1. 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

2. Resective Surgery
Soft Tissue
Curettage
ENAP
Gingivectomy
Hard Tissue
Osseous Resection
Regenerative Surgery
GTR
GBR

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 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

5. Basic procedure:
Local anesthesia
The 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 wall
The area is flushed to remove debris
The 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 knife
Develop to accomplished proper tissue preparation
Procedures:
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 curette
Root plane all exposed cementum
Approximate the wound edges.
Place sutures and a periodontal dressing.
Gain better access to the root surface.

8. Gingivectomy

9. Gingivectomy Gingivoplasty
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

10. Gingivectomy/gingivoplasty 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

11. Contraindications: 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

12. Types of gingivectomy:
1- Surgical Gingivectomy
2- Gingivectomy By Electrosurgery
3- Laser Gingivectomy
4- Gingivectomy By Chemosurgery

13. Surgical Gingivectomy

16. Healing after Surgical Gingivectomy
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
May take 1-2 weeks for complete surface epithelialization (no sooner than 5 days).
By 14 days, the tissues assume a normal clinical form
Some 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 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

19. Advantages: Disadvantages: 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.

20. Lasers gingivectomy CO2, Nd: Yag, and Diode (plus others…)
Same limitations as electrosurgery
Possible decreased post-op discomfort
Possible delayed wound healing

21. Chemical gingivectomy
Potassium hydroxide and Paraformaldenyde
Not recommended
Depth and action is difficult to control
Reshaping of the tissues cannot be accurately accomplished
Healthy tissues may be adversely affected
Delayed wound healing

22. Drug induced gingival enlargement
phenytoin (Dilantin)
Cyclosporin- A
Calcium channel blocker (Nifidepine
Treatment:
Drug substitution/withdrawal
A 3-month interval for periodontal maintenance therapy

23. Which condition is a contraindication for the gingivectomy procedure?
Stahl et al. (1971) noted complete epithelialization following gingivectomy in all specimens after _____ days. 7 14 21 28
During the process of healing after external bevel gingivectomy, surface epithelialization is complete no sooner than _____ days. 2 3 4 5
Which condition is a contraindication for the gingivectomy procedure?
An adequate zone of attached gingiva
Probing depths at or near the mucogingival junction
Suprabony pockets
Enlargement of interdental gingiva

24. Diplomate, American Board of Periodontology
Dr. OMAR ALHUNI
Diplomate, American Board of Periodontology
Tel: