods containing enough vitamins and minerals. Observe these simple rules and your smile will remain beautiful for years to come.

is the number one cause of tooth loss. This disease is characterized by inflammation of the gums and tissues around the teeth, that is, the ligaments that hold them in the alveoli or sockets. The main cause of periodontitis is plaque, which we do not fully clean with a toothbrush or even leave on our teeth after eating. Gradually, it mineralizes and turns into a hard stone. Such deposits are based at the base of the teeth, and often even penetrate under the gums. Toxins produced by microorganisms hard plaque and lead to inflammatory processes. Therefore, the most important thing to do in the treatment of periodontitis is to remove all deposits.

UltraSmile.en I decided to talk about the most effective, according to many dentists, method of cleaning periodontal pockets - gum curettage. What kind of operation it is, how it is performed and whether it really helps to cure the disease - below in our material.

What are periodontal pockets?

With poor-quality cleaning of the teeth, soft plaque forms on their surface. Gradually it hardens, turns into stone. If such deposits are not removed in a timely manner, they penetrate deep under the gums. As a result of this, periodontal pockets are formed, in which the gum exfoliates from the surface of the tooth. In such cavities, food debris, microbes and bacteria accumulate, which actively affect the roots of the teeth and the surrounding bone tissue. Very often, deposits rot, causing extremely bad breath, while pus can even spread throughout the body.

How to clean periodontal pockets

Up to a certain stage of the disease, deposits from under the gums can be removed using either laser cleaning, or using air-abrasive cleansing. Air flow. But if the stone falls under the gum, professional cleaning will not be effective and will require surgical intervention, that is, curettage of the gums.

How is gingival curettage performed?

There are two types of surgical intervention in the treatment of periodontitis: closed and open curettage of the gums. The operation is performed under anesthesia and lasts quite a long time - about 2 hours. At the same time, about 7-8 teeth can be processed in one visit.

Closed curettage does not apply to surgical operation and more like a regular professional cleaning. Its effectiveness is high if the periodontal pockets are shallow - no more than 3 mm. With this method, the doctor uses instruments with a thin hook at the tip (curettes) - he lowers them under the gum, manually removes deposits and cleans periodontal pockets. At the same time, ultrasonic vibrations, air-abrasive treatment, a laser and just ordinary water, which is supplied under pressure (to wash out the crushed stone from under the gums), are used. But this method there is a drawback - the dentist performs the cleaning of the pockets blindly and cannot check whether the granulation tissue has been completely removed. There is a significant risk that the inflammation will start again. That is why in case of periodontitis it is recommended to carry out curettage using open technology.

This method already refers to a full-fledged surgical intervention. Its essence boils down to the fact that the gum exfoliates to clean the periodontal pockets - this allows you to expose the roots of the teeth and conduct a more thorough scraping. The operation is necessarily performed under anesthesia. After the incision of the gums, the doctor uses ultrasound equipment, a laser or hand tools, after removing all the granulations, the neck or bare tooth roots are necessarily polished with a professional brush with a high speed of head rotation - less bacteria will accumulate on a smooth surface. With a strong destruction of bone tissue, its synthetic analogue is placed in the cavity. Next, the gum is returned to its place and sutures (usually self-absorbable) are applied.

Open gum treatment

It is open gum curettage that is the most effective measure for cleaning periodontal pockets in moderate and severe forms of periodontitis. By exfoliating the gums, the doctor has access to all subgingival deposits - they can be removed without residue, which will reduce the risk of re-infection to a minimum.

Flap operation

This operation is almost identical to open gum curettage, with the only difference being that a part of the atrophied gum is additionally cut off. With the formation of voluminous gum pockets, the mucosa often changes so much that even after suturing it will not fit snugly against the tooth surface. That's why the best option restoration of aesthetics will be circumcision of the mucosa to correct its shape and position.

What are the pros and cons of gum curettage

Compared with professional hygiene oral cavity open curettage has quite clear advantages:

better access to deposits due to gingival exfoliation,
no recurrences - during gum curettage, the doctor opens the entire area for work, he can make sure that all granulations are removed,
it is possible to restore the destroyed bone tissue,
at the same time carried out drug therapy and splinting of teeth, it is possible to achieve stable results in the treatment of periodontitis,
adjustment appearance enlarged gums.

Among the disadvantages of a surgical operation is the impossibility of its implementation in patients with purulent discharge, with pathological tooth mobility of an extreme degree, acute infectious diseases, as well as if there is intolerance to painkillers. In addition, among the shortcomings of curettage - quite high price open technique. The cost of cleaning periodontal pockets in the area of 1 tooth is from 1.3 thousand rubles.

After surgery, the patient must be prepared for the fact that the gums will change their shape and even position. Very often, after cleaning of periodontal pockets, it is necessary to carry out plastic surgery to correct the aesthetics of the gums. Exposure of the roots of the teeth may occur, the gingival papillae also descend slightly - but after a few months they increase in size and take the desired shape.

After the operation

After curettage of the gums, the patient needs to improve oral hygiene, removing pathogenic microbes in time - they can lead to infection of the wounds. In the early days, you should refrain from taking hot or cold, as well as too hard food. Be sure to rinse antibacterial drugs and solutions medicinal herbs. In the first few hours of outside cold compresses can be applied to the face to relieve swelling. You should drink through a straw so as not to cause a divergence of the seams.

Drink through a straw after surgery

It is worth noting that gum curettage gives your teeth a chance to serve for many more years. Do not wait until the process becomes irreversible, and seek help from a dentist in time!

