Any dental diseases in the absence of adequate treatment, sooner or later lead to serious complications.

You can avoid them only by consulting a doctor in time.

But even in this case it is not always enough standard treatment, therefore it is necessary to use more complex techniques, for example, one of the curettage methods.

A periodontal pocket is a space that is formed due to the destruction of the periodontal junction. In other words, due to infections and improper oral care, the gums become damaged, resulting in the formation of so-called pockets.

The danger of their appearance is that it is very difficult to clean the space with a regular brush, so over time serious problems begin. inflammatory process. And this, in turn, leads to tooth decay and loss. Therefore, at the first symptoms of the disease, you must contact your dentist.

In order to prevent inflammation and receding gums, you should devote enough time to caring for your oral cavity. Unfortunately, modern means, used at home, are not able to cope with the task. Therefore, it would be a good idea to visit your dentist for a professional cleaning.

Indications for the procedure

The dentist prescribes curettage only if the patient has indications for the procedure. If the development of the disease is in the initial stages, then other methods are used as treatment.

Curettage is prescribed in the following cases:

• moderate periodontitis;
• no bone pockets;
• Tartar deposits on the gums;
• inflammation and bleeding gums.

Diagnosis of the disease is a prerequisite before determining a treatment method. If a number of complications are detected, the procedure is prohibited.

Contraindications

Direct contraindications include:

• discharge of pus from the periodontal pocket;
• suspicion of an abscess;
• formation of bone pockets;
• severe tooth mobility;
• thinning gums;
• other infectious diseases oral cavity;
• pocket depth more than 5 mm.

Open way

There are several types of curettage, and public method among them is one of the most effective. The method is used even if the depth of detachment of the gum from the tooth is more than 5 mm.

1. The patient's oral cavity is treated with antiseptics and anesthetic. Only after this the dentist begins the procedure.
2. The gum in the area of ​​the interdental papillae is separated using several vertical incisions. This is the so-called flap operation.
3. The dentist uses scalers or curettes to remove granulation tissue and tartar.
4. The roots of the teeth must be polished and disinfected during the process..
5. In order for the tissue to grow together faster, the doctor uses special means, accelerating regeneration.
6. After cleansing and applying all necessary medicines the incisions are sutured. A special bandage impregnated with anti-inflammatory agents is applied to the suture site. If the incision site is bleeding, your dentist may not use a bandage to prevent a hematoma.
7. After 10 - 12 days, the stitches are removed.

Until the operated gum area heals, the patient should brush their teeth carefully and avoid eating solid foods.

Watch the video to see how the open curettage procedure is performed.

Closed

If the pocket depth is small and does not exceed permissible norm, then the dentist can use the closed curettage method.

Difference between these two methods dental treatment lies in the fact that during closed curettage the doctor performs all manipulations blindly. That is, the pocket is cleaned without cutting the gum.

The method is less effective and difficult cases improves the patient's oral condition only temporarily, but the procedure is almost painless; local anesthesia can be used:

1. First, a specialist uses ultrasound or dental instruments to clean all deposits.
2. Next, he carefully polishes the roots of the tooth and treats everything with antibacterial agents.
3. At heavy bleeding The doctor’s task is to stop it, but a small clot should remain in the periodontal pocket to protect the pocket from bacteria getting inside.
4. Then a special bandage is applied to the gum.

In practice, the cleaning method allows you to thoroughly clean the pocket and reduce its depth. It is important that the dentist is extremely attentive and careful, since rough work can lead to complications, increase gum healing time and lead to new inflammatory processes.

The video popularly describes the closed method.

Using a vacuum

Often, when performing closed curettage, various additional techniques. Modern dentists successfully use vacuum curettage, which allows you to clean the pocket much more thoroughly.

During the procedure, a special vacuum device with attachments is used, with the help of which dirt is sucked out even from deep pockets.

Treatment of the problem area with disinfectants is carried out automatically.

The advantage of the method is that it stimulates tissue regeneration and improves blood circulation.

Innovative methods of conducting

Progress has also affected the field of dentistry, so modern specialists most often prefer to use various innovative methods of treatment. This also applies to the treatment of periodontal pockets.

Laser

Laser radiation has long been used in both cosmetology and medicine. During curettage laser beam evaporates all contaminants, disinfecting the oral cavity.

The procedure is practically painless and eliminates long-term postoperative period. Moreover, after using the laser you do not need to wear a bandage.

