Journal of Clinical Periodonlology: 1976: 3: 59-65 Key words: gingiveclomy -~ chlorhexidine mouthwash - periodontal Accepted for public:atioii: June 29, 1975.
The use of chlorhexidine mouthwash compared with a periodontal dressing following the gingivectomy procedure M. ADDY AND A. E. DOLBY
Department of Periodontology, Dental School, Welsh National School of Medicine, Cardiff, Wales Abstract. The clinical results achieved were compared when a group of 21 patients requiring gingivectomies in comparable bilateral segments received a dressing or a chlorhexidine mouthwash during the first post-operative week. Initial pre-operative conditions were comparable. In each of the two treatments highly significant reductions in pocket depths were achieved; the sizes of the reductions were of clinical significance (> 1.5 mm). The observed difference (0.16 mm) between the two treatments in favour of the mouthwash, although significant at the conventional 5 % level, was clinically unimportant. More patients preferred the dressing as a post-operative treatment, and the clinical implications of the patients' preferences are discussed.
The simple gingivectomy procedure is used to eliminate pockets and produce a satisfactory gingival contour (Goldman et al. 1964), albeit at the expense of the attached gingiva. Following the surgical removal of gingival tissue, it is normal practice to cover the exposed wound with a periodontal dressing to provide patient comfort and protection for the wound during the initial healing phase (Baer et al. 1969). Prior to 1922 and the introduction of Ward's cement as a periodontal dressing (Ward 1923), the gingivectomy procedure was considered impractical. The exposed wound surface caused considerable discomfort and tended to granulate with the reestablishment, at least in part, of the pocketing. The bacterial contamination of a wound surface results in delayed healing due to an increased inflammatory response and granulation tissue formation (Burke 1971). The
production of exuberant granulation tissue on the healing gingivectomy wound may thus he due to the accumulation of plaque on the teeth and wound area consequent upon the patient's inability to maintain a satisfactory level of oral hygiene. It would seem unlikely that periodontal dressings inhibit granulation tissue formation hy virtue of their anti-bacterial properties, since many in common usage do not possess such a property (Waerhaug .& Loe 1957, Haeny et al. 1972, Addy & Douglas 1975). Instead they may act by obturating the space available for the growth of granulation tissue. With the introduction of new periodontal surgical procedures, the use of periodontal dressings appears to have continued without question as to the need for them. However, the application of a periodontal dressing following the reverse bevel flap procedure has been shown to confer no real
ADDY AND DOLBY benefit upon the final clinical result, and in fact may increase the incidence of postoperative pain (Greensmith & Wade 1974). It would seem unlikely, however, that withholding a periodontal dressing after gingivectomy procedure would produce a comparable result to using a dressing, since considerably more connective tissue is left exposed. If plaque accumulation were inhibited on the wound surface and teeth following gingivectomy, healing comparable with that following the use of a periodontal dressing might be achieved. A trial was therefore carried out to compare the surgical result achieved when an antiseptic mouthwash, chlorhexidine gluconate, was employed with that achieved when a conventional periodontal dressing was placed.
Material and Methods
The patients chosen for the study all required (from clinical and radiographic assessment) comparable bilateral gingivectomies in the upper or lower posterior segments of the mouth. The sites were matched for number and type of teeth present, and as nearly as possible for pocket scores (Table 1). The trial was explained in detail to all the patients, and a total of 21 patients (10 female and 11 male) agreed to participate in the study. The age range of the patients was 20-37, mean age 28. Pre-operative oral hygiene instruction, scaling and polishing and patient reassessment were carried out before any patient was requested to participate in the trial. Immediately prior to gingivectomy, pocket measurements were carried out, the measurements being taken from the mesial and distal surfaces of the teeth to be treated, using a Williams No. 14W round probe and recorded to the nearest millimetre. Two gingivectomies were carried out for each patient under local anaesthesia, using Blake knives with the
technique described by Glickman (1964); and one side was completed on each of the two separate occasions. Following each procedure the patient received either a periodontal dressing (Coepak®, Chicago, 111.) to cover the gingivectomy wound or a 0.2 % chlorhexidine gluconate mouthwash (chlorhexidine digiuconate 0.2 %, cone, peppermint water 0.5 %, alcohol 7 %, purified water to 100 %). The post-operative therapy was randomized in relation to the treatment side. Both postoperative treatments were given for a period of 7 days. In the case of the mouthwash, this was used three times a day with 10 ml being held in the mouth for 1 min. The two gingivectomies were carried out with a minimum of 1 week and a maximum of 2 weeks between the two procedures. On completion of both gingivectomies, the patients were asked to assess their post-operative pain experience in relation to both procedures and to state their preference. One month after each gingivectomy procedure, a second pocket charting was carried out. An observational clinical assessment of healing was made by noting whether the epithelialization of the wound area was complete and the presence or absence of erythema or exhuberant granulation tissue formation. The pocket measuring was carried out blind by one observer for all patients. An assessment of intra-observer variation in recording total pocket depths on different occasions in the same patients was made prior to the trial, and found to be negligible.
