10. 1979 Trevor L, P. Watts, Edwars C. Combe. Periodontal Dressing Materials

8/19/2019 10. 1979 Trevor L, P. Watts, Edwars C. Combe. Periodontal Dressing Materials

1/13

Journal

oj

Clinical Periodontoiogy: 1979:

6: 3-14

Key words: Periodontal dressings - composinon - iherapeulic efjects - lisme irriiation.

Accepted

for

publicat ion: September

4, 197S.

Review Article

Periodontal dressing materials

TREVOR

L. P.

WATTS AND EDWARD

C.

COMBE

Department of Oral Medicine and Den tal M aterials Science Unit,

Turner Dental School, University

of

Manchester,

England

Abstract.

A

detailed review

of

periodonta) dressings

is

presented, covering physical,

chemical and biological aspects. Are as requiring fu rther research are outlined, particularly

in the physico-chemical sphere; and some contra-indications to particular substances are

described. It is concluded that there is a definite place for dressings, but that more know-

ledge is required before optimal properties can be deveioped.

ationale for Usage

A wide variety of reasons has been given

for

the use of

periodontal dressings. These

reasons fall into

two

principal groups:

a

dressing may be employed as a physical

adjunct to periodon ta surgery, or it may

be used therapeutically with or without

surgery.

Physical effects

Opinions vary

as to the

desirable physi-

cal effects

of a

dressing. Prichard (1972)

states that a dressing is used to prevent

postoperative haemorrhage and to protect

the wound area from contact with food,

concluding that a dressing has no other

virtue". Manson (1975) however, considers

that a dressing is to protect a healing wound

from saliva

and

traum a, thus producing

comfort

and

speedier heahng,

to

prevent

the proliferation

of

granulation tissue

and

haemorrhagic effect; whilst Goldman &

Cohen (1973) emphasize the need for a

"secure and rigid surgical dressing" with

good adhesive properties. The advent of

isobutyl cyanoacrylate

has

also

led

Bhaskar

et

al.

(1966b)

to

consider instant haemo-

stasis

one of its

main advantages.

No

other

dressing material has this adhesion - de-

pendent effect. Finally, the advent of flap

repositioning led Ariaudo & Tyreli (1957)

to state that the dressing should act as a

stent. Many other writers have also stated

the above points in textbooks and research

papers, including some whose work

is

quoted elsewhere

in

this review. Thus

we

may conclude that wound protection

and

comfort, and some degree of hacmostasis

and tissue stasis are generally considered

to be desirable effects in a dressing.

Therapeutic effects

Dressings have been used in the absence of


2/13

•WATTS AND COMBE

using paraformaldehyde in a dressing.

Gingival necrosis occurred in 4-8 days. It

was noted that contact with bone would

cause sequestration. This technique does

not seem to have achieved much popularity.

As regards tissue shrinkage, the limited use

of saline and astringent packs for 20 min-

utes following scaling has been reported by

Padgett (1959); this is a variation on the

once popular technique of packing peri-

odontal pockets with an inert substance

(usually a paraffin wax formulation) for

1-2 days following subgingiva scaling

(Pincus 1944, Christensen 1944, McTntosh

1947). Isolation from tooth roots led to a

rapid shrinkage of the gingiva, an effect

which is produced today by the somewhat

slower techniques of plaque control. The

use of special pressure packs to produce

gingival shrinkage has also been advocated

in cases where surgery is medically or

psychogically inadvisable (Weinreb Sha-

piro 1964).

Therapeutic effects after periodontal

surgery have been the goal of many who

have incorporated specific agents in dress-

ings. These agents may be classified as

having a primary effect eitber on oral bac-

teria or upon periodontal tissues.

Eugenol has been shown to have anti-

bacterial properties in several studies in

vitro

(Linghorne

O'Connell 1949, CoU

man 1962, Persson & Thilander 1968a,

O'Neil 1975, Haugen et al. 1977); in vivo,

it has been noted that plaque composition

is definitely altered, presumably as a result

of selective inhibition (Coppes et al- 1967,

Heaney et al. 1972). Pihlstrom et al. (1977)

considered that the total number of micro-

organisms was not noticeably reduced by

eugenol. None of the quoted authors has

suggested that the antibacterial properties

Ariaudo & Tyreil 1957, 1960), zinc baci-

tracin (Baer et al. 1958, 1960, 1969) non-

eugenal phenol derivatives such as chlor-

othymol (Molnar 1962), oil of bergamot

(Schach 1968), and chlorhexidine (Asboe-

Jorgensen et al. 1974, Addy & Douglas

1975,

Pliiss et al. 1975). It should be noted

that chemical inactivation may occur: Baer

et al. (1958) report that eugenol and tannic

acid both affect bacitracin.