Depending on the indications, diode and erbium lasers are used.

Cryo

The essence of the method is to influence the periodontal pocket low temperatures. The procedure is carried out under anesthesia.

With the help of a special cryo-probe, all gum tissue is destroyed. After the session is completed, a bandage is applied to the gum.

It is necessary for the operated tissue to heal as quickly as possible. In addition, the oral cavity should be reliably protected from the occurrence of new infections.

Chemical

They are not always used for curettage mechanical means and devices. There's another one chemical species treatment, which is based on the use of various active agents.

With their help, the dentist softens the gums and removes all deposits. Most often as chemicals citric or lactic acids are used. Therefore, chemical curettage is the most gentle procedure.

During any oral treatment, you will need to spend some time eating or brushing your teeth very carefully.

After open curettage, doctors recommend applying cold compresses and making sure there is no bleeding.

In addition, after treating a periodontal pocket, it is recommended not to stop brushing your teeth, but try not to touch the sore gum.

Dentists advise:

• do not consume hot food and alcohol;
• quit smoking;
• rinse the mouth with antiseptic agents;
• For the first 1–2 days, drink drinks using a straw.

All actions are necessary to avoid damaging the operated gum area and causing bleeding.

Any external intervention will result in the periodontal pocket not being able to heal properly. And then its depth will only increase, which will ultimately lead to tooth loss. Over time, the inflammatory process will spread to neighboring teeth.

In cases with serious complications, it is very difficult to save teeth, and the dentist can only offer the patient prosthetics.

Visits to the dentist are mandatory for the patient. And this must be done not only while the gums are healing.

Often doctors as additional treatment a course of antibiotics is prescribed, but even this approach does not guarantee final recovery. Since previously damaged gums can easily become inflamed again, preventive examinations will help prevent or notice the occurrence of problems in the early stages.

Prices

The cost of dental curettage depends on many factors. Most often, the price formation is influenced by the use of various painkillers and antiseptics.

Closed curettage of one tooth will cost 200 - 300 rubles, while open surgery will cost about 2 thousand rubles.

Such big difference occurs due to the fact that open curettage is a full-fledged surgical operation.

Vacuum curettage in a dental clinic will cost 1200 rubles, and for laser treatment you will have to pay an average of 1,500 rubles.

Cryo-curettage will become available after paying its cost in the amount of 2000 - 2500 rubles. The price for chemical curettage starts from 300 rubles. Naturally, we mean prices per tooth.

At the first symptoms of periodontitis or other oral diseases, you should consult a doctor. It does not matter that there is no pain, and the inflammatory process does not interfere. Over time, even minor inflammation can lead to serious complications, and then you will have to resort to surgery.

Gum tissue diseases are quite common problems in dentistry. Gingivitis and periodontitis worry many patients; advanced cases require surgical intervention For effective treatment. The most common procedure is curettage of periodontal pockets.

The operation is a deep cleansing of the formed pockets, disinfection of the cavities to prevent the re-formation of tartar. Curettage helps speed up recovery and generally improve the condition of the oral cavity.

What is this procedure and why do it?

To fully understand why curettage is necessary, you need to understand the reasons for the appearance, possible complications periodontitis. The disease is characterized by bleeding gums, further development of the inflammatory process, the result is tissue swelling, suppuration, mobility of the teeth, and their further displacement.

The root cause of the disease is poor oral hygiene. As a result of the accumulation large quantities soft plaque consisting of microbes provokes the formation of tartar, which can no longer be removed with a regular brush and paste.

Hard deposits on teeth are the root cause of periodontitis. Lack of any therapeutic measures leads to the following complications:

• atrophy bone tissue. Due to the inflammatory process, active life pathogenic bacteria, the bone tissue begins to dissolve, it does not easily disappear, and gradually turns into granulation formations. They are the ones who have a sharply negative impact on the deterioration of the situation;
• formation of periodontal pockets. Under the influence of hard dental deposits, not only bones are destroyed, but also periodontium (microconnections between the tooth root and bone). In periodontal disease, the cumulative effect negative factors on gum tissue provokes the formation of gaps between it and the tooth (dentists call these formations periodontal pockets).

Read the page about the causes and methods of treatment of apical peri-implantitis.

