Periodontal Dressing: Application and Duration
Periodontal dressings are not universally necessary after periodontal surgery, but when used, they should be applied immediately post-operatively and removed after 7 days, with mechanical cleaning of the treated area forbidden for 1 week. 1
When to Use Periodontal Dressings
Use periodontal dressings selectively in the following situations:
- After periodontal flap surgery when wound protection and clot stabilization are priorities 2, 3
- When patient comfort and hemorrhage control are concerns 4
- To prevent premature epithelialization and promote proper connective tissue healing 2
Do not routinely apply dressings when primary intention healing is achieved with tension-free closure and adequate suturing 1
Application Protocol
Immediate Post-Operative Period
- Apply the dressing immediately after completing the surgical procedure 2, 3
- Ensure the dressing covers the surgical site adequately without excessive pressure 4
- Instruct patients to avoid mechanical cleaning of the treated area for 1 week 1
- Prescribe painkillers as needed 1
Patient Instructions
- Restrict to soft food intake with no biting or chewing in the treated area 1
- Prevent any pressure or forces on the graft site 1
- Begin chlorhexidine 0.12% rinses from day 3 onwards, twice daily for 1 minute, continuing for at least 3 weeks 1
Duration and Removal
Remove the periodontal dressing after 7 days 1, 3
- This 7-day period allows for initial wound stabilization and clot organization 2
- Removal at 7 days coincides with the typical suture removal timeline 1
- Extended application beyond 7 days is not supported by evidence and may increase inflammatory response 5
Material Selection
When choosing to use a dressing, consider the following hierarchy based on clinical evidence:
First choice: Collagen-based dressings 3
- Demonstrated superior wound healing outcomes compared to other materials 3
- Showed significant reduction in gingival index from 1.40 ± 0.14 to 1.10 ± 0.30 at 14 days 3
- Provided better symptomatic relief to patients 3
Second choice: Non-eugenol dressings 6, 3, 4
- Biodegradable formulations using pharmaceutical excipients (sodium carboxymethyl cellulose, Eudragit S 100, povidone K30) show promise 6
- Better dimensional stability with approximately half the swelling rate of commercial products 6
- Avoid eugenol-based products due to potential tissue irritation 5, 4
Third choice: Light-cure dressings 3
- Acceptable alternative with moderate clinical outcomes 3
- Less evidence supporting superiority over non-eugenol options 3
Clinical Benefits When Used Appropriately
Periodontal dressings, when applied correctly, provide:
- Enhanced probing depth reduction: 2.4 ± 0.6 mm with dressing versus 1.6 ± 0.6 mm without 2
- Improved attachment level gain: 2.5 ± 0.4 mm with dressing versus 1.4 ± 0.4 mm without 2
- Clot stabilization preventing detachment during early healing 2
- Prevention of bacterial colonization during the critical wound healing phase 2
Common Pitfalls to Avoid
Do not apply excessive pressure with the dressing, as this can compromise blood supply and delay healing 1
Do not leave dressings in place beyond 7 days, as prolonged application may induce more intensive inflammatory reactions 5
Do not use dressings as a substitute for proper surgical technique - primary closure with tension-free flaps and adequate suturing is more important than dressing application 1, 4
Do not allow patients to mechanically clean the area during the first week, as this can disrupt clot formation and wound healing 1
Avoid eugenol-based dressings (such as traditional Coe-Pak formulations) when non-eugenol alternatives are available, due to better biocompatibility profiles 6, 5, 4
Post-Removal Care
After removing the dressing at 7 days: