Open gum curettage. Curettage - what is it? Curettage: reviews. Open or closed

From this article you will learn:

surgical methods for treating periodontitis – reviews from dentists,
flap surgery, curettage of periodontal pockets – price 2020.

The article was written by a dental surgeon with more than 19 years of experience.

Why do you need to do curettage?

To understand why you need to do curettage or flap surgery, you need to delve a little into the details of the development and course of periodontitis. Periodontitis develops against the background of poor oral hygiene, the presence of a large amount of soft microbial plaque and hard dental deposits. The latter trigger an inflammatory process in the gums, which first manifests itself as bleeding when brushing teeth, pain and swelling of the gums, and later these symptoms are also accompanied by tooth mobility, their displacement, suppuration from under the gums, etc.

So, in the gingival sulcus it turns into hard tartar, which is very tightly attached to the surface of the tooth neck (Fig. 1-2). Tartar microorganisms produce toxins that trigger inflammation in the gums.

During inflammation, the following occurs:

Bone atrophy around the tooth –
those. The bone begins to gradually dissolve. Compare the level of bone tissue in relation to the roots of the teeth in a person without concomitant periodontitis (X-ray 3a) and in a person with moderate periodontitis (X-ray 3b). The distance between “a” and “b” is the level of complete destruction of inert tissue, which is evident from the absence of bone beams in this area.
Moreover, it should be noted that bone tissue does not simply disappear without a trace, but is replaced by the so-called granulation tissue, which contains a large number of microbial cells, bone-resorbing cells (osteoclasts), etc. The appearance of granulation tissue contributes to even more rapid subsequent bone destruction.

Formation of periodontal pockets –
under the influence of inflammation caused by dental plaque, destruction occurs not only of the bone, but also of the periodontal attachment of the tooth to the bone (Periodontium). Periodontium is the microligaments between the tooth root and the bone, with the help of which the tooth is securely attached to the bone tissue.
In Fig. 4 you can see the differences between diseases such as Gingivitis (in which there is no bone destruction, no periodontal pockets) and Periodontitis (in which there is active bone destruction and the formation of periodontal pockets). In periodontitis, the cumulative destruction of bone tissue and periodontal ligaments leads to the formation of periodontal pockets (Fig. 4).
A periodontal pocket is an area whose width and depth has been destroyed by bone tissue, there is no attachment of the gums to the surface of the tooth root, and the defect itself is filled with granulation tissue, dental deposits, and pus. Patients often call a periodontal pocket a dental pocket, a gingival pocket, a pocket in the gum. Such gum pockets can be identified by probing with special periodontal probes or x-rays.
In Figures 4-6 you can see the clinical situation of one patient regarding a deep periodontal pocket in the interdental space between the canine and premolar:
→ in Fig. 4 you can see that the periodontal probe penetrates under the gum by 5-6 mm, with the norm being 1-2 mm.
→ Fig. 5 shows an x-ray of this tooth. It shows that there is a bone defect. Destruction of bone tissue appears radiographically as darkening (indicated by black arrows).
→ Figure 6 shows the appearance of the bone defect during the process of gingival detachment. The granulation tissue from the periodontal pocket has already been practically removed and hard tartar is clearly visible on the surface of the root, which was the cause of bone destruction and the formation of a periodontal pocket.

Surgical treatment of periodontal diseases, in contrast to therapeutic treatment, allows:

So, when deep periodontal pockets of 3-4 mm were formed, partial replacement of bone tissue with granulation tissue occurred - the process essentially becomes irreversible, despite any local and general anti-inflammatory therapy, treatment with antibiotics, laser, removal of dental plaque, etc. d. Why?

Firstly– it is almost impossible to completely remove dental plaque from deep periodontal pockets. The fact is that the doctor inserts the ultrasonic attachment under the gum “blindly”, i.e. he makes movements without seeing what exactly is happening in the periodontal pockets. Therefore, as a rule, a large amount of subgingival deposits remains, which continue to have a destructive effect.
In addition, removing subgingival dental plaque is an extremely painstaking, lengthy task, and the patient will never know if there is anything left there. Therefore, in the conditions of a paid commercial procedure, spending precious time looking for small subgingival pebbles is not very profitable.
Secondly– if deep periodontal pockets have formed, then in them, even after removal of dental plaque and anti-inflammatory therapy, conditions are created for the development of infection and further progression of periodontitis.
Therefore, the only method of treating periodontitis that guarantees improvement is the one that will eliminate:
→ periodontal pockets,
→ remove all subgingival dental plaque,
→ remove granulation tissue that has replaced the resorbed bone.
This can only be done using surgical methods for treating periodontitis.

Surgical methods for treating periodontal diseases

There are several methods of surgical intervention for periodontitis:

curettage of periodontal pockets – “open” and “closed”.
patchwork operations.

1. Closed curettage of periodontal pockets –

Purpose of the operation: to remove granulations from periodontal pockets and subgingival dental deposits. Disadvantages of the technique: curettage is carried out blindly, there is no visual overview of the surface of the roots, periodontal pockets, which is why both granulations and dental deposits remain en masse in their places.

Closed curettage can be more or less effective only with shallow periodontal pockets up to 3 mm, i.e. the mildest degree of periodontitis. With moderate and severe periodontitis, closed curettage (due to a temporary reduction in the mass of granulations) can only temporarily improve the condition of the gums, but this phenomenon will only be short-term, and periodontitis will definitely progress further. In Fig. 7 (a, b) you can see the tools with which closed curettage is performed.

This type of curettage is popular in dental clinics that do not have an experienced periodontist surgeon, and therefore the operation is performed by an ordinary general dentist or even a periodontist. These specialists have neither the skills nor experience in performing complex surgical interventions in the oral cavity, which include open curettage and flap operations.

2. Open curettage of periodontal pockets –

Before starting the operation, careful preparation must be carried out -

After removal of granulation tissue, antiseptic treatment of the surface of tooth roots and bone tissue, synthetic bone is “planted” into deep bone pockets (Fig. 10). This is necessary for bone tissue restoration. Naturally, it is impossible to restore it in full, but it is quite possible to reduce the bone pockets.

In Fig. 11 (a, b) you can see X-rays BEFORE and 3 months AFTER the operation. On an x-ray taken several months after surgery (Fig. 11b), the increase in bone mass in the periodontal pocket can be easily seen.

Suturing. Sutures are placed in the area of the interdental papillae (Fig. 12). At the end of the operation, a gum bandage is also applied, which will protect the operation area and promote speedy healing. Sutures are removed 10 days after surgery.

3. Flap surgery for periodontitis –

The purpose of the operation: to remove all subgingival dental plaque, remove inflammatory granulation tissue from under the gums, eliminate periodontal pockets, stimulate the restoration of bone tissue by “replanting” synthetic bone tissue. Those. exactly the same as with Open curettage. The difference is that the incision during flap surgery is made 1-1.5 mm from the edge of the gum. This thin 1.5 mm strip of gum is further removed. This is done because with prolonged inflammation, the marginal gum is modified in such a way that it can no longer fit tightly to the surface of the teeth, and therefore it must be removed.

Since the flaps of the mucous membrane are mobile, at the end of the operation they are pulled towards the necks of the teeth, which in most cases helps prevent the “drooping” of the gums. There are techniques for flap operations not only for generalized periodontitis, but also to, for example, cover gum recession.

Curettage of periodontal pockets: price 2020

How much does curettage of periodontal pockets cost? The price for 2020 in Moscow will depend on the type of technique, as well as the cost of the materials used (primarily bone material).

closed curettage of periodontal pockets - the price for 1 tooth will be from 500 rubles.
open curettage of pockets – the price for 1 tooth will be from 1500 rubles.
patchwork operation - price for 1 tooth from 2,500 rubles, and a segment of 6-8 teeth - from 10,000 rubles.

This cost, as a rule, does not include the price of bone material. Can be used as high-quality expensive bone material Bio-Oss (Switzerland) - 6500 rubles. per pack of 0.5 g, and Russian drugs such as Kolapol and Kollapan, which cost several times less.

Curettage, patchwork surgery: reviews

I will briefly summarize patient reviews after different types of interventions.

Closed curettage –
It should be done only in the initial form of periodontitis, when there are only shallow periodontal pockets up to 2-3 mm. For moderate and severe periodontitis, in the presence of deep periodontal pockets, it is absolutely ineffective. However, the operation takes little time, is easily tolerated, does not require highly qualified doctors (usually dentists who do not have the skills for major operations like to do it), and is relatively inexpensive. This is the only plus.

Open curettage and flap operations –
Pros - these are the only methods that allow you to eliminate periodontal pockets and achieve stabilization of periodontitis, as well as, by replanting bone tissue, reduce the amount of bone tissue atrophy (which can also reduce tooth mobility). Therefore, if you want to chew with your own teeth for as long as possible, then the choice of surgical technique is obvious.