Results
The pre- and post-operative periodontai status of each patient is indicated by the mean and standard deviation of the pocket depths for the two treatment sides (Table 1). A number of comparisons from Table 1 are of interest (Table 2).
CHLORHEXIDINE RINSINGS FOLLOWING GINGIVECTOMY
L ,
o
/ rfer Post-
o c d o d o d o d c i c d o ^ d o d o o o o
aa ,^ B a
"5
a.
6 g
dd'-ndcid
Q
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- ra o c
d d di o d o d o o d d d d d d d c o d c o a. ?
Eo _ a. O
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§• s
PH
=1. B
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1.
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61
ADDY AND DOLBY
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CHLORHEXIDINE RINSINGS FOLLOWING GINGIVECTOMY Firstly, on average, the pre-treatment periodontal status of the two segments was comparable. The differences in pocket depths for the mouthwash and dressing treated segments were not significant (mean 0.08 ± 0.38 mm, P ^ 0.2). Secondly, both treatment regimes resulted in a significant reduction in pocket depths ( P ^ 0.001). Finally, a comparison of the post-operative pocket depths for the mouthwash and treated segments showed a small mean difference of 0.16 ± 0.34 mm in pocketing in favour of the mouthwash, which was significant (P ^ 0.05). On questioning, 11 of the 21 patients stated a preference for the dressing. All of these patients made the choice on the grounds of pain experienced without dressing. Two stated the discomfort was minimaL Five patients preferred the mouthwash, and five patients had no preference as to the post-operative therapy. Clinically, one patient was noted to have granulation tissue formation interdentally on the dressing side at 7 days. However, no clinically observable differences were noted between the two treatment sides in any of the patients by the end of the 1-month postoperative period in respect of erythema, granulation tissue formation and epithehalization of the wound areas.
Discussion
One of the major considerations before embarking upon a trial of this kind was the discomfort which might be experienced by the patients. An additional consideration was the possible growth of granulation tissue which might occur in the absence of a dressing. That these features might not occur was suggested by our previous experience with chlorhexidine mouthwash used in conjunction with periodontal dressings. In those cases where the dressing had be-
63
come prematurely displaced, neither discomfort nor overgrowth of granulation tissue was apparent. The results of this study largely support these initial clinical observations. Significant pocket reduction was achieved in both segments for all patients by the surgical method employed, irrespective of the post-operative therapy. The mean post-operative pocket depth for the dressing-treated segments was slightly greater than that for the mouthwashtreated segments. However, although significant at the 5 % level, the small difference (0.16 mm) in terms of pocket measurement cannot be considered of clinical significance, particularly since the mean difference is considerably less than the smallest gradation (1 mm) on the periodontal pocket probe employed in the investigation. The possible effect of chlorhexidine mouthwash in preventing the recurrence of pocket formation may be due to a number of factors. The most likely explanation would appear to be the inhibition of bacterial plaque formation (Schiott et al. 1970) at the dento-gingiva! margin during the healing phase. Alternatively, inhibition of cell division may have occurred, although no clinically observable differences in wound healing with the dressing and mouthwash were observed during the trial. Moreover, it is possible that chtorhexidine may promote wound healing after gingival surgery (Asboe-Jorgensen et al. 1974). The greater incidence of patient preference for a dressing would appear to contraindicate the use of chlorhexidine as a routine, post-operative procedure for gingivectomy. It should be noted, however, that despite advice no patient experiencing discomfort with the mouthwash returned during the week following gingivectomy. Furthermore, it is interesting to note that in this small number of patients almost half either had no preference or preferred the mouthwash for the post-operative period.