Apart from haemostatics such as tannic

acid, there have been two attempts to im-

prove postoperative healing by means of

substances with a primary effect on the

tissues. Saad & Swenson (1965) reported

on steroids; and Swann et al. (1975) re-

ported on diiantin. The latter agent had

been previously reported to increase the

rate of healing in skin wounds of rats and

humans, but neither agent showed any

advantage in these periodontal studies.

It is unlikely that the present periodontai

climate will be conducive to the wide-

spread use of therapeutic agents other than

antibacteriats in dressings. Emphasis on

plaque control by the patient has largely

replaced the earlier philosophies based on

professional intervention.

Material Aspects

The literature on periodontal dressings as

materials is so sparse that Mjor (1977) was

quite justified in complaining of its paucity.

It is clear that manufacturers want to be

free to vary the composition of their prod-

ucts and Smith (1970) gives Just such an

example in relation to the reports of Pers-

son & Thilande r (1968 a, b) concerning

Coe-Pak®. The limited factual information

available will now be described and will

highlight areas where knowledge is defi-


3/13

PERIODONTAL DRESSING MATERIALS

hydrogenated fat dressing described by

Baer et al. (1960), most dressings are in-

tended to set, though not necessarily to

the point of rigidity. At least five different

systems are discernible in presently avail-

able materials: (1) The reaction of zinc

oxide with eugenol to form zinc eugenolate.

The reaction is slow, and even with the use

of accelerators such as zinc acetate, there

will always be free eugenol available dur-

ing the normal life of a periodontal dress-

ing (Molnar 1967). The significance of this

free eugenol will be discussed below (Bio-

logical side-effects). (2) Organic solvent

loss is the basis of setting in Peripac®

(Eberle & Miihlcniann 1959), and a physical

hardening results. (3) The reaction between

a metallic oxide and fatty acids is the

basis of Coe-Pak (Molnar 1962). A re-

quirement of water insolubility and suit-

able melting points limits the typs of

acids which may be used. (4) Tissue

conditioners have formed the basis for

certain dressing materials (Frisch et al.

1968 b, Levin et al. 1969, Addy & Douglas

1975). Their setting is usually a physical

process (Combe 1977), with an elastic gel as

the result. (5) Cyanoacrylate tissue adhe-

sives set by polymerisation in the presence

of anions, such as OH- (Combe 1977). (6)

In addition, an experimental polycarboxy-

late system was used on a limited basis by

Smith (1970). These setting systems may

therefore be categorised as chemical or

physical, and at present there is no clear

basis for choice of one or the other, except

for individual preference in the clinical sit-

uation. If a particular system were acknow-

ledged to be advantageous in other respects

(for example, by not inactivating a useful

antibacterial agent), then these factors

would help determine choice.

odontal dressings may be kept in place.

Hirschfeld & Wasserman (1958) listed a

whole battery of techniques, including the

use of wire, floss, acrylic, adhesive tin foil

and copper bands. At the other extreme.

Gold (1964) preferred a cement type pack

because, in his estimation, it could even

splint mobile teeth. When flap reposition-

ing techniques were established, Ariaudo &

Tyreil (1957) wanted the dressing to act as

a stent; but Seibert (1961) clearly had no

faith in any dressing to achieve this, and

advocated the use of cobalt-chromium

tacks to hold flaps in place. Numerous

splints and stents have been described, em-

ploying latex (Munns 1952), acrylic resin

(McKenzie 1951, Gottsegen 1954, Hileman

1957, Holmes 1962, Reader 1970, Glcn^

dinning 1976) and a vinyl polymer (Frisch

et al. 1968a, Kalkwarf et al. 3974). Some of

these have been related to repositioning

and grafting techniques. Other means of

increasing retention which have been ad-

vocated include wiring (Cowan 1965, La-

rato 1967), interproximal usage of spiral

saws and lengthwise cotton thread (Waer-

haug & Aanerud 1953), foil (Berman et al.

1961,

Nelson et al. 1977), and cotton tapes

with interdental sutures if necessary

(Castenfelt 1962). There is no experimental

evidence that objects placed within a dress-

ing are likely to contribute to its retention;

on the contrary, they are likely to weaken

the dressing material since they decrease

its cross-sectional area and contribute to

stress concentration phenomena, thus ren-

dering it more liable to fracture. External

retention with splints and stents is free

from this criticism, but they are incon-

venient to both patient and operator. Ideal-

ly the dressing should be sufficiently re-

tentive without the need for extra devices.

