home Thyroid Treatment of gums Curettage. Open and closed curettage of gum pockets Open curettage of a tooth

Treatment of gums Curettage. Open and closed curettage of gum pockets Open curettage of a tooth

Sometimes medication alone is not enough to treat gum disease. The most common cause of inflammatory processes is contamination of the periodontal pocket with food debris. With regular teeth brushing, this area remains inaccessible, so it can cause the development of serious diseases. Treatment in this case is based on cleaning out the cavity between the tooth itself and the gum. This procedure is called curettage.

In order to understand what curettage is, you need to roughly understand where exactly the problem is. Teeth are bony outgrowths that are fed by blood vessels and nerve endings. The root canal goes deep into the gum, which covers most of the tooth, leaving only the coronal part necessary to perform its functionality. However, the gum itself does not fuse with the tooth, creating a hollow area between the tooth and the soft tissue. The greatest separation between the tooth and the gum is located near the crown part, so food debris often gets into this gap, but it is not possible to remove them from there yourself.

Curettage is a dental procedure in which, using special means, a cavity is cleaned, which is also called a periodontal pocket. This procedure relieves inflammation of the gums and eliminates other problems of the soft tissues of the oral cavity. Ultrasonic cleaning agents or surgical instruments can be used to carry out the procedure. The choice of curettage tools depends on how deep the separation needs to be cleaned. Also, a similar procedure can be carried out for diagnostic purposes in order to understand the condition of the root canal hidden by the gum.

Types of curettage

There are 2 types of curettage:

Open;
Closed.

There are quite a lot of differences between the two types of procedures, since open curettage is a full-fledged operation, while the closed method uses less traumatic methods of “entering” the periodontal pocket, although in both cases anesthesia is used in order to avoid unpleasant and painful sensations during procedure time.

Closed curettage is performed after professional teeth cleaning. This sequence allows you to maximally avoid additional contamination of the sinuses during the procedure. This procedure, despite a rather harmless and even beneficial interaction, is carried out only as prescribed by a dentist after the cause of gum disease has been identified. Either special instruments are inserted into the periodontal pocket to help manually clean the sinus, or ultrasonic cleaning is used as a more effective and simpler method.

The open type of curettage involves cutting the gums, which is why the operation is often called patchwork. This method is used for deep periodontal pockets, since conventional instruments are not designed for a depth of more than 5-6 mm. When the gums are cut, the doctor gets a complete picture of the condition of the tooth root, as well as the adjacent soft tissues. During the operation, not only the formations are removed, but also the application of strengthening drugs to the tooth enamel. As a rule, a bone-forming ointment is used, which promotes the fusion of the gum and tooth root, and also strengthens the root itself. After the cleaning procedure, the gums are closed and sutured.

Curettage of periodontal pockets and teeth

Curettage is not always carried out to remove formations in the cervical part of the tooth. Sometimes in this way they diagnose the condition of the root or treat the tooth with preliminary cleansing of the sinus. As a therapeutic measure for curettage of teeth, polishing of the enamel is used, as well as the application of medications. Typically, such manipulations are performed with open curettage.

In all cases, after the procedure, the affected periodontal pocket expands, so the first time after the procedure may be accompanied by painful sensations in the oral cavity. However, despite the increase in large pockets, the small ones close completely, and after some time the soft gum tissue begins to move closer to the tooth, closing the large sinuses with a minimum gap.

Indications for curettage

The main indication for curettage is gum disease, the most common of which is periodontitis or gingivitis. After diagnosing the disease, the dentist determines what type of curettage will help solve the problem. Closed curettage with ultrasound is prescribed when the disease is not too serious, when the depth of the dissection is about 4 mm. Gums with such a depression are quite dense, so there are no additional complications during the procedure. You also need to make sure there are no bony pockets, as these will prevent the sinuses from clearing.

