1. Gingival Curettage
Wilkins, chapter

2. 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

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

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

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

6. 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

7. 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

8. 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

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

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

11. 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

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

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

14. 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

15. 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

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

17. 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