When the formations between the tooth and gum reach 3–4 mm, the process becomes irreversible. Granulation tissue cannot be treated; it can only be removed surgically. Local, general therapy antibiotics, laser treatment treat periodontal disease only at the beginning of its development, then curettage is used, There are several reasons for surgery:

• It is almost impossible to completely clean out the periodontal gum canals; using a laser, the doctor works blindly, removing only visible deposits. The remaining microorganisms continue their vital activity, resuming the inflammatory process. The process itself is costly, laborious, and ineffective advanced cases, spending time and money on it is not rational;
• the formation of deep periodontal pockets, even after complete cleaning, and anti-inflammatory therapy still remain an excellent environment for the development of bacteria. The oral cavity is constantly exposed to external factors, it is impossible to completely exclude the entry of pathogenic bacteria.

Based on all of the above, we can conclude: it is possible to cope with periodontitis completely, irrevocably only with complete removal periodontal canals, granular tissue, all dental deposits. Curettage helps to cope with all problems in one operation.

Types of curettage

Subgingival dental plaque is removed in two ways: using open and closed curettage. Both operations are aimed at solving the same problem, but there are some differences; dentists use different techniques based on the clinical situation of each patient.

Closed

It is carried out to remove granulations, affected root cement, and periodontal pockets. The procedure is indicated for mild to moderate periodontitis. Prerequisites: the depth of the gaps in the gums does not exceed 4 mm, the tissue has a dense structure. It is prohibited to carry out this kind of manipulation if there is purulent discharge, suspected abscess, depressions up to 5 mm. Fibrous changes tissues, tooth mobility of the third degree are also contraindications for closed curettage.

A significant disadvantage of the procedure is the lack of direct visibility, which increases the risk of incomplete removal of ingrown periodontal tissue and granulations. The manipulation technique requires special skill and patience from the specialist. When removing pathological tissue blindly, the doctor must not damage healthy areas and completely eliminate pathogenic formations.

Open

The purpose of the manipulation is to excise the epithelium that has grown into the pocket, the affected areas of the teeth and gums. The technique allows you to cope with large granulations, pockets up to 5 mm deep, complete adhesion of the gingival margin to the dentition.

It is forbidden to perform open curettage during flow acute diseases in the oral cavity, having infectious nature, necrotic gum formations, severe suppuration. It is also impossible to perform surgery on the patient in this way if the gum tissue is too thin, or if the depressions are more than 5 mm.

Preparation for surgery is serious; powerful therapy with antibiotics, splinting of all groups of teeth (if necessary), and other important manipulations are required. Usually 7-8 teeth are put in order in one approach, the entire procedure is carried out under local anesthesia.

There is a third way to overcome the disease - using patch surgery. The intervention technology is similar to open curettage; it is carried out in very advanced cases; the affected tissue is not only removed, but also stretched over the neck of the tooth. Process increases efficiency surgical intervention, prevents the “drooping” of gum tissue.

Characteristic

Comparing the advantages and disadvantages of each type of manipulation will help you make the right decision.

Pros of the open method:

• low cost;
• no need for highly qualified doctor;
• short duration of surgery;
• easy to carry.

Disadvantages of open curettage:

• used exclusively for mild to moderate periodontitis;
• low effectiveness (in almost 99% of cases disease progression is observed).

The procedure is not popular due to its almost complete uselessness; with its help, the patient’s condition only temporarily improves.

Advantages of closed curettage:

• the only way to completely restore chewing function, achieve periodontal stabilization, and completely remove the formed pockets.

Disadvantages of flap surgery:

• high cost. The operation requires decent payment for the doctor, nurses, and supplies;
• a qualified specialist is required; not all clinics employ experienced doctors;
• there is a risk of exposing the roots of the tooth, which causes significant aesthetic damage to the patient;
• interdental papillae are eliminated, gum tissue changes appearance;
• The duration of the operation on 7–8 teeth is approximately two hours.

The advantages of the latter method are obvious; it is better to walk with a healthy oral cavity, but slightly modified, than to remain with beautiful gums for a while, but soon periodontitis will return, bringing with it even more problems.

How to stop it in a child? Find out effective methods treatment.

In what cases is it necessary to do panoramic shot teeth and what can you see on it? Reply page.

Look at the address for a review of effective medicines from periodontal disease.