Smith (1970) reported on preliminary trials


4/13

WATTS AND COMBE

their chlorhexidine-carrying material, by

employing polyacrylic acid. Two other

research groups, Asboe-Jorgensen et al.

(1974) and Pluss et al. (1975), decided to

employ auxiliary methods of retention for

their chlorhexidine-containing dressings.

Other attempts at improving dressing re-

tention have used frankly adhesive materi-

als. The use of cyanoacrylate tissue ad-

hesives is well attested to in the literature

(Bhaskar et al 1966, Ewen 1967, Forrest

1974,

Levin et al 1975). The production of

haemostasis, flap immobilisation and pos-

sibly quicker healing are described as the

principal advantages of the technique. No

problems of removal have been described

in the literature, since cyanoacrylates are

apparently biodegradable and are gradually

depolymerised and phagocytosed (CDA

Council for Dental Materials and Devices

1977).

From the variety of ideas, it is apparent

that retention of dressings presents numer-

ous problems. This is to be expected, since

a periodontal dressing is intended to be

removed after a short period of time. If

retention were too good, removal might

become a problem; therefore, an optimum

level of retention should be specifiable.

Biological and therapeutic compatibility

Biological side-effects of dressings are con-

sidered below; certain authors have sought

to ensure biological compability by using

intermediate materials under dressings.

Stern (195S) reported the use of Telfa®,

the inner layer of which was a thin, per-

forated polyester film which was non-ad-

herent and could be used to cover bone.

The use of specially prepared fabrics has

been advocated by Schultz (1962) and

Chasens & Marcus (1963). These fabrics

used under any zinc oxide and eugenol

dressing for the first 6 days. Cleariy it

would be simpler if intermediate materials

were not needed; it is also possible that

they might adversely affect retention of

the,

dressing.

Therapeutic compatibility is important

if an active pharmacological agent is incor-

porated in a dressing. It would seem from

the results of Addy & Douglas (1975) that

their dressing did not substantially inter-

fere with chlorhexidine activity. The warn-

ing of Baer et al. (1960) regarding bacitra-

cin has already been mentioned.

Restorative material compatibility

It is important that periodontal dressings

should not damage permanent restorations

in teeth. There are two possible problems

which could arise. First, an interaction

might take place between dressing and

restoration leading to physical breakdown

of the latter. The authors have heard one

such report from a reliable periodontolog ist.

Second, anterior restorations might be

stained at their margins by substances such

as chlorhexidine in dressings. Protection

by a separating agent would be possible,

but might affect retention. Further experi-

mental data are required on this subject.

Biological Side effects

It is essential that no risk should accom-

pany the use of dressing materials. The

patient should not suffer any side-effects,

the surgical procedures should in no way

be compromised, and there should be no

health risks to the operator and his staff.

In general, three methods of testing materi-

als are used: tissue culture, animal experi-

ments and human trials.


5/13


variations, both types of material can be

cytotoxic when tested against HeLa cells

(Kreth et al. 1966), fibroblasts (Hildebrand

& DeRenzis 1974) and polymorphs (Rivera-

Hildalgo et ai. 1977). It is possible that in

vivo dilution may occur, as toxic substances

leach into saliva (Rivera-Hidalgo et ai.

1977), and therefore these dressings may be

better tolerated by a patient who is using

frequent mouthrinses. Culture studies of

cyanoacryiates (DeRenzis Aleo 1970)

on mouse fibroblasts show that a short

side-chain molecule (methyl cyanoacrylate)

is considerably more toxic than one with a

long side chain (isobutyl or n-octyl cyano-

acrylates). However, all substanees tested

showed definite cytotoxicily.

Certain problems arise when experimen-

tal animals are used for tests of dressing

materials. Most important of these is the

animal's natural tendency to remove the

dressing as an extraneous object. Thus

Englcr et a . {1966) decided no dressing

was needed in their gingivectomy healing

studies in rhesus monkeys, and Loe & Sil-

ness (1961) used acrylic splints as dressing

retainers in mongrels. Other workers have

used subdermal or paraperiosteal implanta-

tion (e.g. Mitchell 1959, Baer & Wert-

heinier 1961, Frisch & Bhaskar 1967).

