DENTALPRODUCTSREPORT.COM | September 201292

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CliniCal 360°periodontics

At A glAnce

Patients often experence oral inflammation. It may be caused by self-induced trauma or the inflam-mation may be in an area that must heal following a dental procedure. MIS Implants Technolog ies’ PeriZone™ PerioPatch® acts as a barrier while it provides relief and absorbs excess wound exudates to promote healing.

The patch is a Class I medical device consisting of two layers: the outer backing and the gel lay-ers. Both layers provide protection from irritation that can occur from eating and speaking.

The following article indicates clinical applications using Perio-Patch for a variety of cases.

Per ioPat ch ( I z u n Ph a r m a Ltd., Jerusalem, Israel) is a topi-cal hydrogel patch that adheres

and immediately conforms to the shape of the soft tissues. The physical barrier created by Perio-Patch absorbs wound exudates and protects the oral mucosa from trauma and possible irritants that could aggravate the wound, thus, improving patients’ comfort. This hydrogel patch is composed of an absorptive polymolecular matrix based on natural plant extracts. Its ingredients are ingestible, and therefore, there is no risk if any part of the patch is swallowed.

Due to its herbal components, PerioPatch not only forms a pro-tective seal over inflamed gingiva and oral mucosa, but, at the same time, promotes natural healing and reduces the signs and symptoms of inf lammation with minimal side effects.

A novel device to enhance soft tissue healing Clinical applications of PerioZone PerioPatch in a variety of cases.by C a r l o s E . N E m C o v s k y , D E pa r t m E N t o f p E r i o D o N t o l o g y a N D D E N ta l i m p l a N t o l o g y t h E

m a u r i C E a N D g a b r i E l a g o l D s C h l E g E r s C h o o l o f D E N ta l m E D i C i N E , t E l av i v u N i v E r s i t y

FIgS. 1-3 Pre-operative aspect of inflamed buccal gingival tissues, in spite of proper oral hygiene, during orthodontic treatment (Fig. 1). PerioPatch applied on the inflamed gingival tissues(Fig. 2). Reduced clinical signs of inflammation can be appreciated already after 2 days of PerioPatch application(Fig. 3).

AbOUT ThE AUThOR

Carlos E. Nemcovsky graduated from dental school

in Montevideo, Uruguay and did his post-graduate studies in Periodontology at Tel-Aviv University. A

specialist in Periodontology since 1997, he is a Full Professor at the Department of Periodontology and Implant Dentistry, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel-Aviv University A Former-President of the Israel Periodontal and Osseointegration Society, he has authored or co-authored more than 100 scientific publications (90 listed in Pubmed.org) in leading international journals in the fields of Dental Research, Occlusion, Oral Rehabilitation, Periodontology and Dental Implants. Carlos is well renowned international speaker and holds a private practice limited to Periodontics and Dental Implants (www.professor-nemcovsky.com).

The TAkE-AwAyS Ȝ PerioPatch can provide relief and promote healing in a variety of cases.

Ȝ The physical barrier created by PerioPatch absorbs wound exudates and protects the

“Due to its easy application, this innovative medical therapeutic device presents versatile applications such as enhancing healing of all types of oral wounds...”

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FIgS. 4-8. Ulcerated gingiva in the interdental areas between lateral incisor and cuspid and first and second premolars(Fig. 4). PerioPatch applied on the affected area(Fig. 5). Aspect after 2 days of PerioPatch application, note advanced soft tissue healing(Fig. 6). Note improved aspect of gingival tissues following altogether 4 days of application(Fig. 7). Gingival aspect with almost complete healing after 7 days(Fig. 8).

Standard uses In clinical practice, for standard cases, the application of three PerioPatch within the first 24 hours followed by 2-3 additional days of maintenance usage applying 1 or 2 patches per day is recommended. After application, the outer backing of the PerioPatch will loosen and can be removed by the patient. The gel will remain in place and continue to provide protection for up to 6 hours.

Due to its easy application, this innovative medical therapeutic device presents versatile applications such as enhancing healing of all types of oral wounds, inju-ries and ulcerations of the gingival and oral mucosa, including stomatitis, minor chafing, traumatic ulcers, and lesions associated with dental procedures.

