SRM Journal of Research in Dental Sciences

ORIGINAL ARTICLE
Year
: 2019  |  Volume : 10  |  Issue : 2  |  Page : 78--81

AZODO suture: A simple periodontal pocket reduction treatment technique


Clement C Azodo 
 Department of Periodontics, University of Benin, Benin City, Nigeria

Correspondence Address:
Clement C Azodo
Room 21, 2nd Floor, Prof. A. O. Ejide Dental Complex, University of Benin Teaching Hospital, Benin City
Nigeria

Abstract

AZODO suture is a simple, easy, success-oriented periodontal pocket reduction and gingival papilla reconstruction procedure. It starts with obtaining informed consent for the procedure followed by scaling, root planing, and curettage of the diseased pocket and then by an interrupted suture with polyglycolic resorbable suture. When the pockets on two adjacent teeth exist, a modification (MODIFIED AZODO suture) in the form of horizontal mattress suturing technique is used. The hypothesized mechanism of action is that the suturing of the gingiva apposes the facial and lingual side of the interdental gingiva with the tissues filling the interdental space-generating pressure that facilitates the apposition of the gingiva on the distal/mesial surfaces of the tooth with pocket. The consequent tissue modeling facilitates a proper interdental papilla. This prevents food impaction, ensures cleanliness, facilitates healing, and restores the interdental health.



How to cite this article:
Azodo CC. AZODO suture: A simple periodontal pocket reduction treatment technique.SRM J Res Dent Sci 2019;10:78-81


How to cite this URL:
Azodo CC. AZODO suture: A simple periodontal pocket reduction treatment technique. SRM J Res Dent Sci [serial online] 2019 [cited 2019 Nov 13 ];10:78-81
Available from: http://www.srmjrds.in/text.asp?2019/10/2/78/262385


Full Text

 Introduction



Periodontal disease is usually not considered serious by patients because of its nonpainful and insidious nature even at complicated stages. These characteristics cum the cumulative nature of the disease lead to it being the main cause of tooth loss with aging. Many dentists globally casualize periodontal disease in their patients even when periodontal health is critical to the long-term success of restorative and orthodontic treatments. The attention of clinicians is usually increased when a patient presents with periodontal pain, and this periodontal pain may be from acute necrotizing ulcerative gingivitis, acute herpetic gingivostomatitis, acute pericoronitis, acute nonspecific gingivitis, acute periodontitis, and acute exacerbation of chronic periodontitis. The nonpainful periodontal diseases are more common and end up with tooth loss or complex complications.

The most common periodontal condition that presents without pain is chronic gingivitis followed by chronic periodontitis. However, chronic gingivitis is reversible on treatment and adherence of patients on postcare instructions. The treatment for chronic gingivitis is easily administered by a dentist irrespective of experience and location. Chronic periodontitis is also a common dental condition, especially among the aging population and nonregular dental attendees seeking care with pain from the periodontal pockets or abscess. Several reports revealed Nigerians as symptomatic and nonregular dental attendees.[1],[2] The reported prevalence of chronic periodontitis in Nigeria is 15.4%.[3] Chronic periodontitis manifests mainly with symptoms related to periodontal pockets. Periodontal pocket, which reflects connective tissue attachment loss but commonly depicted as increased probing depth due to migration of junctional epithelia, is a major clinical manifestation of chronic periodontitis.

Surgical and nonsurgical management of periodontal pocket manifestation of periodontal disease constitutes a major activity in periodontology clinics. The outcome prediction of nonsurgical management of periodontal pocket is highly dependent on the expertise of the clinician and compliance of the patient to the postcare instructions. The nonsurgical management of periodontal pocket is usually a blind procedure that the perfection depends on tactile experience of the clinical, while the healing outcome depends on health status and compliance of the patient to posttreatment care instructions geared toward keeping the site clean to enhance and accelerate healing.

The mainstay of treatment for chronic periodontitis among dentists in developing countries is nonsurgical treatment.[4] Unfortunately, many of these dentists consider the motivation of the affected patients as very low and conclude that the formed long junctional epithelia as a result of treatment are very transient. Based on the aforementioned findings, some dentists are now being so radical to consider extraction for the affected tooth/teeth because they cannot guarantee favorable outcome to the patients. This may be related to the lack of expertise in either performing nonsurgical treatment or flap surgery for periodontal pocket management. There is a need to develop a treatment method that is easy and can be performed by any dentist irrespective of experience and location. The researcher considered application of periodontal dressing after scaling and root planing. Although this achieved a relatively superior result, consideration of the additional cost from the periodontal pocket and need for recall visit to remove the dressing discouraged the recommendation as a versatile method. A new treatment method that is easy and can be performed by any dentist irrespective of experience and location was consequently developed and used. The objective of this study was to report this simple, easy, success-oriented, periodontal pocket reduction, and gingival papilla reconstruction procedure – AZODO suture.

