Download gingival curettage and gingivectomy

GINGIVAL CURETTAGE AND
GINGIVECTOMY
Dr. OMAR ALHUNI
Diplomate, American Board of Periodontology
Residency specialty training in Periodontics
Master of Sciences in Dentistry, Saint Louis University
Bachelor of Dental Surgery, Garyounis University
Resective
Surgery
Soft Tissue
Curettage
ENAP
Regenerative
Surgery
Hard Tissue
Gingivectomy
Osseous
Resection
GTR
GBR
CURETTAGE
•
It is a surgical procedure designed to remove the soft tissue
lining of the periodontal pocket with a curet, leaving only a
gingival connective tissue lining
•
Rationale : to removes chronically inflamed granulation tissue
that forms in the lateral wall ( inner surface) of the periodontal
pocket
•
it should always be preceded by scaling and root planning
Basic procedure:
1)
Local anesthesia
2)
The curette is selected so that the cutting edge will be against the tissue
3)
The pocket wall may be supported by gentle finger pressure
4)
Scooping motion of the curette to remove the inner lining of the pocket wall
5)
The area is flushed to remove debris
6)
The tissue is adapted to the tooth by gentle finger pressure
American Academy of Periodontology:
•
The actual result obtained with curettage is most often a long junctional epithelium,
which is the same result obtained with SRP alone.
•
Short- and long-term clinical trials have confirmed that gingival curettage provides
no additional benefit when compared to SRP alone in terms of probing depth
reduction, attachment gain, or inflammation reduction.
•
Dental community as a whole regards gingival curettage as a procedure with
no clinical value.
EXCISIONAL NEW ATTACHMENT PROCEDURE
(ENAP)
•
•
•
It is a definitive subgingival curettage performed with a knife
•
Gain better access to the root surface.
Develop to accomplished proper tissue preparation
Procedures:
1) Internal bevel incision is made from the margin of the free
gingiva apically to a point below the bottom of the pocket.
2) Remove the excised tissue with a curette
3) Root plane all exposed cementum
4) Approximate the wound edges.
5) Place sutures and a periodontal dressing.
GINGIVECTOMY
• Gingivectomy
• The excision of a portion of the gingiva; usually performed to reduce the soft tissue wall
of a periodontal pocket.
• Gingivoplasty
• Reshaping of the gingiva to produce a surface form and topography that simulates those
features of gingival health
• Gingivectomy/gingivoplasty
1)
2)
3)
4)
indications:
To eliminate gingival pockets (suprabony pockets)
To create an esthetic gingival form in cases of delayed passive eruption
To reduce gingival enlargements
To create clinical crown length for restorative/endo
• Contraindications:
1)
2)
3)
4)
5)
6)
7)
Acutely inflamed gingiva
Inadequate oral hygiene
PD that is apical to the MGJ
inadequate keratinized gingiva
Presence of infrabony defects
Inadequate depth of the vestibule
When removal of soft tissue would create an unacceptable cosmetic compromise
TYPES OF GINGIVECTOMY:
• 1- Surgical Gingivectomy
• 2- Gingivectomy By Electrosurgery
• 3- Laser Gingivectomy
• 4- Gingivectomy By Chemosurgery
SURGICAL GINGIVECTOMY
HEALING AFTER SURGICAL GINGIVECTOMY
1.
2.
3.
4.
Initial healing involves hemostasis and fibrin clot formation to cover the wound surface
Cellular proliferation of epithelium at the wound margins
Vascular proliferation (3-4 day peak)
Epithelium begins to migrate across the CT surface after 2days until the wound surface is
covered
5. May take 1-2 weeks for complete surface epithelialization (no sooner than 5 days).
6. By 14 days, the tissues assume a normal clinical form
• Some hypervascularity may persist (redness)
7. Remodeling may continue for 3 months
• Small front teeth
• Gingivecyomy
procedure
•Full exposure of
anatomic crown
GINGIVECTOMY BY ELECTROSURGERY:
• High frequency electric current is used to cut and coagulate soft tissue
• Brushing motion is used to remove incremental portions of soft tissue
• Best limited to superficial soft tissue procedures to avoid contact with bone or
tooth root
• Advantages:
• Bloodless field
• Use in areas where application of
knives is difficult / impossible.
• Disadvantages:
•
•
•
•
Possible heat damage
Increased time
Unpleasant odor
Cannot be used in pts with noncompatible
or poorly shielded pacemakers
• May result in delayed healing, loss of
attachment, and cemental burns.
• Lasers gingivectomy
•
•
•
•
CO2, Nd: Yag, and Diode (plus others…)
Same limitations as electrosurgery
Possible decreased post-op discomfort
Possible delayed wound healing
• Chemical gingivectomy
• Potassium hydroxide and Paraformaldenyde
• Not recommended
1.
2.
3.
4.
Depth and action is difficult to control
Reshaping of the tissues cannot be accurately accomplished
Healthy tissues may be adversely affected
Delayed wound healing
• Drug induced gingival enlargement
• phenytoin (Dilantin)
• Cyclosporin- A
• Calcium channel blocker (Nifidepine
• Treatment:
• Drug substitution/withdrawal
• A 3-month interval for periodontal maintenance therapy
• Stahl et al. (1971) noted complete epithelialization following gingivectomy in all specimens after _____ days.
A.
B.
C.
D.
7
14
21
28
• During the process of healing after external bevel gingivectomy, surface epithelialization is complete no
sooner than _____ days.
A. 2
B. 3
C. 4
D. 5
• Which condition is a contraindication for the gingivectomy procedure?
A.
B.
C.
D.
An adequate zone of attached gingiva
Probing depths at or near the mucogingival junction
Suprabony pockets
Enlargement of interdental gingiva
Dr. OMAR ALHUNI
Diplomate, American Board of Periodontology
Tel: 092-382-9123
Email: [email protected]