Periodontitis Essay

Periodontitis is an immunoinflammatory disease characterized by the loss of tooth supporting structures, including the connective tissue attachment and the alveolar bone. Plaque and bacteria are generally recognized as the primary cause of the periodontal disease [1] [2].

Currently, scaling and root planning (SRP) represent the most widely used procedure in the treatment of the periodontitis [3]. The main goal of SRP is the removal of the components of the subgingival biofilm, which play a major role in the initiation and progression of the disease [2].

However, this procedure creates the development of a wound in the periodontal area. It is well known that its healing induces the formation of a junctional long epithelium rather than a new connective attachment [4].

The wound healing process in nonoral sites has been studied carefully [5]. As a matter of principle, after an injury, a blood clot is formed. This clot has two main functions. First, it is able to protect tissues. Second, it provides for a provisional matrix that links firmly two different surfaces (bone and tooth) allowing the migration of undifferentiated cells [5].

A large number of inflammatory cells populate the clot within hours, preventing bacterial colonization of the wound. In the first 3 days, this allows the inflammatory response to decrease in intensity and macrophages to migrate into the wound secreting polypeptides involved in the successive phases of healing [5]. These cells can play a key role in the formation of the granulation tissue, inducing the healing through liberation of growth factors and cytokines. Consequently, fibroblasts produce a new collagenrich matrix, and allow endothelial cells to migrate and form new vascular vessels [6].

Currently, the indications for the use of a periodontal dressing are limited. For instance, its use is suggested in repositioned flap surgery to protect the flap from displacement [7]. Apart from Sigusch et al., no author recommends its use after nonsurgical therapy [8]. In the past, other authors discussed the positive effects of dressing. AsboeJorgensen suggested its use especially for improving patient comfort [9]. On the other hand, Ramfjord stated that closed curettage could induce periodontal trauma that leads to a relatively wide dehiscence of the buccal and lingual papillae. Therefore, the soft tissue should be brought into close contact with the tooth after the treatment, either by interproximal sutures or by a firm dressing [10][11]. Moreover, Pritchard and Sachs et al. observed advantages of periodontal dressing in terms of preventing persistent bleeding and keeping away mechanical influences during the healing process [12][13]. Finally, Plagmann observed an important effect in the use of the periodontal dressing. He supported the idea that coagulum should be stabilized to prevent any movement and to obtain the connective attachment to the hard tissue [11].

Thus, the rationale of some studies is that the application of a periodontal dressing after the scaling and root planning procedure in patients suffering from moderatetosevere periodontitis can stabilize the clot and protect it from forces usually created during daily movements, such as talking and chewing.