procedures of periodontal surgery(gingival surgery) is one the most important surgical part in periodontology and endodontics.

1. PROCEDURES OF
PERIODONTAL
SURGERY(GINGIVAL
SURGERY)
Dr. LIDETU AFEWORK ANJULO and
Dr. BETHEL MESFIN SEYOUM
WOLAITA SODO UNIVERSITY

2. INTRODUCTION
Historically periodontal surgery is resective, mean cut and
remove damaged infected periodontal tissues
Modern periodontal surgery emphasis on rebuild and
regeneration of lost periodontal tissues
Most periodontal surgical technique begin by performing
periodontal flap

3. Out comes of periodontal surgery
Formation of long junctional epithelium
Resolution of inflammation and the associated periodontal
pocket
Regeneration which is expectation of some periodontal
surgery not in non surgical periodontal therapy

4. Indication of periodontal surgery
• To provide access for
improved periodontal
instrumentation of root
surface
• To reduce pocket
depths
• To provide access to
periodontal osseous
defect
• To resect or remove
tissues
• To graft bone or bone
stimulating material
into osseous defects
• To allow placement of
dental implant

5. Contraindication of periodontal surgery
oPts who have certain
systemic diseases and
condition
oPts who are totally
incompliant with self
care
oPts who have a high risk
for dental caries
 Pts who have unrealistic
expectation for surgical
outcomes

6. PROCEDURES OF PERIODONTAL
SURGERY(GINGIVAL SURGERY)
A. Initial preparation
• Oral hygiene instruction
• Sub gingival debridement's
• Removal of cervical decay
• Correcting of overhanging restoration

7. B.Re-evaluation phase
• To asses patient compliance
• Plaque control
• Reduction in inflammations
• Pocket depth
• Furcussion involvements
• Tooth mobility

8. C.Surgical phase
• Initial effort may eliminate the need for surgery
• If patient fails to practice good plaque control periodontal
disease may recur after surgery
• So attention must given for plaque control

9. INDICATION FOR GINGIVAL SURGERY
• Elimination of pseudo pockets
• To correct changes in gingiva without thick bony ridges or
craters .
• Esthetics
• Function

11. CONTRAINDICATION OF GINGIVAL
SURGERY
1.Bony defects
If true periodontal pocket are presents then bone loss must
have occurred so epithelium attachments moved apically
Bone loss commonly occurs in between teeth creating
proximal intrabony defects
The presence of bony craters or ridges preclude the use of
gingivectomy

13. 2.Adequate band of gingiva
Adequate band of gingiva is needed about 2mm can be
used as guide
3.cosmotic concern
Gingivectomy may result in clinical crown and dark
interproximal area
long clinical crown
darkness.

14. TYPES OF GINGIVAL SURGERY
1.GINGIVAL CURATTAGE
2.GINGIVECTOMY.
EXTERNAL BEVELING GINGIVECTOMY (EBG)
INTERNAL BEVELING GINGIVECTOMY(IBG)
3.GINGIVOPLASTY

15. 1.GINGIVAL CURATTAGE
• Deals with inner side of gingival pockets
• It is removing of bacterial deposits in inner surface of
gingiva .
• It is scraping of gingival pockets
• Removal of chronically inflamed granulation tissue that
forms in lateral walls of periodontal pockets.
• Local anesthesia is often used

16. 2.Gingivectomy
A.EBG.
. It is classic form
.The entire soft walls of pseudo pockets including sulcular
,junctional &oral epithelium are removed.

17. Technical procedures
1.Provide anesthesia
2.Create bleeding points
3.Make incision
4.Remove interproximal tissues
5. Contour surface
6.Remove previously missed calculus & tissue
7.Apply dressing

18. Fig. Gingivectomy. The straight incision technique
Fig. Gingivectomy. The scalloped incision technique

19. Bleeding points

20. Conti…

21. Conti…

22. Conti…

23. B.INTERNAL BEVELING
GINGIVECTOMY
• IBG.it is used instead of an EBG.if tissue to be excised is
thick e.g. palate
• The resultant large wound of EBG devoid of surface
epithelium and can be painful and slow to heal.

25. Character of IBG
• More difficult & time consuming
• Involve thinning of gingiva from an internal aspect
projecting to through the tissue to the alveolar crest where
incision end .
• IBG must be sutured
• Post surgical surface is a layer of epithelium while in EBG
it is raw connective tissue
• Dressing is also not required.

29. 3.Gingivoplasty
• It is surface reshaping of gingival deformities for the
purpose of creating a more easily cleaned physiologic
form .
• It differs from other gingival surgery it does not remove
the junctional or sulcular epithelium & does not reduce
probing depth
• It can be used alone or more commonly as part of EBG .

30. HEALING AFTER GINGIVECTOMY
• First formation of protecting surface
• Clot of blood underlying tissue became acutely inflammed
with some necrosis.
• Then clot will be replaced by granulation tissue
• By 24 hours increased connective tissue and healing will
be achieved.