Flap surgery is performed in virtually all other cases of periodontitis, when the gum itself begins to loosen. In such situations, the teeth are extremely mobile due to poor attachment to the gum, because the width of the pocket is 5 mm. Also, periodontitis begins to appear externally in the form of abundant tartar, as well as deformation of the interdental papillae. Also, an indication for open curettage may be complications in tooth treatment, in particular the need to strengthen the root with a special bone-forming compound.

Gum curettage

Gum curettage is a medical procedure that is often compared to professional teeth cleaning.

The main goal of both procedures is to remove deposits, in particular tartar, which spreads along the enamel not only on the coronal part visible to the naked eye. Some of the deposits are located close to the gums and are difficult to remove with daily hygiene. This condition may also be an indication for a curettage procedure.

Together with tartar, when curettage of the gums, antiseptic treatment of the oral cavity, as well as periodontal pockets, is carried out, which makes it possible to kill bacteria that multiply in the recess between the tooth and the gum. The waste products of such organisms are destructive substances that negatively affect both the condition of tooth enamel and the condition of the hard part of the gums. A prime example is gingitis, a symptom of which is gum porosity.

Socket curettage

The curettage procedure is performed not only around the entire tooth or filling. Very often the area after tooth extraction needs such cleaning. Such a hole is the most vulnerable place for bacteria, especially if the tooth extraction was unplanned. A hole occurs in cases of natural tooth decay in people who, for some reason, could not consult a dentist about the problem in time. Most of the tooth is removed naturally, but fragments remain in the socket, which scratch the soft tissue and often cause irritation, swelling or inflammation.

Curettage of the hole involves several stages of the procedure, the main of which is the cleansing of part of the gum from large tooth fragments and the remains of a destroyed filling. When the main debris has been removed, the dentist proceeds to treat the gums, including cutting out some of the damaged tissue and cleaning the areas of inflammation from accumulated pus or bacteria. Lastly, the patient’s operated area is disinfected with antiseptics. However, to avoid infections and re-inflammation of the gums, it is necessary to adhere to the recommendations during the recovery period.

Rehabilitation period after curettage

The curettage procedure is not only painful, but also quite painful in the subsequent period. Immediately after the procedure, the oral cavity is especially vulnerable to infection. In addition, the problem of gum swelling and tooth pain does not go away within a few days. Patients who have undergone periodontal pocket curettage must adhere to several rules:

Refusal of solid food. The first few days your gums will be very sore, so in order not to injure them with stress, you need to switch to a liquid diet.
Refusal to brush your teeth. After the procedure, the dentist will tell you exactly how long you should abandon any type of oral hygiene, including rinsing, since even a soft toothbrush causes mechanical damage to the gums, and rinses can cause long-term non-healing in the postoperative period.
Mouth rinses. After 3-5 days, the gums will begin to heal; home care, in particular, rinsing the mouth with antiseptics and other medications will help speed up this process.
Mandatory visit to the dentist. Depending on the speed of healing, further recommendations for caring for the oral cavity in the postoperative period depend, so the dentist will schedule a session to check the condition of the gums; skipping an appointment with the doctor is not recommended.

Contraindications

The procedure has practically no contraindications, since most of them are temporary. You cannot undergo the procedure for acute general diseases, as well as during the acute period of gum inflammation, since operations during this period are very traumatic. The inflammatory process at such moments is expressed in swelling, change in gum color, as well as the release of pus from the periodontal canals.

Constant contraindications include excessive looseness of the teeth (above the third degree of mobility), which indicates a pathology of fibrous tissue that does not want to hold the teeth. Also, the procedure is not performed if bone pockets are identified.

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A procedure called curettage may be used to treat periodontal gum pockets. It consists in the fact that these pockets are cleaned mechanically or otherwise. In this case, one of two traditional methods of cleansing can be used - open or closed. Other, more modern types can also be used. We will tell you everything about periodontal pocket curettage - what kind of procedure it is, in what cases it is indicated, and when it is contraindicated.

We often forget that in addition to our teeth, we also need to carefully monitor the condition of our gums. But many diseases begin precisely with the pathology of their delicate tissue. You should try to thoroughly clean the area near the gums. Here bacteria find the most favorable secluded places for reproduction.