Eugcnol has been implicated as an irritant

in some animal studies (e.g. Waerhaug &

Loe 1957), though this is a relative effect

For instance Mitchell (1959) found croton

oil to be a more severe tissue irritant and

Gugliani & Allen (1965) rated several ma-

terials to be more irritant, including baci-

tracin-containing dressings. Ne ither Triadan

965) nor Yokoyama (1976) could detect

unfavourable effects of eugenol histologi-

cally, and Persson & Thilander (1968b)

felt that the strong antibacterial substances

parison is in agreement with these results

(Haugen & Mjor 1978), even though the

composition of Coe-Pak is now believed

to be different. On the other hand, Baer

& Wertheimer (1961) compared several

dressings above and below periosteum, and

concluded that a non-eugenol dressing was

better, and that if possible the periosteum

should be left intact. Ochstein ct al. (1969)

agreed with the desirability of split flaps

and the inferiority of eugenol dressings,

but recommended isobutyl cyanoacrylate to

Coc-Pak (presumably of the older formula-

tion). This study involved actual gingival

surgery on beagles, and was therefore clos-

er to the clinical situation than that of

Frisch & Bhaskar (1967) which found no

difference in the response in rats to sub-

periosteai implants of eugenol and non-

cugenoi dressings.

As regards cyanoacrylates, other studies

have shown a generally moderate tissue

response to the longer-chain molecules

(Bhaskar et al. 1966a, Bhaskar et al. 1967,

Binnie & Forrest 1974). If sub-epithehal

leakage occurs, there is however a swift

foreign body response (Miller et al. ]974,

Ericksson 1976). Miller et al. (1974) also

noted some bone resorption in response to

cyanoacrylates, and considered that heat of

polymerisation migbt also affect tissues.

In human beings, Bernier & Kaplan

(1947) studied the healing process after

gingivectomy, and stated that surface con-

tact of tbe dressing was of primary im-

poriance during the first 10 days, and that

constituents were only of secondary impor-

tance. Orban & Arcber (1945) considered

the blood clot of prime importance in the

immediate post-operative period, a view

shared by Radden (1962) with regard to

extraction sockets. The latter author also


6/13

WATTS AND COMBE

al. 1968) by considering the effects of

dressings. They concluded there was no

detrimental effect detectable in either dress-

ing used (Coe-Pak, Peripac), on the ground

of biopsy examination. They also gave a

figure of 7-14 days for complete epi-

thelialisation to occur, and it is interesting

that Ramfjord

Costich (1963) gave a

figure of 6 days for epithelialisation after

gingivectomy, but using Wondrpak® (Ward

1923, 1929), a eugenol-containing material.

Finally, Levin et al. (1975) biopsied 350

out of 725 patients in whom isobutyl

cyanoacrylate had been used after a variety

of surgical procedures, and found that heal-

ing was excellent.

On the basis of these studies, it would

be reasonable to say that whilst eugenol

and other strong antibacterials do have

some irritant effect on healing tissues, it

has yet to be shown that this effect dam-

ages the overall healing process. Tissue irri-

tation is not a ground for the definite exclu-

sion of any materials, except the short side-

chain cyanoacrylates. However, factors

such as patient comfort will play some

part, and the irritant effects of eugenol are

perhaps countered to some extent by its

obtundent action.

Tissue disturbance

It is important that tissue flaps and grafts

should remain precisely adapted and be

undisturbed by dressing materials. Sutures

are used for tissue retention with most

dressing materials, but it is claimed that

cyanoacrylates make sutures unnecessary.

Binnie & Forrest (1974) observed more in-

flamm ation with sutures than cyanoacrylate,

but Ericksson (1976), utilising the buccal

mucosa, preferred sutures to adhesive, be-

cause of fistula formation and cyano-

acrylate inclusion in wounds. Without

cularisation, but in the largest reported

study (Levin et al. 1975), this did not seem

a problem. However, these authors did note

that overextension of the adhesive into the

vestibule led to mucosal ulceration, and a

tissue adhesive cannot be moulded like a

conventional dressing.

Allergy

Contact ailergy differs from tissue irrita-

tion in several respects, such as the need

for previous exposure to an antigen, a

latency period following this, and the low

antigen dose required to elicit a response

in the subject (Magnusson et al. 1970).

Where tissue is damaged, a very low dose

of antigen may sensitize a person. It is

therefore of great importance to minimise

the antigenicity of periodontal dressings.

