Detachment of the periodontal canal between teeth is a disease. What is dental curettage? Possible complications and risks after curettage

From this article you will learn:

surgical methods treatment of periodontitis – reviews from dentists,
flap surgery, curettage of periodontal pockets – price 2019.

The article was written by a periodontist 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 are launched in the gum inflammatory process, which first manifests itself as bleeding when brushing teeth, pain and swelling of the gums, and later these symptoms are also accompanied by mobility of teeth, their displacement, suppuration from under the gums, etc.

So, in the tooth-gingival groove 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:

Atrophy bone tissue 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 periodontitis medium degree severity (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 plaque, 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).
→ Fig. 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, antibiotic treatment, laser treatment, 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.
That's why the only way treatment of periodontitis that guarantees improvement is 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. most mild degree 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 instruments with which closed curettage is performed.

This type of curettage is popular in dental clinics ah, in which there is no 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 –

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.

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

After removal of granulation tissue, antiseptic treatment surfaces 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 surgery. 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 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 when long-term 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, for example, to cover gum recession. Recession is a receding gum in the area of 1-2 teeth, accompanied by exposure of the roots.

Curettage of periodontal pockets: price 2019

How much does curettage of periodontal pockets cost? The price for 2019 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 package 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 the patient reviews after different types 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, and does not require highly qualified doctors (usually dentists who do not have the skills like to do it major operations), 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.

Minuses -

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 on 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.

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Some dental patients are faced with a procedure such as open or closed curettage of periodontal pockets. We’ll talk about what it is, prices and reviews in more detail below. After all, the patient needs to know what he is going into and what to prepare for mentally.

It should be understood that any inflammatory processes in tissues cannot be cured without high-quality cleaning and treatment of subgingival deposits. And do this with the help ultrasound procedure not always possible. Therefore, doctors have to resort to more complex and painful manipulations to effectively and completely eliminate foci of infection.

Characteristics of the periodontal pocket

In medicine, this phrase refers to a small natural gap between the neck of a tooth and the gum covering it. Normally, it should not be open and deep. So, if the size of the periodontal pocket does not exceed 0.15 mm, then they can be cleaned of various deposits using regular ultrasound treatment.

In other cases, food debris, plaque, tartar, and bacteria accumulate more and more intensively and lead to inflammatory processes, thereby widening the gap between the gum and tooth and aggravating the clinical picture. This phenomenon can be observed both on one jaw and on both jaws at once.

Doctors believe that even the formation of a periodontal pocket of 3 mm or more is already one of the symptoms of tissue pathology. And if you don't do it timely treatment on early stages, then this will lead to chronic, which is much more difficult to get rid of.

Symptoms

The formation of plaque, deposits, bacterial growth and deepening of pockets occurs unnoticed at first. And only with the appearance of serious complications does the patient notice signs of inflammation:

discomfort in the gums;
loved ones complain when talking, even if hygiene procedures were performed before;
redness and swelling form on the mucous membrane, its surface becomes shiny;
at the slightest touch and processing it begins;
during diagnostic palpation, pain is felt and tissue compliance is observed;
sometimes pus is released;
the dimensions of the neglected periodontal pocket are increased so much that the gap with its contents is visible to the naked eye upon visual inspection;
teeth are getting stronger, even if they are healthy;
Gaps also appear between units in a row and space is freed up;
worsens with severe intoxication general state patient, resulting in weakness and other symptoms.

For any of the individual signs mentioned, you need to see a dentist as soon as possible in order to stop the development of the disease and prevent complications.

Causes

This pathology occurs in many patients, but most often the following factors contribute to this:

habit of eating incorrectly, abuse of carbohydrate foods;
illiterate actions during hygiene procedures, or even completely neglecting them;
some bad habits(for example, smoking);
are common systemic diseases, promoting the spread of infection throughout the body;
hormonal disorders in different periods human life;
low level of immune system;
untreated dental diseases.

In addition to cleansing and undergoing periodontal treatment, you need to determine why the pocket formed and eliminate the root cause. This is the only way to prevent its re-inflammation.

