Gingival Curettage Wilkins, chapter

Learning Objectives Distinguish between gingival and subgingival curettage Identify the indications & contraindications for gingival curettage Describe the procedure Describe the healing that takes place following curettage

Introduction Refers to the scraping of the pocket wall Separates diseased soft tissue Inadvertent curettage occurs with periodontal debridement

Definitions Gingival Curettage: Removal of inflamed soft tissue Removes diseased sulcular & junctional epithelium Indications: pseudopockets, shallow true pockets Objective: gingival shrinkage

Definitions Subgingival Curettage: Performed apical to epithelial attachment Removes connective tissue attachment down to alveolar crest Indications: deep pockets Objectives: reattachment

Rationale Removes granulation tissue Within granulation tissue we find: Areas of chronic inflammation Bacteria, calculus Epithelial tissue lines granulation tissue May pose barrier to new fiber attachment

Rationale However, Questionable: Granulation tissue slowly resorbs following debridement Bacteria eliminated Tissue heals Questionable: Whether curettage significantly improves health of tissue beyond what is seen with periodontal debridement

Indications Generally limited: Moderately deep infrabony pockets where new attachment attempted Closed surgery advised Technically difficult procedure Inadequate accessibility When surgical techniques not advised Due to age, systemic problems Goal of pocket elimination compromised

Indications Maintenance therapy In areas of chronic inflammation, especially if client has had pocket reduction surgery

Basic Technique Periodontal debridement performed prior to curettage Tissues anaesthesized Appropriate selection of instruments Curettes, universal curette Curette blade placed against tissue Horizontal stroke

Basic Technique Irrigate tissues to flush out debris Gentle finger pressure applied to adapt tissues Separated interdental papillae may require sutures Surgical dressing may be indicated

Other Techniques Excisional New Attachment Procedure Ultrasonic Curettage Chemical Curettage Laser Fiber Curettage Students can do their own research on the above techniques

Healing Following Debridement & Curettage Uneventful healing Formation of long junctional epithelium No significant differences when compared to debridement therapy alone

Curettage using Laser Fiber Fiber tip slowly inserted into pocket & kept parallel to tooth Usually painless Moved apically until pocket base reached Vaporizing of pocket epithelium, subgingival plaque & some granulation tissue occurs

Curettage using Laser Fiber Fiber, held in contact with root surface, is slowly moved coronally & withdrawn This vaporizes microbial debris on root surface Any remaining deposits can be removed with a curette

Results of Curettage - Laser Fiber Before treatment – pockets measure 7-8 mm

Results of Curettage - Laser Fiber Gingival Curettage Results of Curettage - Laser Fiber Just after treatment 3 months after treatment – 3 mm pockets Soft Tissue Management DEN4361