Methodology for performing closed curettage surgery. Open and closed curettage

Today, gum problems are very common. Treatment for gum disease consists of a series of different procedures, which identify and eliminate the cause of the disease, and also 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 classical technique curettage 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, are created favorable conditions 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, using synthetic refill bone tissue 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.

Effective closed curettage with periodontal pockets up to three millimeters. For periodontitis with moderate and severe, closed curettage 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 gum pockets, develop tactics further treatment or prevention of re-occurrence of tartar, patients are prescribed a return visit to the dentist after three to four months.

Despite all the imaginary harmlessness of periodontal diseases, their course is often aggravated by complex therapy apply surgical methods treatment, including curettage, open and closed type, patchwork and plastic surgery, operations on soft tissues 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 performed to eliminate a periodontal pocket as a consequence of periodontal disease, for example: curettage of the tooth socket, plastic short bridle lips, deepening of the small vestibule, patchwork operations.

The second logically includes interventions aimed at eliminating the causes of the inflammatory process and some associated with the disease symptoms. 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 degree 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 tissue, tooth mobility 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 tissue gums and teeth.

Method of performing closed curettage surgery

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

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 carried out curettage of periodontal pockets often entails the development various complications, and accordingly 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 this surgical treatment It can be judged objectively 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 this method, there are still some disadvantages, the same notorious lack of visual control. Which means incomplete removal 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 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 is removed using hoes, curettes, and scalers and pathological tissue- infected tooth root cement. 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 inner surface detached soft tissues.

Variety of modified techniques of this type operations are united by one significant nuance, this is 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

Indications for use surgical intervention Periodontitis of moderate and severe severity is of this type, 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 for flap surgery are the presence of resorption alveolar process more than half the length of the root, there is 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 antiseptic solutions, performing 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 treating the tooth tissues, the treatment of soft tissues begins. WITH inside granulation tissue and strands of ingrown epithelium are excised from 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 means for oral care, from the category for sensitive teeth, as well as dentists carry out a number of measures to reduce the sensitivity of the necks of teeth in clinical settings. 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 related to this group, despite various ways access to pathological process, have in 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.

Some diseases of the oral cavity require special approach. Often drug treatment sometimes it is not enough, it is necessary to eliminate the cause of the disease and get rid of its consequences. One of the most striking examples of an inflammatory process that affects the jaw bones and even the ligaments that can hold the crown in place is periodontitis.

Curettage of the tooth socket will help cure this disease. Using this procedure, carried out using an open or closed method, the doctor will be able to remove accumulated plaque and stone with a curette and irrigator, and also clean the sockets from waste products of bacteria and viruses.

Periodontal pockets - what are they?

Over time, tartar is deposited, its accumulation can lead to the development of an inflammatory process in periodontal tissues and their further destruction, affecting bone tissue. As a result of inflammation, a depression is formed, starting from the gums and ending with the cervical part of the crown, called the “periodontal pocket”.

Depending on the depth and width of the pocket between the teeth, the doctor will be able to determine the extent of the disease. You can diagnose the early stage using x-ray examination, and if inflammation progresses, it can be determined visually. Normally, the depression should not exceed 3 mm - if the gum pocket extends beyond the specified limits, this indicates the presence of a dental disease.

Curettage of gum pockets in dentistry

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Curettage is medical term, meaning cleansing body cavities, organs or skin using a special instrument called a curette. Using this surgical procedure, the doctor removes the affected areas and cleans the areas where they accumulate. pathogenic microorganisms. The curette will also help produce diagnostic curettage in order to subsequently transfer the obtained biological material for laboratory research.

Socket curettage is one of the most common medical procedures carried out in the treatment of periodontitis that occurs after tooth extraction. During the procedure, the dentist removes purulent tumors, tartar located under the gum, and areas of decayed teeth.

Indications for the procedure

At a dentist's appointment, a patient may be recommended curettage of periodontal pockets in the following cases:

Curettage of periodontal pockets is a completely different procedure than enamel cleaning, which only removes plaque. Cleaning the dental pocket allows you to get rid of accumulated deposits and also prevents further tissue decay.