Antibiotics are a well-known source of

allergic reactions, but neither Fraleigh

(1957) nor Baer et al. (1960) detected any

true allergies in their respective studies with

tetracycline and bacitracin. It is interesting

that both of these studies used agents

which have been implicated as allergens in

later work: eugenol and colophony (rosin:

abietic acid). Koch et al. (1971) were able

to sensitize guinea pigs to both agents, and

tested 18 patients who had clinical mani-

festations suggestive of allergy after perio-

dontal surgery. Of these, about two-thirds

were sensitive to eugenol and/or colophony.

Subsequently, Koch et al. (1973) were able

to produce a 10 % incidence of allergy to

eugenol or colophony in a group of patien ts

from which previously sensitized persons

were excluded. Case reports of other work-

ers have also appeared in the literature:

Romanow (1957) may have been the first

to indict eugenol and colophony: Lysell

(1976) described a reaction to colophony

alone, and Poulsom (1974) gave details of


7/13


substance in this case appears to have been

tannin (Poulsom 1977), which was incor-

porated in both dressings.

In view of the possibility of rare and

very serious allergic reactions, it seems wise

to exclude substances with a well-known

sensitizing potential from periodontal dress-

ings. Indeed, it seems desirable to work

with pure and fully-identified materials, in

view of their application to wound areas.

In this connection, it is of interest that bay

oil has been suggested as a constituent of

eugenoi-free materials (Molnar 1962): yet

according to the Merck Index (Windholz

et al. 1976) this oil contains 40-55 % eu-

genol.

Asbestos-related disease

Asbestos has been incorporated into nume-

ous dressing materials as a binder and filler

(Mcintosh 1947, Linghorne & O'Connell,

1949, Blanquie 1962, O'Neil 1975), but

increasing knowledge regarding its possible

side-effects has led to warnings that it

should be avoided. Dyer (1967) pointed

out that asbestos had not only been incrim-

inated in chronic destructive lung disease,

but also in carcinoma of the lung and

mesothelioma. Otterson & Arra (1974)

showed that it was possible to mix asbestos

into a dressing and not infringe the strin-

gent U.S. Department of Labor regulations,

but advised against use of asbestos on the

grounds that the patient would have a res-

ervoir of the substance in any periodontal

dressing.

Liver toxicity

Tannic acid was also used in some dress-

ings (e.g. Box

Ham 1942) but absorption

of this substance may lead to liver damage

(Baer et al. 1969, CDA Council for Dental

may easily occur where antibacterial dress-

ings are used (Heaney et al. 1972). If an

antibiotic is employed, two possible prob-

lems may occur: emergence of resistant

organisms, and opportunistic infection. In

the study quoted, organisms resistant to

certain antibacterials predominated under

the dressings used, but led to no adverse

effect. However, Romauow (1964) found

that clinical signs of candidiasis occurred

when using tetracycline in dressings, and

that bacitracin enhanced the growth of

yeasts, though without clinical signs in this

series.

Gruber et al. (1966) showed in vitro

that Candida would grow on tissue condi-

tioners, but Frisch et al. (1968c) found no

signs of candidiasis in patients using tissue

conditioners as periodontal dressings. Thus,

evidence suggests that antibacterials may

lead to this problem, but not tissue condi-

tioners.

Cri t ical Assessment

It has been asked whether periodontal

dressings are necessary. The answer to this

question surely depends on the type of

surgery employed. For instance, Stahl et al.

(1969) in a post-gingivectomy biopsy study

found no marked differences between

dressed and undressed sites; Greensmith

& Wade (3974), using carefully sutured

flaps in a controlled trial, found that pa-

tients healed more easily and more com-

fortably without dressings; but Prichard

(1977) clearly considered the dressing an

important and not-so-simiple aspect of the

interdental denudation procedure. Further-

more, a dressing will play some part in the

retention of an apically positioned flap,

preventing undesirable coronal movement.

As regards comfort, opinions are in con-


8/13

10

WATTS AND COMBE

studied because of the subjective phenom-

ena involved.

Comfort is at least partly involved in the

question of whether biological agents

are needed in dressings. Haugen .& Gjermo

(1978) found that Peripac was less com-

fortable than either Coe-Pak or Wondrpak.

However, O'Neil (1975) found that Peripac

had better antibacterial properties than

Coe-Pak, although the former has no

specific antibacterial agent, and concluded

that the physical properties of Coe-Pak

were responsible for its clinical success.

Oliver

Heaney (1970) on the other hand

found that though a eugenol dressing was

more easily fractured than Coe-Pak, there

was no difference in comfort between the

two.

