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  2. 2. Contents <ul><li>Definition </li></ul><ul><li>Indications </li></ul><ul><li>Contra-Indications </li></ul><ul><li>Types of Gingivectomy </li></ul>
  3. 3. Gingivectomy <ul><li>Definition </li></ul><ul><ul><li>Excision of Gingiva by removing the diseased pocket wall thereby exposing tooth surface which provides the visibility & accessibility that are essential for the complete removal of irritating surface deposits & thorough smoothening of the roots. </li></ul></ul><ul><li>Indications </li></ul><ul><ul><li>Suprabony pocket </li></ul></ul><ul><ul><li>Fibrous enlargement (Pseudo Pocket) </li></ul></ul><ul><ul><li>Crown lengthening </li></ul></ul><ul><ul><li>Perio Aesthetic </li></ul></ul><ul><ul><li>Suprabony periodontal abscess. </li></ul></ul>
  4. 4. CONTRAINDICATIONS <ul><li>Bone defect can not be corrected </li></ul><ul><li>Fragile gingiva </li></ul><ul><li>Location of the base of the pocket apical to mucogingival junction. </li></ul><ul><li>TYPES OF GINGIVECTOMY </li></ul><ul><li>Surgical Gingivectomy </li></ul><ul><li>Gingivectomy by chemosurgery </li></ul><ul><li>Gingivectomy by Electro surgery </li></ul><ul><li>Gingivectomy by Cryosurgery </li></ul><ul><li>Gingivectomy by Laser </li></ul>
  5. 5. Instruments Required In Surgical Gingivectomy <ul><li>Krane Keplan Pocket Marker </li></ul><ul><li>Kirkland Periodontal knife </li></ul><ul><li>Orban periodontal knife </li></ul><ul><li>Bard – parker handle </li></ul><ul><li>Bard – Parker blades no 11 & 12 </li></ul><ul><li>Supra & subgingival scalers </li></ul><ul><li>Curettes </li></ul>1. SURGICAL GINGIVECTOMY
  6. 6. STEPS IN- SURGICAL GINGIVECTOMY <ul><li>Anaesthetize area </li></ul><ul><li>Mark the pocket </li></ul><ul><li>Resect the gingiva </li></ul><ul><li>Remove granulation tissue </li></ul><ul><li>Remove calculus </li></ul><ul><li>Place periodontal pack </li></ul>
  7. 7. Pocket Marking <ul><li>Pocket on each surface are explored with periodontal probe and marked with pocket marker at three places on each tooth on each labial & lingual surfaces. </li></ul><ul><li>Pocket should be marked systematically beginning on distal surface of the last tooth then moving on the facial surface and proceeding anteriorly to the midline </li></ul>
  8. 8. INCISION GIVEN INSURGICAL GINGIVECTOMY Type of incision : Internal bevel incision It may be continuous or discontinuous <ul><li>A) Discontinuous: From the facial surface at distal angle of last tooth to distofacial angle of the next tooth. Next incision begins in the interdental space to distofacial angle of next tooth. </li></ul>
  9. 9. <ul><li>Continuous:- Started on the facial surface from the disto angular region & carried forward anteriorly following the course of pocket without interruption. procedure is repeated on lingual surface. </li></ul><ul><li>Distal incision: Facial and lingual incision are joined by an incision across the distal surface of the last erupted tooth. </li></ul>
  10. 10. STEPS IN SURGICAL GINGIVECTOMY <ul><li>Start apical to points marking of the course of periodontal pocket & is directed coronally to a point b/w the base of the pocket & crest of the bone. </li></ul><ul><li>Should be close to bone but not exposed it. </li></ul><ul><li>The incision should be beveled at approximately 45 degree to the tooth surface to follow the normal festooned pattern of the gingiva </li></ul><ul><li>Should not leave diseased Pocket wall. </li></ul><ul><li>The incision should pass completely through soft tissue to tooth. </li></ul>
  11. 11. REMOVE RESECTED- GINGIVA <ul><li>Remove the marginal & inter dental gingiva starting from distal surface of last tooth detach gingiva at the line of incision with the help of surgical hoes & scalers. </li></ul><ul><li>APPRAISE THE FIELD </li></ul><ul><li>Bead like granulation tissue. </li></ul><ul><li>Calculus ruminants. </li></ul><ul><li>A band of light zone on the root surface. </li></ul><ul><li>Softening of root surface resorptions & cementum protuberances. </li></ul>