When is treatment contraindicated?

You should refuse the operation if there are any purulent discharge, there is a high probability of developing an abscess, or the gum pocket has spread to the bone structures. If the depth of the periodontal pocket is more than 5 mm, the gums are too thin, there are fibrotic changes, or tooth mobility reaches grade 3, then the doctor will refuse to perform this surgical procedure. Also, in order to avoid complications, you should not go for the socket curettage procedure if you have acute infection in the oral cavity or with impaired physiological functions.

Pros and cons of curettage

There are several positive and negative aspects procedure such as curettage. The advantages of this procedure include:

Unfortunately, there are also plenty of shortcomings. Concerning private method, then in advanced stages Periodontitis almost always recurs. Another disadvantage is the duration of the procedure. The patient will have to spend about two hours during open curettage on teeth 6-7.

The open method requires the surgeon to be extremely focused and attentive. An unqualified doctor can injure the mucous membranes and teeth.

Methodology of the procedure

Translated from in English“Curettage” is nothing more than “scraping.” In dentistry, the meaning of this term is much broader. When performing curettage to treat gum disease, doctors adhere to the following tactics:

the procedure site is treated with an antiseptic solution;
anesthesia is administered;
plaque and tartar are removed from the surface of the teeth (as seen in the photo) using a periodontal irrigator;
The affected area of cementum and dentin are removed from the root of the tooth using scraping movements;
the tooth root is leveled and polished;
tissues damaged by infection are eliminated;
An antiseptic is applied to the cleaned tissues;
A fixing bandage is applied to the gum pressed to the tooth.

After a correctly performed operation, shown in the video, blood circulation and lymph flow are restored in the gum canal. In this way, all conditions are created for rapid tissue regeneration.

Closed

A distinctive feature of the closed method of treating periodontal pockets is the inability to visually monitor the condition of the dental roots, so granulations and tartar may remain intact. The effect of the procedure is possible if the depth of the periodontal pocket is no more than 3 mm (we recommend reading:). With periodontitis, only temporary relief is possible; the disease itself will continue to progress.

In one procedure of closed curettage of periodontal pockets, a doctor can clean the cavity of 2-3 teeth; after the procedure, the healing process can drag on for a week. Diagnosis can be made no earlier than a month after dental intervention. Usually, gum curettage is used only in those dental clinics where there are no highly qualified specialists, and the procedure is performed not by an experienced surgeon, but by a dental therapist.

Open

Open curettage allows you to remove all existing subgingival deposits and damaged tissue in the area of one tooth, synthetic bone tissue is planted, and during the treatment the gum pocket disappears. Open curettage is performed under local anesthesia.

During laser curettage, the surgeon makes an incision in the neck of the tooth and then peels away the gum. The doctor is able to detect all existing subgingival deposits so that such treatment can subsequently remove them using a curette or irrigator. The area where the operation is performed must be treated with an antiseptic. If the bone pocket is deep, then the doctor uses synthetic material for extension.

At the end of the operation, the doctor will apply stitches, which should be removed after ten days. In progress laser surgery it is possible to dissect tissue without contact, minimize pain and instantly coagulate blood vessels. Restoration of gingival papillae in postoperative period happens faster.

Curettage and flap surgery on gums

The use of flap surgery for gum inflammation leads to good results. During the operation, the surgeon has good visual control, so all affected areas are removed. This surgical intervention involves cutting out the periosteal surface of the periodontium, including treatment of root and soft tissues.

Complications are possible in the postoperative period. The necks of the teeth may be exposed, or changes in the alveolar processes may occur. Aesthetic defects or the occurrence of dentin hypertension are also possible.

Is it possible to carry out treatment at home?

If the periodontal space hurts, self-medicating at home means consciously taking a risk. Periodontal disease is serious illness requiring medical supervision.

Any traditional methods Treatments for gum pockets at home are ineffective. The patient, trying to clean the gum pocket on his own and suppress the symptoms of the disease, wastes precious time.

You can get help at home various methods, which will be combined with therapy prescribed by an experienced periodontist. For example, you can treat gum sockets using various ointments and gels that can improve metabolism and blood supply to tissues.