Indications and contraindications for the procedure

In cases of formation of deep periodontal pockets and their pathological inflammation, curettage is performed different ways. What it is? This procedure helps to thoroughly clean the infected area and prevent the spread of bacteria to surrounding tissues.

This is the only way to carry out full treatment and achieve high efficiency. The most common indications for curettage are:

the onset of inflammation of the mucous membrane;
the formation of a noticeable gap between soft and hard tissues;
abundant deposition of tartar in the subgingival area.

Although curettage is prohibited or undesirable in some cases:

purulent discharge and suspicion of a soft tissue abscess;
formation of cavities in the bone structure;
the periodontal pocket is too deep – more than 5 mm;
thinning gums;
started fibrotic changes fabrics;
extreme loosening of teeth;
acute infections in oral cavity;
some common diseases.

How is treatment carried out?

How is curettage done? To do this, use a special dental instrument - a curette. It is thin enough to carry out the necessary treatment of the root area of the tooth even without opening the tissues.

Sometimes doctors resort to modern way– laser curettage. To do this, special equipment is used and painlessly performs high-quality cleaning of periodontal pockets and restoration of affected tissues.

In addition, specialists can take other measures to cleanse and treat periodontitis - antibacterial therapy, other methods of removing dental plaque, anti-inflammatory drugs and even physiotherapeutic methods. But best result There are two types of curettage - open and closed. All other methods remain auxiliary.

No need to be confused this procedure with preventative. Indeed, in the second case, only the processing of the visible surfaces of the enamel and its polishing are performed.

It is possible to completely get rid of subgingival deposits, bacterial accumulation and enlargement of periodontal pockets only surgically, which will prevent re-inflammation and ensure cleanliness and tissue regeneration.

Open curettage of periodontal pocket

This technique is chosen in cases where the size of the gap is set to more than 5 mm or closed method didn't give desired results. Surgical opening of the gums is performed to better review deposits, better processing, elimination of granulation and additional procedures.

So, in this case they can perform splinting to fix the dentition, build up bone tissue and fully cure and restore the mucous membrane. The doctor performs the following manipulations:

Conduct general diagnostics and determine the need for surgery.
Next, some preparation is required - processed antiseptics the desired area, and the patient is given local anesthesia.
The mucosa is opened using small incisions to access the root part of the jaw.
The necessary high-quality cleaning is carried out, all remnants of bacterial activity, dead cells, damaged areas of tissue, etc. are removed.
If necessary, an osteogenic preparation capable of short time increase the volume of fabric.
The mucous membrane is sutured, and top part pulled to the necks and fixed.
After ten days, if healing is normal, the sutures are removed.
A special bandage with medicinal agents is applied to the treated wound surface.

The total healing time can take 2-3 months. In this case, the doctor prescribes antibiotics, anti-inflammatory and painkillers, as well as rinses or other auxiliary procedures carried out at home.

During one such operation, a specialist can simultaneously process up to eight units located in a row. In addition to cleansing, the periodontal tissue is partially built up and the resulting pocket is reduced. Only an experienced doctor with sufficient knowledge can carry out such a procedure. high level qualifications.

Closed curettage of periodontal pocket

This method of treating and cleaning the resulting gap is selected in cases where the size of the pocket does not exceed 3 mm. As a result, the subgingival area can be treated only with simple instruments.

True, the technique has disadvantages:

during one session, only 2-3 units in a row are available;
visual control over actions and quality of work is impossible, all manipulations occur blindly;
Because of this, and also as a result of difficult access, the doctor cannot completely clean the periodontal pocket; there is a high risk that some of the granulation formations will remain in place, which will lead to re-inflammation.

But this operation occurs without mechanical damage tissues, without opening them, which makes the patient feel better and speeds up the healing time. In the process of such curettage, it is possible to reduce a deep periodontal pocket or completely get rid of a small gap.