 Procedural Methodology



AZODO suture starts with obtaining informed consent for the procedure. Full-mouth scaling through manual or ultrasonic means is done and then local anesthetic is administered. Performance of proper root cleaning in the form of root planning is done, followed by curettage of the diseased pocket, copious irrigation of the area, and restart of bleeding and then followed by an interrupted suture with polyglycolic resorbable suture [Figure 1]. When the pockets on two adjacent teeth exist, a modification (MODIFIED AZODO suture) in the form of horizontal mattress suturing technique is used [Figure 2].{Figure 1}{Figure 2}

The suturing is under pressure which defies the surgical principle, which is detectable by blanching on the facial and lingual/palatal gingiva. Polyglycolic acid suture used is mainly degraded by hydrolysis in tissue fluids through enzymes involved in the Krebs cycle. The ability of polyglycolic acid suture to retain strength for up to 14 days contributes to the success. Another surgical principle that it defied is that none of the sutured tissues is mobile.

Blanching on the buccal or labial and lingual or palatal aspects of the tissues is confirmatory of adequate pressure with the suture knotting. Prescription of antibiotics is compulsory to help mop up some retained exudates and infection. Drug prescription is usually analgesics, amoxicillin and metronidazole combination, but may involve other antibiotics in allergic or immunocompromised patients. Oral hygiene advice on diet, smoking, and alcohol to prevent adverse consequences is given before patient discharge. The minimum recall period after the procedure is fortnightly.

AZODO AND MODIFIED AZODO sutures yielded good clinical outcome as periodontal pocket reduction procedure in five selected patients [Table 1] and proved to be a simple, easy, cost-effective procedure that additionally facilitates interdental papilla reconstruction, but only two cases were described here (one case of AZODO suture and one case of MODIFIED AZODO sutures). Selection criteria were patients with pockets of 4–10 mm that presented pain with or without controlled systemic diseases. Patients with uncontrolled systemic diseases were excluded from the study. The criteria for success were absence of pain and food packing, no sensitivity, no masticatory and sleep disturbance, no headaches, no bleeding on brushing, and restoration of pink color to affected papilla.{Table 1}

 Discussion



This procedure is a bridge between the outdated subgingival curettage and flap surgery. The hypothesized mechanism of action is that the suturing of the gingiva apposes the facial and lingual side of the interdental gingiva with the tissues filling the interdental space-generating pressure that facilitates the apposition of the gingiva on the distal/mesial surfaces of the tooth with pocket. The consequent tissue modeling ensures a proper interdental papilla emergence. This prevents food packing, ensures cleanliness, facilitates healing, and restores the interdental health.

The advantages of AZODO suture are that it is an easy, success-oriented approach to periodontal pocket reduction and can be performed by any dentist irrespective of experience and location. It is a nonsurgical procedure and is cost-effective by being cheaper than surgery. It can be repeated easily, and it can be performed in immunocompromised patients. In addition, it facilitates interdental papilla reconstruction.

However, there are some disadvantages which include: (1) Periodontal abscess may result from inadequate scaling, root planing, and curettage. (2) Periodontal abscess may also result if the proper antibiotics were not prescribed or patient is not compliant on drugs; (3) Additional cost though but this is minimal may results from suture use and suturing. (4) The application of suture in immobile gingival tissue is difficult and may needs patience to get properly done. (5) The prognosis is <100% in embrasure Type 3.

AZODO AND MODIFIED AZODO sutures have shown good clinical outcome, but need further radiological and histological confirmation from the research. The evaluation of oral health-related quality of life among patients with chronic periodontitis before and after intervention with AZODO AND MODIFIED AZODO sutures is recommended.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

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2Azodo CC, Ogbebor OG. Dental attendance and teeth cleaning characteristics among medical and pharmacy students. Indian J Multidiscip Dent 2018;8:7-12.
3Umoh AO, Azodo CC. Prevalence of gingivitis and periodontitis in an adult male population in Nigeria. Niger J Basic Clin Sci 2012;9:65-9.
4Umeizudike KA, Ayanbadejo PO, Savage KO, Taiwo OA. Pattern of periodontal treatments performed at the periodontology clinic of the Lagos University teaching hospital: 22 months review. Nig Q J Hosp Med 2012;22:7-13.