Who did open curettage? Open and closed curettage of gum pockets. Open curettage of dental pockets

CURETAGE

The purpose of curettage is to eliminate periodontal pockets due to the formation of a scar. To do this, it is necessary to remove dental plaque, granulation tissue, and the epithelium of the inner surface of the gums. As a result of the formation of a blood clot, scarring of the periodontal pocket occurs.

When performing curettage, the following requirements must be observed:

Complete anesthesia of the operated area;

Careful attitude towards the treated tissues;

Compliance with hygiene rules in the postoperative period;

Blood clot protection.

When performing curettage, sterile, sharp, comparable 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., the literature distinguishes between simple and subgingival curettage.

Simple curettage limited by the circular epithelium and 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 treatment of the surface of the crown and root of a tooth to remove plaque, stone, and stains.”

The term "periodontal debridement" is considered an alternative to the terms "scaling" and "root planning". The decisive difference between these procedures is considered to be the different treatment of the root. If with “scaling” the removal of cement is not considered necessary, and sometimes even undesirable for achieving periodontal health, then with “rootplaning” it is a primary task.

Curettage in the classical sense (scraping out the contents of a 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. Contraindications 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 in fibrous-changed gums, explaining this by the fact that the fibrous-changed wall of the periodontal pocket does not adhere well 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 epithelium are removed from the walls and bottom of the periodontal pocket. To do this, place a finger on the outer surface of the gingival wall of the pocket and, using instruments (curettes), remove pathological granulations “finger by finger”. If necessary, refresh the edge of the gums and alveolar process. Curettage is completed with antiseptic treatment of the surgical wound, hemostasis, tight pressing of the gum to the tooth and application of a gingival bandage.

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

a - removal of subgingival stone; b - curettage of the gingival pocket wall; 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 “muff” to the tooth root (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 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, the scar change of which provides the hypothetical result of the operation: attachment of the gum to the root of the tooth, or rather the restoration of the epithelium of the gingival sulcus with close adaptation of the gingival coupling to the root of the tooth (the probable result of the operation).

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

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

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

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

The “open” curettage technique involves dissecting the tops of the interdental papillae in the area of ​​several teeth with a scalpel or gum scissors, followed by blunt delamination of the interdental gum to the bottom of the pockets. After this, curettage is performed according to the described method. It should be emphasized that with “open” curettage, it is sometimes advisable and technically possible to perform de-epithelialization of flaps using gingival scissors and even partial (up to 1.5 mm) excision of the gum in cases of its proliferation while maintaining the scalloped gingival margin. Upon completion of the operation and thorough hemostasis, a gingival dressing is applied. There are reports about the advisability of suturing in the interdental spaces of the gums.

Contraindications for “open” curettage surgery include periodontal pockets with a depth of more than 5 mm, the presence of bone pockets, sharp thinning of the gums in the area of ​​the intended 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 “open” curettage technique not as a modification of curettage, but as a type of patchwork operation.

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

INDICATIONS

Horizontal type of bone atrophy.

Deep gingival and periodontal pockets (up to 6 mm), when high-quality blind treatment is impossible.

The location of the attached gum zone 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 must be said that during curettage, in addition to the mechanical removal of dental complications, chemical agents are used to dissolve them. For this purpose, currently a 20% solution of lactic acid or a 5% solution of citric acid is usually used. The acid is injected into the periodontal pocket on a cotton pad or using a syringe under slight pressure. A number of foreign scientists believe that “chemical” curettage provides predictable uniform removal of the inner wall of the pocket, no need for tissue anesthesia, and a reduction in bleeding due to the hemostatic effect of the chemical.

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

A known technique is vacuum curettage, in which curettage of pathological periodontal pockets is carried out under vacuum conditions using special equipment. The authors recommend performing vacuum curettage when the depth of the periodontal pocket is more than 5-7 mm, single and multiple abscesses. For a better overview of the surgical field, it is possible to perform a gingivotomy first.

Stages of vacuum curettage:

1. Pain relief (application, injection).

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

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

4. Treatment of the bottom of the periodontal pocket and alveolar ridge using sharp hollow attachments for a vacuum device. The alveolar edge 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 treatment, congestion in periodontal tissues decreases, blood and lymph circulation improves.

The authors specially designed hollow hooks for vacuum curettage and a compressor apparatus, which, when connected to the network in one of the containers, creates a vacuum in 3-5 seconds, capable of sucking out blood, mucus, plaque, tiny particles of tartar, granulations, etc. during the curettage operation. alveoli. At the same time, a low excess pressure is created in the second container, allowing the supply and irrigation of the surgical field with an antiseptic solution.