The steps of the procedure themselves are quite simple:

Local anesthesia is administered.
Using a curette, the walls of the tooth and the subgingival area are processed, thoroughly cleaning the bottom of the pocket.
The accessible area is washed with sodium chloride solution.
At the end, a bandage is applied that can speed up healing and protect weakened tissues from external influences on the postoperative period. Typically, stomalgin, zincoplast or repin are used for this.

After 1-2 months the patient feels complete healing. True, at first they are present painful sensations, increased irritability of the mucous membrane and mobility of the crowns.

Possible consequences

Curettage of periodontal pockets is considered one of the most effective techniques treatment of periodontitis and other inflammatory processes in the soft tissues of the oral cavity. However, in some cases complications or lack of the expected result are possible. This happens if:

the doctor does not have the proper level of qualifications or experience and does not thoroughly clean the cavity;
granulomatous formations remain, which grow again over time;
some individual characteristics the patient’s body, which sometimes leads to unexpected results;
Pocket depth is too deep when more serious intervention is required.

In this case, the patient feels better for a short period, and then all the symptoms of the disease return, as the infection spreads again and leads to re-infection.

Video: how is closed curettage of periodontal pockets performed?

Price

The cost of the procedure depends largely on the level of the clinic in which it will be performed, the region of residence, the number of units processed and the complexity of the manipulations. Typically, the average price in Moscow ranges from 500-6000 rubles per tooth open method and 350-1200 rubles closed.

If we talk about segments or cleaning the entire jaw, then prices vary more. So, for one segment processed, some doctors charge 3,000 rubles, while others charge up to 20 thousand. Laser procedure It also turns out to be significantly more expensive than any other method of treatment.

Today there are a number of pathological conditions and diseases for the treatment of which the method of curettage, or in other words, curettage, cleaning, is used.

Curettage - what is it?

The medical term "curettage" means cleansing a body cavity, any organ or surface skin using a special surgical instrument - a curette.

The main purpose of this surgical procedure is local cleansing of the body from disease-causing or affected areas. In addition, it can be used for further laboratory research obtained biological materials.

Areas of use

Quite often, curettage is used in the following areas of medical practice:

dentistry;
obstetrics and gynecology;
oncology;
surgery;
aesthetic medicine.

Curettage of the armpits

This type surgical intervention in the armpit area is used to treat excessive sweating. It's so effective method that in 80% of cases a person forgets about such unpleasant condition. Of course, there is a risk of so-called compensatory hyperhydria and some others postoperative complications, but surgeons can easily cope with any undesirable consequences, but the result remains positive.

The essence of the operation is to destroy the innervation of the sweat glands and remove them completely or partially. Curettage of the armpits is a minor surgical procedure and is performed under local anesthesia. First, the surgeon determines the area of increased sweating, which, as a rule, coincides with the hair growth area. For a more accurate determination, a Minor test is performed (treatment with starch and iodine). Then, after the necessary tests and sterilization surgical field, curettage is performed directly.

The recovery period after curettage is minimal (on average 1-2 days), since the access area for surgical manipulations does not exceed half a centimeter.

Curettage of periodontal pockets and teeth

With different more often inflammatory in nature(periodontitis), dental curettage is used for treatment. What is it and what is this technique? This procedure consists of cleaning the gum pockets from food debris, stones, various deposits and affected tissues. These spaces are not physiological, but are formed during detachment from the surface of the tooth. Curettage of the gums promotes their healing and produces a therapeutic effect.

Types of gum scraping

Depending on the severity and depth of the formed hole, two main types of curettage are used:

closed;
open.

Let's try to understand them in more detail.

Closed curettage is performed when the gums are detached from the tooth surface by less than half a centimeter. For the slightest deviation (1-2 mm), it is preferable to use the method laser cleaning. For surgical cleaning, special instruments are used - dental curettes. At the end, antiseptic treatments are necessarily carried out and prescribed.

Open curettage is a more extensive intervention used when the depth of the periodontal pocket is more than 0.5 cm. General principles same as the previous method, the only difference is the direct incision of the gum to gain access to more deep layers. After the procedure, the surface of the tooth, especially its root, is carefully polished, treated with an antiseptic, and the gum is sutured. Special medicinal ointments or gels that promote faster healing.

