|Year : 2013 | Volume
| Issue : 6 | Page : 753-756
Light-cured resin "Barricaid" - An aesthetic and biocompatible dressing: A step ahead
Ellora Madan1, Vipin Bharti2, KK Chaubey1, Vipin K. R. Arora1, Rajesh K Thakur1, Anubha Nirwal1
1 Department of Periodontics, Kothiwal Dental College and Research Center, Moradabad, Uttar Pradesh, India
2 Department of Periodontics, Government Dental College and Hospital, Patiala, Punjab, India
|Date of Submission||25-Jul-2012|
|Date of Acceptance||18-Sep-2013|
|Date of Web Publication||7-Jan-2014|
Department of Periodontics, Kothiwal Dental College and Research Center, Moradabad 244 001, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Clinical trial registration jisp_147_12
| Abstract|| |
Background: Periodontal dressings have been used for several years as a protection over injured tissue to shield the area from further insult . Several dressings are commercially available. A recently introduced light-cured resin, claimed to be more biocompatible and esthetic, needs critical evaluation. Aim: To compare this dressing with most widely used non-eugenol pack in the perspective of esthetics, acceptance, and healing following periodontal flap surgery. Materials and Methods: Twenty patients suffering from generalized chronic periodontitis, requiring periodontal flap surgery on contralateral sides of the arch, were selected and divided randomly into Group I (control) and Group II (test). In Group I, a non-eugenol dressing and in Group II light-cured dressing were applied after flap surgery. Pain and discomfort scores were recorded on day 1, 2, and 3 while plaque scores, gingival index, and bleeding index were recorded on day 7. Patient's subjective evaluation and preference for the dressing material were recorded. The data was collected and statistically analyzed. Results: Group II showed better results than Group I when plaque scores, bleeding scores, modified gingival index scores, and pain and discomfort scores were compared though the differences were not statistically significant. Subjects found no unpleasant taste/smell and perceived the light-cured dressing to be better. A significantly higher number of patients preferred light-cured resin as a post-surgical dressing over Coe-pak. Conclusion: The light-cured dressing showed better patient acceptability and proves to be a better alternative to Coe-pak as a dressing material.
Keywords: Light-cured dressing, periodontal dressing, resin
|How to cite this article:|
Madan E, Bharti V, Chaubey K K, Arora VK, Thakur RK, Nirwal A. Light-cured resin "Barricaid" - An aesthetic and biocompatible dressing: A step ahead. J Indian Soc Periodontol 2013;17:753-6
|How to cite this URL:|
Madan E, Bharti V, Chaubey K K, Arora VK, Thakur RK, Nirwal A. Light-cured resin "Barricaid" - An aesthetic and biocompatible dressing: A step ahead. J Indian Soc Periodontol [serial online] 2013 [cited 2019 Jul 18];17:753-6. Available from: http://www.jisponline.com/text.asp?2013/17/6/753/124494
| Introduction|| |
Periodontal surgery involves the surgical manipulation of the oral mucosa and the tooth supporting structures to alleviate a variety of problems. The sequelae of periodontal surgery are commonly pain, swelling, inflammation, bleeding; and many periodontists advocate that some form of protection should be applied over the surgically traumatized tissue so that it is shielded from further insult.  Such protection is offered by periodontal dressings or packs that cover and protect wounds from post-operative irritation, trauma, salivary contamination, and food stagnation. Simultaneously, they have been claimed to alleviate pain, reduce hemorrhage, and facilitate recovery. 
Introducing periodontal dressings in 1923, Ward  advocated the use of a packing material, Wondrpak, around teeth following periodontal flap surgery. Traditionally, periodontal dressings were based on zinc oxide eugenol system. Due to the various side-effects of eugenol, latest periodontal dressings are usually formulated without it. [ 4] A very widely used periodontal dressing is the non-eugenol dressing "Coe-pak" (GC AMERICA, INC. ALSIP, IL 60803 U.S.A.), which offers a standard, to which other periodontal dressings can be compared. Although widely accepted, Coe-pak has a number of disadvantages, e.g., poor appearance, ill-defined setting time, and poor flow properties during manipulation. 
Recently developed visible light-cured periodontal dressing material based on a polyether urethane dimethacrylate resin is stated to be an advanced concept in the protection of periodontal wound sites.  Commercially known as Barricaid (Dentsply International Inc. Milford, DE 19963-0359, U.S.A.), its superior physical properties like easy manipulation, better surface smoothness, interdental retention, and mechanical stability have been claimed to favor its clinical application. Additionally, it has the advantage of possessing a translucent pink color, which is esthetically pleasing.
