Gingival curettage

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  • 2.  gingival curettage  curette  subgingival curettage
  • 3.
    • CURETTAGE : scraping of the gingival wall of a
    • periodontal pocket to separate the diseased soft tissue
    • GINGIVAL CURETTAGE : removal of the inflamed soft
    • tissue lateral to the pocket wall
    • SUBGINGIVAL CURETTAGE : performed apical to the
    • epithelial attachment, severing the C.T. attachment to
    • the osseous crest
    • INADVERTANT CURETTAGE : some degree of
    • curettage done unintentionally during scaling and root
    • planings
    • AIM : to reduce pocket depth by enhancing gingival
    • shrinkage, new C.T. attachment or both
  • 4.  gingival curettage  subgingival curettage
  • 5.
    •  removal of chronically inflamed granulat n tissue that
    • forms in the lateral wall of the periodontal pocket.
    • This contains granulat n tissue, chronic infl n , pieces of
    • dislodged calculus & bacterial colonies
    • inflamed granulat n tissue is lined by epithelium
    •  root planing  major source of bact. disappears &
    • pocket pathologic changes resolve. Existing granulat n
    • tissue is slowly resorbed & bact. are destroyed
    •  it may also eliminate all or most of the epithelium that
    • lines the pocket wall and the J.E.
    • purpose of curettage is valid particularly when attempt
    • is made at new attachment esp in infrabony pockets
  • 6.
    •  to eliminate shallow suprabony pockets located in
    • accessible areas & have an inflamed oedematous pocket wall that shrinks to sulcus depth after Rx
    •  as part of new attachment attempt in moderately deep infrabony pockets in inaccessible areas (close surgery)
    • as a non- definitive procedure prior to flap surgery to reduce infln or in whom more aggressive surgical techq’s are c/I due to age, systemic problem,etc.
    • as maintenance treatment on recall visits for areas of recurrent infln & pocket depth
    • AIMS:
    •  to eliminate periodontal pocket
    • to restore gingiva to normal health w.r.t. colour, contour, consistency, surface texture
    •  to eliminate infl n in v. deep pockets before doing any surgery
  • 7.
    • Local
    • where pockets are tortuous
    • where opening of pocket is narrow & base is broad
    • molars are tilted
    • soft ts wall is fibrotic (hyperplasia in pt. on dilantin sodium in
    • epilepsy)
    • furcation involvement
    • Systemic
    • H/o bld dyscrasias, diabetes or any other debilitating disease
    • Drug history- pt. on corticosteroid or allergy to l.a.
  • 8.
    • Basic technique:
    • Armamentarium-
    • Gracey curettes
    • L.A- surface anesthesia (superficial curettage)
    • infiltrate (deep curettage)
    • before doing curettage, S/RP shd be done thoroughly
    • L.A.
    • curette selection
    • insert the inst so as to engage the inner lining of the pocket wall & is carried along the soft tissue usually in a horizontal stroke . The pocket wall may be supported by gentle finger pressure on external surface.
    • subgingival curettage– ts attached b/w the bottom of the pocket & alv crest are removed with a scooping motion of the instrument to the tooth surface
  • 9.
    • wash the area
    • ts is partly adapted to the tooth by gentle finger pr
    • suturing and pack
    a. removal of pocket lining b. subgingival curettage
  • 10.
    • Excisional New Attachment Procedure (ENAP)–
    • a definitive subgingival procedure performed with a knife
    • after adequate L.A., mark the pocket with a perio probe With a surgical blade make an internal bevel incision from the free gingiva apical to a point below the
    • bottom of the pocket carrying it I/P on both facial & lingual sides
    • remove the excised ts with a curette
    • root planing (preserve all c.t. fibres that remain attached to the root surface)
    • irrigate
    • approximate the wound edges (recontour bone if required)
    • sutures and dressing
  • 11. ay also eliminate all o
  • 12. Ultrasonic curettage- using ultrasonic devices ultrasonic vibrations disrupt ts continuity & lift off the epithelium results in a narrow band of necrotic ts  ed infl n & less removal of C.T These inst’s are not as effective as hand inst’s in removing c.t. & leaving a smooth pocket wall Chemical curettage- using caustic drugs sodium sulfide alk sodium hypochlorite phenol These were discarded after studies showed their ineffectiveness The extent of ts destruction cannot be controlled They may  rather than reduce the amount of ts to be removed by enzymes & phagocytes
  • 13. HEALING:  immediately after curettage, a bld clot fills the pocket area ( this is organized into granul n ts) haemorrhage in ts (dilated cap’s) &  PMNL’s on wound surface  rapid proliferation of granul n ts  ts maturation (  smal bld vs)  epithelization of sulcus takes 2-7 days CLINICAL APPEARANCE: immediately after curettage, gingiva appears hemorrhagic & bright red after 1 wk, gingiva is slightly redder than normal apical shift in position of marginal gingiva after 2wk, normal color, contour, consistency, s.t. gingival margin well adapted
  • 14.
    • Dev of sensitivity- assure the pt.that it disappears as
    • the denuded root gets new attachment & J.E
    • If it does not disappear by few days, then
    • prescribe desensitizing T/P
    • local application of 8% zinc chloride
    • 10% strontium chloride
    • 5% sodium fluoride
    • 2. Pain on percussion- bec of infl n in pdl fibres
    • 3. Bleeding can also occur