Thus, tooth curettage is not only a therapeutic manipulation, but primarily a preventive one. Carrying out this manipulation makes it possible to prevent the development of more serious illnesses and keep the tooth healthy and the gums uninflamed.

Curettage in gynecology

Among all gynecological operations, curettage of the uterine cavity is one of the most common and widely used, but among other types of curettage it is the most serious and invasive. The procedure itself is not so long and lasts about 15 minutes. The woman is observed for a few more hours after the procedure to exclude bleeding.

Curettage of the uterus can be performed either under general anesthesia, and under local or epidural anesthesia - it all depends on the specific case and the extent of the intended interventions.

Indications

Can be produced for two main purposes: therapeutic (for treatment) and diagnostic (for establishing the final clinical diagnosis), and the indications for it are as follows:

uterine bleeding;
leftovers membranes or tissues after complicated delivery or abortion;
polyps;
synechia;
inflammatory diseases of the uterus;
uterine hyperplasia;
undiagnosed changes in the mucous membranes of the uterus (cervix or body);
long and heavy menstruation;
infertility;
abortion;
miscarriage;
ectopic pregnancy;
as preoperative preparation.

Curettage technique

IN gynecological practice Curettage is very often used. What it is is well known to gynecologists. Let us consider in more detail the stages of its implementation.

After all the necessary general clinical studies and exclusion of acute inflammatory diseases pelvic organs and somatic pathologies After obtaining the patient's written consent for the procedure, curettage of the uterine cavity is performed. During the operation, only upper layer mucous membrane, which is rejected independently during menstruation.

Having placed the patient in and given anesthesia, they expand the vaginal walls with special instruments, then the cervix, and only after that proceed to direct cleaning.

Often, not only the uterine cavity, but also the cervical canal is scraped out, which is called. The resulting samples are placed in sterile tubes, labeled and sent to the laboratory for further analysis.

Preventive measures after curettage

Within 10-14 days after curettage, it is strictly prohibited:

use tampons (only pads);
to make love;
douche;
lie in the bathtub or go to the bathhouse (sauna);
take aspirin or other blood thinning medications;
exercise and carry weights.

Possible complications and risks after curettage

Although this procedure is routine, if the technique is not followed, unfavorable structural features of the organs, or simply a coincidence of circumstances, certain complications may arise:

allocation copious clots blood or bleeding;
spastic pain;
infectious diseases;
inflammatory processes;
infertility;
perforation of the walls of the uterus or cervix.

Therefore, if after surgery you experience at least one of the symptoms listed below, contact your doctor immediately.

Signs requiring emergency care:

prolonged bleeding or large clots (more than two or three pads were used in two to three hours);
pain or discomfort in the lower abdomen;
increased body temperature;
unpleasant-smelling vaginal discharge.

It is also necessary to monitor the nature of menstruation after cleaning and during mandatory report changes to your doctor.

Curettage: reviews

Many patients have undergone this procedure. Reviews indicate that curettage of periodontal pockets helps remove microbes under the gum, as well as granulomas that are located on the root of the tooth. Many patients with periodontal disease respond positively to the procedure.

The recovery period after uterine curettage, according to reviews, passes quite quickly. The operation is usually prescribed for women with hyperplasia and polyps.

According to patients, curettage armpits- quite expensive, but really effective procedure.

Conclusion

So, we looked at a procedure called curettage. What it is, you now know. Armed with the necessary knowledge, you can easily and without consequences, if necessary, sign an informed consent to this procedure.

Some gum diseases can be accompanied by such an unpleasant process as the formation of periodontal pockets. By various reasons the gums become inflamed and no longer fit tightly to the teeth; they become clogged into the resulting gap fine particles foods that are known to serve as an excellent breeding ground for microbes. To stop this process and restore soft tissues to health, as well as to prevent the destruction of bone tissue, the ligamentous apparatus of the tooth and its roots, a special procedure is performed in dentistry - gum curettage. What is the complexity of this manipulation and why is it needed? Let’s take a closer look.