Cons –

Requires a highly qualified doctor and should be performed only by dental surgeons specializing in periodontology.
The operations are expensive: they require not only the payment of a doctor and nurse, but also the purchase of expensive consumables, for example, synthetic bone tissue, expensive suture material (it must be monofilament), etc.
Removal of inflammatory granulation tissue and inflamed gums may be accompanied by “recession” of the gums (i.e., exposure of the roots). The amount of root exposure will directly depend on the initial amount of bone tissue atrophy.
Also, after the operation, the appearance of the gingival papillae temporarily changes; they are flattened and do not occupy the entire space between the teeth. After a few months, the gingival papillae take their normal shape and the interdental spaces are thus eliminated.
The operation is time-consuming: a segment of 7-8 teeth takes about 2 hours.

Sources:

1. Add. professional,
2. Based on personal experience as a periodontist,
3. National Library of Medicine (USA),
4. American Academy of Periodontology (USA),
5. “Atlas of cosmetic and reconstructive periodontal surgery” (Cohen E.).

It is usually not possible to solve the problem without surgical intervention during complex treatment. Curettage allows you to remove the pocket between the tooth and gum. The procedure involves: removing tartar, scraping granulations from the walls of the gums and the bottom of the formed cavity, treating tissues with antiseptic drugs, and applying protective bandages.

Indications

There are a number of indications that require periodontal pocket curettage:

inflammation of the gums;
the formation of cavities between the tooth wall and gums;
the occurrence of abundant deposits of tartar;

Curettage of gum pockets should not be considered as an alternative to professional enamel cleaning. In the latter case, only plaque is removed and surfaces are polished. Complex treatment of pockets in the gums not only allows you to get rid of deposits, but also eliminate the course of pathological processes in the tissues and avoid their decay.

Contraindications

Treatment of periodontal pockets using curettage is contraindicated in cases of purulent discharge, suspected tissue abscess, the presence of pockets in the bone structure, or expansion of periodontal cavities to a depth of more than 5 mm. It is prohibited to carry out the procedure in cases of extreme thinning of the gums, their fibrous changes, or grade 3 tooth mobility.

Curettage of periodontal pockets - types

There are several types of procedure:

Open curettage – required when opening pockets to a depth of 4 to 5 mm. During the event, the affected area is visited, which makes it possible to gain open access to the preparation of the tooth roots and perform deep tissue cleaning.
Closed curettage of periodontal pockets is performed when the depth of the canals is insignificant. The procedure does not require cutting the gums.
Patchwork gum - not only pockets are cleaned, but also deep surfaces and tooth roots. To restore the tooth structure, artificial materials can be used to stimulate the growth of new tissue.

Flap surgery on gums

Open curettage

The operation is relevant when the depth of the pathologies is more than 5 mm. In addition, the method is used if closed treatment of gum pockets does not bring results.

A prerequisite for this is surgical dissection of the affected gum. Open curettage of periodontal pockets is carried out in several successive stages:

The condition of the gums is diagnosed.
Local anesthesia is performed.
The gums are dissected in the area of the interdental papillae, which facilitates access to the base of the pockets.
The fabric is cleaned using specialized tools.
For the purpose of restoration, the bone pocket is treated with osteogenic stimulating drugs.
At the end of the operation, the gums are sutured.

It is carried out if the pocket in the gum between the teeth has a depth of up to 5 mm. The operation is performed without surgery and consists of the following measures:

General diagnostics of tissue condition.
Local anesthesia.
Using a special tool, the periodontal pocket is cleaned without disturbing the structure of the gums.
The tissues of the tooth roots are polished.

The closed method allows you to reduce deep periodontal pockets and completely eliminate small ones. The operation causes less discomfort for the patient compared to the open method of preparation. Therefore, closed curettage looks preferable if it is possible to carry it out.

Closed

Flap surgery

The method involves cutting out the periosteal surface of the gums, followed by treatment of the root and internal soft tissue. Flap surgery for periodontitis provides good visual control, which facilitates convenient removal of pathological material.

During the recovery phase, a number of complications may occur. First of all, this is an increased likelihood of exposure of the necks of the teeth, changes in the alveolar processes, dentin hypertension and aesthetic defects of the external tissues.

Features of flap surgery and its consequences

Periodontal treatment using this method involves sanitizing the oral cavity, local anesthesia and the use of antiseptics. Further to the transitional fold, starting from the edge of the gum, several vertical incisions are made. Two more incisions are created on the vestibular and oral sides with an indentation of 2.5 mm. The cut off parts of the tissue are removed. In order to preserve the natural material, one horizontal section is allowed, similar to an open curettage.

