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Gingivectomy

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Gingivectomy Presentation Transcript

  • 1. GINGIVECTOMY DEPARTMENT OF PERIODONTICS
  • 2. Contents
    • Definition
    • Indications
    • Contra-Indications
    • Types of Gingivectomy
  • 3. Gingivectomy
    • Definition
      • 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.
    • Indications
      • Suprabony pocket
      • Fibrous enlargement (Pseudo Pocket)
      • Crown lengthening
      • Perio Aesthetic
      • Suprabony periodontal abscess.
  • 4. CONTRAINDICATIONS
    • Bone defect can not be corrected
    • Fragile gingiva
    • Location of the base of the pocket apical to mucogingival junction.
    • TYPES OF GINGIVECTOMY
    • Surgical Gingivectomy
    • Gingivectomy by chemosurgery
    • Gingivectomy by Electro surgery
    • Gingivectomy by Cryosurgery
    • Gingivectomy by Laser
  • 5. Instruments Required In Surgical Gingivectomy
    • Krane Keplan Pocket Marker
    • Kirkland Periodontal knife
    • Orban periodontal knife
    • Bard – parker handle
    • Bard – Parker blades no 11 & 12
    • Supra & subgingival scalers
    • Curettes
    1. SURGICAL GINGIVECTOMY
  • 6. STEPS IN- SURGICAL GINGIVECTOMY
    • Anaesthetize area
    • Mark the pocket
    • Resect the gingiva
    • Remove granulation tissue
    • Remove calculus
    • Place periodontal pack
  • 7. Pocket Marking
    • 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.
    • 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
  • 8. INCISION GIVEN INSURGICAL GINGIVECTOMY Type of incision : Internal bevel incision It may be continuous or discontinuous
    • 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.
  • 9.
    • 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.
    • Distal incision: Facial and lingual incision are joined by an incision across the distal surface of the last erupted tooth.
  • 10. STEPS IN SURGICAL GINGIVECTOMY
    • 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.
    • Should be close to bone but not exposed it.
    • The incision should be beveled at approximately 45 degree to the tooth surface to follow the normal festooned pattern of the gingiva
    • Should not leave diseased Pocket wall.
    • The incision should pass completely through soft tissue to tooth.
  • 11. REMOVE RESECTED- GINGIVA
    • 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.
    • APPRAISE THE FIELD
    • Bead like granulation tissue.
    • Calculus ruminants.
    • A band of light zone on the root surface.
    • Softening of root surface resorptions & cementum protuberances.
  • 12. Remove granulation tissue
    • The curettes are used for this purpose. The curette is guided along the tooth surface & under the granulation tissue.
    • REMOVE CALCULUS:
    • The remaining calculus & necrotic cementum are to be removed using scalers & curettes. Check each surface of every tooth for calculus & soft tissue reminants.
    • Wash area several times with saline and cover with gauze sponge.
  • 13. Place Periodontal Pack
    • After the bleeding is control and Hemostatis achieved, the Gingivectomy wound is covered with periodontal pack .
    • HEALING AFTER SURGICAL GINGIVECTOMY
  • 14.
    • - The initial response after gingivectomy is Clot formation
    • Underlying tissue become acutely inflammed with some necrosis.
    • The clot is replaced by granulations tissue .
    • * After 24 Hrs. increased in new connective tissue cells mainly angioblasts beneath the surface layer of inflammation& necrosis.
    • * By 3 rd day numerous young fibroblast located in the area.
    • * Highly vascular granulation tissue grows coronaly, creating new free gingival margin and sulcus.
    • * Capillaries derived from blood vessels of periodontal ligament migrates into the granulation tissue & within two weeks they connect with gingival vessels.
    • After 12 to 24 Hrs. epithelial cells at the margin start to migrate over the granulation tissue separating it from the clot.
    • Epithelial cells advance by tumbling action
    • Surface epithelization is generally complete after 5 to 14 days.
  • 15. 2. GINGIVECTOMY BY CHEMOSURGERY
    • Agent Used.
    • 25% phenol with 75% camphor.
    • 5% paraformaldehyde in ZnO eugenol pack.
    • ADVANTAGES OF CHEMOSURGERY
    • No analgesia or anesthesia required for the procedure.
    • Procedure is easy to perform & require less instruments.
  • 16. Disadvantage
    • Bone necrosis might result.
    • Periodontal abscess might result.
    • Delayed wound healing
    • Subsequent plaque retention
    • Bone resorption
    • 3. Gingivectomy by electro surgery
    • Advantages:
    • Less Bleeding
    • Disadvantages
    • Procedure produces heat which causes necrosis of adjacent tissue.
    • If it transfer to the bone, resorption take place.
  • 17. 4 . Gingivectomy by cryosurgery
    • Temperature -50 to -60 0 c is apply to gingiva by means of a probe.
    • Advantages
    • The procedure does not cause pain & bleeding.
    • 5 . Gingivectomy by LASER:
    • TYPE OF LASER USED:
    • Co 2 Laser
    • Nd: YAG Laser
    • ADVANTAGES
    • Similar to electro surgery more sofasticated, produces no heat thereby, least necrosis.
    • Similar to electro surgery no past operative dressing is required.
  • 18. Clinical Picture Shows inflammed GIngiva in lower anterior region . Clinical Picture Shows Removal of the diseased gingiva to expose calculus
  • 19. Pre-operative Clinical Photograph Post Operative Clinical Photograph
  • 20. Maintenance After Gingivectomy
    • Prescribe Chlorhexidine gluconate rinses.
    • Advice patient to maintain good oral hygiene.
    • Recall for professional cleaning.
  • 21. References:
    • Michel G. Newmann , Henry H. Takel , Fermin A. Carranza ; Carranza’ s clinical periodontology ; 9th edition.
    • Jan Lindhe , Thorkild Karring , Niklaus P Lang ; clinical periodontology & the implant dentistry ; 4th edition.