indication ... contraindication .... types ... gingivoplasty

2.  DEF : excision of the gingiva.
By:
removing the pocket wall
provides visibility and accessibility for complete calculus
removal
smoothing of the roots creating a favorable environment for
gingival healing and restoration of a physiologic gingival
contour

3.  Elimination of suprabony pockets
 Elimination of gingival enlargements
 Elimination of suprabony periodontal abscesses
 Crown lengthening
 Perio aesthetic
INDICATIONS

4.  bone defect can not be corrected
the base of the pocket is apical to the mucogingival
junction
Esthetic considerations
Contraindications

5. SURGICAL GINGIVECTOMY
GINGIVECTOMY by
ELECTROSURGERY
LASER GINGIVECTOMY
GINGIVECTOMY BY
CHEMOSURGERY

6. Steps of surgical procedures:
Pocket of each surface is explored by periodontal
probe and marked by pocket marker each pocket is
marked in several area Crane-Kaplan
Pocket Marker
SURGICAL GINGIVECTOMY

7. It should be close to bone without exposing it..but if
occur should cover by periodontal pack

8. Remove exist pocket wall, clean area . granulation
tissue may be seen on excited soft tissue
Granulation tissue is curetted out and remove any remaining
Cover the area with surgical pack.

10. The initial response is the formation of a protective surface
blood clot , the underlying tissue becomes acutely inflamed
with some necrosis
The clot is then replaced by granulation tissue , by 24 hours
there is an increase in new connective tissue cells mainly
angioblasts.
By the third day numerous young fibroblasts are located in
the area
The highly vascular granulation tissue grows coronally
creating a new free gingival margin and sulcus.
Healing after surgical
Gingivectomy

11. During the first 2 weeks
- granulation tissue forms within the clot
- the epithelium forms the wound edge & migrates over this
granulation tissue
From about 10 days to about 30 days
- organization of C.T
- keratinization of epithelium
Healing after surgical
Gingivectomy
NOTE :
The time required for complete healing varies
depending on the area of the cut surface and
interference from local irritation and infection .

12. GINGIVECTOMY BY ELECTROSURGERY
Advantages
Permits an adequate contouring of the tissue and controls hemorrhage
Disadvantages
1) Cannot be used in patients with Cardiac pacemakers.
2) unpleasant odor .
3) damage can be done .
4) The heat generated by injudicious use can cause tissue damage.

13. Indication ( limited to superficial procedures)
- Removal of gingival enlargement
- Gingivoplasty
- Relocation of frenum
- muscle attachments
Contraindication
It should not be used for procedures that involve proximity to the bone
such as flap operations or mucogingival surgery

14.  For removal of gingival enlargements and
Gingivoplasty we use the needle electrode
supplemented by the small ovoid loop for
festooning , A blended cutting and coagulating
current is used .
 Frenum and muscle attachments
can be relocated to facilitate pocket elimination
using a loop current .
Technique

16. The lasers most commonly used in dentistry are the carbon
dioxide and the Nd:YAG .
The CO2 laser beam
used for the excision of gingival growths although
healing is delayed when compared with healing after the
conventional scalpel gingivectomy .
precautions to avoid reflecting the beam on instrument
surfaces which could reflect into neighboring tissues and the
eye of the operator.
LASER GINGIVECTOMY
It is not recommended to use laser for periodontal surgery as it is not
supported by research .

18.  Techniques to remove the gingiva using chemicals such
as 5% paraformaldehyde or potassium hydroxide have
been described in the past but are not currently used.
GINGIVECTOMY BY CHEMOSURGERY

19. Its Disadvantages :
The depth of action cannot be controlled so the healthy
attached tissue underlying the pocket may be injured.
Gingival remodeling cannot be accomplished effectively .
Epithelialization and reformation of the junctional
epithelium and reestablishment of the alveolar crest fiber
system are slower in chemically treated gingival wounds
than in those produced by a scalpel.
SO The use of chemical methods are not recommended.