Why do periodontal pockets form?

In order for the tooth to sit tightly in the bone socket, it is surrounded by special fabric– periodontium. And on top it all covers the gums. It is a kind of protective layer of the periodontium, consists of epithelium, penetrated by blood vessels and capillaries. And it is the gums that take on the attack of bacteria very first, protecting the tissues located under it.

If for some reason it becomes inflamed, and this process is not treated in any way, pathogenic microbes penetrate deeper and begin to destroy the periodontium. Thus, a free space is formed between the neck of the tooth and the inner surface of the gum, which doctors call. Particles of food become clogged into it and begin to rot, because a person, as a rule, cannot clean these voids on his own. As a result, the gums swell, bleed, and the person develops bad smell from the mouth and discomfort while eating.

In such cases, you must definitely contact the dentist for medical care. Patients with periodontal disease, as a rule, in combination with other procedures, are prescribed curettage of periodontal pockets - a surgical intervention that involves mechanical cleaning inner surface gums and neck of the tooth from pathological deposits.

About what curettage is

Curettage is surgery, the purpose of which is to remove plaque and tartar covered with bacterial deposits from under the gums. Without this procedure, further treatment of periodontitis and periodontal disease is ineffective, because if the plaque is not removed, the inflammatory process on the gums will be impossible to stop.

The procedure can be performed using hand tools, a laser, or an ultrasonic scaler. Upon completion, the patient can also simultaneously undergo augmentation of bone tissue that has atrophied as a result of the course of the disease.

When is curettage indicated?

with severe inflammation of the gums (including swelling, bleeding, etc.),
with inflammation or destruction of periodontal tissues, with periodontal disease,
when deepening periodontal pockets: the procedure is recommended for patients who have periodontal pockets with a depth of more than 3-4 millimeters,
if there is hard plaque under the gums,
during the resorption of bone tissue and the formation of granulation structures in its place,
with dental mobility.

“My gums began to itch and swell, the doctor said it was because food was getting under them. He said that it was periodontitis and that curettage should be done. I agreed because I was afraid that my teeth would start to loosen (the doctor warned that this happens even in young people). The procedure went well, under anesthesia, so there was no pain. After the curettage, everything healed quickly, too, only at first my teeth ached while eating. Now there have been no relapses for two years, I just clean with a special brush and floss.”

Andrey, visitor to the health forum one1. ru

When surgery cannot be performed

The doctor chooses the method of cleaning the gum pocket. At the same time, he is always guided by several criteria, such as the degree of inflammation, the depth of the gum pocket, the distribution of deposits (are they located only on the surface of the gums and the neck of the tooth or have penetrated into the root part). The doctor also takes into account factors that may interfere with the procedure. Among them:

the presence of infection, purulent contents, increased bleeding of the mucous membrane,
severe tooth mobility,
Availability allergic reaction for anesthetics and other types of pain relief (anesthesia, sedation),
malocclusion,
a history of severe chronic diseases or cancer.

Types and technologies of the procedure

Curettage of periodontal pockets can be closed or open. Let's look at both types in more detail.

1. Closed type

Using special instruments, hooks and ultrasound, as well as under local “freezing”, the periodontist removes tartar and dead tissue and places it in the pocket medicinal product with an antiseptic effect.

Attention! Closed curettage of the gums is carried out only when the depth of the formed periodontal pocket is less than 6 mm, and the inflammatory process has not yet reached the bone tissue. If the gum pocket is much deeper, and pathological process affected the root system, the patient is indicated for open curettage.

The undoubted advantage of the procedure is that it is easily tolerated by patients, because does not require extensive surgical intervention. Doctors do not cut the gums.

But the method also has its drawbacks. The most important risk in conditions of limited visibility of the contents of periodontal pockets is leaving them in pathogenic microorganisms and not fully carry out asepsis and cleansing. Therefore, the procedure is recommended for mild and moderate stages of development of periodontitis and periodontal disease, otherwise the inflammatory process will continue.

