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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 po...
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   ...
Principle of the Operation1. Continuous incision at 45° angle at the base of the   pocket2. Sharp dissection of tissues in...
Instruments•   Size, shape and angulation of the    working tip, and also by the    comfortable handle•   Gingivectomy kni...
Pocket marking forceps •   Paired (L & R) •   Use: indicate the location of the base of     the pocket
Pocket marking forceps
Gingivectomy knives                       •   GV knife (Kirkland, L & R)Sharpness!             •   Papilla knife (Orban, L...
Gingivectomy knives        45° angle to the tooth long axis        Anterior area: single-bend        Less accessible ar...
Electrosurgery apparatus and tips•    Use: gingiplasty, papillectomy, smooth out abrupt edges,     expose the margins of a...
Electrosurgery apparatus and tips To reduce the bulbous marginal gingival contour
Periodontal Dressings            & Tissue Adhesives• Reduce postaperative pain• Prevent colonization of plaque• Left in si...
• Peripac: ready-to-use, gypsum base + acrylic,  sets quickly when contacting with saliva, hard  edgesdanger of pressure ...
• CHX power: reduce plaque formation
• Tissue adhesives (Cyanoacrylate): Histoacryl,  Bucrylate• Use: minor GV/GP wounds, instead of sutures• Applied by plasti...
Operative Procedure
Operative Procedure
Operative Procedure
Operative Procedure
Operative Procedure
Operative Procedure
Operative Procedure
Operative Procedure
Operative Procedure
Operative Procedure
Operative Procedure
Operative Procedure
Operative Procedure
Operative Procedure
Operative Procedure
Operative Procedure
Operative Procedure
Operative Procedure
Operative Procedure
Operative Procedure
Operative Procedure
Operative Procedure
Operative Procedure
Operative Procedure
Operative Procedure
Drug-induced Gingival Overgrowth                            Calcium1    Anti-     convulsants      2     Channel          ...
Prevalence                           children      J Periodontol 2004;75:1424-1431.
Prevalence      J Periodontol 2004;75:1424-1431.
GV/GP - Phenytoin-induced   gingival overgrowth
GV/GP - Phenytoin-induced   gingival overgrowth
GV/GP - Phenytoin-induced   gingival overgrowth
References1. Color Atlas of Dental Medicine: Periodontology:   Periodontology. Herbert F. Wolf, Klaus H. Rateitschak2. Inf...
MERRY CHRISTMAS~!!
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Gingivectomy

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Transcript of "Gingivectomy"

  1. 1. GINGIVECTOMY Date: 2012-12-21Presenter: R2 鄭瑋之 Instructor: VS 陳娟娟
  2. 2. Definition• A surgical procedure in which gingival pockets are eliminated by removal of gingiva.
  3. 3. Indications1. Gingival enlargement or overgrowth2. Idiopathic gingival fibromatosis3. Pseudopockets4. Shallow suprabony pockets  modified Widman5. Areas with difficult access6. Minor corrective procedures
  4. 4. Contraindications1. Narrow or absent attached gingiva2. Infrabony pockets3. Thicking of marginal alveolar bone
  5. 5. Advantages1. Technically simple; good visual access2. Complete pocket elimination3. Predictable morphological result
  6. 6. 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
  7. 7. 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)
  8. 8. Instruments• Size, shape and angulation of the working tip, and also by the comfortable handle• Gingivectomy knife + papilla knife, singly or doubly angled
  9. 9. Pocket marking forceps • Paired (L & R) • Use: indicate the location of the base of the pocket
  10. 10. Pocket marking forceps
  11. 11. Gingivectomy knives • GV knife (Kirkland, L & R)Sharpness! • Papilla knife (Orban, L & R)Arkansas stone + oil • Universal knife
  12. 12. Gingivectomy knives  45° angle to the tooth long axis  Anterior area: single-bend  Less accessible area: double-bend
  13. 13. 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
  14. 14. Electrosurgery apparatus and tips To reduce the bulbous marginal gingival contour
  15. 15. 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.
  16. 16. • Peripac: ready-to-use, gypsum base + acrylic, sets quickly when contacting with saliva, hard edgesdanger of pressure aphthous ulcer• Coe-pak: 2 component (zinc oxide + fatty acids), pliable after setting
  17. 17. • CHX power: reduce plaque formation
  18. 18. • Tissue adhesives (Cyanoacrylate): Histoacryl, Bucrylate• Use: minor GV/GP wounds, instead of sutures• Applied by plastic tubes, brushes or cannulate
  19. 19. Operative Procedure
  20. 20. Operative Procedure
  21. 21. Operative Procedure
  22. 22. Operative Procedure
  23. 23. Operative Procedure
  24. 24. Operative Procedure
  25. 25. Operative Procedure
  26. 26. Operative Procedure
  27. 27. Operative Procedure
  28. 28. Operative Procedure
  29. 29. Operative Procedure
  30. 30. Operative Procedure
  31. 31. Operative Procedure
  32. 32. Operative Procedure
  33. 33. Operative Procedure
  34. 34. Operative Procedure
  35. 35. Operative Procedure
  36. 36. Operative Procedure
  37. 37. Operative Procedure
  38. 38. Operative Procedure
  39. 39. Operative Procedure
  40. 40. Operative Procedure
  41. 41. Operative Procedure
  42. 42. Operative Procedure
  43. 43. Operative Procedure
  44. 44. Drug-induced Gingival Overgrowth Calcium1 Anti- convulsants 2 Channel Blockers 3 Immuno- suppressants1. Phenytoin for 1. Antihypertensive 1. Cyclosporin A for seizure drugs for angina prevention of2. Valpronic acid, or peripheral transplant carbamazepine, vascular disease rejection, phenobarbitone 2. Nifedipine first autoimmune like rare in early 1980s rheumatoid3. Vigabatrin new 3. Diltiazem, arthritis  verapamil limited by renal, 4. Amlodipine, cardiac, and felodipine rare gingival fibrosis J Periodontol 2004;75:1424-1431.
  45. 45. Prevalence children J Periodontol 2004;75:1424-1431.
  46. 46. Prevalence J Periodontol 2004;75:1424-1431.
  47. 47. GV/GP - Phenytoin-induced gingival overgrowth
  48. 48. GV/GP - Phenytoin-induced gingival overgrowth
  49. 49. GV/GP - Phenytoin-induced gingival overgrowth
  50. 50. 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.
  51. 51. MERRY CHRISTMAS~!!
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