Unfortunately, the brush simply cannot reach many areas. The remaining plaque quickly turns into hard tartar. Due to the fact that gum tissue is constantly in contact with bacteria, it becomes inflamed and weakened.

Curettage is the cleaning of the space that appears between the tooth and gum.

With this pathology, the gum tissue begins to peel off from the tooth enamel. A space appears between the tooth and gum. In dentistry it is called a periodontal pocket. This is an extremely undesirable defect. It quickly accumulates food debris. This further promotes bacterial growth. Over time, periodontal disease develops.

note: If periodontitis is not treated promptly, it can progress to periodontal disease. This is an even more formidable pathology. It weakens the ligaments that hold the tooth. It begins to loosen and eventually falls out. Periodontal disease is difficult to treat. It must be comprehensive and long-lasting.

Curettage is the cleaning of the space that appears between the tooth and gum. It is used for or periodontitis. This procedure can also be used to remove stones that have formed. The doctor’s task is to lift the sore gum, which has peeled off, and carefully clean the resulting pocket of accumulations. Then he will treat the tissue with an antiseptic and “glue” it to the tooth. For this, a special composition is used.

This procedure uses a special instrument – a curette (also known as a curette spoon). Gum curettage is not a substitute for professional teeth cleaning. This is just one of the stages of care.

Kinds

Two types are considered traditional - closed and open. Along with them, other variations of the procedure are now used:

Closed. This type of cleaning does not cut fabrics.
Open. This method is used to access deep pockets. This cuts the gum.
Vacuum. A type of closed curettage. It is carried out using a vacuum apparatus. The plaque is removed instantly.
Laser. The curette is replaced by a laser. It simply evaporates the plaque.
Cryo-curettage. A special freezing probe is used.
Chemical. To better remove plaque, it is treated with acid.

Open and closed curettage

Closed curettage of periodontal pockets is prescribed for removing plaque, stone, and teeth whitening. The doctor does not open the gum. Open is mainly performed for severe periodontitis. With this pathology, the formation of pockets is observed not only in the gums, but also in the bone tissue. Indications for open and closed curettage will be different.

Closed is prescribed for:

Open is held when:

severe form of periodontitis;
deep periodontal pockets (5 mm or more);
detachment of the gum edge from the tooth;
lesions of the papillae;
large accumulations of stone.

Whatever type of curettage the doctor chooses, he must perform it under local anesthesia.

Stages

To perform closed curettage, the doctor will need 30 minutes. The duration will be influenced by the degree of tissue damage. The procedure will be carried out over several stages:

After the procedure, the doctor should give detailed recommendations. It is important that he explains in detail how to properly ensure oral hygiene. Open curettage includes the following steps:

Local or even general anesthesia is administered.
The oral cavity is disinfected.
Periodontal pockets are opened. In this case, the doctor makes a vertical incision in the gum. This provides him with the opportunity to see all the affected areas and reach them. Pockets are thoroughly cleaned.
Remains of food and tartar are removed. Nowadays, the vacuum cleaning method is increasingly used. It helps to quickly remove all deposits.
To eliminate periodontitis, medication is applied.
Stitches are applied.

Important: After open curettage, you should carefully care for your gums. The main thing is not to infect the remaining wounds. The doctor should tell you in detail how to ensure good oral hygiene at home.

Contraindications

This procedure has the following contraindications:

Post-procedure care

It is important to remember that after such an intervention you cannot:

touch the treated area with the brush;
careless about oral hygiene, not brushing your teeth;
spit;
Eat solid food in the first days after the procedure.

- wipe the surface of the teeth with antiseptics (Miramistin or Chlorhexidine solution);
- if there is pain or slight inflammation, you can apply cold;
- do not drink or eat hot foods;
- In the first hours you should drink only through a straw.

Curettage is a completely safe and painless procedure. The main thing is that it is performed by a professional, and the patient provides high-quality subsequent gum care. This procedure will help stop periodontal disease, strengthen the gums and preserve weakened teeth.