2. Open type

Open gum curettage is a more complex and traumatic procedure. It is also performed under local anesthesia, but in some cases the use of so-called medicated sleep (anesthesia) or sedation may be required.

During the operation, the doctor makes a small incision in the gum and turns it away to gain full access to the bone. Microbes and granulation tissue are removed using special tools, the cleaned surfaces are polished and treated with an antiseptic. If the clinical picture requires it, the specialist performs bone tissue augmentation using bone blocks and bone chips. Afterwards the gum is sutured.

The open curettage procedure is very effective. But after it it is better not to stop there, but also to improve the aesthetics of the mucous membrane with the help of patch surgery. After all, the formation of deep periodontal pockets is always associated with a violation of the contour, beauty, and structure of the gums - they become loose and can hang over the teeth.

What instruments are used to perform the procedure?

There are combined curettage methods that combine hardware and instrumental cleaning of surfaces. For example, periodontists can often remove deposits using ultrasound machine"Vector" and hard surfaces clean instrumentally.

Another common method for eliminating periodontal pockets is laser curettage. Its essence and goals are the same as when performing a conventional procedure, with only one difference: the instrument is a laser beam - diode or erbium. The first is most effective for removing deposits from soft tissues, but erbium does an excellent job of removing tartar.

Advantages of laser curettage:

the laser beam is very thin, which means it can reach the most “hidden” corners of the pocket,
the laser is low-traumatic because it does not mechanically affect tissue in any way, that is, pain is minimized,
the laser beam is sterile,
it provides instant coagulation blood vessels, so the operation takes place without blood.

Important! Curettage can also be performed under the crown - usually closed or instrumental. If the clinical picture requires only open cleaning, then the treatment plan is developed individually by the periodontist.

Rehabilitation process

Recovery after closed curettage occurs faster due to the low-traumatic nature of the procedure. After open curettage, the patient is prescribed a number of restorative procedures, a special hygiene regimen and even a diet. It is also worth remembering that after curettage the gums will hurt, so painkillers are often prescribed along with medications to care for them.

How to care for your mouth after surgery:

special attention should be paid to oral hygiene: use toothbrush only with soft bristles, rinse your mouth after eating with a disinfectant solution,
to avoid injury to the gums, you should only eat liquid or soft foods,
for the same reason, spicy, hot, sour, cold foods, as well as alcohol, should be excluded from the diet,
you need to quit smoking,
follow all doctor's instructions and carry out healing procedures(rinsing, irrigation, taking antibiotics, etc.).

Attention! Many patients, fearing to disturb their gums after curettage, stop brushing their teeth altogether. This is the wrong approach, because it is in the postoperative period soft fabrics, the necks of the teeth and periodontium are the most vulnerable to microbes, so the more thorough your dental care is, the more effective the treatment will be.

How much does the procedure cost?

The price for curettage of a periodontal pocket consists of three components: the total clinical picture, from the choice of treatment method and the amount of work. On average, the cost of closed curettage around one tooth varies from 500 to 1200 rubles, and open curettage - from 700 to 1500 rubles.

Have you missed a couple of routine dental checkups and missed your gum disease? It can happen to anyone, because at first periodontitis is asymptomatic. When the gums become swollen, begin to hurt and bleed, bad breath appears and the teeth turn yellow from plaque - everyone runs to the doctor.

At such stages of gum inflammation, curettage of periodontal pockets is indicated - mechanical removal of subgingival deposits. It is carried out in open and closed ways. Read more about each in our article.

Description of the procedure

Curettage of a periodontal pocket is carried out using a special instrument - a dental curette (another name is a curettage spoon).

A curette is inserted into the gum pocket and all plaque accumulated in the pocket is scraped out. The procedure is painful, so it is performed under local anesthesia.

In case of advanced periodontitis, granulation tissues are also removed. They replace atrophied bone tissue, which has dissolved under the influence of toxins secreted by bacteria “living” in the pocket.