Folk remedies for periodontal pocket disease can also help when it comes to initial stage diseases. Solutions and decoctions help well medicinal plants with antimicrobial and wound-healing effects, they can be used to rinse your mouth.

Possible complications

If curettage of periodontal canals is carried out experienced doctor and strictly adheres to the methodology for its implementation, then complications can be avoided. However, there are cases when, due to a certain combination of circumstances, complications arose:

heavy blood loss;
inflammation in the postoperative period;
secondary infection.

If the doctor is not experienced enough in performing such operations, or the work was performed carelessly during the operation, then not all pathogenic tissues will be removed from the periodontal pocket. In this case, there is a high probability of relapse. The patient must again seek help from a specialist who can perform high-quality cleaning of periodontal cavities.

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

Surgical dentistry: prices for all services

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 effective prevention periodontitis.

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

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

It is impossible to cure periodontal diseases without removing tartar. The fact is that dental plaque is the main source pathogenic bacteria. They will immediately infect the periodontium. Therefore, any treatment will be ineffective. The best way getting rid of hard dental deposits - curettage of periodontal pockets. What it is? This will be discussed in this article.

What is a periodontal pocket?

When there is a lot of dental plaque, it starts inflammatory processes in the gums. Because of this, the mechanism of destruction of periodontal and inert tissue is triggered. As a result, a periodontal pocket is formed,

An experienced doctor only needs to look at the gums to determine the degree destruction periodontal The deeper and wider the visible gap, the further the decay process has gone.

At severe forms pathologies can destroy the sockets of the teeth, which leads to the loss of the latter.

On early stages this pathology can only be detected using an x-ray.

Main symptoms of pathology

At first, the formation of a periodontal pocket does not manifest itself in any way. But the further the disease develops, the more acute and varied the symptoms:

If any of these symptoms appear, it is better for the patient to immediately consult a dentist. Otherwise, the disease can lead to tooth loss.

The main reasons for the appearance of a periodontal pocket

As mentioned above, this disease appears due to the penetration of bacteria into the cervical area of the dental crown. Microbes form an invisible film with the naked eye on the surface of the enamel and begin to actively multiply. Their waste products provoke severe inflammation.

Microbial growth is accelerated by the following factors:

What consequences does pathology lead to?

A periodontal pocket is not a simple tissue deformation. This is enough dangerous pathology, which needs to be treated as early as possible. Otherwise, the patient may face quite serious complications.

The most common complication is acute abscess. If the patient ignores it, it will become chronic.

A periodontal pocket, among other things, very often causes mobility of the dentition. Loose teeth often cause severe pain. And sometimes they simply fall out of the alveolar sockets.

Inflammatory the process in the periodontium causes lymphadenitis and very often leads to general intoxication of the patient.

If the patient does not receive quality treatment, then the pathology will most likely affect the jaw bones.

What is the treatment for periodontal pockets?

In the treatment of this pathology, both therapeutic and surgical treatment methods can be used. Dentists resort to one method or another based on the severity of the pathology and the results analyzes.

At the very beginning of the development of pathology, it can be dealt with using conservative treatment. We are talking about hygienic teeth cleaning with ultrasound and the use of antiseptics: Chlorhexidine or Miramistin.

These procedures effective only in cases where the depth of the periodontal pocket has not reached 2 mm. If the pocket depth is more than 2 mm, then without surgical intervention not enough.

Surgical methods of treatment

All surgical methods for treating periodontal pockets are called curettage. Curettage is a direct instrumental impact on the subgingival space. Depending on the severity of the pathology, doctors resort to open or closed curettage.

Currently more effective There is simply no way to treat periodontal pockets. After it, the patient’s periodontium is completely restored. It is worth considering that each treatment method has its own indications and contraindications.

The main task of the surgeon with closed curettage is to remove subgingival deposits and granulation tissue that has replaced the destroyed periodontium. The main disadvantage of closed curettage is that the surgeon is forced to work blindly. He does not see the surface of the roots and cannot assess the condition of periodontal pockets. For this reason, some of the granulation formations and deposits on the teeth may remain in place.

