Ân article tron:. 'l'he Nen' York §tate.,\cademl, of (ieneral l]entistn'

Cyanoacrylates as an Easy Yersatile Oral DressingB:, J*ltn Huttllllll}§, SrS

I"rr nran\, years researchers have heen investigating the r:ses

r:f cvan{")âcn'lates in dentistr_\,. ln the 196üs. Dr, §.N, l}haskar had

seteral articks puhlished discussing cvanoacnlates as etlbctiveperi*d*ntal dressings" and in Âpril lÿ73. an article rtas puhlishedin the .lournsl of Ar:lerican Medical Âssociation tDermatologv)discussing c3,.ancacn'lates as superiar extra-nral u,clurd dressingsCvanoacrylates \\'ere cliscovered in lç4? br, Dr. ilarry Conver.however the1, \\ere n*t cornnlercialized until 195 L 1'hev wereused e.xtensiveh, during the Vietnarr War to dress rvr-mnds incr-rrred

on the hattletreld. Ânalogues rlf the *riginal tnrmulatiorr- n-hutvland 2-nctl'l. have heen used extensivelf in [:oth rnedicine and

dentistn, ftrr topical rçound clasure and as peri*d*ntal dressingsdue tn their ease of use and lack of histotoxicitr' 'l'hase analoguesas *,ell as hlends of hoth have ev*lr,ed üver the last 5{} 1'ears trhec*me etlicient, con\Ienient. paint-an dressings rvhich set ilpinstanth' u'hen the.r' c$rne in cCIntact u,ith hvdrox5,l ir:ns { ll'ater}.Âpplving a genTle n'ater sprav rl'ill accclerate the setting time.ütlectiüüs regarding ease of trandling have been greatlv f,)vËrc(rme

due to the ilsfr tf rnicrnhrushes and micropipettes" along rt'ithhigher viscasitl' ti:rmulations "l'he standard material has a visc*si-tl,similar ta rvatetr. anrj can he applied freel],arrd rapidll'over a

large ârea Cvanoacnlates rt'itl'r higher viscosit-ç are denser andrvill nt:t t'lou, f)\,'er tissues ffs rluicklr,. allorving the practitioRer tospread easilv ûver the rlesired are& of application Àreas coveredrlre then protected fr*m trauma induceel bv hrushing and toodimpactian. Loose and rnnhile f'laps can he held in place to firrm an

initial hlood clot and then secured rvitlr a thin la.ver of c1'anoacn-late I use a terhnique I call tacking ür spr:t n'elding ta secure thegratl. and then I appll' adclitional lar ers to lirrm an excellentperiodontal dressing LJsing this prncess- [ am ahle to make anotheru'ise clifïrcult and length,r' suturing prcrcess. take less than a

minute.'l'his dressing can he used alone ür rvith sutltres to

completeh sscure lorse tissues and aclrieve flull primarv closurÈ.

\h'her"r a more cor*nal positi*ning of a flap is desired tliig. I).cvanoâcrylates can be used w'ith tissue pick-ups to hold rvtrrere

desired for cosrne{ic or hinlngic rati*n*le. When pert*rrning sotlTissue gratïs t ltig 3 X. the dressitrg can he used alone ûr u,ithrninimal snturing tc, §erure the gratt in place and provide a protec-Tive shield tirr post-operative romt-ort. 'l'he

mCIst important üümpo-Rent is to ensure thaT â sscure fihrin clot has firrr:red, and nû c\'ânr]-acrylate linds its \r'al, underneath the tissue. ln üsseüus grafls

tltig"i, coul-tesr, af llr" Rnn Zoknl), complete closlrre or cilyeragecan be achieved. otien securing or prote*ting a mernLrrane or gelItram" orer an osseüus augmsntation or socket preservation grattatter an e.xtractirn -1"his u,ill take onl1,' sec*nrls. A complete cyârlo-acrylate merrhrane can he placed ta complet*l1. protect all areas ofthe saft tissue margins and the contents of the clsseüus graft \À''hen

sutures pull the tissue in an atternpt to cover the cftntents of thegraft or implant {l;ig'l)- the cvenüaür}'late meR"1hr&ne tan he incor-pnrated rvith the sutures to extend the tirne of protecTi*n and

cûverage t'or as lrng as trvn neeks In areas of gingivectomr{ I;igs.5&{:i- a thin laver of cl,anoacn late can provide prntecti*n tathe sensitive tissue. futultiple lar,ers cail he huilt up over the area

and sec,urecl to adiacent tissue and teeth ln areas u'here crûrlrns ürhridges have had soft tissue managerJ u'ith gingival retractioncnrd. laser or electrc)surgerT,ir thin laYer *f dressing can be used tnsecilre the sotÏ tissue in place rl ith*ut sutures t)tlen the tissue is

loose and irrtlarxed- ar"ld â cyffnoâcrylate dressing will fir thisdamaged tissue in ;:lace u,{rere it is firost cnsmeticalh' pleasing ûrhiologicall,v healthl.'. 't'he tender tissue u'ill he more c*mtürtableanctr protected frarn tqrothhrush iniurç. food irnpaction" anrJ â n'tt:re

desirahle result u,ill he achieved

I'ig" I I;ig 2 Fig 3

trig .t I;ig 5 Fig 6

In areas af apthous ulcers or herpes sirnplex il;ig.7). cvan*acn late

can he pla*ed CIrer the siæ tn prnter:t the areâ and provide patienlc*mfnr1. [n t:ur hsgiene departrtrent. tire h-vgienist places ü\'&tloâc-

n,late dressings along the gingival nTargin to make tl"re pâtientn"ïore c*mfrrrtahle and prevent iqiur,r' atïer r*ot planning tl'ig.&t. ltalsn preser\"es and protects the hload clnt to ensure better reattach-ment rcsults. tltlen hetorc the use of cvanoacrylate clressings ttrepatient rvould nttt return fbr all quadrants of r*at planning. due tcl

lhe pain incurred rJuring the healing prücess tr}v using cr'anüacry,-

late as a protective dressing" hot" cold. and tactile selrsitivit)'can lre

reduced or eliminated during the healing pracess. With the costs cfsutures and the time to place them, c\'ânûacrvlateq provide gre*tbenefits to the practitioner" r\t ahout $J per applicati*n. There is

tremend(-Ius savings in hoth time and suture costs.'l'he\'ftre avail-able in clear ttrr anterior cosmetic züne Lrse or can he pigrnented torea§\j visnalization ir: posteri*r areas. I heliel'e that rvith time and

practice" adding r)'ünnecn'lates to the surgical n:anagementaptions of u'ound closure h"v the practitianer u'ill vield hugehenefits h*th f*r the clirricialr and the patient,

I:ig 7 l;ig I