The prepared gum is peeled off, the periosteal flap is folded back to the transitional fold - the mobile area of the mucous membrane. Pathological root cement is removed. The gum pockets are cleaned. The dental roots are polished with periodontal burs and rasps.

Cleaning pockets

Upon completion of the treatment of hard surfaces, soft tissues are prepared. Subsequently, the ingrown epithelium is removed and the granulation tissues are truncated. Alveolar osteoporotic processes are treated, the surgical wound is washed with antiseptic solutions.

If dissection of the gums reveals bone defects, the anatomical structure of the tissue is restored using artificial graft material. The flaps are placed in place, after which surgical sutures are applied. Finally, the prepared tooth is covered with a protective bandage.

For several weeks after the operation, tooth mobility is observed. Then the effect gradually disappears. Additionally, an increase in tissue sensitivity to temperature and chemical irritants may be felt. Discomfort may persist for a month.

As practice shows, brushing your teeth with a desensitizing paste helps eliminate discomfort after surgery. The consequences of the procedure may include bruising and swelling, which disappear naturally after 2 weeks.

Closed and open curettage does not allow you to open your mouth wide at first. The functions of the jaw muscles are restored within 5-10 days.

Postoperative period

To avoid opening the prepared periodontal pockets, you should avoid eating and drinking after surgery. During the first 10 hours, it is forbidden to brush your teeth, rinse your mouth, or actively spit saliva.

In order for gum surgery to give the expected result, you need to carefully brush your teeth using a brush with soft bristles. Cleaning the oral cavity should be done by bypassing the problem area.

Prepared gum pockets must be periodically rinsed with salted water or chlorhexidine solution. It is acceptable to apply cold compresses to the outside of the postoperative area during the first hours after the procedure.

Salted water

At first, liquid, pureed and soft food is taken. The consumption of cold and hot drinks is prohibited. For a week after curettage of the periodontal canals has been performed, you should avoid physical activity, contact sports, and visiting the sauna.

In the postoperative period, it is necessary to resort to the use of special oral care products for sensitive teeth. Additionally, you can contact your dentist to carry out a number of measures that will reduce the sensitivity of the necks of your teeth.

Quality criteria

Cleaning the cavities from granulation material stops the processes of damage resorption. The use of restorative bone-forming substances stimulates the growth of missing tissue. In general, the operation should close the dental pocket, relieve tissue inflammation, and remove hard deposits.

Price

The price of curettage is on average from 200 to 500 rubles for the procedure using the closed method and from 300 to 1000 rubles for the open method of preparation. The stated range varies slightly depending on several factors.

Technical capabilities, level of equipment, availability of materials, and quality of anesthesia come first. The human factor is also important – the characteristics and nature of the disease in a particular patient. The cost of service is influenced by the class and experience of the specialist, the status of the clinic, and reviews of curettage from regular clients.

More expensive is laser curettage of periodontal pockets, which does not use traditional surgical instruments, and the procedure is performed quickly and painlessly.

Laser

It is better to perform a procedure so important for health and future well-being by contacting a dentist with a good reputation, regardless of the financial implications.

In conclusion

As you can see, despite the different approaches to performing surgery and methods of gaining access to the area of development of pathological processes, methods that have common features can eliminate a pocket in the gum. The described methods are aimed primarily at removing granulations, dental and subgingival deposits, ingrown oral epithelium, and cement of an infected tooth root. In other words, in all cases the formed pocket is eliminated, the same tissues are truncated, but using different approaches.

Despite all the imaginary harmlessness of periodontal diseases, their course is often aggravated and surgical treatment methods are used as part of complex therapy, including curettage, open and closed, flap and plastic surgeries, and operations on the soft tissues of the 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 carried out to eliminate the periodontal pocket as a consequence of periodontal disease, for example: curettage of the tooth socket, plastic surgery of the short frenulum of the lips, deepening of the small vestibule, patchwork operations.

The second logically includes interventions aimed at eliminating the causes of the inflammatory process and some symptoms accompanying the disease. 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 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 of the 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 tissues of the gums and teeth.

Method of performing closed curettage surgery

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

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 performed curettage of periodontal pockets often entails the development of various complications, and, accordingly, a 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 the surgical treatment can be objectively judged 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 of this method, there are still disadvantages, the same notorious lack of visual control. This means that incomplete removal of 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 when the pocket depth is more than 5 millimeters, when 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 of the 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 and pathological tissue - infected tooth root cement - are removed using hoes, curettes, and scalers. 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 operation site. Sometimes, in case 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 the inner surface of exfoliated soft tissues.