Today, there are a number of pathological conditions and diseases for the treatment of which the method of curettage, or in other words, curettage or cleaning, is used.

Curettage - what is it?

The medical term “curettage” means cleansing a body cavity, an organ or the surface of the skin using a special surgical instrument - a curette.

The main purpose of this surgical procedure is local cleansing of the body from disease-causing or affected areas. In addition, it can be used for further laboratory studies of the obtained biological materials.

Areas of use

Quite often, curettage is used in the following areas of medical practice:

dentistry;
obstetrics and gynecology;
oncology;
surgery;
aesthetic medicine.

Curettage of the armpits

This type of surgery in the armpit area is used to treat excessive sweating. This is such an effective method that in 80% of cases a person forgets about such an unpleasant condition once and for all. Of course, there is a risk of so-called compensatory hyperhydria and some other postoperative complications, but surgeons can easily cope with any undesirable consequences, and the result remains positive.

The essence of the operation is to destroy the innervation of the sweat glands and remove them completely or partially. Armpit curettage is a minor surgical procedure and is performed under local anesthesia. First, the surgeon determines the area of increased sweating, which, as a rule, coincides with the hair growth area. For a more accurate determination, a Minor test is performed (treatment with starch and iodine). Then, after the necessary tests and sterilization of the surgical field, curettage is performed directly.

The recovery period after curettage is minimal (on average 1-2 days), since the access area for surgical manipulations does not exceed half a centimeter.

Curettage of periodontal pockets and teeth

For various types of inflammation (periodontitis), dental curettage is used for treatment. What is it and what is this technique? This procedure consists of cleaning the gum pockets from food debris, stones, various deposits and affected tissues. These spaces are not physiological, but are formed during detachment from the surface of the tooth. Curettage of the gums promotes their healing and produces a therapeutic effect.

Types of gum scraping

Depending on the severity and depth of the formed hole, two main types of curettage are used:

closed;
open.

Let's try to understand them in more detail.

Closed curettage is performed when the gums are detached from the tooth surface by less than half a centimeter. With the slightest deviation (1-2 mm), it is preferable to use the laser cleaning method. For surgical cleaning, special instruments are used - dental curettes. At the end, antiseptic treatments are necessarily carried out and prescribed.

Open curettage is a more extensive intervention used when the depth of the periodontal pocket is more than 0.5 cm. The general principles are the same as in the previous method, the only difference is the direct incision of the gum to gain access to the deeper layers. After the procedure, the surface of the tooth, especially its root, is carefully polished, treated with an antiseptic, and the gum is sutured. Special medicinal ointments or gels are applied to promote rapid healing.

Thus, tooth curettage is not only a therapeutic manipulation, but primarily a preventive one. Carrying out this manipulation makes it possible to prevent the development of more serious diseases and keep the tooth healthy and the gums free of inflammation.

Curettage in gynecology

Among all gynecological operations, curettage of the uterine cavity is one of the most common and widely used, but among other types of curettage it is the most serious and invasive. The procedure itself is not so long and lasts about 15 minutes. The woman is observed for a few more hours after the procedure to exclude bleeding.

Uterine curettage can be performed either under general anesthesia or under local or epidural anesthesia - it all depends on the specific case and the extent of the intended interventions.

Indications

It can be performed for two main purposes: therapeutic (for treatment) and diagnostic (to make a final clinical diagnosis), and the indications for it are as follows:

uterine bleeding;
remnants of membranes or tissue after complicated delivery or abortion;
polyps;
synechia;
inflammatory diseases of the uterus;
uterine hyperplasia;
undiagnosed changes in the mucous membranes of the uterus (cervix or body);
long and heavy menstruation;
infertility;
abortion;
miscarriage;
ectopic pregnancy;
as preoperative preparation.

Curettage technique

Curettage is very often used in gynecological practice. What it is is well known to gynecologists. Let us consider in more detail the stages of its implementation.