TO closed Doctors resort to curettage when the depth of the periodontal pocket does not exceed 3 millimeters. This allows you to more or less guarantee complete cure patient. If the pocket is deeper, the effect of this procedure will be temporary. Pretty soon, periodontitis will return with renewed vigor.

This procedure has several contraindications:

Pus is released from the periodontal pocket.
There is a suspicion of an abscess.
There are pockets in the bone tissue.
Thinning of gum tissue.
Tooth mobility of the 3rd degree.

Closed curettage of the periodontal pocket is carried out in several stages:

The doctor performs antiseptic treatment of the mouth. He then numbs the area with local anesthetics.
Using curettes and scalers, the doctor removes deposits from the surface of the tooth and darkened root cement. After this, the surface of the teeth is polished using a special tool.
Using an excavator or rasp, the doctor cleans out the contents of the periodontal pocket: granulations, epithelium, softened deposits.
The treated pocket is washed with an antiseptic and hemostatic agents. It is very important to fix the blood clot that blocks access to the tooth sockets.
At the final stage, a protective bandage is applied.

After curettage of the periodontal pocket to the patient for three days prohibited eat solid food.

Often, after closed curettage, the patient encounters complications such as: pulpitis, bleeding, suppuration of the gums. This is not an indicator of the quality of the surgeon's work. The final results of the procedure can only be said after the scar has formed. This will happen no earlier than in a few weeks.

Because of its simplicity, closed curettage is often practiced in small dental clinics that cannot afford experienced periodontal surgeons. In expensive clinics, when treating moderate and severe periodontal disease, they always resort to open curettage.

This is a type of closed procedure. Its main difference from classic closed curettage is that during the operation the doctor uses curettes connected to vacuum apparatus. This allows you to not only scrape off deposits, but also remove them immediately. This can significantly reduce the risk of complications. But this is the only advantage of this method. Otherwise, it has the same disadvantages as classic closed curettage.

During operations the surgeon removes all deposits from the surface of the teeth, removes granulation formations from under the gums, completely eliminates periodontal pockets and implants artificial bone tissue.

The main indication for this operation is the depth of the periodontal pocket of more than 3 millimeters. This procedure is also carried out when identifying pathological deformation interdental papillae and detection of loose adherence of the gum to the tooth.

This operation it is forbidden carried out in the following cases:

The pocket depth exceeds 5 mm.
Gums are too thin.
Necrotic processes along the gum edge are visible to the naked eye.
Infectious diseases oral cavity.

The operation is preceded by a thorough Preparation:

All surface deposits are removed from the teeth.
Therapy is carried out to relieve inflammation from the gums.
If there are indications, then groups of teeth are splinted.

Surgery is performed under local anesthesia. At one time, the doctor treats an area that covers no more than 8 teeth.

Open Curettage consists of the following stages:

Flap surgery

This is a type of open curettage. Its main difference from the classical procedure is that to access the contents of the pocket, the surgeon creates a completely mobile flap. That is, a section of the gum is simply thrown aside. This allows you to better see the bone pockets and the surface of the tooth roots.

The operation should refuse, If:

There is resorption of the alveolar process to a depth up to the middle of the tooth root.
Resorption of bone tissue is detected in close proximity to a multi-rooted tooth
The patient has a serious somatic pathology.

Patchwork The operation is carried out in several stages:

The surgeon or his assistant sanitizes the oral cavity and treats it with antiseptic solutions. Local anesthesia is then administered.
The doctor creates a flap and folds it back.
The surgeon completely removes all deposits from the surface of the tooth, dark cement from the root, and polishes their surfaces using special tools. After this, all granulation formations and excess epithelium are removed from the soft tissues.
The flap is placed in place and sutured. At the same time, the edges of the flap are tightened suture material to the necks of the teeth.
The operation is completed by applying a protective bandage.

The main disadvantage of flap surgery is that it can provoke pathological mobility of teeth and cause exposure of their necks.

Conclusion

Closed and open curettage, as well as all varieties of these operations have one common task - removing deposits and eliminating periodontal pockets. Without these procedures, it is impossible to achieve stabilization of advanced periodontitis.