The variety of modified techniques of this type of operation are united by one significant nuance: 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

The indication for surgical intervention of this type is periodontitis of moderate and severe severity, 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 to flap surgery are the presence of resorption of the alveolar process for more than half the length of the root, the presence of 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 with antiseptic solutions and administer 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. Granulation tissues and strands of ingrown epithelium are excised from the inside of 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, exposure of the necks of the teeth occurs, their hyperesthesia - gum retraction.

In connection with this, in the postoperative period it is recommended to use special oral care products for sensitive teeth, and dentists also carry out a number of measures to reduce the sensitivity of the necks of teeth in a clinical setting. 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 belonging to this group, despite the different ways of accessing the pathological process, have a 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.

The word “curettage” itself is of French origin, literally translated as “treatment with a small surgical spoon-curette.” Such spoons with a long handle are used for manual scraping of small cavities.

In the maxillofacial area, in addition to pathological pockets, they are also used to remove cysts in the jaws (curettage), growths in the maxillary chambers and nasal cavity.

Reasons for the formation of periodontal pockets in the gums

Normally, around each tooth there is a small fold of gum with a depth of no more than 0.3 mm, which, like a collar, fits tightly to its cervical part. Below is the circular ligament of the tooth, which is designed to:

hold the tooth firmly in the socket;
do not allow food, germs and other foreign bodies into the socket.

The gingival fold is called a physiological periodontal (gingival) pocket.

With poor dental care or due to hereditary factors (for example, the chemical composition of saliva), soft deposits accumulate on the teeth, first in the interdental spaces. In this loose substance, saprophytic microorganisms that live in the mouth find shelter. The products of their vital activity are also added to the mass of sediments.

Microflora, especially fungal ones, secrete enzymes that convert soft plaque into crystalline inclusions - this is how supra- and subgingival hard dental deposits are formed.

Subgingival tartar, accumulating on the tooth wall, pushes back the marginal fold of the gum. A pathological gum pocket is formed, which can reach a significant depth. This causes gum inflammation and bleeding.

The space between the gum and the tooth surface is gradually filled with loose, easily bleeding granulations. As a result of inflammation, the bone tissue of the socket is destroyed, which is clearly visible on an x-ray.

Blood is an excellent breeding ground for microbes; the process of sedimentation is noticeably accelerated. Blood pigments give tartar a dark color. The gums swell and increase in size. Bad breath appears, as well as constant or periodic suppuration from pathological pockets.

The teeth lose their support in the form of the circular ligament and bone socket, begin to loosen and eventually fall out.

How to deal with tartar

At the first signs of periodontitis (inflammation of the gums), you should contact your dentist. Depending on the severity of the situation, with teeth and pathological pockets, the doctor may offer several types of manipulations.

Therapeutic service – professional teeth cleaning.

As well as surgical intervention:

closed gum curettage;
open curettage of periodontal pockets;
flap surgery.

Professional teeth cleaning

If the patient comes in on time, while deep destructive processes have not yet occurred in the gum pockets, and the integrity of the sockets is not compromised, professional teeth cleaning to remove supra- and subgingival calculus is sufficient to improve the health of the gums.

The doctor, under local anesthesia or even without it, removes hard and soft dental plaque using:

hand tools;
ultrasonic scaler;
laser beam.

Each of these procedures is completed by grinding and polishing the surface of the teeth to reduce the likelihood of rapid formation of new plaque.

Surgical methods

When the depth of pathological pockets reaches 2 mm, then such superficial cleaning turns out to be meaningless, because without curettage it is impossible to qualitatively clean them from pathologically changed tissues.

Indications and contraindications for curettage

Curettage of periodontal pockets is necessary if:

there are gingival crevices more than 2 mm deep;
gums are inflamed and bleeding;
copious subgingival calculus fills the pockets.

Contraindications for curettage are some general and local circumstances:

acute infectious diseases (flu, acute respiratory infections);
infectious processes in the mouth and pharynx (stomatitis, sore throat);
suppuration from under the gums;
fibromatous growths of the gums;
thinning of the gum mucosa;
anomalies in the position of teeth in the dentition;
underdevelopment of the jaw;
tooth mobility III-IV degree;
blood clotting disorder.