ADDY AND DOLBY It is unfortunate that it is difficult, if not impossible, to assess pre-operatively the preference of the individual patient between the two post-operative treatments. Both treatments pose potential, but different, problems for the individual patient and, as borne out by this study, neither can be considered as an ideal compromise for all patients. It would seem possible that a combination therapy of dressing and mouthwash may possess the advantages of both post-operative procedures whilst limiting the disadvantages. Certainly, tbe earliest possible restoration of normal oral hygiene measures would seem advisable in patients undergoing periodontal surgery.
Acknowledgements We are grateful to Dr T. Khosla, Senior Lecturer in the Department of Medical Statistics, Welsh National School of Medicine, for his help and advice in tbe statistical analysis of the results.
Zusammenfassung Vergleich zwischen Chlorhexidin - MundspUlung und parodontalem Wundverhand nach Gingivektomie Bei 21 Patienten wurden die oben angefiihrten klinischen Variabein miteinander verglichen. Die Gingivektomie wurde bei den Probanden in vergleichbaren bilateralen Segmenten vorgenommen. Nach der Operation wurde entweder der iibliche parodontale Wundverband angelegt oder es wurde lediglich mit Mundspiilungen (Chlorhexidin) nachbehandelt. Initial e praeoperative Voraussetzungen fiir beide Formen der Nachbehandlung waren vergleichbar. Beide Behandlungsformen resultierten in statistisch eindeutig in gesicherter Reduktion der Taschentiefen. Die erhaltene Veringerung der Taschentiefen war gleichfalls klinisch bedeutungsvoU {1,5 mm). Der Unterschied in endgultiger Taschentiefe, der zwischen den beiden Nachbehandlungs-
formen beobachtet wurde (um 0,16 mm giinstiger bei Mundspulung mit Chlorhexidin) war, obwohl statistisch gesichert {5 % Niveau), kaum von klinischer Bedeutung. Die meisten Patienten bevorzugten jedoch den parodontalen Wundverband als postoperative Behandlungsform. Die Verfasser bedauern, dass es unmoglich ist die individuelle Preferenz eines Patienten fur eine der beiden moglichen Formen der Nachbehandlung bereits vor der Operation festzustellen. Vielleicht ware die Kombination beider Verfahren empfehlenswert. Am wichtigsten ist jedoch, dass die hausliehe Selbstbehandlung sobald als moglich wiederaufgenommen wird.
Comparaison entre 1'utilisation de bains de bouche a la chlorhexidine et Vapplication de pansements parodontaux apres ies gingivectomies Une comparaison a ete faite entre Ies resultats cliniques obtenus lorsque, dans un groupe de 21 patients chez lesquels il etait necessairc de pratiquer des gingivectomies sur des segments bilateraux comparables, on utilisait pendant les 8 jours suivant I'operation, soit des pansements au ciment chirurgical, soit des bains de bouche a la chlorhesidine. Les conditions initiales pre-operatoires etaient comparables. Ces deux types de traitement post-operatoire ont permis d'obtenir des reductions hautement significatives de la profondeur des culs-de-sac; ces reductions etaient d'un ordre de grandeur significatif du point de vue clinique {> 1,5 mm). La difference observee (0,16 mm), en faveur des bains de bouche, entre les resultats des deux types de traitement, bien que significative au niveau conventionnel de 5 % du point de vue statistique, n'avait pas d'importance du point de vue clinique. Les pansements parodontaux ont ete preferes comme traitement post-operatoire par un plus grand nombre de patients. Malheureusement, il est difficile, sinon impossible, de determiner avant I'operation quelles seront Ies preferences de chaque patient en ce qui concerne les deux types de traitements post-operatoires. Ces deux types possedent pour chaque patient des problemes latents, mais ces problemes different d'un, patient a l'autre, et il ressort de cette etude que ni Fun ni I'autre de ces traitements ne peut etre considere comme un compromis ideal pour tous les patients. II n'est pas impensable
CHLORHEXIDINE RINSINGS FOLLOWING qu'un traitement post-operatoire combinant les pansements et les bains de bouche puisse posseder les avantages de ces deux methodes tout en limitant leurs inconvenients. II n'est pas douteux que les patients soumis a un traitement parodontal chirurgical aient avantage a reprendrele plus tot possible les soins d'bygicne bucco-dentaire normaux. References
Addy, M. & Douglas, W. H. (1975) A chlorhexidine-containing methacrylic gel as a periodontai dressing. Journal of Feriodonlology. 46, 465-468. Asboe-Jorgensen, V., Attstrom, R., Lang, N. P. & Loe, H. (1974) Effect of chlorhexidine dressing on the healing after periodontal surgery. Journal of Periodonlology 45, 13-17. Baer, P., Sumner, C. F. & Miller, G. (1969) Periodontal dressings. Dental Clinics of North America 13, 181-184. Burke, J. F. (1971) Effects of inflammation on wound repair. Journal of Dental Research 50, 296. (Suppl.) Glickman, I. (1964) Clinical Periodontology. 3rd ed., pp. 549-581. Philadelphia and London: W. B. Saunders, Goldman, H. M., Schulger, S., Fox, L. & Cohen, D. W. (1964) Periodontal Therapy. 3rd ed., pp. 406-463. New York: C. V. Mosby.