After all the necessary general clinical examinations and the exclusion of acute inflammatory diseases of the pelvic organs and somatic pathologies, and obtaining the patient’s written consent for the procedure, curettage of the uterine cavity is performed. During the operation, only the top layer of mucous membrane is removed, which is rejected independently during menstruation.

Having placed the patient in and given anesthesia, they expand the vaginal walls with special instruments, then the cervix, and only after that proceed to direct cleaning.

Often, not only the uterine cavity, but also the cervical canal is scraped out, which is called. The resulting samples are placed in sterile tubes, labeled and sent to the laboratory for further analysis.

Preventive measures after curettage

Within 10-14 days after curettage, it is strictly prohibited:

use tampons (only pads);
to make love;
douche;
lie in the bathtub or go to the bathhouse (sauna);
take aspirin or other blood thinning medications;
exercise and carry weights.

Possible complications and risks after curettage

Although this procedure is routine, if the technique is not followed, unfavorable structural features of the organs, or simply a coincidence of circumstances, certain complications may arise:

excessive blood clots or bleeding;
spastic pain;
infectious diseases;
inflammatory processes;
infertility;
perforation of the walls of the uterus or cervix.

Therefore, if after surgery you experience at least one of the symptoms listed below, contact your doctor immediately.

Signs requiring emergency care:

prolonged bleeding or large clots (more than two or three pads were used in two to three hours);
pain or discomfort in the lower abdomen;
increased body temperature;
unpleasant-smelling vaginal discharge.

It is also necessary to monitor the nature of menstruation after cleaning and be sure to report changes to your doctor.

Curettage: reviews

Many patients have undergone this procedure. Reviews indicate that curettage of periodontal pockets helps remove microbes under the gum, as well as granulomas that are located on the root of the tooth. Many patients with periodontal disease respond positively to the procedure.

The recovery period after uterine curettage, according to reviews, passes quite quickly. The operation is usually prescribed for women with hyperplasia and polyps.

According to patients, curettage of the armpits is a rather expensive, but really effective procedure.

Conclusion

So, we looked at a procedure called curettage. What it is, you now know. Armed with the necessary knowledge, you can easily and without consequences, if necessary, sign an informed consent to this procedure.

Despite all the imaginary harmlessness of periodontal diseases, their course is often aggravated and surgical treatment methods are used as part of complex therapy, including curettage, open and closed, flap and plastic surgeries, and operations on the soft tissues of the gums.

All surgical methods aimed at treating periodontal disease are conventionally divided into two groups. The principle of their grouping is determined by several factors, such as the purpose of the planned operation, the etiology of the inflammatory process, and the methodology.

The first of these groups includes operations carried out to eliminate the periodontal pocket as a consequence of periodontal disease, for example: curettage of the tooth socket, plastic surgery of the short frenulum of the lips, deepening of the small vestibule, patchwork operations.

The second logically includes interventions aimed at eliminating the causes of the inflammatory process and some symptoms accompanying the disease. For periodontal abscess - gingivotomy, gingivectomy for hypertrophy of the gingival margin.

In this article we will describe surgical methods from the first group, which, while pursuing the same goal - the elimination of pathologically altered tissues, differ only in the methods of prompt access to them.

Closed curéage

Target

As with all operations belonging to this group, “closed” curettage of periodontal pockets is carried out with the aim of removing vegetative epithelium, subgingival “tartar”, decayed tissue, granulations, as well as affected root cement.

Indications

Indications for closed curettage include periodontitis of moderate and mild severity, provided that the depth of the periodontal pockets is 3.5 - 4.0 millimeters, there are no bone pockets, and the gums have a dense structure.

Contraindications

Like any operation, curettage of periodontal pockets has contraindications, such as: discharge of purulent secretion from the pocket, suspicion of an abscess and its reliable presence, presence of bone pockets, and also when periodontal pockets reach a depth of more than 5 mm. Fibrous and thinned gum tissues, tooth mobility of the III degree, are also a contraindication to curettage.

