The Doxirobe two-syringe system is easy to use but requires some practice. Gently place the tip of the cannula to the depth
of the treated (scaled and root planed) pocket and move it across the length of the pocket as you slowly insert the material
(Figure 7). Continue inserting the gel until a small amount extrudes from underneath the gingival edge. Don't overfill the pocket.
By applying light digital pressure on the top of the gum and by gently scraping the cannula tip on the tooth surface, the
cannula can be removed without taking the gel with it.
The gel stiffens within a minute or two. To speed up the process, place a drop of water on the material. Once firm, gently
pack the visible material into the pocket with a plastic composite filling instrument (beaver tail). Instruct the owner not
to brush the dog's teeth in the treated area for about a week (gels and solutions are recommended) and not to pick at the
ridge of material that may become visible (light yellow-brown). The material is biodegradable and does not need to be removed.
Mucogingival surgery includes a variety of procedures designed to gain access to deep periodontal defects and to recontour
or reposition gingival tissue. Mucogingival flaps are created to gain exposure to diseased root surfaces. In pockets > 5 mm,
it is impossible to adequately scale and root plane without surgical exposure.
The simplest flap design is the envelope flap, in which the incision is made through the gingival attachment at the sulcus
(sulcular incision) and the gingiva and oral mucosa are reflected without releasing incisions. When greater exposure is needed,
releasing incisions can be made. Both the periosteum and the mucosa should be included in the flap (full thickness). After
root planing, the flap should be reapposed and sutured in place with fine, absorbable suture.
Gingivectomy is a surgical procedure in which certain areas of gingiva are excised to restore a healthier periodontal pocket
depth. Gingivectomy should be reserved for cases of gingival hyperplasia in which gingival overgrowth creates deep pseudopockets.
Not long ago, gingivectomy and other periodontal surgical procedures to reduce pocket depth (e.g. apical repositioned flaps) were recommended treatments. However, preserving gingival height is now considered a goal of treatment.
GUIDED TISSUE REGENERATION
After a periodontal pocket undergoes thorough root planing, the tissue heals and the pocket depth is reduced. The reduction
in pocket depth results from soft tissue reattachment. Reattachment is good, but true regeneration of periodontal tissue,
including alveolar bone and periodontal ligament, is ideal. The problem is that the rapid initial regrowth of epithelial attachment
(granulation tissue) interferes with the slower regeneration of bone and periodontal ligament. So in order for bone to regenerate,
the epithelial regrowth must be delayed or obstructed. The process of excluding epithelial regrowth to encourage regrowth
of periodontal tissue is called guided tissue regeneration. The success of guided tissue regeneration depends on many factors, a major one being defect morphology. Narrow, vertical
pockets are more amenable to treatment than are broad, wide defects.
Various types of barriers have been developed to exclude epithelial regrowth. Consil (Nutramax Laboratories) is a bioactive,
osteoconductive bone graft material that functions as a barrier to exclude epithelial attachment and promote bone regeneration.
Because Consil is incorporated into the new bone, there is no need to remove Consil after its use.
Infrabony pockets often occur on the palatal and lingual aspects of canine teeth in dogs (especially small, dolichocephalic
breeds). Left untreated, periodontal defects on the palatal aspect of the maxillary canine teeth often progress to oronasal
fistulas, necessitating extraction. If caught early, these defects may be successfully treated with open curettage and guided
Educating clients about providing good oral hygiene at home is essential in preventing periodontitis.