GINGIVECTOMY
65
Greensmith, A. L. & Wade, A. B. (1974) Dressing after reverse bevel flap procedures. Journal of Clinical Periodontology 1, 97-106. Heaney, G. G., Melville, T. H. & Oliver, W. M. (1972) The effects of two dressings on the flora of periodontal surgical wounds. Oral Surgery, Oral Medicine and Oral Pathology 33, 146-151. Schi0tt, C. R., Loe, H., Jensen, S. B., Kilian, M., Davies, R. M. & Glavind, K. (1970) The effect of chlorhexidine moutb rinses on the human oral flora. Journal of Periodontal Research 5, 84-89. Waerhaug, J. & Loe, H. (1957) Tissue reaction to gingivectomy pack. Oral Surgery, Oral Medicine and Oral Pathology 10, 923-937. Ward, A. W. (1923) Inharmoniotis cusp relation as a factor in periodontoclasia. Journal of the American Dental Association 10, 471481.
Address: M. Addy Lecturer in Periodontology Dental School Welsh National School of Medicine Heath Cardiff Wales England
The use of chlorhexidine mouthwash compared with a periodontal dressing following the gingivectomy procedure M. ADDY AND A. E. DOLBY
Department of Periodontology, Dental School, Welsh National School of Medicine, Cardiff, Wales Abstract. The clinical results achieved were compared when a group of 21 patients requiring gingivectomies in comparable bilateral segments received a dressing or a chlorhexidine mouthwash during the first post-operative week. Initial pre-operative conditions were comparable. In each of the two treatments highly significant reductions in pocket depths were achieved; the sizes of the reductions were of clinical significance (> 1.5 mm). The observed difference (0.16 mm) between the two treatments in favour of the mouthwash, although significant at the conventional 5 % level, was clinically unimportant. More patients preferred the dressing as a post-operative treatment, and the clinical implications of the patients' preferences are discussed.
The simple gingivectomy procedure is used to eliminate pockets and produce a satisfactory gingival contour (Goldman et al. 1964), albeit at the expense of the attached gingiva. Following the surgical removal of gingival tissue, it is normal practice to cover the exposed wound with a periodontal dressing to provide patient comfort and protection for the wound during the initial healing phase (Baer et al. 1969). Prior to 1922 and the introduction of Ward's cement as a periodontal dressing (Ward 1923), the gingivectomy procedure was considered impractical. The exposed wound surface caused considerable discomfort and tended to granulate with the reestablishment, at least in part, of the pocketing. The bacterial contamination of a wound surface results in delayed healing due to an increased inflammatory response and granulation tissue formation (Burke 1971). The
production of exuberant granulation tissue on the healing gingivectomy wound may thus he due to the accumulation of plaque on the teeth and wound area consequent upon the patient's inability to maintain a satisfactory level of oral hygiene. It would seem unlikely that periodontal dressings inhibit granulation tissue formation hy virtue of their anti-bacterial properties, since many in common usage do not possess such a property (Waerhaug .& Loe 1957, Haeny et al. 1972, Addy & Douglas 1975). Instead they may act by obturating the space available for the growth of granulation tissue. With the introduction of new periodontal surgical procedures, the use of periodontal dressings appears to have continued without question as to the need for them. However, the application of a periodontal dressing following the reverse bevel flap procedure has been shown to confer no real
ADDY AND DOLBY benefit upon the final clinical result, and in fact may increase the incidence of postoperative pain (Greensmith & Wade 1974). It would seem unlikely, however, that withholding a periodontal dressing after gingivectomy procedure would produce a comparable result to using a dressing, since considerably more connective tissue is left exposed. If plaque accumulation were inhibited on the wound surface and teeth following gingivectomy, healing comparable with that following the use of a periodontal dressing might be achieved. A trial was therefore carried out to compare the surgical result achieved when an antiseptic mouthwash, chlorhexidine gluconate, was employed with that achieved when a conventional periodontal dressing was placed.