Some dentists note such a disadvantage of closed curettage as the lack of visualization of the process, that is, the inability to visually control the operation, which means that there is a risk that the removal of the ingrown epithelium in the periodontal pocket and the granulations developing in it may not be completely removed. The technique of carrying out such an operation requires enormous patience and scrupulousness from the specialist, because in addition to removing pathological tissues blindly, the doctor must manage not to injure or damage healthy tissues of the gums and teeth.

Method of performing closed curettage surgery

The first and mandatory manipulations before curettage of a periodontal pocket are antiseptic treatment of the oral cavity and anesthesia.

Then, using curettes and scalers, pathologically altered root cement and dental deposits are removed. All tooth surfaces are subject to treatment, after which they are polished using special periodontal burs.

Then, using an excavator or rasp, the bottom of the pocket is processed by scraping the softened surface layer of the edges of the alveolar processes and interalveolar septa. Then the oral epithelium that has grown into the pocket and granulations are scraped out.

A characteristic feature of this technique is the unconditional, almost jewellery, caution required from the doctor, since roughly performed curettage of periodontal pockets often entails the development of various complications, and, accordingly, a delay and deterioration of healing.

The final step is to rinse the treated pocket with antiseptic solutions. At the same time, manipulations are carried out aimed at stopping bleeding, including measures that preserve the blood clot filling the cavity from the periodontal pocket.

A protective gum bandage is then applied. Over the next 2-3 days after curettage, it is not recommended to eat solid, rough food, and also, without stopping brushing your teeth, to use gentle treatment in the curettage area. Special baths and rinses using wound healing and antiseptic solutions are recommended.

Protective gum bandage

When performing rough curettage, complications such as bleeding, pulpitis, and suppuration often occur. However, the effectiveness of the surgical treatment can be objectively judged only after 2-3 weeks, that is, after the formation of a connective tissue scar.

Vacuum curettage

A type of “closed” curettage is vacuum curettage of periodontal pockets, which differs from conventional closed curettage in that the operation is performed using curettes connected to a device that creates a vacuum. To a certain extent, this is a plus, since the excised pathologically altered tissues are immediately removed from the pocket, which helps reduce the risk of complications. But, despite the advantages of this method, there are still disadvantages, the same notorious lack of visual control. This means that incomplete removal of granulations, oral epithelium and other tissues remains possible.

Open curettage

Target

“Open” curettage of periodontal pockets is carried out to remove pathological tissues and formations. Excision of epithelium grown into the pocket, granulations, removal of infected root cement and dental subgingival deposits - elimination of the periodontal pocket.

Indications

Indications for the use of this technique are periodontal pockets up to 5 millimeters deep, significant growth of granulation, respectively, deformation of the interdental papillae, as well as the absence of a complete tight fit of the gingival margin to the tooth.

Contraindications

It is contraindicated to perform surgery using this method if the pocket depth is more than 5 millimeters, if the gum tissue is too thin, if there are necrotic changes in the gingival margin, abscessation and suppuration from the pocket and surrounding gums, acute inflammatory and infectious diseases of the oral cavity.

Carrying out open curettage

First of all, antiseptic treatment of the oral cavity and anesthesia are carried out.

Next, a horizontal incision is made along the tops of the interdental papillae of the gum, then both the oral and vestibular sections of the interdental gum are peeled off, and the mucous flap is then peeled off only to the depth of the pockets, respectively, no further than the alveolar bone.

Then, with full visual control, in contrast to closed curettage techniques, dental plaque and pathological tissue - infected tooth root cement - are removed using hoes, curettes, and scalers. The root surfaces are polished with periodontal burs. Next, after treating the dental tissues, they begin to excise soft tissue pathologies, namely, using a curettage spoon, scalpel, or scissors, they remove the oral epithelium and granulations that have grown into the pocket.

If the gingival margin has significant deformation, it is possible to remove part of the gum up to 1.0-1.5 millimeters wide.

As a rule, curettage of gingival pockets ends with washing the surgical field with antiseptic preparations, placing interdental papillae and fixing them with catgut sutures. Next, a protective gum bandage impregnated with anti-inflammatory drugs is applied to the surgical site. Sometimes, in cases of extreme bleeding, it is possible to omit a bandage in order to prevent the formation of a hematoma.