Tools for the procedure

The specificity of the surgical field in the form of narrow but deep periodontal pockets and interdental spaces requires the use of special instruments that have a small width with a sufficiently long working part.

When curettage is used:

Scalers are sickle-shaped and hoe-shaped.
Dental excavators of different diameters.
Universal curettes.
Gracie curettes.
Curettage spoons of different diameters.
Fabric trimmers.

The main requirement for the instrumentation is that its working parts must be impeccably sharp, so that any pathological growths can be cut off without unnecessary injury.

Closed curettage

The procedure is called closed because it is performed blindly with minimal access to the problem area.

Closed curettage of periodontal pockets is performed when:

periodontitis is mild;
The gum pocket has a depth of 2 to 5 mm.

How is the operation performed?

Stages of the operation:

The doctor cleans the walls of the teeth from hard plaque and uses curettes to thoroughly scrape out the soft tissue from granulations.
Then the periodontal pockets are irrigated from a syringe with a thick, blunt needle with a warm antiseptic solution, while small grains of stone and granulation are washed out of them.
A protective bandage is applied to the gums - this is the name in dentistry for a soft medicinal mass containing zinc oxide, oil and other healing components. In order for the bandage to perform its protective function longer, the patient is prohibited from eating for three hours.

Subsequently, for several days, the person who has undergone curettage carries out regular antiseptic mouth rinses.

If necessary, painkillers are prescribed.

Open curettage

Open curettage is performed if there are pathological gum pockets deeper than 5 mm and a good overview of the surgical field is necessary to remove granulations.

Preparation

The operation of open curettage is necessarily preceded by local anti-inflammatory measures, suppuration is eliminated.

Sometimes, before the intervention, preliminary splinting (fastening with thin wire) of mobile teeth is carried out.

Progress of the operation

Open curettage of periodontal pockets is carried out simultaneously in the area of no more than 4-6 teeth. Each jaw is sanitized in 2-3 curettage sessions:

Using special graduated dental probes, the depth of each pathological pocket is measured and a mark is made on the gum.
Under local anesthesia, the doctor makes a horizontal scalpel, removes the cut flap of the mucous membrane and gains free access to the granulations.
He scrapes out the exposed walls of the socket and tooth with curettes, then grinds them with cutters.
After antiseptic treatment, drugs that stimulate osteosynthesis are applied to the wound surface.
Sutures are placed on the mucous membrane in each interdental space.
The top of the seams is covered with a protective bandage.

Painkillers and regular antiseptic rinses are prescribed.

Flap surgery

Very rarely, if it is necessary to preserve a tooth with a deep periodontal pocket, they resort to a flap operation, in which two vertical incisions are made along the gum on both sides of the tooth root, then the mucous membrane is peeled off. After curettage, crushed bone or synthetic osteogenic powder is placed around the tooth. Stitches are applied.

Currently, due to the development of implantology, such operations are becoming less relevant.

Rehabilitation

To reduce postoperative swelling and relieve pain, it is recommended to apply cold compresses to the lips or cheeks in the first days. The sutures after curettage are removed on days 7-10.

Complete restoration of bone tissue occurs 2-3 months after curettage. During this entire time, the patient continues antiseptic rinses. For better gum healing, he is prescribed keratoplasty drugs based on vitamin A, methyluracil, pentoxyl and, if necessary, analgesics.

Good postoperative care under the supervision of a dentist will prevent the development of complications such as:

inflammation of the gums;
postoperative wound suppuration;
loosening of teeth.

Price

Considering the lack of effectiveness of therapeutic methods for treating periodontitis, when inflammation develops in the gum pockets, it is necessary to tune in to a surgical solution to the problem. The result will be periodontal restoration and strengthening of teeth.

It is very important to contact a reliable dental clinic that has:

certificate for providing this type of service;
qualified surgical specialists.

When planning curettage of gum pockets, one must proceed from the fact that high-quality curettage costs within the following limits:

closed curettage – at least 200 rubles. for one tooth;
open curettage – at least 2 thousand rubles. for one tooth.
the cost of flap surgery is even higher.

The cost of curettage depends not only on its type, but also on the category of the clinic and the dentist. Prices are current as of September 2017.

If pathological phenomena occur in the cervical area of the gum, one cannot rely on a miracle. Without treatment, the process of gum destruction will only get worse. Therefore, it is not recommended to delay the time of visiting the dentist.

Useful video about open curettage

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.

Please 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.

Species

Two types are considered traditional - closed and open. Along with them, other variations of the procedure are now used:

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