Material and Methods
The patients chosen for the study all required (from clinical and radiographic assessment) comparable bilateral gingivectomies in the upper or lower posterior segments of the mouth. The sites were matched for number and type of teeth present, and as nearly as possible for pocket scores (Table 1). The trial was explained in detail to all the patients, and a total of 21 patients (10 female and 11 male) agreed to participate in the study. The age range of the patients was 20-37, mean age 28. Pre-operative oral hygiene instruction, scaling and polishing and patient reassessment were carried out before any patient was requested to participate in the trial. Immediately prior to gingivectomy, pocket measurements were carried out, the measurements being taken from the mesial and distal surfaces of the teeth to be treated, using a Williams No. 14W round probe and recorded to the nearest millimetre. Two gingivectomies were carried out for each patient under local anaesthesia, using Blake knives with the
technique described by Glickman (1964); and one side was completed on each of the two separate occasions. Following each procedure the patient received either a periodontal dressing (Coepak®, Chicago, 111.) to cover the gingivectomy wound or a 0.2 % chlorhexidine gluconate mouthwash (chlorhexidine digiuconate 0.2 %, cone, peppermint water 0.5 %, alcohol 7 %, purified water to 100 %). The post-operative therapy was randomized in relation to the treatment side. Both postoperative treatments were given for a period of 7 days. In the case of the mouthwash, this was used three times a day with 10 ml being held in the mouth for 1 min. The two gingivectomies were carried out with a minimum of 1 week and a maximum of 2 weeks between the two procedures. On completion of both gingivectomies, the patients were asked to assess their post-operative pain experience in relation to both procedures and to state their preference. One month after each gingivectomy procedure, a second pocket charting was carried out. An observational clinical assessment of healing was made by noting whether the epithelialization of the wound area was complete and the presence or absence of erythema or exhuberant granulation tissue formation. The pocket measuring was carried out blind by one observer for all patients. An assessment of intra-observer variation in recording total pocket depths on different occasions in the same patients was made prior to the trial, and found to be negligible.
Results
The pre- and post-operative periodontai status of each patient is indicated by the mean and standard deviation of the pocket depths for the two treatment sides (Table 1). A number of comparisons from Table 1 are of interest (Table 2).
CHLORHEXIDINE RINSINGS FOLLOWING GINGIVECTOMY
L ,
o
/ rfer Post-
o c d o d o d o d c i c d o ^ d o d o o o o
aa ,^ B a
"5
a.
6 g
dd'-ndcid
Q
ddddcd-Hdddo
- ra o c
d d di o d o d o o d d d d d d d c o d c o a. ?
Eo _ a. O
•
-," P-
•2-^-I «
§• s
PH
=1. B
•
" ^ -w
"^ S c ^ ^ o Q
1*
1.
B-. a , o_
•5-S 5
oil
61
ADDY AND DOLBY
eat'
P-
i3
li
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"2
=i, B
S S "-:
•a a
Co C
x: .5 al a El. re
o S
> cd
'—
OJ
x:
O. O
s
Q
•E« fi K •-. ~^ "i T; a>
™
iJ
i.
S
s
^
IJ C O
•^
,C)
•;;
o .S
"i
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H '5
CHLORHEXIDINE RINSINGS FOLLOWING GINGIVECTOMY Firstly, on average, the pre-treatment periodontal status of the two segments was comparable. The differences in pocket depths for the mouthwash and dressing treated segments were not significant (mean 0.08 ± 0.38 mm, P ^ 0.2). Secondly, both treatment regimes resulted in a significant reduction in pocket depths ( P ^ 0.001). Finally, a comparison of the post-operative pocket depths for the mouthwash and treated segments showed a small mean difference of 0.16 ± 0.34 mm in pocketing in favour of the mouthwash, which was significant (P ^ 0.05). On questioning, 11 of the 21 patients stated a preference for the dressing. All of these patients made the choice on the grounds of pain experienced without dressing. Two stated the discomfort was minimaL Five patients preferred the mouthwash, and five patients had no preference as to the post-operative therapy. Clinically, one patient was noted to have granulation tissue formation interdentally on the dressing side at 7 days. However, no clinically observable differences were noted between the two treatment sides in any of the patients by the end of the 1-month postoperative period in respect of erythema, granulation tissue formation and epithehalization of the wound areas.