During the first 2 - 3 days after curettage of periodontal pockets, it is recommended to apply cold to the face in the area of the postoperative wound. As well as the exclusion of irritating, hard and rough foods. Teeth brushing is allowed, but subject to gentle treatment in the area of the operation. It is also recommended to rinse the mouth and mouth baths based on antiseptics and herbal infusions and decoctions, especially after meals.

Flap operations

A separate text should cover questions about flap operations, since all of them, at least, differ from the others in the creation of a fully mobilized flap. Flap surgery is essentially cutting out and folding back the mucoperiosteal area of the gums, and subsequent treatment of bone pockets, surfaces of tooth roots and the inner surface of exfoliated soft tissues.

The variety of modified techniques of this type of operation are united by one significant nuance: complete visual control and careful maximum removal of pathological tissue, which reliably ensures the longest stabilization of periodontal processes.

Flap surgery on the gums, reviews of which are generally positive, can still cause exposure of the necks of the teeth, an increase in their mobility, a decrease in the height of the alveolar processes, and the development of dentin hyperesthesia and the development of conditions that contribute to the appearance of an aesthetic defect cannot be ruled out.

Indications

The indication for surgical intervention of this type is periodontitis of moderate and severe severity, the pockets in which have a depth of 5-8 millimeters, and bone tissue resorption is developed over half the length of the tooth root. And as a result of resorption of bone tissue by two-thirds of the root length, but subject to the use of transplantation materials.

Contraindications

Contraindications to flap surgery are the presence of resorption of the alveolar process for more than half the length of the root, the presence of an extensive focus of bone tissue resorption in the immediate vicinity of the bifurcation of a multi-rooted tooth. The presence of severe somatic pathology, especially if flap surgery on the gums can aggravate its course.

Technique of flap surgery

The primary task of the dentist before performing an operation is to sanitize the oral cavity and treat it with antiseptic solutions and administer anesthesia.

Next, two incisions are made vertically from the edge of the gum to its transitional fold, then two more incisions are made from the oral and vestibular sides, retreating from the gingival edge by 2.0 - 2.5 millimeters, while the cut off part of the gum is removed. However, with minor changes in the marginal part of the gum, in order to reduce loss of soft tissue, one horizontal incision is allowed, as with “open” curettage.

Then, the mucoperiosteal flap is peeled off and folded down to the moving part of the mucous membrane - the transitional fold. And then dental deposits and pathological root cement are carefully removed, then the root surfaces are polished with periodontal rasps and burs.

After processing the tooth tissues, we begin to process the soft tissues. Granulation tissues and strands of ingrown epithelium are excised from the inside of the flap. Then the osteoporotic alveolar processes are treated and the surgical wound is washed with antiseptics. Bone defects, if any, are filled with graft material. The flaps are then placed in place and sutures are applied, pulling them towards the necks of the teeth. This is followed by the application of a therapeutic and protective gum bandage.

Often, after “open” curettage and patchwork operations on the periodontium, the necks of the teeth are exposed, their hyperesthesia occurs - gum retraction.

In connection with this, in the postoperative period it is recommended to use special oral care products for sensitive teeth, and dentists also carry out a number of measures to reduce the sensitivity of the necks of teeth in a clinical setting. Some flap operations for periodontitis make it possible to preserve or even restore the maximum physiological shape of the gingival margin, especially in the area of the front teeth.

As can be seen from the above, operations belonging to this group, despite the different ways of accessing the pathological process, have a common characteristic feature. Namely, the fact that regardless of the technique, be it curettage or flap surgery, they are aimed at removing granulations, oral epithelium grown into the pocket, subgingival dental deposits, infected tooth root cement, that is, excision of the same tissues.

Today, gum problems are very common. Treatment for gum disease consists of a number of different procedures that identify and eliminate the cause of the disease and prevent its recurrence. Often when treating gums, a procedure such as curettage of periodontal pockets is used.

