GINGIVECTOMY Date: 2012-12-21Presenter: R2 鄭瑋之 Instructor: VS 陳娟娟
Definition• A surgical procedure in which gingival pockets are eliminated by removal of gingiva.
Indications1. Gingival enlargement or overgrowth2. Idiopathic gingival fibromatosis3. Pseudopockets4. Shallow suprabony pockets modified Widman5. Areas with difficult access6. Minor corrective procedures
Contraindications1. Narrow or absent attached gingiva2. Infrabony pockets3. Thicking of marginal alveolar bone
Advantages1. Technically simple; good visual access2. Complete pocket elimination3. Predictable morphological result
Disadvantages1. Very limited indications2. Gross wound; postoperative pain3. Healing is by secondary intention (ca. 0.5 mm/day)4. Danger of exposing bone5. Loss of attached gingiva6. Exposes cervical area of tooth (sensitivity, esthetics, caries)7. Phonetic and esthetic problems in anterior area
Principle of the Operation1. Continuous incision at 45° angle at the base of the pocket2. Sharp dissection of tissues in the interdental area3. Smoothing of the incision edge4. Contouring the gingival surface (GP)5. Scaling and root planing6. Wound coverage (periodontal dressing)
Instruments• Size, shape and angulation of the working tip, and also by the comfortable handle• Gingivectomy knife + papilla knife, singly or doubly angled
Pocket marking forceps • Paired (L & R) • Use: indicate the location of the base of the pocket
Gingivectomy knives • GV knife (Kirkland, L & R)Sharpness! • Papilla knife (Orban, L & R)Arkansas stone + oil • Universal knife
Gingivectomy knives 45° angle to the tooth long axis Anterior area: single-bend Less accessible area: double-bend
Electrosurgery apparatus and tips• Use: gingiplasty, papillectomy, smooth out abrupt edges, expose the margins of a tooth preparation before taking the impressions or seating a restoration• Hemostatic effect• Not recommended for primary gingivectomy injury to the root, periosteum or bone
Electrosurgery apparatus and tips To reduce the bulbous marginal gingival contour
Periodontal Dressings & Tissue Adhesives• Reduce postaperative pain• Prevent colonization of plaque• Left in situ for 7~10 days• A second dressing may be indicated if healing is inadequate.• Only eugenol-free dressings are recommended.
• Peripac: ready-to-use, gypsum base + acrylic, sets quickly when contacting with saliva, hard edgesdanger of pressure aphthous ulcer• Coe-pak: 2 component (zinc oxide + fatty acids), pliable after setting
References1. Color Atlas of Dental Medicine: Periodontology: Periodontology. Herbert F. Wolf, Klaus H. Rateitschak2. Informational Paper - Drug-Associated Gingival Enlargement, J Periodontol 2004;75:1424-1431.