The purpose of the present report is to present sev-eral clinical applications in the oral cavity for this novel device including: symptomatic treatment of gingival inflammation, as well as gingival and oral mucosa ulcer-ations, following scaling and root planning procedures, and following periodontal and other dental procedures.

Symptomatic relief of gingival inflammationReduction of gingival inf lammation not related to plaque accumulation may be rapidly achieved fol-lowing PerioPatch application with the mentioned protocol (Figs. 1-3). In a double-blind, randomly controlled clinical trial in patients with moderate to severe gingivitis the PerioPatch, as a sole intervention, without any mechanical plaque debridement of the area, significantly reduced localized gingival inflammation. PerioPatch aplication appeared to be a safe and effective means of topically controlling gingival inflammation.

PerioPatch reduced the local inflammatory media-tors, along with the crevicular f luid volume and improved inflammatory signs associated with gingivitis. Another valuable application is in cases presenting gin-gival inflammation due to manipulation during dental and implant rehabilitation procedures such as tooth and abutment preparation with subginvial margins impres-sion taking and provisional crowns, where a rapid reso-lution of the inflammation is desired.

gingival and oral mucosa ulcerationsPeriopatch application is appropriate for gingival and oral mucosal ulcerations such as aphthae, small soft tissue lacerations following dental treatment and other oral inflammatory lesions. In certain cases longer patch application periods may be needed until the complete lesion resolution is achieved (Figs. 4-8).

Application following scaling and root planing proceduresThe main goal of scaling and root planning (SRP) procedures is the reduction of inflammation through elimination of bacterial contamination and calculus.

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“ Reduction of gingival inflammation not related to plaque accumulation may be rapidly achieved following PerioPatch application ...”

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FIgS. 9-11. Intense clinical signs of gingival inflammation in the lower anterior teeth(Fig. 9). Immediately after scaling and root planning in the affected area, PerioPatch was applied; new patches were applied every 8 hours during the following 2 days(Fig. 10). Aspect of gingival tissues, with no clinical signs of inflammation, already after 5 days(Fig. 11).

FIgS. 12-15 Marked clinical signs of gingival inflammation in the maxilla(Fig. 12). Aspect immediately after scaling and root planing(Fig. 13). PerioPatch was applied only on the right upper quadrant during the next 5 days(Fig. 14). Reduced clinical signs of inflammation 5 days post scaling and root planing. Note the marked improvement on the right side, where PerioPatch was applied compared to the left side, with no patches(Fig. 15).

However, because this inflammation is due to a disease process, elevated levels of inflammatory collagenases have been shown to be present. PerioPatch in addition to SRP has been shown to reduce MMP-9 levels, com-pared to SRP alone.

Also, during this procedure certain laceration of the soft tissues usually occurs. PerioPatch application immediately after these procedures leads to a rapid reduction in clinical signs of inf lammation, leading to better clinical results (Figs. 9-11). Inflammation is necessary for the effective defense against pathogens and to set in motion tissue repair following injury. Yet inf lammation itself is the culprit in a wide variety of common diseases, among them rheumatoid arthritis, atherosclerosis, and others.

PerioPatch was shown to reduce inflammation when used in conjunction with conventional mechanical treatment. This improvement was significantly greater than that seen with conventional treatment alone (Figs. 12-15).

In a recent, unpublished study, PerioPatch was applied immediately following SRP treatment by the treating clinician, followed by two subsequent applica-tions at eight-hour intervals by the patient, and re-eval-uated 2-4 weeks later. On a separate visit, a similar area of gingival inflammation was identified on the contra lateral side and treated with SRP alone, here too with re-assessment after 2-4 weeks.

The PerioPatch treated area showed significantly reduced inf lammation and bleeding, as measured by gingival index (GI) and bleeding on probing (BOP). The areas treated with SRP alone showed improvement as well, though this was significantly less pronounced, both with respect to GI and BOP.