Hence, the present study was carried out to compare the tissue response and patient compliance of this newly introduced light-cured dressing Barricaid with Coe-pak following periodontal flap surgery.
| Materials and Methods|| |
The study design and protocol were put before the Ethical Committee of G.D.C. Patiala and approval was obtained.
Twenty patients in the age group of 30-55 years with generalized chronic periodontitis requiring periodontal flap surgery were selected fulfilling the following criteria: Non-smokers, non-alcoholic, systemically healthy, co-operative, showing acceptable oral hygiene during phase I therapy, presenting almost similar periodontal involvement bilaterally as determined by clinical and radiographic assessment, and requiring periodontal flap surgery on both sides of the arch. Patient's informed consents were obtained.
Selected sites in each patient were randomly divided into two groups; Group I and Group II. In Group I, Coe-pak was used as a periodontal dressing, and in Group II, Barricaid was used post-operatively. At day 0 (baseline), both groups were subjected to the recording of plaque index (Quigley- Hein and Elliot),  gingival index (Lobene et al.),  and bleeding index (Muhlemann et al.).  Pain and discomfort were recorded using the visual analogue scale (VAS).  All the evaluations were made by the same examiner (VB) who was blinded for the surgical procedures and pack applications.
In Group I, following sulcular incisions, a full thickness mucoperiosteal flap was reflected both facially and lingually. After thorough debridement and root planing of the exposed root surface, the flap was placed in its original position and sutured using non-resorbable silk thread. The surgical site was dried using gauze, and Coe-pak was then applied [Figure 1]. Similar surgical procedure was adopted on the contralateral side, and photocured dressing (Barricaid) was applied thereafter in Group II [Figure 2]. All the surgical procedures were carried out by the same operator (EB). The third operator (KKC) applied either of the dressings according to the randomizing sequence. Inter examiner variation was reduced to the acceptable level.
Application of photocured dressing
The photocured dressing was dispensed at the juncture of the cervical one-third of the teeth and the margin of the surgical site on the facial aspect. It was exposed to a visible light-curing unit for 10 seconds per site per tooth until the entire dressing was cured. Same procedure was repeated for the lingual side. Occlusal clearance over the dressing coverage was checked prior to dismissing the patient.
The third operator (KKC) who had applied the dressings removed them on the seventh day. Pain and discomfort scores for the 1 st , 2 nd , and 3 rd postoperative day were recorded for each patient using the visual analog scale (VAS) and findings tabulated by the first operator (VB) who had examined at baseline and was unaware of the type of dressing applied. Then, the subjects were examined and plaque index, bleeding index, and modified gingival index were scored. Patients were also given a post-operative assessment questionnaire [Table 1], in which they were asked about taste, appearance, and retention of both the dressings and following the second procedure, they were requested to state their preference, if any, for a particular dressing.
|Table 1: Table depicting assessment of the dressings by the subjects in group I and group II |
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| Results|| |
All the data obtained was put to statistical analysis. In the present study, 'T'- Test was utilized for the assessment of significance.
In Group I and Group II, mean increase of modified gingival index from baseline to day 7 were 1.55 ± 0.24 and 1.46 ± 0.23, respectively, and it was statistically significant (P < 0.001). On comparing, the mean increase in modified gingival index was found to be statistically non-significant, but slightly lower for Group I (P = 0.254) [Table 2].
|Table 2: Comparison between group I and group II for increase in mean, modified gingival index scores, plaque scores, and papillary bleeding scores at different time intervals |
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In Group I and Group II, the mean increase in plaque scores were 1.91 ± 0.29 and 1.82 ± 0.28, respectively, from baseline to day 7, which was statistically significant (P < 0.001). On comparing, though the mean increase in plaque scores in Group II from baseline to day 7 was found to be slightly less in comparison with Group I, but this difference was statistically non-significant (P = 0.309) [Table 2].
In Group I and II, the increases in mean bleeding index scores from baseline to day 7 were 10.51 ± 1.88 and 10.1 ± 1.89, respectively, which were statistically significant (P < 0.001). On comparing, mean increase in bleeding index scores on day 7 as compared to baseline was statistically non-significant but lower for Group II (P = 0.506) [Table 2].