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

The technique 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 when the depth of the periodontal pocket is up to 3 mm and when the gingival wall is thinned.

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. cryocurettage: 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 volume of tissue to be destroyed. At the end of cryotherapy, the working part of the device is removed from the periodontal pocket after electrical thawing;

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

Cryonecrosis after surgery occurs within 24-48 hours, and regeneration of the damaged area occurs 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 co-directionally with 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 strength of 10-15 mA is 2-4 s. To avoid burns to the cement of the tooth root, it is recommended to cover the active electrode with an insulating varnish, leaving free a small part of the electrode in contact with the tissues to be coagulated (Danilevsky N. F. [et al.], 1993). For hypertrophic gingivitis, active electrodes in the form of a thin blade are used, with the help of which the gingival papillae are cut off from their base on the vestibular and lingual (palatal) side.

"Diseases, injuries and tumors of the maxillofacial region"

edited by A.K. Iordanishvili

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 the 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:

1. Closed. This type of cleaning does not cut fabrics.
2. Open. This method is used to access deep pockets. This cuts the gum.
3. Vacuum. A type of closed curettage. It is carried out using a vacuum apparatus. The plaque is removed instantly.
4. Laser. The curette is replaced by a laser. It simply evaporates the plaque.
5. Cryo-curettage. A special freezing probe is used.
6. 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.

Treatment methods for periodontitis: essence, features, reviews
This article was written by a periodontist with a long-term work experience of more than 20 years.
Here you can find out:

• the essence and characteristics of a disease such as periodontitis;
• reasons why surgical treatment is necessary;
• existing methods of surgical control of periodontitis;
• advantages and disadvantages of the presented methods;
• patient reviews on the effectiveness of each type of surgery;
• the answer to the question of what is the best way to treat periodontitis.

To obtain a complete understanding of the need for surgical treatment of periodontitis, the process of its occurrence and development should be considered.

Causes, features and consequences of periodontitis

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

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

Firstly, the bone tissue around the tooth begins to gradually dissolve. It doesn’t just disappear; in its place, another tissue appears—granulation tissue—containing many microbes that also dissolve the bone. Thus, bone tissue atrophy occurs many times faster.
Secondly, periodontal pockets are formed. Inflammation causes destruction of the attachment of the tooth to the bone (the so-called periodontium). With the help of periodontium, the tooth is securely attached to the bone tissue with microbonds.

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

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

There are several reasons for this.

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

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

Types of surgical treatment of periodontitis

There are three main methods of surgery for this disease: open and closed curettage of gum pockets and flap surgery. Let's look at the features of each method in more detail.

Closed curettage of periodontal pockets

The purpose of closed curettage is to get rid of granulation in periodontal pockets, as well as subgingival dental plaque. But the technique has a significant drawback - when performing curettage, there is no view of the root surface and periodontal pockets, so granulations and deposits may remain in the same places, and in considerable quantities.

This technique is effective only if the patient has periodontal pockets up to 3 mm. This is a mild degree of periodontitis. In more complex stages of the disease, curettage can provide only short-term relief, and in any case, the progression of periodontitis is inevitable.

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

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

This specialist also treats gingivitis. This disease is much less dangerous, but it causes a lot of problems for the “owner”. With gingivitis, the gums change color and swell, bleed, painful sensations appear in the mouth (burning, itching, pain in the gums) and an unpleasant odor.

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

At the early stage of gingivitis, the doctor removes plaque, cleans stones in the gum pockets and smoothes the surface of the tooth root.
At the middle or late stage, the need for surgical intervention arises.

In general, a periodontist treats periodontal diseases and studies periodontal tissues. In general, his work directly depends on the patient’s goal. Someone may need an examination for preventive purposes and receive recommendations to help prevent the occurrence of diseases of the teeth and gums, and maintain proper oral hygiene.

Other patients need a complete diagnosis of the oral cavity, identification of the causes of periodontal disease and the development of effective treatment methods and recommendations.

Be that as it may, a periodontist is needed in any highly qualified dental clinic, and if periodontal disease occurs, you should contact this kind of doctor.

Open curettage of dental pockets

The purpose of open curettage is to get rid of granulation in periodontal pockets, subgingival dental plaque, eliminate gum pockets and stimulate bone tissue restoration by replanting synthetic tissue.

The operation is usually performed under local anesthesia. Before it begins, serious and thorough preparation is carried out. Dental plaque is removed, anti-inflammatory therapy is carried out, etc. As a rule, during one operation one segment (7-8 teeth) is operated on.

