Blind periodontal curettage
I- Introduction:
Scaling and root planing are two distinct procedures with very different justifications and indications. They aim to debride the dental wall of the pocket. The word curettage is used in periodontics to designate the elimination of the gingival wall of a periodontal pocket, thus eliminating the affected soft tissue. Some authors differentiate curettage (gingival) in the case of a gingival pocket (gingivitis) from subgingival curettage (radicular, periodontal) in the case of a periodontal pocket (periodontitis). In any case, this therapeutic procedure aims to obtain healing by bringing together dental and gingival tissues made biologically compatible.
II- Definitions:
“Glickman 1973”. Periodontal curettage involves removing degenerated tissue that lines the gingival wall of the periodontal pockets.
• “Lindhe 1986”: Periodontal curettage is defined as the removal using a curette of the internal face of the soft tissue wall of the pocket.
• The American Academy of Periodontology (AAP) in 1989 defined gingival curettage as follows: “Gingival curettage consists of curetted soft tissues from the gingival wall of a periodontal pocket.” It is a procedure that aims only to remove the soft tissues of the pocket using a curette, passing through the marginal and papillary gingival margin, without tearing the gingival wall.
III- Objectives:
This is a blind procedure under anesthesia intended to:
• remove pathological epithelial tissue bordering the pocket and epithelial tissue obliterating the base of the pocket (residual epithelial attachment)
• eliminate infiltrated connective tissue (so-called granulation tissue), contaminated inflammatory tissue.
• reduce pocket depth by facilitating contraction of the gingival wall. • create an environment favorable to pocket depth reduction by the neo-attachment of gingival fibers and epithelium to the tooth surface previously denuded by the disease.
VI- Indications and contraindications:
1. Indications:
– blind periodontal curettage is indicated in the presence of edematous gingiva and a shallow pocket less than 0.5 mm without infrabony lesion;
-curettage allows the assessment of scar tissue response;
-this is the preparatory step for periodontal surgery;
-in the case of severe and advanced periodontitis, periodontal curettage can constitute preparation for surgery and promote healing.
2. Contraindications:
-local: unmotivated patients, presence of fibrous gum consistency.
-general: those of periodontal surgery.
V- Instrumentation and operating protocol:
1. Instrumentation:
Periodontal curettage is performed using periodontal curettes. There are a large number of periodontal curettes that differ mainly in their handles and the angulation of their working parts. The working part of the periodontal curette can very roughly be compared to a part of a spoon with all the edges very sharp. The most commonly used curettes are Goldman-Fox, Gracey and universal curettes.
2. Operating protocol:
– asepsis of the operating field;
-anesthesia: will preferably be with vasoconstrictor, contact, followed by periapical anesthesia, supplemented by intrapapillary filtrations;
• a sharp curette is inserted to the bottom of the pocket, with the sharp edge pointing towards the gum. The practitioner activates the curette with a coronal-external movement, while maintaining finger pressure on the external surface of the gum. It is generally necessary to perform several curette movements to remove all the epithelium and all the granulation tissues
• After curettage of the soft tissues, the regularity of the root surface must be checked using a fine probe. Any imperfections can be corrected at this time.
-washing with an antiseptic;
-very firm compression is carried out using a gas compress for 2 to 3 minutes in order to promote the adaptation of the superficial periodontal tissues to the root surface and the formation of an adequate blood clot;
-surgical dressing for proper soft tissue rehabilitation on the root surface, and helps to minimize clot between the gingiva and the root surface.
Blind periodontal curettage
NB: Gingival curettage is generally easier to perform on single-rooted teeth, because “blind” curettage of the furcation walls in particular can pose major problems given the difficulty of accessing very rough surfaces.
3. Post-operative care and advice:
-drug prescription based on anti-inflammatories;
– chlorhexidine-based mouthwashes, with 2 rinses for 1 minute per day for 5 days;
-avoid hot and spicy foods;
-recommendation to use soft toothbrushes;
-the patient will be informed that he should expect moderate discomfort. Possible consequences: slight gingival recession, hyperesthesia at the dental surfaces, dental discoloration.
VI- Healing:
There will be an epithelial-connective reattachment: in certain cases the epithelium adheres to the root by forming a long epithelial sleeve, this type remains fragile and under the effect of PB can disappear and allow microorganisms to recolonize the root.
Blind periodontal curettage
Deep cavities may require root canal treatment.
Interdental brushes effectively clean between teeth.
Misaligned teeth can cause chewing problems.
Untreated dental infections can spread to other parts of the body.
Whitening trays are used for gradual results.
Cracked teeth can be repaired with composite resins.
Proper hydration helps maintain a healthy mouth.