In both the groups, the mean values of pain and discomfort showed a decrease from day 1 to day 3. On comparison, the mean pain and discomfort scores between Group I and II on day 1 and day 3 following surgery, difference was statistically non-significant at all time intervals, but the scores were found to be slightly lower for Group II [Table 3].
|Table 3: Comparison between group I and II for differences between mean, scores of pain and discomfort at different time intervals |
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Three out of 20 subjects complained of an unpleasant appearance in Group I and none in Group II; however, the difference was statistically non-significant (P = 0.231). An equal number of subjects complained of the dressing being loose in each group. A significantly higher number of subjects, (5/20) complained of unpleasant taste and smell when Coe-pak was used (P = 0.047). Also, a significantly higher number of subjects (16/20) preferred Barricaid as a dressing (P = 0.0004) [Table 1].
| Discussion|| |
Use of dressing materials in periodontics has remained debatable. Each school of thought has its own reasoning and claims. However, one of the most widely used non-eugenol dressings is Coe-pak and as such offers a standard, to which other dressings can be compared. When new dressing materials with claims of superior properties are developed, their clinical performance should be assessed and compared with established products.  Commercially available brand 'Barricaid" is a recently introduced visible light-cured periodontal dressing, based on a polyether urethane dimethacrylate resin. It is said to have the advantage of possessing a translucent pink color, which is aesthetically pleasing and a rate of curing, which is easily controlled by illumination with visible light.  Furthermore, histologic studies have shown that extracts and solid specimens of polymerized Barricaid are exceedingly biocompatible in general as stated by Alpar et al. (1999)  and Cilbert et al. (1994).  Hence, the present study was planned to compare the biocompatibility and patient acceptance of this new pack with age-old rosin-based "Coe-pak."
To observe the effects of light-cured resin pack material on soft tissue during healing period, modified gingival index of Lobene et al. was assessed pre- and post-operatively, and an increase was noted. This increase may be attributed to the normal inflammatory response of tissues after surgical manipulation or to the tissue reaction to the presence of silk sutures as stated by Leknes et al. (2005),  Abi Rached et al. (1992).  No ulceration, erythema, or any untoward reaction was observed in either of the groups [Figure 3].
Application of dressing has been said to be associated with more plaque accumulation. To test the plaque-retentive property for this material, plaque index of Quigley, Hein, and Elliot was evaluated. On comparing, though the mean increase in plaque score in Group II (Barricaid) was found to be slightly less in comparison with Group I (Coe-pak) from baseline to day 7, this difference was found to be statistically non-significant. These results are in accordance with the study of Heaney and Appleton  (1976), Pluss et al. (1975),  Newman and Addy (1982),  Sachs et al. (1984)  who reported accumulation of plaque beneath the periodontal dressings but not to a detrimental level to retard the healing process.
The increase in mean bleeding scores in both the groups from baseline to day 7 could be attributed to the early wound healing status resulting in an increased inflammatory response. This is in accordance with the studies of Cheshire et al. (1996),  Othman et al. (1989),  Asboe-Jorgensen et al. (1974)  who recorded higher bleeding scores following one week of periodontal surgery during the healing period. This material was not associated with any significant increase in bleeding, thus reflecting its acceptable biocompatibility. Bleeding on probing one week postoperatively was done with an intent to assess the inflammatory response and not to assess the integrity of the attachment apparatus. Gentle probing with a blunt probe was carried out taking care not to disturb the epithelium. Similar procedure was undertaken by Cheshire et al. (1996) while assessing the healing response of tissue to an experimental periodontal dressing.
Mean pain and discomfort scores for Group II on day 1, 2, and 3 following surgery were found to be slightly lower, but intergroup results were statistically non-significant at all time intervals. In this respect, it is worth to mention a study of Jorkend and Skoglund (1990)  who reported a higher incidence of pain following the use of Coe-pak as a periodontal dressing when compared to eugenol-containing dressings. This was attributed to the fact that Coe-pak lacks eugenol that exerts local anesthetic effect. But, eugenol-containing dressings have their own demerits, due to which they are no more in vogue. Lower pain scores with Barricaid seem to have influenced the better acceptance of the dressing.
Over the years, with increase in the life expectancy and strong desire to retain the natural dentition, advancements have been made in the field of periodontics. Geriatric patients are now opting for regenerative and periodontal plastic surgeries, which are the need of the hour. Newer and more invasive surgeries are performed to get more predictable results. These procedures require a better periodontal dressing, which should not interfere with the routine work because of its bulk, color, taste, or smell. The criteria to evaluate these aspects were included in this study. A higher number of patients complained of unpleasant appearance of the dressing in Group I, though the number was statistically non-significant. A significantly higher number of patients complained of unpleasant taste/smell with Coe-pak, and a significantly higher number of patient preferred Barricaid as a dressing.
| Conclusion|| |
It may be concluded than visible light-cured periodontal dressing Barricaid is easily applied, offers a perfect color match with no unpleasant taste or smell; hence, the patient is not hesitant to carry out his routine activities. It is biocompatible, offers good retentivity, and only a thin layer is required to be applied. So, the higher cost of dressing is a mere illusion, and it does not limit its application in clinical practice.
With due consideration to the above, it could be said that Barricaid proves to be a better alternative to Coe-pak as a dressing material, as it overcomes the limitations of Coe-pak. It is important to emphasize that a larger number of subjects has to be taken up to compare the efficacy of these dressings.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3]