A serious disease of periodontitis develops in many people who ignore regular and high-quality oral hygiene. The disease causes a lot of problems and complications, and some of them require curettage or 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 it was possible to clean the pockets and stop the inflammatory process, anatomical changes remain in the body that contribute to regular relapses of periodontitis.

So, curettage of the periodontal pocket remains the only method that guarantees complete cure from illness.

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 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 . Professional cleaning of the entire oral cavity from plaque, tartar and pus is carried out, 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 depths 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 expendable materials, 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.

Insufficient care oral cavity leads to the formation of soft plaque and stones on the teeth, resulting in inflammation. At first, its symptoms are quite harmless: slight bleeding of the gums, soreness, and sometimes swelling. But gradually there is mobility of the teeth and the release of pus from under the gums. At this stage, we can safely talk about advanced periodontitis, for the treatment of which curettage of periodontal pockets is used. What is this procedure?

Periodontal pocket: what is it?

Due to the inflammatory process, bone tissue is destroyed and gradually replaced by granulation tissue. The latter mainly consists of osteoclasts and microbial cells, which, gradually expanding the zone of their "habitat", lead to even more active bone atrophy. Against the background of such "events" there is a violation of the ligament between the tooth and the gum.

As a result, a periodontal or periodontal pocket is formed. It is a space equal in size to the area of the destroyed bone and filled with granulation tissue, purulent masses, food debris. Such a pocket is diagnosed in one of the following ways:

with the help of an x-ray. Bone atrophy is determined by the presence of darkening in the picture;
periodontal probe. Normally, the probe penetrates under the gums by 1-2 mm, the excess of this indicator indicates a gum pocket.

Lack of treatment leads to further deepening of the periodontal pockets, with the result that the teeth sooner or later take up a "fan" position. It should be noted that inconsistent with the doctor folk remedies in this case, treatment is not considered.

Why curettage of periodontal pockets is necessary

There is a practice when, to get rid of periodontitis, they do not go surgically, but are limited to taking antibiotics, removing dental deposits, using a laser or local anti-inflammatory therapy. But such steps are more an attempt to cure the disease than really effective remedy from periodontitis. Why might this therapy not work?

If the periodontal pocket is very deep, then it is impossible to completely clean it from deposits with ultrasound. The procedure is blind: the dentist “fumbles” with a nozzle under the gum, but does not see what is happening there. Therefore, even after the highest quality cleaning, there is a possibility that a certain amount of subgingival calculus remains in its place.
Anti-inflammatory therapy and cleaning from subgingival deposits cannot serve as a guarantee that periodontitis will stop, since a favorable "climate" for the development of infection still remains.

That is why most doctors strongly advise patients to decide on surgery. Only surgical intervention allows you to get rid of all the problems associated with periodontitis, namely:

remove granulation;
remove gum pockets;
remove deposits from under the gums.

Among the most popular surgical methods treatment of periodontal diseases – curettage of periodontal pockets. If necessary, it can also be used for periodontal disease and gingivitis.

Closed curettage of periodontal pockets: how is it performed

The operation is effective with a depth of gingival pockets of 3-5 mm. It is simple and does not require special skills from the doctor, so the intervention can be carried out by an ordinary dentist-therapist.

Conventionally, the following stages of the procedure are distinguished:

Inspection of the gums, introduction of the patient into local anesthesia.
Cleaning pockets without cutting the gums.
Polishing of tooth roots.

At the same time, the operation can be performed in the area of 2-3 teeth. During the week, the main wounds heal, but the formation process connective tissue and attachment of the gum to the tooth takes about a month. A significant drawback of closed curettage is that during the intervention, the doctor does not see whether all the pathological formations have been removed.

With a depth of periodontal pockets of more than 5 mm, such an operation can only temporarily stop the development of periodontitis. Partial removal granulation and cleaning of deposits allows you to get a temporary respite, but in almost 100% of cases the disease begins to progress again.

The price of the operation is about 1200 rubles, but the cost may vary depending on the degree of prestige of the clinic.

Open curettage of periodontal pockets: features of the procedure

Such an intervention requires high professionalism from the doctor and special training, so this service is not provided in all dental clinics. The duration of the operation on 7-8 teeth is about 2.5 hours. The intervention involves the following steps:

Teeth cleaning from plaque and calculus.
The use of anti-inflammatory drugs.
If necessary, splinting of moving teeth.
Gingival incision near the neck of the teeth, which helps to exfoliate the mucous from the bone tissue.
Removal of granulations with a curette and stones with ultrasound.
Antiseptic treatment of dental roots.
Planting in cleaned pockets synthetic fabric designed to induce natural bone growth.
Suturing and closing the wound with a gum bandage.

1.5 weeks after surgical intervention stitches are removed. A few months later it happens full recovery damaged tissues, and the gingival papillae re-close the gaps between the teeth. Sometimes the operation leads to the exposure of the roots, but the degree of gum prolapse directly depends on how much the bone tissue has been destroyed.

The cost of open curettage includes both the doctor’s work and the price of “consumables” (mostly the costs go to the purchase suture material and synthetic fabric). On average, for an operation on one tooth, you will have to pay 2400 rubles.

Curettage of periodontal pockets is often the only way get rid of loose teeth and purulent discharge from gums. Therefore, if the disease has already gone far, and the operation seems too expensive, you should not save. Further dental implantation will cost much more.