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 ID: 1046925
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1. GINGIVAL CURETTAGE AND GINGIVECTOMY Dr. OMAR ALHUNIDiplomate, American Board of PeriodontologyResidency specialty training in PeriodonticsMaster of Sciences in Dentistry, Saint Louis UniversityBachelor of Dental Surgery, Garyounis University
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3. Curettage
4. 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 liningRationale : to removes chronically inflamed granulation tissue that forms in the lateral wall ( inner surface) of the periodontal pocketit should always be preceded by scaling and root planning
5. Basic procedure:Local anesthesiaThe curette is selected so that the cutting edge will be against the tissue The pocket wall may be supported by gentle finger pressure Scooping motion of the curette to remove the inner lining of the pocket wallThe area is flushed to remove debrisThe tissue is adapted to the tooth by gentle finger pressure
6. 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.
7. Excisional New Attachment Procedure (ENAP)It is a definitive subgingival curettage performed with a knifeDevelop to accomplished proper tissue preparationProcedures:Internal bevel incision is made from the margin of the free gingiva apically to a point below the bottom of the pocket.Remove the excised tissue with a curetteRoot plane all exposed cementumApproximate the wound edges. Place sutures and a periodontal dressing.Gain better access to the root surface.
8. Gingivectomy
9. Gingivectomy The excision of a portion of the gingiva; usually performed to reduce the soft tissue wall of a periodontal pocket.GingivoplastyReshaping of the gingiva to produce a surface form and topography that simulates those features of gingival health
10. Gingivectomy/gingivoplasty indications:To eliminate gingival pockets (suprabony pockets)To create an esthetic gingival form in cases of delayed passive eruptionTo reduce gingival enlargementsTo create clinical crown length for restorative/endo
11. Contraindications:Acutely inflamed gingivaInadequate oral hygiene PD that is apical to the MGJinadequate keratinized gingivaPresence of infrabony defectsInadequate depth of the vestibuleWhen removal of soft tissue would create an unacceptable cosmetic compromise
12. Types of gingivectomy:1- Surgical Gingivectomy2- Gingivectomy By Electrosurgery3- Laser Gingivectomy4- Gingivectomy By Chemosurgery
13. Surgical Gingivectomy
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16. Healing after Surgical GingivectomyInitial healing involves hemostasis and fibrin clot formation to cover the wound surfaceCellular proliferation of epithelium at the wound marginsVascular proliferation (3-4 day peak)Epithelium begins to migrate across the CT surface after 2days until the wound surface is coveredMay take 1-2 weeks for complete surface epithelialization (no sooner than 5 days).By 14 days, the tissues assume a normal clinical formSome hypervascularity may persist (redness)Remodeling may continue for 3 months
17. Small front teeth Gingivecyomy procedure Full exposure of anatomic crown
18. GINGIVECTOMY BY ELECTROSURGERY:High frequency electric current is used to cut and coagulate soft tissueBrushing motion is used to remove incremental portions of soft tissueBest limited to superficial soft tissue procedures to avoid contact with bone or tooth root
19. Advantages:Bloodless fieldUse in areas where application of knives is difficult / impossible.Disadvantages:Possible heat damageIncreased timeUnpleasant odorCannot be used in pts with noncompatible or poorly shielded pacemakersMay result in delayed healing, loss of attachment, and cemental burns.
20. Lasers gingivectomyCO2, Nd: Yag, and Diode (plus others…)Same limitations as electrosurgeryPossible decreased post-op discomfortPossible delayed wound healing
21. Chemical gingivectomyPotassium hydroxide and ParaformaldenydeNot recommendedDepth and action is difficult to controlReshaping of the tissues cannot be accurately accomplished Healthy tissues may be adversely affectedDelayed wound healing
22. Drug induced gingival enlargementphenytoin (Dilantin)Cyclosporin- ACalcium channel blocker (NifidepineTreatment:Drug substitution/withdrawalA 3-month interval for periodontal maintenance therapy
23. Stahl et al. (1971) noted complete epithelialization following gingivectomy in all specimens after _____ days.7142128During the process of healing after external bevel gingivectomy, surface epithelialization is complete no sooner than _____ days.2345Which condition is a contraindication for the gingivectomy procedure?An adequate zone of attached gingivaProbing depths at or near the mucogingival junctionSuprabony pocketsEnlargement of interdental gingiva
24. Dr. OMAR ALHUNIDiplomate, American Board of PeriodontologyTel: 092-382-9123Email: omar4huni@yahoo.com