Let's consider the progress of such an operation

The specialist makes an incision around the required dental necks, after which flaps of the gum mucosa are peeled off from the teeth. Thus, the root surface and bone tissue defects become visible. The surgeon can now visually observe all gum pockets and subgingival deposits. Using ultrasound, it removes granulation tissue and all tartar. Then the roots of the teeth and bone tissue are treated with an antiseptic and the replanting of synthetic bone tissue begins. This procedure is not able to completely restore the tissue, but it helps to significantly reduce the depth and width of the pockets.

A little should be said about synthetic bone tissue. It is an artificial powdery raw material that completely replaces bone. Not dangerous for allergy sufferers as it is hypoallergenic.

After replanting the bone tissue, the periodontist surgeon places sutures in the area of ​​the interdental papillae, then a bandage is also applied to the operated area. Sutures are removed after 10 days.

Flap surgery

As for flap surgery, it helps to achieve the following goals: remove granulation tissue from under the gums, clean out subgingival dental deposits, remove gum pockets, and finally, stimulate the restoration of bone tissue by planting its synthetic analogue. As you can see, these goals completely coincide with the goals achieved with open curettage.

However, there is a difference between these methods. It consists in the fact that when performing a flap operation, an incision is made 1-1.5 mm from the edge of the gum. Subsequently, this strip of gum is cut out, since being inflamed for a long time, the gum changes and loses its ability to fit tightly to the tooth surface. At the end of the procedure, flaps of the gum mucosa are stretched to the dental necks. This “tension” helps prevent “recession” of the gums.

Flap operations are used both for generalized periodontitis and to cover receding gums in the area of ​​1-2 teeth and exposed roots.

We invite you to consider reviews from patients after they have tested different surgical techniques.

Review of closed curettage

This procedure is very short-lived and can be tolerated without any problems. To perform such an operation you do not need an experienced periodontist surgeon; a regular dentist or periodontist will do. Moreover, in terms of price, this is the cheapest of all the presented methods of surgical treatment. And perhaps these are the only advantages of closed curettage.

There are many more disadvantages.

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

Feedback on open curettage and flap surgery

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

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

Secondly, the prices for these operations “bite”, and this is not an exaggeration. In addition to the labor of the doctor, his assistant or nurse, the patient must also pay for the purchase of expensive materials (monofilament - suture material, synthetic bone tissue, etc.).

During surgery, when the doctor removes granulation tissue and inflamed gums, there is a risk of gingival recession (that is, the gums seem to “sink”, exposing the roots). The extent of such root exposure fully depends on the extent of bone tissue atrophy.

In addition, several months after surgery, the gingival papillae are flattened and cannot fill the entire interdental space. And only after a long period of time do they take on their previous shape, eliminating cavities between the teeth.
Finally, the last disadvantage of such operations is the duration of their implementation. Working with one segment (7-8 teeth) takes approximately 2 hours.

Choosing a surgical treatment method for periodontal disease

As can be seen from the presented article and from the reviews of operated patients, each surgical technique has advantages and disadvantages. At the initial stage of the development of periodontitis, closed curettage can help, but such an operation is ineffective and its results are short-lived - in the future it will be necessary to repeat it several times.

For moderate to severe stages of periodontal disease, it is better to choose other methods. The most reliable and effective option is flap surgery and open curettage, since only they can cope with the moderate and severe stages of periodontitis, while ensuring that the disease does not progress in the future.

In any case, you should not neglect examination and treatment in specialized clinics, since dental health is a very valuable gift, which not everyone manages to maintain in adulthood.

Cost of curettage of periodontal pockets

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

Some dental patients are faced with a procedure such as open or closed curettage of periodontal pockets. We’ll talk about what it is, prices and reviews in more detail below. After all, the patient needs to know what he is going into and what to prepare for mentally.

It should be understood that any inflammatory processes in tissues cannot be cured without high-quality cleaning and treatment of subgingival deposits. But it is not always possible to do this using an ultrasound procedure. Therefore, doctors have to resort to more complex and painful manipulations to effectively and completely eliminate foci of infection.

Characteristics of the periodontal pocket

In medicine, this phrase refers to a small natural gap between the neck of a tooth and the gum covering it. Normally, it should not be open and deep. So, if the size of the periodontal pocket does not exceed 0.15 mm, then they can be cleaned of various deposits using regular ultrasound treatment.

In other cases, food debris, plaque, tartar, and bacteria accumulate more and more intensively and lead to inflammatory processes, thereby widening the gap between the gum and tooth and aggravating the clinical picture. This phenomenon can be observed both on one jaw and on both jaws at once.

