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| Step 1: Oral exam on awake animal |
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| Step 2: Oral exam under general anesthesia |
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| Step 3: Charting |
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| Step 4: Dental radiology |
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| Step 5: Calculus removal above gumline |
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| Step 6: Calculus removal below the gumline with a curette |
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| Step 7: Polishing |
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| Step 8: Irrigation |
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| Step 9: Application of fluoride |
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| Step10: Therapy to treat lesions |
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| Step 11: Home care instructions |
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| Step 12: Follow up to monitor periodontal disease and prevent halitosis |
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Complex surgical techniques such as the apical reposition flap procedure may sometimes be required to successfully reduce the depth of periodontal pockets. These “flap” procedures require advanced surgical training on the part of the veterinary practitioner. Another technique the veterinary practitioner might consider to help save patients' teeth is the instillation of DOXIROBE® Gel into periodontal pockets. Use of the product has been shown to reduce pocket depth and to improve overall periodontal health. Prior to instillation of DOXIROBE® Gel, the veterinarian should perform thorough root planing and subgingival curettage to remove as much subgingival plaque, calculus and necrotic tissue as possible.
DOXIROBE® Gel is a flowable polymer gel into which doxycycline is incorporated. Its use is most successful in pockets from four to ten millimeters in depth. DOXIROBE® Gel is supplied in a foil pouch containing two syringes, Syringe A and Syringe B. The syringes are locked together, and then the contents are exchanged from one syringe to the other until proper mixing has been accomplished. The flowable polymer gel is then instilled into the periodontal pockets and allowed to harden, which usually occurs in 30 to 60 seconds. Adding a drop of water to the surface of the polymer visible at the gingival margin will hasten the hardening process. If necessary, the hardened polymer gel can then be molded with a dental instrument such as a spatula or a suitable alternative.
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A probe can be inserted subgingivally into the pocket formed by the loss of attachment to the gum tissue. Note bleeding on probing. Tooth mobility may be present. Breath odor is present.
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Between 10 and 30 percent of the bone has been lost around roots.
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Drawing of periodontal pocket prior to DOXIROBE™ Gel insertion
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DOXIROBE™ Gel insertion. Filling pocket with gel
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Periodontal probe before insertion
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4 mm pocket
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DOXIROBE™ Gel
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Envelope contents
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Mixing gel
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Insertion of DOXIROBE™ Gel into cleaned and prepared pocket
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Application of water to harden gel
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Use of plastic instrument to pack DOXIROBE™ Gel in pocket
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Before cleaning
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11 mm probing depth
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After cleaning - Pocket still present
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Interdental incisions
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Flap exposure
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Curette used to remove calculus and plaque
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Apically repositioned flap to eliminate pocket
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| Incision into pocket |
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| Interdental incision for flap exposure |
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| Cross cut fissure bur used to section buccal roots of maxillary fourth premolar |
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| Palatal root sectioning prior to luxation |
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| Stage 4: Periodontal Disease - Mandibular first and second molars |
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| Flap exposure and hemisection |
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| Luxator used to pry root sections free |
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| Extracted first molar Second molar also extracted |
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