(This finding also highlights the diffi-

culty of assessing materials for which the

detailed formulation is not available: Did

Oliver & Heaney (1970) use the low anti-

bacterial post'Persson & Thiiander (1968b)

formulation of Coe-Pak, or did they use

the older formulation?) It seems that there

is a dearth of evidence showing any definite

advantage to biological agents. Of the three

chlorhexidine studies quoted, two utilised

auxiliary retention for the dressings as noted

above, and one of these (Pliiss et al. 1975)

used Peripac because it permitted a relative-

ly large plaque accumulation. Only the

study of Asboe-Iorgensen et al. (1974) con-

cerned the direct tissue effects, and a high

degree of professional attention yielded a

moderate difference only. An effect was

certainly demonstrated, but would it be

worth-while under the normal conditions

of periodontal practice? And to what ex-

tent was it related to the surgical techniques

employed?

No doubt the cyanoacrylates will con-

tinue to have their enthusiastic adherents,

to the ulceration observed by Levin et al.

(1975).

Many authors have indicated a need for

specific physical properties in periodontal

dressings, including Gottsegen (1954) Aria-

udo & Tyreil (1957, 1960), Loe & Siiness

(1961),

Berman et al. (1961), Castenfelt

(1962),

Gold (1964), Kalkwarf et al. (1974),

Addy & Douglas (1975), Heaney & Apple-

ton (1976). This area is overdue for re-

search, and new questions of chemical and

biological compatibility will probably arise

as a consequence.

In conclusion, it appears that there are

definite surgical indications for the use of

periodontal dressings; that certain materials

should be excluded because of toxic or

other side-effects, that there is no definite

indication for the use of biological agents;

and that there is a need for research on the

chemical and physical aspects of dressing

materials.

Zusammentassung

Parodontale Wundverbdnde. Eine Ubersicht

Es wird eine eingehende Ubersicht tiber paro-

dontale Wundverbande vermittelt, in der physi-

kalisehe, chemiscbe und biologiscbe Ge.sichts-

punkte beriicksichtigt werden. Weiterbin wer-

den Gebiete umri^sen die weiterer Eorscbung

bedurfen - vor allem handelt es sich hierbei

um physikalisch-chemische Fragestellungen.

Kontraindizierte Substanzen werden bescbrie-

ben. Es wird gefolgert, dass der Wundverband

seinen Platz in der parodonto-chirurgischen

Bebandlung behauptet. Es ist jedoch eingehen-

deres Wissen erforderlich bevor Verbande mit

optimal en Eigenschaften entwickelt werden

konnen.

Resume

Pansements parodontaux. Mise-au-point sur les

matcriaux

On trouvera iei une mise-au-point detaillee sur


9/13


de quelques eontre-indications concernant cer-

taines subsiances particulieres. En eonciusion,

les pansements parodontaux ont sans aueun

doute un role a jouer, mais certaines connais-

sances necessaires manquent encore pour pou-

voir realiser des produits ayant des proprietes

optimales.

Reierences

Addy, M. & Douglas, W. H. (1975) A chlor-

hexidine containing me tbacrylic ge as a

periodontal dressing.

Journal of Periodonto-

iogy 46, 465-468.

Addy, M. & Dolby, A. E. (1976) The use of

chlorhexidine mouthwash compared with a

periodontai dressing following the gingivec-

tomy procedure. Journal of Clinical Peri-

odonlology 3, 59-65.

Ariaudo, A. A. & Tyreil, H.

.\.

(1957) Reposi-

tioning and increasing the zone of attacbted

gingiva. Journal of Periodonlology 28, 106-

no.

Ariaudo, A. A. & Tyreil, H. A. (1960) Elimina-

tion of pockets extending to or beyond the

mucogingival junction.

D ental Clinics of

North America,

4, 67-74.

Asboe-Jdrgerisen, V., Attstroni, R., Lang, N. P.

& Loe, H. (1974) Effect of a chlorbexidine

dressing on the healing after periodontal

surgery. Journal of Periodontoiogy 45, ]3-17.

Baer, P. N. & Wertheimer, F. W. (1961) A

histologic study of the effects of several

periodontal dressings on periosteal-covered

and denuded bone.

Journal of Dental Re-

search 40, 858.

Baer, P. N., Goldman, H. & Scigliano, J. (1958)

Studies on a bacitracin periodontal dressing.

Oral Surgery, Oral Medicine and Oral Patho-

logy

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Address:


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10. 1979 Trevor L, P. Watts, Edwars C. Combe. Periodontal Dressing Materials

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