Doctors believe that even the formation of a periodontal pocket of 3 mm or more is already one of the symptoms of tissue pathology. And if you do not undergo timely treatment in the early stages, this will lead to chronic disease, which is much more difficult to get rid of.

Symptoms

The formation of plaque, deposits, bacterial growth and deepening of pockets occurs unnoticed at first. And only with the appearance of serious complications does the patient notice signs of inflammation:

• discomfort in the gums;
• loved ones complain when talking, even if hygiene procedures were performed before;
• redness and swelling form on the mucous membrane, its surface becomes shiny;
• at the slightest touch and processing it begins;
• during diagnostic palpation, pain is felt and tissue compliance is observed;
• sometimes pus is released;
• the dimensions of the neglected periodontal pocket are increased so much that the gap with its contents is visible to the naked eye upon visual inspection;
• teeth are getting stronger, even if they are healthy;
• Gaps also appear between units in a row and space is freed up;
• with severe intoxication, the patient’s general condition worsens, which is expressed in weakness and other symptoms.

For any of the individual signs mentioned, you need to see a dentist as soon as possible in order to stop the development of the disease and prevent complications.

Causes

This pathology occurs in many patients, but most often the following factors contribute to this:

• habit of eating incorrectly, abuse of carbohydrate foods;
• illiterate actions during hygiene procedures, or even complete neglect of them;
• some bad habits (for example, smoking);
• general systemic diseases that contribute to the spread of infection throughout the body;
• hormonal disorders at different periods of a person’s life;
• low level of immune system;
• untreated dental diseases.

Indications and contraindications for the procedure

In cases of the formation of deep periodontal pockets and their pathological inflammation, curettage is performed in various ways. What it is? This procedure helps to thoroughly clean the infected area and prevent the spread of bacteria to surrounding tissues.

Only in this way can complete treatment be carried out and achieve high effectiveness. The most common indications for curettage are:

• the onset of inflammation of the mucous membrane;
• the formation of a noticeable gap between soft and hard tissues;
• abundant deposition of tartar in the subgingival area.

Although curettage is prohibited or undesirable in some cases:

• purulent discharge and suspicion of a soft tissue abscess;
• formation of cavities in the bone structure;
• the periodontal pocket is too deep – more than 5 mm;
• thinning gums;
• the onset of fibrous tissue changes;
• extreme loosening of teeth;
• acute infections in the oral cavity;
• some common diseases.

How is treatment carried out?

How is curettage done? To do this, use a special dental instrument - a curette. It is thin enough to carry out the necessary treatment of the root area of ​​the tooth even without opening the tissues.

Sometimes doctors resort to a modern method - laser curettage. To do this, special equipment is used and painlessly performs high-quality cleaning of periodontal pockets and restoration of affected tissues.

In addition, specialists can take other measures to cleanse and treat periodontitis - antibacterial therapy, other methods of removing dental plaque, anti-inflammatory drugs and even physiotherapeutic methods. But the best results are distinguished by two types of curettage - open and closed. All other methods remain auxiliary.

This procedure should not be confused with a preventive one. Indeed, in the second case, only the processing of the visible surfaces of the enamel and its polishing are performed.

Completely getting rid of subgingival deposits, bacterial accumulation and enlargement of periodontal pockets can only be done surgically, which will prevent re-inflammation and ensure cleanliness and tissue regeneration.

Open curettage of periodontal pocket

This technique is chosen in cases where the size of the gap is set to more than 5 mm or the closed technique did not give the desired results. Surgical opening of the gums is performed for a better view of the deposits, better treatment, elimination of granulation and additional procedures.

So, in this case they can perform splinting to fix the dentition, build up bone tissue and fully cure and restore the mucous membrane. The doctor performs the following manipulations:

1. A general diagnosis is carried out and the need for surgery is determined.
2. Next, some preparation is required - the desired area is treated with antiseptic agents, and the patient is given local anesthesia.
3. The mucosa is opened using small incisions to access the root part of the jaw.
4. The necessary high-quality cleaning is carried out, all remnants of bacterial activity, dead cells, damaged areas of tissue, etc. are removed.
5. If necessary, an osteogenic drug is administered that can increase tissue volume in a short time.
6. The mucous membrane is sutured, and the upper part is pulled to the cervixes and fixed.
7. After ten days, if healing is normal, the sutures are removed.
8. A special bandage with medicinal agents is applied to the treated wound surface.

The total healing time can take 2-3 months. In this case, the doctor prescribes antibiotics, anti-inflammatory and painkillers, as well as rinses or other auxiliary procedures carried out at home.

