Gingival curettage


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  • Gingival curettage

    2. 2.  gingival curettage  curette  subgingival curettage
    3. 3. <ul><li>CURETTAGE : scraping of the gingival wall of a </li></ul><ul><li>periodontal pocket to separate the diseased soft tissue </li></ul><ul><li>GINGIVAL CURETTAGE : removal of the inflamed soft </li></ul><ul><li>tissue lateral to the pocket wall </li></ul><ul><li>SUBGINGIVAL CURETTAGE : performed apical to the </li></ul><ul><li>epithelial attachment, severing the C.T. attachment to </li></ul><ul><li>the osseous crest </li></ul><ul><li>INADVERTANT CURETTAGE : some degree of </li></ul><ul><li>curettage done unintentionally during scaling and root </li></ul><ul><li>planings </li></ul><ul><li>AIM : to reduce pocket depth by enhancing gingival </li></ul><ul><li>shrinkage, new C.T. attachment or both </li></ul>
    4. 4.  gingival curettage  subgingival curettage
    5. 5. <ul><li>RATIONALE/ BASIS/ PRINCIPLE: </li></ul><ul><li> removal of chronically inflamed granulat n tissue that </li></ul><ul><li>forms in the lateral wall of the periodontal pocket. </li></ul><ul><li>This contains granulat n tissue, chronic infl n , pieces of </li></ul><ul><li>dislodged calculus & bacterial colonies </li></ul><ul><li>inflamed granulat n tissue is lined by epithelium </li></ul><ul><li> root planing  major source of bact. disappears & </li></ul><ul><li>pocket pathologic changes resolve. Existing granulat n </li></ul><ul><li>tissue is slowly resorbed & bact. are destroyed </li></ul><ul><li> it may also eliminate all or most of the epithelium that </li></ul><ul><li>lines the pocket wall and the J.E. </li></ul><ul><li>purpose of curettage is valid particularly when attempt </li></ul><ul><li>is made at new attachment esp in infrabony pockets </li></ul>
    6. 6. <ul><li>INDICATIONS </li></ul><ul><li> to eliminate shallow suprabony pockets located in </li></ul><ul><li>accessible areas & have an inflamed oedematous pocket wall that shrinks to sulcus depth after Rx </li></ul><ul><li> as part of new attachment attempt in moderately deep infrabony pockets in inaccessible areas (close surgery) </li></ul><ul><li>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. </li></ul><ul><li>as maintenance treatment on recall visits for areas of recurrent infln & pocket depth </li></ul><ul><li>AIMS: </li></ul><ul><li> to eliminate periodontal pocket </li></ul><ul><li>to restore gingiva to normal health w.r.t. colour, contour, consistency, surface texture </li></ul><ul><li> to eliminate infl n in v. deep pockets before doing any surgery </li></ul>
    7. 7. <ul><li>CONTRA INDICATIONS </li></ul><ul><li>Local </li></ul><ul><li>where pockets are tortuous </li></ul><ul><li>where opening of pocket is narrow & base is broad </li></ul><ul><li>molars are tilted </li></ul><ul><li>soft ts wall is fibrotic (hyperplasia in pt. on dilantin sodium in </li></ul><ul><li>epilepsy) </li></ul><ul><li>furcation involvement </li></ul><ul><li>Systemic </li></ul><ul><li>H/o bld dyscrasias, diabetes or any other debilitating disease </li></ul><ul><li>Drug history- pt. on corticosteroid or allergy to l.a. </li></ul>
    8. 8. <ul><li>PROCEDURE </li></ul><ul><li>Basic technique: </li></ul><ul><li>Armamentarium- </li></ul><ul><li>Gracey curettes </li></ul><ul><li>L.A- surface anesthesia (superficial curettage) </li></ul><ul><li> infiltrate (deep curettage) </li></ul><ul><li>before doing curettage, S/RP shd be done thoroughly </li></ul><ul><li>L.A. </li></ul><ul><li>curette selection </li></ul><ul><li>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. </li></ul><ul><li>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 </li></ul>
    9. 9. <ul><li>wash the area </li></ul><ul><li>ts is partly adapted to the tooth by gentle finger pr </li></ul><ul><li>suturing and pack </li></ul>a. removal of pocket lining b. subgingival curettage
    10. 10. <ul><li>OTHER TECHNIQUES </li></ul><ul><li>Excisional New Attachment Procedure (ENAP)– </li></ul><ul><li>a definitive subgingival procedure performed with a knife </li></ul><ul><li>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 </li></ul><ul><li>bottom of the pocket carrying it I/P on both facial & lingual sides </li></ul><ul><li>remove the excised ts with a curette </li></ul><ul><li>root planing (preserve all c.t. fibres that remain attached to the root surface) </li></ul><ul><li>irrigate </li></ul><ul><li>approximate the wound edges (recontour bone if required) </li></ul><ul><li>sutures and dressing </li></ul>
    11. 11. ay also eliminate all o
    12. 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. 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. 14. <ul><li>COMPLICATIONS: </li></ul><ul><li>Dev of sensitivity- assure the pt.that it disappears as </li></ul><ul><li>the denuded root gets new attachment & J.E </li></ul><ul><li>If it does not disappear by few days, then </li></ul><ul><li>prescribe desensitizing T/P </li></ul><ul><li>local application of 8% zinc chloride </li></ul><ul><li>10% strontium chloride </li></ul><ul><li>5% sodium fluoride </li></ul><ul><li>2. Pain on percussion- bec of infl n in pdl fibres </li></ul><ul><li>3. Bleeding can also occur </li></ul>