Management of Traumatized Gingival Wound Using Tissue Adhesive in Dental Hygiene Practice

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(1)Journal of Dental Hygiene Science Vol. 3, No. 1, pp. 1~ 4 (2003).

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(3) Management of Traumatized Gingival Wound Using Tissue Adhesive in Dental Hygiene Practice †. Won-Gyun Chung , Hie-Jin Noh and Sun-Ok Jang Department of Dental Hygiene, Wonju College of Medicine, Yonsei University, 162 Ilsan-Dong, Wonju-City, Kangwon-Do, Korea. The purpose of this paper is to present the potential application of tissue adhesive in the management of traumatized gingival wound in clinical dental hygiene practice. Cyanoacrylate adhesive has been used for closure of superficial laceration without suturing, which is available in periodontal and oral surgery. Small gingival or mucosal lacerations may occur by improper or excessive instrumentation of the dental hygienist during scaling and root planing procedure. In this circumstances, tissue adhesive is very effective, simple, and convenient method as an alternative to conventional wound closure by suturing. The tissue adhesive consists of monomeric n-butyl-2-cyanoacrylate, which polymerizes quickly in contact with tissue fluid. The sutureless treatment of gingival laceration with tissue adhesive has advantages of good esthetic results, less trauma, time saving, antibacterial and hemostatic effects. In addition, local anesthesia as well as re-visit for dressing and removal of suture are not required. Use of tissue adhesive could be beneficial to both dental hygienist and patient in the management of procedural error.

(4) . Tissue adhesive, Dental hygiene practice, Gingival laceration wound. . y z{ | VW F RJ}, FG'2 ? j~ ~ v j'}, Y {'2 @ H YK & F ReX Q H / ' % )'&. \ H / @# $ % :'2 ;<= >? vJ8 4 J8 kl* / h m \K &.. (oral prophylaxis)

(5) !"# $ %&. '( )* +, -. /01'2 ! 3 / 4 55 !"6&. 4 78 9 :'2 ;<= >?' @ A BC, D EFG H IJ8 KLM N BO 'P )* QF R $ %SFI TU' VW XP YK 2 4K9 , Z[\ ]^_ `ab(c d' ef $ g&. ; L : >?: TU 'h i" TU4 j& kl*(Tissue adhesive, Tissue glue) 'h m kU n' m( o M[ &. +, p'2 qr H p9 W9' esP 4K Kt 8 @ (iatrogenic traumatic injury) BC YKu[ o +, v'&. kl* 'h ? wx TU. . kl* >? TU 'h F R\ ' h h kl q8, C[ d , h kl* M -q'&. Histoacryl (Braun, Melsungen, Germany, Fig. 1) Tisuacryl H J8 Q\ % kl* n-butyl-2-cyanoacrylate (monomer) Z W ¡J8, h ^¢ ' £¤J8 N X¥ ¦§¤ ¨'7© (gentian violet) H ª: «{ ¬Q %& . e®e ¯°±'²(cyanoacrylate) ³ k´ @>µ¶(exothermal reaction) dJ·} ¸¹ ºUQ ; kl» @¼& . . . 1). †. Corresponding author Tel: 033-741-0392 Fax: 033-742-5034 E-mail: [email protected]. 2). .

(6) . Management of Traumatized Gingival Wound Using Tissue Adhesive in Dental Hygiene Practice . Clinical advantages of tissue adhesive. No need for local anesthesia, dressing, and removal of the stitches No use of needle holder, suture needle, and suture material Additional visits are not required Time saving Immediate hemostasis and antibacterial effect Good esthetic results. 8 : å >?(minor skin wound) TU 'h m F R\ , wx ëJ8 h6& . 3 ì§Oí OI >?'2 Ø»' h F R wx 6 ¶Î' 6&. Z(2 m( / L ; L X Mv Û 2Ô nJ8 j\Q\ % &. e®e¯°±'² /J8 m( F Mh Ø< (Table 1)' % ) 1960 70½ îï ¡Ð h Ï: L % ð& . Forrest 3½ îï 300mñ YK_ kl* h m $4

(7) Û, ~ / v òÀ&\ j\ A&. TU 'h i" äó M M jAJ} +' h: gÀ\ FGX Mv &\ A&. Perez H : 130ñ YK_ kl* h m ô*(apicoectomy), @(molar extraction) õ :<= ' (mucogingival graft) 4

(8) Û, ; ö ' ÷\, Òø9 FG' N }, Â ~ M. òÀ&\ j\ A&. ' L kl* 'h ù9 TU4 Üú Û j'FI, FGv C$ \ 4 ' ûC ÌJ} YK_ Ù ü ¿{# $ %& o ù 9 / v Ó ¯&\ A&. +,, :<= '(mucogingival graft) \ ým(donor sites) j~ ûC Mh &\ A&. , ; þ æ åÂ m j~ hX8X ¶hÿ $ %& . Æ <= 6 þ X \ _ lQF R ) 2~3d 2 n' dµ'&. FI þ æ j~ m Î } Á | Ùü Bü É $ % ) X. ' 6&. Ä e®e¯°±'² l(bone fixation)X v9 nJ8 j\QÀ& . +,, '

(9) \ m( ø9 BC H 'h i" äój& Mh &. 2). . Histoacryl , tissue adhesive.. 1949½ e®e¯°±'²P '¾ klq' ¿!8 j\QÀJ} , 9 kl hX8 Coover & Shearer(1957½) Á Â@QÀ& . e®e¯°± '² dµ9 -: &Á ª&. 2). 3). 3). 7). 1). CN | CH2 = C − COOR (R :. ÃÄ, Ä, Å8V, Ä H) m( e®e¯°±'² ÆÇ (Homologues) (Histotoxicity) u L , ÈÉ ox(Alkyl side chain) Ê' Z U k9 uuË %&. ox Ì: e®e¯°±'²d$¥ ÍÎµ¶ Ï' Ð ) kl* U(Biocompatibility) uÑ L 8 Ä e®e¯°±'²(butyl cyanoacrylate) zQ %&. Ò, Ä e®e¯°±'² ÈÉ o x Ê' J8 Ó Ê ) ¿{ ÍÎµ¶ 2ÔÕ& . Öi hQ\ % Ä e®e¯°±'² m( M× Ø<X Ù \ [ + Ë, Ò Ú ;X )*<' %& . ÛU»: ÜÝ ;ÞX Ù \ ;X ß ), >?' Êà2 Ø»' h ? l ÚQ ác <X %&. '( )*< Û m Ä e®e¯°±'²j& 4â Ú ;X ãÄ e®e¯°±'²(Octyl-2-cyanoacrylate) Â@Q Dermabond (Ethicon Inc, Summerville, NJ) P J8 Q\ %X & . Ä e®e¯°±'² :<= $4(mucogingival surgery)'2 @ $4 ? M ä F R nJ 8 j\Q\ %& . Z(2, '2 å(flap) 8 h QÀ BC 'µ¶(foreign body reaction) 2Ô ), tB'2 Gu Ø æ klhJ8 e Z h' yçQ\ %F R&. è5 @ u Ñ +' ÎàX 2Ô2F R\ %& . 3,4). 2). . 2). 5,6). 6).

(10) . e®e¯°±'² kl* p8 ®é6 æê ? Ò,. 8). 9).

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(12) @Q : >?(gingival laceration wounds): ' 2 \(finger rest)' m O(Fà2 BC 8 @ _ 6&. YK K 'à2 ' [ J8 h BC 9k L:'2 M^: H ,_ Q }, 3 <='2 F I._ 6&. >ù« 4 ù8 ( Øl# é ' ù F R: Å(clamps) L :' Å !" éG Æµ (crushing wound)'.

(13) Journal of Dental Hygiene Science Vol. 3, No. 1, pp. 1~4 (2003). . @# $ %&. , û²#b $%2 Ý $% &# , e'ü L 2 uL H (ù h# BCX ' ª: ) * : !"# $ %&. :Dâ [ _ & à2 +, H m( / - M )* % $ %&(Table 2). '._ @6 ¡ >?: '2 B \, ? ¯ \ Ù/0 ) TU 4X F R: " 1_ 6&. 2P >? wx i" TU 7," : Ó3 ¯_ # $X %J}, BC 2P TU Ùå _ = F àÐ )*<' 425_ 6&. ' ª: BC kl* vJ8 hÿ $ %&. . Possibilities of accidental gingival laceration arising from procedural carelessness in dental hygiene practice. Slippage of scaler or curet during improper instrumentation Gingival impingement caused by incorrect placement of rubber dam clamps Improper handling of rotary devices Incorrect placement of matrix band or orthodontic band Forcible packing of gingival retraction cord. 6 kl*9 Histoacryl (Fig. 1): 6Pb7 8 9 h ³ :8 ;% <6 J8 ØQ ý= 6&. > 5X ' ?@: ju }, h <6 A ¡ 'h m BF &(Fig. 2). >?: BÛ \ N C :8 MF X¥ }, >? ØK[ D _ EX¥ U F >? æ ¿ { kl* X&(Fig. 3). h 8 b}. ? M ä# $ % ) Ð &. kl* O _ # VW % BC GH6 ¨I H JK h# $ %&. h , ß 1 ¡ L \ M8 MF m kl* ºUQX¥ &. |= 2 Ø JF RX¥ VW FI eN(acetone) H h*(solvent)8 *à N &. ù: e OKFF RPFI Ä e®e¯°±'² $ 5 H Î Q* }, ¸¹ FGv F\ % &. 2P, :>? FG { õ kl Æ