Contraindications

It is prohibited to carry out any type of procedures:

• course of acute infectious diseases(flu, sore throat);
• presence of oncology;
• blood diseases;
• spicy allergic reactions for anesthesia, any other material that is used during surgery;
• weakened immune system;
• availability diabetes mellitus, hepatitis, tuberculosis;
• constant disregard for the rules of oral hygiene, pathology of the bite without the possibility of correction, destruction of bone tissue by more than half, mobility of teeth 3–4 degrees, the presence of ulcers.

Important! Only an experienced doctor determines the need for surgical intervention. Do not trust little-known clinics or amateur doctors. Carrying out an operation requires high professionalism and a considerable amount of money; approach this issue seriously.

Classical operation

Until recently, periodontal pockets were an almost unsolvable problem. With the development of technology, doctors have come up with techniques to cope with severe form periodontitis. Closed or open surgery is performed according to classical technology, includes the following aspects:

• disinfection of the surgical field;
• anesthesia of the operation site;
• using special devices, solid deposits are crushed into fine dust;
• procedures are carried out to collect ground stones, plaque, sediment on tooth roots and other harmful substances;
• the doctor polishes, grinds, levels the treated surfaces;
• using instruments, affected areas of tissue, waste products of microorganisms, and bloody discharge are removed;
• complete disinfection of the oral cavity;
• pressing the gum tissue to the base of the tooth, bringing the tissue as close as possible to healthy state periodontal

During the procedure, the dentist pays special attention normalization of blood circulation, removal of all wounded tissues. After the operation, the doctor carefully monitors the patient, checks the normal process of tissue scarring, monitors general condition person.

If any complications occur, consult your doctor immediately, repeated inflammatory process threatens total loss dentition.

Prevention of periodontal diseases

It is possible to avoid curettage, follow the rules of personal hygiene, and if you find problems in the oral cavity, visit the dentist. It is precisely because of untimely contact with a specialist and letting periodontitis take its course that the need for surgical intervention arises.

Remember: any operation is a huge stress for the body, there is a risk of complications and other troubles, the postoperative period itself does not bring pleasure to anyone. Be vigilant, watch your health, do not allow dire situations, a smile is business card any person!

Video. Technology for open curettage of periodontal pockets:

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 get a complete picture of the need surgical treatment 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 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 using 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 examination, a person is found to have deep gum pockets(from 3-4 mm), 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 guarantees complete cure- No.
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 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 mild degree periodontitis. In more complex stages of the disease, curettage can only provide 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.

Also this specialist 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, and appear in the mouth. painful sensations(burning, itching, pain in the gums) and 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 methods diagnostics Thanks to them, he can promptly identify the signs of an incipient disease and promptly provide qualified assistance.

On early stage For gingivitis, the doctor removes plaque, cleans stones in the gum pockets and smoothes the surface of the tooth root.
On average or late stage there is a need for surgical intervention.

In general, a periodontist treats periodontal diseases and studies periodontal tissues. In general, his work directly depends on the patient’s goal. Some may need an examination at for preventive purposes and receiving recommendations to help prevent the occurrence of dental and gum diseases, follow proper hygiene oral cavity.

Other patients need full diagnostics oral cavity, identifying the causes of periodontal disease and developing effective ways treatment 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. In this way, 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. The 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 plaque, 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 testing them different techniques surgical interventions.

Review of closed curettage

This procedure is very short-lived and can be tolerated without any problems. To carry out such an operation you do not need experienced surgeon-periodontist, 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 stage 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 destruction of gum pockets and stabilization of periodontitis. In addition, such operations reduce bone tissue atrophy by replanting it 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. On initial stage The development of periodontitis can be helped by closed curettage, but such an operation is ineffective and its result is short-lived - in the future it will need to be repeated several times.

For moderate to severe stages of periodontal disease, it is better to choose other methods. The most reliable and effective option can be called flap surgery and open curettage, since only they are able to cope with the moderate and severe stages of periodontitis, while ensuring the cessation of progression of the disease in the future.

In any case, neglect examination and treatment in specialized clinics It’s not worth it, 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

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 relapse. 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.

1. Antiseptic treatment is carried out in the place where the procedure will be performed.
2. Anesthesia is performed using application or injection agents.
3. 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.
4. The cement and dentin affected and destroyed by infection are scraped off on the root part of the tooth.
5. The root part of the tooth is leveled and smoothed, its surface is polished.
6. 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.
7. Cleaned fabrics are treated with antiseptics and antibacterial drugs.
8. 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, 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 bone pockets deep, then the 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 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-term.

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.