It is worth noting that scraping subgingival deposits does not replace full-fledged professional teeth cleaning. This is just one stage of it, along with the removal of tartar and soft coating with enamel, as well as polishing the surface of the teeth.

When to curettage gum pockets

The most important indication is inflammation of the gums, in which periodontal pockets more than 3 mm deep are formed. This means that the gums “lag behind” the tooth, and as a result, a cavity is formed between them, into which microbes penetrate.

This can happen against the background of the following diseases:

periodontitis;
periodontal disease;
gum injuries.

Contraindications

The presence of periodontal abscess (purulent tumor);
copious discharge pus from gum pockets;
thinning gums;
gum fibromatosis;
pathological mobility of teeth III-IV degrees;
acute infectious diseases of the oral mucosa;
others spicy infectious diseases(sore throat, flu, etc.);
general contraindications to surgical procedures.

Methods of conducting

Vacuum curettage

Closed curettage, which uses vacuum apparatus, instantly removing the scraped plaque from the pocket.

Laser curettage

Instead of a curette, a laser device is used, under the influence of which the plaque evaporates.

Cryo-curettage

A special cryo-probe destroys plaque with ultra-low temperatures.

Chemical curettage

Before removing plaque, it is softened with lactic or citric acid.

Most dental clinics use closed and open methods - they are considered traditional when removing subgingival deposits.

The technique is justified if the depth of periodontal pockets does not exceed 5 mm - at the mildest stages of periodontitis. Its peculiarity is that the doctor performs the procedure virtually blindly, since there is no opportunity to look under the gums. At the same time, delicacy is very important; if you work carelessly, you can damage healthy gum tissue and scratch the surface of the tooth.

This surgical procedure is performed in cases where the depth of the gum pockets is more than 5 mm. Using a scalpel, the surgeon makes incisions in the gum and peels off a flap of its mucous membrane from the teeth.

The exposed roots are thoroughly cleaned of plaque and granulation tissue and then polished. The area is treated with antiseptic agents, after which an osteogenic preparation is placed into the periodontal pockets to stimulate the restoration of bone tissue.

Then the gum flap is returned to its place, sutures are applied in the area of the interdental papillae, then a protective gum bandage is applied. The sutures are removed ten days after the operation.

After the procedure you cannot:

stop caring for the oral cavity (germs can enter tissues weakened after surgery and cause inflammation);
touch the area of the gum where the procedure was performed with the brush;
eat solid food for the first two to three days;
spit.

avoid hot food and drinks until healing;
use antiseptics - wipe your teeth with solutions of Chlorhexidine, Miramistin, rinse your mouth with these and similar drugs after meals;
if necessary, apply cold, which will help relieve inflammation after surgical procedures;
drink only through a straw in the first hours after open curettage, so as not to cause bleeding.

What is the price

The average price of closed curettage is 100-200 rubles for cleaning a gum pocket in the area of one tooth.
Open - in the area of one tooth costs from 2,000 rubles, for a quadrant (six to seven teeth) - from 9,000 rubles.

Pros and cons

Benefits of the procedure:

the possibility of eliminating pathological gum pockets. Open curettage is the only method that allows you to achieve this result);
restoration of bone tissue due to the implantation of osteopreparations using an open technique;
getting rid of pathological tooth mobility. When bone tissue is restored, teeth are held stronger;
low cost of closed curettage.

There are also many disadvantages. First of all, the low effectiveness of closed curettage for moderate and severe periodontitis (in 99.98% of cases the disease recurs) and the high cost open method(in addition to the doctor’s work, the total amount includes suture material and osteogenic preparations).

duration of the open curettage procedure.

Approximately 2 hours to work in the area of 6-7 teeth;

high requirements to qualify as a doctor.

Otherwise, there may be injuries to the mucous membranes and damage to the teeth.

Open curettage of periodontal pockets should be performed exclusively by surgeons specializing in periodontology. On our website you can find clinics that successfully treat periodontitis using a similar technique.