(14) # $ %&. / 4K 9 8 9 ;L ' @# $ %J}, BC 2P ¶=-J8 è. Preparation of ampoule. Hold ampoule at the bottom end without finger pressure, and then cut the tip bevelled with scissors. .

(15) Mode of application. Apply tissue adhesive very thin to well-adapted wound edges, and hold it in place for approximately 1 minute. QX &. Ò, $4X2 (bur) H \R(ùS , @ K H )[ 'TQ :, K, 4, U< = H !" _ 6&. ' Ü / 'V -' @# W: J8 &. FI ' M -' d N: X } Y_2 @ # $ %&. kl* h: -Ý2 r H /.  Clinical case: closure of gingival laceration using Histoacryl tissue adhesive. (a) Preoperative view of traumatized gingival laceration wound. (b) Immediate view after closure using tissue adhesive without suturing. Note that bleeding is stopped. (c) 2 weeks postoperatively (Courtesy of Dr. Byung-Ho Choi).

(16) . Management of Traumatized Gingival Wound Using Tissue Adhesive in Dental Hygiene Practice. ÖØ vJ8 # $ % äó' ÿ $ %&. YK ? {'2 @ & # VW g& kl* '<' 4K 0$2 8 9 !"6 YK Ù ¿{# $ % )'&.. . \ / $

(17) @# $ % p : äóJ8 kl * h ä¤ \K A&. e®e¯°±' ² kl* æê >? X TUó F R\ -q kl äJ8 wx hX8 Z Æ¤ ;p2 $4 ¡Ð Z ¶h' ]«Q ð&. *à õ ô4 H 4 à2 X :'2 ;<= >?' !"ÿ $ %&. '( - @ A BC, kl* 'h m >? wx ûC v'} \ [ &. kl* n-butyl-2-cyanoacrylate8 Q % J}, $¡ k´ ¸5_ ºUQ kl» 2Ô Õ&. kl* 'h :>? Z 3O Û ~ }, y9 ' g Z esP 4 ä ó' m ' _ {W6&. z{ | VW RJ}, ? {'2 TU *à YK & F ReX Q H m( / Ø<' %&. ? ü Í äF2 FG h HX v'&. kl* . / @# $ % óJ8 YK 2 ]^_ Mh _ hÿ $ %&.. . 1. Perez M, Fernandez I, Marquez D, Bretana RM: Use of N-butyl2-cyanoacrylate in oral surgery: biological and clinical evaluation. Artif Organs Mar 24(3): 241-243, 2000. 2. Quinn J, Wells G, Sutcliffe T: A randomized trial comparing octylcyanoacrylate tissue adhesive and sutures in the management of lacerations. JAMA 277: 1527-1530, 1997. 3. Herod EL: Cyanoacrylates in dentistry: a review of the literature. J Can Dent Assoc Apr 56(4): 331-334, 1990. 4. Bhaskar SN, Frisch J: Use of cyanoacrylate adhesives in dentistry. J Am Dent Assoc Oct 77(4): 831-837, 1968. 5. Miller GM, Dannebaum R, Cohen DW: A preliminary histological study of the wound healing of mucogingival flaps when secured with the cyanoacrylate tissue adhesives. J Periodont 45: 608-618, 1974. 6. Greer RO: Studies concerning the hsitotoxicity of isobutyl-2cyanoacrylate tissue adhesive when employed as an oral hemostat. Oral Surg Oral Med Oral Pathol Nov 40(5): 659-669, 1975. 7. Forrest JO: The use of cyanoacrylates in periodontal surgery. J Periodontol Apr 45(4): 225-229, 1974. 8. Bhaskar SN, Frisch J, Margetis PM, Leonard F: Applications of a new chemical adhesive in surgery of the periodontium and the mouth. Med Hyg (Geneve) Sep 18; 26(838): 1030-1031, 1968. 9. Gosain AK: The current status of tissue glues: I. For bone fixation. Plast Reconstr Surg Jun 109(7): 2581-2583, 2002. (Received May 6, 2003; Accepted June 9, 2003).

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