  12. 12. Remove granulation tissue <ul><li>The curettes are used for this purpose. The curette is guided along the tooth surface & under the granulation tissue. </li></ul><ul><li>REMOVE CALCULUS: </li></ul><ul><li>The remaining calculus & necrotic cementum are to be removed using scalers & curettes. Check each surface of every tooth for calculus & soft tissue reminants. </li></ul><ul><li>Wash area several times with saline and cover with gauze sponge. </li></ul>
  13. 13. Place Periodontal Pack <ul><li>After the bleeding is control and Hemostatis achieved, the Gingivectomy wound is covered with periodontal pack . </li></ul><ul><li>HEALING AFTER SURGICAL GINGIVECTOMY </li></ul>
  14. 14. <ul><li>- The initial response after gingivectomy is Clot formation </li></ul><ul><li>Underlying tissue become acutely inflammed with some necrosis. </li></ul><ul><li>The clot is replaced by granulations tissue . </li></ul><ul><li>* After 24 Hrs. increased in new connective tissue cells mainly angioblasts beneath the surface layer of inflammation& necrosis. </li></ul><ul><li>* By 3 rd day numerous young fibroblast located in the area. </li></ul><ul><li>* Highly vascular granulation tissue grows coronaly, creating new free gingival margin and sulcus. </li></ul><ul><li>* Capillaries derived from blood vessels of periodontal ligament migrates into the granulation tissue & within two weeks they connect with gingival vessels. </li></ul><ul><li>After 12 to 24 Hrs. epithelial cells at the margin start to migrate over the granulation tissue separating it from the clot. </li></ul><ul><li>Epithelial cells advance by tumbling action </li></ul><ul><li>Surface epithelization is generally complete after 5 to 14 days. </li></ul>
  15. 15. 2. GINGIVECTOMY BY CHEMOSURGERY <ul><li>Agent Used. </li></ul><ul><li>25% phenol with 75% camphor. </li></ul><ul><li>5% paraformaldehyde in ZnO eugenol pack. </li></ul><ul><li>ADVANTAGES OF CHEMOSURGERY </li></ul><ul><li>No analgesia or anesthesia required for the procedure. </li></ul><ul><li>Procedure is easy to perform & require less instruments. </li></ul>
  16. 16. Disadvantage <ul><li>Bone necrosis might result. </li></ul><ul><li>Periodontal abscess might result. </li></ul><ul><li>Delayed wound healing </li></ul><ul><li>Subsequent plaque retention </li></ul><ul><li>Bone resorption </li></ul><ul><li>3. Gingivectomy by electro surgery </li></ul><ul><li>Advantages: </li></ul><ul><li>Less Bleeding </li></ul><ul><li>Disadvantages </li></ul><ul><li>Procedure produces heat which causes necrosis of adjacent tissue. </li></ul><ul><li>If it transfer to the bone, resorption take place. </li></ul>
  17. 17. 4 . Gingivectomy by cryosurgery <ul><li>Temperature -50 to -60 0 c is apply to gingiva by means of a probe. </li></ul><ul><li>Advantages </li></ul><ul><li>The procedure does not cause pain & bleeding. </li></ul><ul><li>5 . Gingivectomy by LASER: </li></ul><ul><li>TYPE OF LASER USED: </li></ul><ul><li>Co 2 Laser </li></ul><ul><li>Nd: YAG Laser </li></ul><ul><li>ADVANTAGES </li></ul><ul><li>Similar to electro surgery more sofasticated, produces no heat thereby, least necrosis. </li></ul><ul><li>Similar to electro surgery no past operative dressing is required. </li></ul>
  18. 18. Clinical Picture Shows inflammed GIngiva in lower anterior region . Clinical Picture Shows Removal of the diseased gingiva to expose calculus
  19. 19. Pre-operative Clinical Photograph Post Operative Clinical Photograph
  20. 20. Maintenance After Gingivectomy <ul><li>Prescribe Chlorhexidine gluconate rinses. </li></ul><ul><li>Advice patient to maintain good oral hygiene. </li></ul><ul><li>Recall for professional cleaning. </li></ul>
  21. 21. References: <ul><li>Michel G. Newmann , Henry H. Takel , Fermin A. Carranza ; Carranza’ s clinical periodontology ; 9th edition. </li></ul><ul><li>Jan Lindhe , Thorkild Karring , Niklaus P Lang ; clinical periodontology & the implant dentistry ; 4th edition. </li></ul>