During one such operation, a specialist can simultaneously process up to eight units located in a row. In addition to cleansing, the periodontal tissue is partially built up and the resulting pocket is reduced. Only an experienced doctor with a sufficiently high level of qualifications can carry out such a procedure.

Closed curettage of periodontal pocket

This method of treating and cleaning the resulting gap is selected in cases where the size of the pocket does not exceed 3 mm. As a result, the subgingival area can be treated only with simple instruments.

True, the technique has disadvantages:

• during one session, only 2-3 units in a row are available;
• visual control over actions and quality of work is impossible, all manipulations occur blindly;
• Because of this, and also as a result of difficult access, the doctor cannot completely clean the periodontal pocket; there is a high risk that some of the granulation formations will remain in place, which will lead to re-inflammation.

But this operation occurs without mechanical damage to the tissues, without opening them, which makes the patient feel better and speeds up the healing time. In the process of such curettage, it is possible to reduce a deep periodontal pocket or completely get rid of a small gap.

The steps of the procedure themselves are quite simple:

1. Local anesthesia is administered.
2. Using a curette, the walls of the tooth and the subgingival area are processed, thoroughly cleaning the bottom of the pocket.
3. The accessible area is washed with sodium chloride solution.
4. At the end, a bandage is applied that can speed up healing and protect weakened tissues from external influences during the postoperative period. Typically, stomalgin, zincoplast or repin are used for this.

After 1-2 months the patient feels complete healing. True, at first there is pain, increased irritability of the mucous membrane and mobility of the crowns.

Possible consequences

Curettage of periodontal pockets is considered one of the most effective methods for treating periodontitis and other inflammatory processes in the soft tissues of the oral cavity. However, in some cases complications or lack of the expected result are possible. This happens if:

• the doctor does not have the proper level of qualifications or experience and does not thoroughly clean the cavity;
• granulomatous formations remain, which grow again over time;
• some individual characteristics of the patient’s body appear, which sometimes leads to unexpected results;
• Pocket depth is too deep when more serious intervention is required.

Video: how is closed curettage of periodontal pockets performed?

Price

The cost of the procedure depends largely on the level of the clinic in which it will be performed, the region of residence, the number of units processed and the complexity of the manipulations. Typically, the average price in Moscow ranges from 500-6000 rubles per tooth using the open method and 350-1200 rubles using the closed method.

If we talk about segments or cleaning the entire jaw, then prices vary more. So, for one segment processed, some doctors charge 3,000 rubles, while others charge up to 20 thousand. The laser procedure also turns out to be significantly more expensive than any other treatment method.

Curettage of periodontal pockets is a deep cleaning of pathological gingival depressions in the root zone of the teeth.

In dentistry “All yours!” 2 methods of cleaning pathological areas are used - closed and open. Closed curettage is performed with pocket depths up to 5 mm: the roots of the teeth are cleaned of subgingival deposits without surgical dissection of the gums.

The open method is practiced for deeper periodontal pockets (from 5 mm): the gums are peeled off, granulations are removed and the roots of the teeth are polished. Then stitches and a protective bandage are applied in the intervention area. The procedure is not pleasant, but thanks to effective anesthesia and the experience of periodontal surgeons at our clinic, it is absolutely painless for the patient.

In “All Yours!” You have the opportunity to undergo both manual and laser curettage of periodontal pockets - using a dental curette or diode laser. Curettage is performed using sterile instruments, in compliance with the standards of the Anti-AIDS program. And the price for the service is one of the most affordable in Moscow.

Cost of curettage of periodontal pockets

Timing of curettage

Closed curettage lasts 30-40 minutes, open - 1-2 hours, depending on the number and size of periodontal pockets.

Their depth is determined using a dental probe. For generalized periodontitis and visible atrophy of the jaw bone, radiography is used for diagnosis.

Complete healing of periodontal tissue occurs 3-4 weeks after the procedure. Removal of sutures when using open cleaning of the roots of the teeth is carried out after 5-7 days.

Why is curettage of gum pockets performed?

Properly performed closed curettage allows you to eliminate periodontal pockets, restore atrophied bone tissue, and prevent gum recession and loosening of teeth.

During the procedure, the roots of the teeth are cleaned of granulations and microbial plaque - subgingival deposits, polished and treated with antibacterial drugs, which serves as an effective prevention of periodontitis.

When the normal structure of the alveolar process of the jaw is destroyed in the intervention area, synthetic bone tissue is grafted.

Lack of timely treatment leads to deepening of gum pockets and pathological mobility of teeth, which is an indication for their removal.