INDICATIONS

To remove deposits of plaque, calculus, and debris from the tooth surfaces in periodontal pockets and gently debride the inner lining of the pocket
To further treat select periodontal pockets with subgingival medicaments to enhance healing of the lesion

EQUIPMENT

Periodontal probe (see Fig. 6-1)
Hand curette
W-3 plastic filling instrument (PFI)—“beaver tail”
Doxirobe™ Gel (Pfizer Animal Health New York, NY)
Irrigation solution

Figure 6-1 Periodontal probe, hand curette (with round end), and W-3 “beaver tail” for packing perioceutic.

PROCEDURE

Provide preoperative and intraoperative (local) analgesia where appropriate
Identify and select periodontal pockets of appropriate depth for additional therapy (3–5 mm) (Fig. 6-2)
- These are moderate-depth, suprabony, soft tissue pockets
- Deeper soft tissue pockets (greater than 5 mm) would require performing a gingival flap to open the site for adequate cleaning (open root planning)
- Deeper infrabony pockets (with vertical bone loss) would require more advanced periodontal procedure with gingival flap for access, complete curettage of infrabony pocket, and placement of material to encourage bone regrowth
Select appropriate hand curette: curettes have a round toe at the end and rounded back (in cross section, half-moon shape, flat edge—face of instrument)
- Curettes are double-ended; the two ends are mirror images of each other, as only one side will contact tooth surface for root planing
- Curette working ends are numbered (e.g., 11/12), with varying angulations (designed in human dentistry to clean specific tooth surfaces)
  - Some equipment companies have specialized veterinary curettes (feline)
- Size of working ends can also vary: some smaller types (mini) may be useful for instrumentation in periodontal pockets of small dogs and cats
Insert curette head into depth of pocket, adjusting the cutting edge to contact the tooth surface (closed face) (Fig. 6-3)
With a pull stroke, bring curette edge down the surface of the root, dislodging calculus and debris; use this pull stroke in several different directions in a cross-hatching pattern to effectively root plane the surface free from debris (Fig. 6-4)
As the surface is cleaned of debris, the tactile (and auditory) sensation will go from a rough feel to a smooth feel
With light digital pressure on the external surface of the pocket, allow the opposite edge of the curette to gently debride the diseased soft tissue (subgingival curettage or debridement); there will be moderate hemorrhage
Some (not all) ultrasonic units are made to allow subgingival cleaning, which allows cavitation of bacteria in addition to scaling
- Other ultrasonic scalers should not be used below the gum line, as once the tip is buried, the water spray cannot adequately cool the tip, potentially causing overheating and damage to tooth
Polish the crown surface and gently splay the foot of the prophy cup to polish a millimeter or two of the root surface (Fig. 6-5)
Irrigate then air-dry the area thoroughly to remove any remnants of calculus, debris, or prophy paste (Fig. 6-6)
Prepare the perioceutic (Doxirobe Gel) according to manufacturer’s recommendations
- Once mixed, and before you disconnect the two syringes, balance the syringes upright with syringe “A” on the bottom, to allow the gel to settle, then remove the excess air and place the blunted tipped cannula on the syringe
Introduce the blunt-tipped cannula into the pocket, but not embedded into the soft tissue; start with the tip at one extent of the pocket (Fig. 6-7)
Slowly inject the gel into the pocket; as the gel starts to extrude from the pocket, move the cannula tip along the length of the pocket, filling the void with the gel, but not overfilling (Fig. 6-8)
- To help with retention of the gel, use a finger to help keep it in the pocket and gently scrape the tip of the cannula on the tooth surface at the end of the administration to dislodge the gel from the cannula tip
Place a drop of water to hasten the solidification of the gel, although it will harden on its own in 1–3 minutes (Fig. 6-9)
Use the W-3 flat against the tooth to push the remaining gel underneath the gingival margin (Fig. 6-10); use light digital pressure on a buccal pocket to force the gel into the recesses of the pocket
Note: there are other perioceutics used in human dentistry and other products with clindamycin
If fluoride is to be applied, do so after the gel, because water used to firm the gel will deactivate the fluoride
Home care: oral solutions or gels may be used initially, but the owner should not brush for 14 days; recheck at 2 weeks to assess healing and start brushing at that time
Prescribe antibiotics and pain medication postoperatively as appropriate
Recheck and re-treat in 6 months

Figure 6-2 (a) Probe inserting into periodontal pocket—5 mm in depth. (b) Probe placed at the 5-mm mark on top of the gingiva to indicate the depth of the pocket.