Blackwell's Five-Minute Veterinary Consult Clinical Companion. Группа авторов

href="#ulink_6dbed599-711d-5a0b-be1b-56d5a2f2a1b3">Figure 5.7 After irrigating all debris and prophy paste off the tooth, a gentle blast of air into the sulcus helps dry the area and shows clean surfaces.

       Prepare the perioceutic according to manufacturer’s recommendations.

       Introduce the material into the pocket, following manufacturer’s instructions.

       Note: there are other perioceutics used in human dentistry and other products with clindamycin.

       Homecare: oral solutions or gels may be used initially, but the owner should not brush for 14 days. Recheck at two weeks to assess healing and start brushing at that time.

       Prescribe antibiotics and pain medication postoperatively as appropriate.

       Recheck and re‐treat in five months.

       Treat interdental periodontal pockets with planned extraction(s) of one of the teeth. For example, mandibular third incisor extraction to treat canine; mandibular fourth premolar or second molar extraction to treat first molar.

       Removal of persistent or redundant tissue that is forming pockets (mandibular canines).For descriptive purposes, images are provided to show how excess or redundant tissue will be excised from the mesial aspect of a mandibular canine tooth to manage the soft tissue and reduce the pocket depth (Figure 5.8).Make a reverse bevel incision into the interdental or mesial/proximal tissue, extending from the mesial aspect of 304, through the redundant tissue both buccally/labially and lingually, preserving a collar of attached gingiva (Figure 5.9). This would extend to the mesial aspect of third incisor for its extraction flap. If this incision is made to incorporate the extraction of 301, 302, 303, it can be termed a “wedge” excision.Use a blade to make a sulcular incision around the tooth/teeth to be extracted (403 plus), and at the mesial aspect of 304 if the pocket affects the canine (second incision).Using crown and collar scissors, curettes, or serrated periosteal elevator, debride the pocket lining and redundant tissue as the 403 is elevated or excess tissue removed (Figures 5.10 and 5.11).Further debride the now accessible area adjacent to 304, including open root planing and ultrasonic scaling of the tooth/root surface. If an infra‐bony pocket between 304 and bone is present, a bone graft material can be used.Suture the healthy gingival margins, with care at the mesial aspect of 404; this closure may be located further apically on the tooth, with resultant root exposure, but the pocket will be minimized (Figure 5.12).Figure 5.8 Area of redundant tissue between mandibular canines after incisors have been lost; deep pockets are present.Figure 5.9 Make a reverse bevel incision into the proximal tissue, extending from the mesial aspect of 304, through the redundant tissue both buccally/labially and lingually, preserving a collar of attached gingiva.Figure 5.10 Using crown and collar scissors or curettes, debride the pocket lining and redundant tissue.Figure 5.11 Further debride the now accessible area adjacent to 304, using a serrated periosteal elevator to remove granulation tissue, and including open root planing and ultrasonic scaling of the tooth/root surface.Figure 5.12 Suture the healthy gingival margins with care at the mesial aspect of 304. This closure may be located further apically on the tooth, with resultant root exposure, but the pocket will be minimized.

COMMENTS

       Blunt or dull curettes will be ineffective in root planing; keep instruments sharpened.

       Using the perioceutic without effective root planing will have poor results.

       Attempting to root plane or treat a pocket deeper than 5 mm without using a gingival flap will be ineffective.

       Excessive pressure when root planing can damage the root surface.

       Appropriate preoperative diagnostics when indicated prior to procedure.

       Appropriate antimicrobial and pain management therapy when indicated.

       Appropriate patient monitoring and support during anesthetic procedures.

      See also the following chapters:

        Chapter 4

        Chapter 9

        Chapter 20

      Abbreviation

       PFI = plastic filling instrument or W‐3

      Author: Heidi B. Lobprise, DVM, DAVDC

      Consulting Editor: Heidi B. Lobprise, DVM, DAVDC