Discussion
One of the major considerations before embarking upon a trial of this kind was the discomfort which might be experienced by the patients. An additional consideration was the possible growth of granulation tissue which might occur in the absence of a dressing. That these features might not occur was suggested by our previous experience with chlorhexidine mouthwash used in conjunction with periodontal dressings. In those cases where the dressing had be-
63
come prematurely displaced, neither discomfort nor overgrowth of granulation tissue was apparent. The results of this study largely support these initial clinical observations. Significant pocket reduction was achieved in both segments for all patients by the surgical method employed, irrespective of the post-operative therapy. The mean post-operative pocket depth for the dressing-treated segments was slightly greater than that for the mouthwashtreated segments. However, although significant at the 5 % level, the small difference (0.16 mm) in terms of pocket measurement cannot be considered of clinical significance, particularly since the mean difference is considerably less than the smallest gradation (1 mm) on the periodontal pocket probe employed in the investigation. The possible effect of chlorhexidine mouthwash in preventing the recurrence of pocket formation may be due to a number of factors. The most likely explanation would appear to be the inhibition of bacterial plaque formation (Schiott et al. 1970) at the dento-gingiva! margin during the healing phase. Alternatively, inhibition of cell division may have occurred, although no clinically observable differences in wound healing with the dressing and mouthwash were observed during the trial. Moreover, it is possible that chtorhexidine may promote wound healing after gingival surgery (Asboe-Jorgensen et al. 1974). The greater incidence of patient preference for a dressing would appear to contraindicate the use of chlorhexidine as a routine, post-operative procedure for gingivectomy. It should be noted, however, that despite advice no patient experiencing discomfort with the mouthwash returned during the week following gingivectomy. Furthermore, it is interesting to note that in this small number of patients almost half either had no preference or preferred the mouthwash for the post-operative period.
ADDY AND DOLBY It is unfortunate that it is difficult, if not impossible, to assess pre-operatively the preference of the individual patient between the two post-operative treatments. Both treatments pose potential, but different, problems for the individual patient and, as borne out by this study, neither can be considered as an ideal compromise for all patients. It would seem possible that a combination therapy of dressing and mouthwash may possess the advantages of both post-operative procedures whilst limiting the disadvantages. Certainly, tbe earliest possible restoration of normal oral hygiene measures would seem advisable in patients undergoing periodontal surgery.
Acknowledgements We are grateful to Dr T. Khosla, Senior Lecturer in the Department of Medical Statistics, Welsh National School of Medicine, for his help and advice in tbe statistical analysis of the results.
Zusammenfassung Vergleich zwischen Chlorhexidin - MundspUlung und parodontalem Wundverhand nach Gingivektomie Bei 21 Patienten wurden die oben angefiihrten klinischen Variabein miteinander verglichen. Die Gingivektomie wurde bei den Probanden in vergleichbaren bilateralen Segmenten vorgenommen. Nach der Operation wurde entweder der iibliche parodontale Wundverband angelegt oder es wurde lediglich mit Mundspiilungen (Chlorhexidin) nachbehandelt. Initial e praeoperative Voraussetzungen fiir beide Formen der Nachbehandlung waren vergleichbar. Beide Behandlungsformen resultierten in statistisch eindeutig in gesicherter Reduktion der Taschentiefen. Die erhaltene Veringerung der Taschentiefen war gleichfalls klinisch bedeutungsvoU {1,5 mm). Der Unterschied in endgultiger Taschentiefe, der zwischen den beiden Nachbehandlungs-
formen beobachtet wurde (um 0,16 mm giinstiger bei Mundspulung mit Chlorhexidin) war, obwohl statistisch gesichert {5 % Niveau), kaum von klinischer Bedeutung. Die meisten Patienten bevorzugten jedoch den parodontalen Wundverband als postoperative Behandlungsform. Die Verfasser bedauern, dass es unmoglich ist die individuelle Preferenz eines Patienten fur eine der beiden moglichen Formen der Nachbehandlung bereits vor der Operation festzustellen. Vielleicht ware die Kombination beider Verfahren empfehlenswert. Am wichtigsten ist jedoch, dass die hausliehe Selbstbehandlung sobald als moglich wiederaufgenommen wird.