What is curettage of periodontal pockets?

The recess between the edge of the gum and the cervical part of the tooth is the gingival (periodontal pocket). Normally, the depth of such a pocket is usually about three millimeters. And in the case when the size of the pocket is larger, this is already a symptom of dental diseases.

A medical procedure used in the treatment of periodontal disease is curettage of periodontal pockets. During this procedure the contents of periodontal canals are removed: granulation tissue, subgingival tartar, bacteria, their waste products, areas of softened tooth cement.

Technique of the procedure

Translated from English, curettage means “scraping.” However, in dentistry, this cleansing procedure has a broader meaning.

Stages of the classical curettage technique in the treatment of periodontal diseases.

Antiseptic treatment is carried out in the place where the procedure will be performed.
Anesthesia is performed using application or injection agents.
The surface of the tooth is destroyed and soft and hard deposits are removed(organic plaque, stones). This is done using special equipment (ultrasound) or dental instruments.
The cement and dentin affected and destroyed by infection are scraped off on the root part of the tooth.
The root part of the tooth is leveled and smoothed, its surface is polished.
Using an instrument, epithelial cords and granulations that are damaged by infection of necrotic gum tissue are scraped off. The scraped material is removed from the cavity of the periodontal pocket along with blood and mucus.
Cleaned fabrics are treated with antiseptics and antibacterial drugs.
The gum is pressed against the root surface of the tooth and a bandage is applied to it.

If the procedure was carried out correctly, then in the periodontal pocket lymph flow and blood circulation improves, favorable conditions are created for the occurrence of physiological hemostasis. The final result of treatment is the reattachment of the gum, restoration of its epithelial covering and the lower edge of the gingival sulcus.

Surgical methods of treatment

Open curettage of periodontal pockets

During this operation, all subgingival deposits and inflamed granulation tissues are removed from under the gums, periodontal pockets are eliminated, with the help of synthetic bone tissue grafting, bone tissue is restored.

Preparation for surgery:

dentures are removed;
anti-inflammatory therapy is carried out;
Splinting of teeth is carried out (according to indications).

The operation is performed under local anesthesia, against the background of antibiotic therapy. Typically, one segment (7-8 teeth) is processed in one operation.

Key points of the operation technique:

The mucous membrane of the teeth and gums peels off in order to get to the bone tissue. To do this, an incision is made around the necks of the teeth;
To detect defects, flaps of bone tissue are removed from the bone. This allows you to see all the subgingival deposits and periodontal pockets, from which, using special surgical curettes and an ultrasonic scaler, granulation tissue and tartar are removed;
The surface of bone tissue and tooth roots is treated with antiseptics. If the bone pockets are deep, then synthetic bone is “planted”. This is necessary for bone tissue restoration. It will not be possible to restore it in full, but it is quite possible to reduce the bone pockets;
Sutures are placed in the area of the interdental papillae. A gum dressing, which will promote healing and protect the surgical area, is applied at the end of the surgery. Ten days after open curettage, the sutures are removed.

Closed curettage of periodontal pockets

The purpose of this operation is to remove periodontal pockets and subgingival dental plaque. The disadvantage of this technique is that curettage is performed blindly, without a visual overview of the roots and periodontal pockets. Because of this, dental plaque and granulation remain in place.

Closed curettage is effective for periodontal pockets up to three millimeters. For moderate to severe periodontitis, closed curettage is only temporarily improves gum condition by reducing the mass of granulation. Periodontitis will progress further, since this phenomenon will be short-lived.

At the same time, closed curettage is performed only in the area of \u200b\u200btwo or three teeth. The cleaned cavity heals for about a week. But only in a month diagnostic probing can be performed gingival groove.

This type of curettage is popular in those dental clinics where there is no experienced surgeon, and the operation is performed by an ordinary dentist-therapist.

In order to assess the condition of the gum pockets, develop tactics for further treatment or prevent the re-occurrence of tartar, patients are prescribed a return visit to the dentist after three to four months.