Application after periodontal and other surgical oral proceduresIn addition to reducing the signs and symptoms of inflammation, PerioPatch also assists in protecting and preventing the oral soft tissues from continued damage,

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“ Application immediately after these procedures leads to a rapid reduction in clinical signs of inflammation, leading to better clinical results.”

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especially after surgical procedures. PerioPatch applica-tion following oral surgical procedures enhances soft tissue healing in addition to inflammation control.

PerioPatch application leads to a rapid reduction of localized pain and irritation which makes it useful for relieving acute and chronically inflamed soft tissues, or soothing the local trauma to the gingiva, often asso-ciated with surgical and periodontal oral treatments. PerioPatch may also be applied to improve soft tissue healing of surgical wounds in implant (Figs. 16-25) and periodontal (Figs. 26-37) procedures.

An interesting application for PerioPatch may be in dental implant guided bone regeneration proce-

dures (Figs. 16-25). Primary soft tissue closure and maintenance are indispensable for the success of bone augmentation procedures with use of resorbable and non-resorbable barrier membranes.

Early exposure of these membranes leads to decreased bone regeneration. PerioPatch acts as a protective mechanical barrier, while at the same time reducing clinical signs of inflammation and enhancing soft tissue healing at the surgical site, therefore, reduc-ing the possibility of detrimental soft tissue dehiscence over the barrier membranes.

FIgS. 16-25 spect of implants placed in the maxilla, note large implant exposure commanding a bone augmentation procedure(Fig. 16). Bone augmentation was performed with Mineralized freezed dried bone allograft and BoneBone™ used as particle binder and covered with a collagen barrier membrane(Fig. 17). Primary soft tissue closure was achieved(Fig. 18). PerioPatch applied on the sutured area(Fig. 19). Aspect of the surgical wound following 2 days, note improved soft tissue healing(Fig. 20). Advanced soft tissue healing after 5 days(Fig. 21). Soft tissue aspect after 9 days, with almost complete healing of the surgical wound(Fig. 22). Aspect immediately after suture removal(Fig. 23). Aspect of the treated area, 5 months post implant placement with bone augmentation(Fig. 24). Note complete calcified tissue healing around the implants, compared to situation at the time of placement (Fig. 16)(Fig. 25).

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3number of recommended patches to be applied within the first 24 hours, followed by the application of 3 additional patches as needed on subsequent days.Source: www.perizoneonline.com

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Final thoughtsThe PeriZone PerioPatch is ideal for patients suffering from the following conditions:

• Irritated gums (such as immediately following SRP and other dental procedures), wounds, extractions, injuries, and ulcerations of the gingiva and oral mucosa

• Stomatitis, minor chafing and traumatic ulcers• Abrasions caused by braces and dentures• Minor burns caused by food or chemicals (i.e.

bleaching)As this article has showcased, PerioPatch, f irst

placed by a clinician chairside, delivers optimal results in tissue healing in a variry of clinical cases.

FIgS. 26-37 Pre-operative aspect of lower anterior teeth, note large gingival recession and lack of kertinized gingival around cuspid and lateral incisor commanding a root coverage procedure(Fig. 26). Root coverage procedure included a free connective tissue graft containing an epithelial rim in the lower cuspid and lateral incisor areas(Fig. 27). Final sutures following the root coverage surgical procedure(Fig. 28). Sutures in the palatal donor site(Fig. 29). PerioPatch applied on the palatal donor site(Fig. 30) PerioPatch applied on the surgical area(Fig. 31). Two days post-operative aspect of the surgical area(Fig. 32). Two days post-operative aspect of the donor site(Fig. 33). Aspect of the lower anterior area 5 days post root coverage procedure, note advanced soft tissue healing(Fig. 34). Aspect of the lower anterior area 1 week post root coverage procedure, note advanced wound healing(Fig. 35). Palatal donor area 2 weeks post-op, note complete healing of the surgical wound(Fig. 36). Aspect of the lower anterior teeth 2 months after the root coverage surgical procedure. Note degree of root coverage in all treated teeth and gain in keratinized tissue mostly around cuspid and lateral incisor(Fig. 37).

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