Comparaison entre 1'utilisation de bains de bouche a la chlorhexidine et Vapplication de pansements parodontaux apres ies gingivectomies Une comparaison a ete faite entre Ies resultats cliniques obtenus lorsque, dans un groupe de 21 patients chez lesquels il etait necessairc de pratiquer des gingivectomies sur des segments bilateraux comparables, on utilisait pendant les 8 jours suivant I'operation, soit des pansements au ciment chirurgical, soit des bains de bouche a la chlorhesidine. Les conditions initiales pre-operatoires etaient comparables. Ces deux types de traitement post-operatoire ont permis d'obtenir des reductions hautement significatives de la profondeur des culs-de-sac; ces reductions etaient d'un ordre de grandeur significatif du point de vue clinique {> 1,5 mm). La difference observee (0,16 mm), en faveur des bains de bouche, entre les resultats des deux types de traitement, bien que significative au niveau conventionnel de 5 % du point de vue statistique, n'avait pas d'importance du point de vue clinique. Les pansements parodontaux ont ete preferes comme traitement post-operatoire par un plus grand nombre de patients. Malheureusement, il est difficile, sinon impossible, de determiner avant I'operation quelles seront Ies preferences de chaque patient en ce qui concerne les deux types de traitements post-operatoires. Ces deux types possedent pour chaque patient des problemes latents, mais ces problemes different d'un, patient a l'autre, et il ressort de cette etude que ni Fun ni I'autre de ces traitements ne peut etre considere comme un compromis ideal pour tous les patients. II n'est pas impensable
CHLORHEXIDINE RINSINGS FOLLOWING qu'un traitement post-operatoire combinant les pansements et les bains de bouche puisse posseder les avantages de ces deux methodes tout en limitant leurs inconvenients. II n'est pas douteux que les patients soumis a un traitement parodontal chirurgical aient avantage a reprendrele plus tot possible les soins d'bygicne bucco-dentaire normaux. References
Addy, M. & Douglas, W. H. (1975) A chlorhexidine-containing methacrylic gel as a periodontai dressing. Journal of Feriodonlology. 46, 465-468. Asboe-Jorgensen, V., Attstrom, R., Lang, N. P. & Loe, H. (1974) Effect of chlorhexidine dressing on the healing after periodontal surgery. Journal of Periodonlology 45, 13-17. Baer, P., Sumner, C. F. & Miller, G. (1969) Periodontal dressings. Dental Clinics of North America 13, 181-184. Burke, J. F. (1971) Effects of inflammation on wound repair. Journal of Dental Research 50, 296. (Suppl.) Glickman, I. (1964) Clinical Periodontology. 3rd ed., pp. 549-581. Philadelphia and London: W. B. Saunders, Goldman, H. M., Schulger, S., Fox, L. & Cohen, D. W. (1964) Periodontal Therapy. 3rd ed., pp. 406-463. New York: C. V. Mosby.
GINGIVECTOMY
65
Greensmith, A. L. & Wade, A. B. (1974) Dressing after reverse bevel flap procedures. Journal of Clinical Periodontology 1, 97-106. Heaney, G. G., Melville, T. H. & Oliver, W. M. (1972) The effects of two dressings on the flora of periodontal surgical wounds. Oral Surgery, Oral Medicine and Oral Pathology 33, 146-151. Schi0tt, C. R., Loe, H., Jensen, S. B., Kilian, M., Davies, R. M. & Glavind, K. (1970) The effect of chlorhexidine moutb rinses on the human oral flora. Journal of Periodontal Research 5, 84-89. Waerhaug, J. & Loe, H. (1957) Tissue reaction to gingivectomy pack. Oral Surgery, Oral Medicine and Oral Pathology 10, 923-937. Ward, A. W. (1923) Inharmoniotis cusp relation as a factor in periodontoclasia. Journal of the American Dental Association 10, 471481.
Address: M. Addy Lecturer in Periodontology Dental School Welsh National School of Medicine Heath Cardiff Wales England
