Curettage, Gingivoplasty & Gingivectomy            INDIAN DENTAL ACADEMY         Leader in Continuing Dental Education    ...
Curettage                            Contents what is curettage ?Aim & Rationale Curettage & Esthetics IndicationsBas...
Introductionwww.indiandentalacademy.com
History(Hirschfeld L Subgingival curettage in periodontal treatment. J AmDent Ass 1952; 44:301-314).          www.indiande...
What is curettage ?Curettage in periodontics means the scraping of the gingival wall of aperiodontal pocket to separate di...
TYPESGingival curettageSubgingival curettageInadvertent curettage      www.indiandentalacademy.com
Aim & Rationale o f Curettage   Aim is to reduce pocket depth by enhancing gingival shrinkage, newconnective tissue attach...
Removal of granulation tissue                   Flap surgery - technical ratherCurettage                   than biologic r...
Curettage in treatment of gingivitis ??  Reconstitution of a normal gingival plexus of bl.vessels in tissues ….  altered b...
Curettage & EstheticsCurrently, esthetics is a major consideration of therapy (anterior & requires preservation of the int...
INDICATIONSAs part of new attachment attemptsAs a nondefinitive procedure to reduce inflammation prior to pocketeliminatio...
Indications & ContraindicationsIndications   1. Edematous and inflamed tissues   2. Shallow pockets   3. Suprabonypockets ...
Procedure for CurettageBasic Technique   Does not eliminate the causes of inflammation   (i.e., bacterial plaque and depos...
In subgingival curettage, the tissues attached between the bottom ofpocket and alveolar crests are removed with a scooping...
www.indiandentalacademy.com
www.indiandentalacademy.com
Other Techniques1) Excisional new attachment procedure (ENAP)2) Ultrasonic curettage3)Chemical curettage4 ) Laser curettag...
Excisional New Attachment Procedure(ENAP)   U.S. Naval Dental Corps   Yukna et al. (1976), ..attempt to overcome limitatio...
ENAPIndications   1. Suprabony pockets   2. Adequate keratinized tissue   3. When esthetics are unimportantAdvantages   1....
ENAPDisadvantages   1. Difficult to determine apical extent of epithelial attachment   2. Does not result in new attachmen...
Technique – ENAP Internal bevel incisionRemove the excised tissue with acurette, & RP…preserve the ctApproximate the wound...
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
Modified E.N.A.P. Technique                  DIAG In 1977, Fredi and Rosenfeld modified the technique…… partial-thickness,...
Ultrasonic Curettage.Ultrasonic vibrations disrupt tissue continuity, lift off epithelium,dismember collagen bundles, & al...
CHEMICAL CURETTAGE   Drugs such as sodium sulfide, alkaline sodium hypochlorite solution  (Antiformin), & phenol have been...
Laser curettagewww.indiandentalacademy.com
Laser curettage    The goals …are epithelial removal, as with previous methods & in    addition, bacterial reduction.    A...
Laser ENAPA recent commercial advertisement describes a "revolutionary . .breakthrough in periodontal surgery that regener...
Statement Regarding Use of Dental Lasers forExcisional New Attachment Procedure (ENAP)The Academy is not aware of any publ...
In conclusion, The Academy is not aware of any randomized blinded     controlled longitudinal clinical trials, cohort or l...
Laser gingivectomy    www.indiandentalacademy.com
HEALING AFTER SCALING AND CURETTAGE Immediately after curettage - a blood clot Hemorrhage ….polymorphonuclear leukocytes a...
CLINICAL APPEARANCE AFTER CURETTAGE  Immediately after curettage, the gingiva appears hemorrhagic and  bright red.  After ...
The American Academy of Periodontology StatementRegarding Gingival Curettage  The actual result ……..long JE, which is the ...
The American Academy of Periodontology StatementRegarding Gingival Curettage   The consensus report of the Proceedings of ...
The American Academy of PeriodontologyStatement Regarding Gingival Curettage   ADA has deleted the code from the fourth ed...
Gingivectomy and Gingivoplasty     www.indiandentalacademy.com
ContentsHistoryDefinition & RationaleIndications & ContraindicationsSurgical GingivectomyGingivoplastyHealing after Surgic...
IntroductionWhat happens if your teeth look too small,too wide, too short or are not symmetricalin size?Do you have a "gum...
HistoryROBICSEC (1884)GRANT ET AL (1979) – Excision of the soft tissue wall of pathologicperiodontal pocketROBICSEC (1884)...
Definition  Gingivectomy is the Excisional removal of gingival tissue for pocket  reduction or elimination.  Gingivoplasty...
Rationale   1. Pocket elimination for root accessibility   2. Establish physiologic gingival contoursIndications   1. Supr...
Contraindications   1. An inadequate zone of keratinized tissue   2. Pockets that extend beyond the Mucogingival line   3....
Advantages   1. Predictability   2. Simplicity   3. Ease of pocket elimination   4. Good access   5. Favorable esthetic re...
Gingivectomy Technique  www.indiandentalacademy.com
InstrumentsLocal anesthetic syringes, needles & anesthetic solutionGoIdman-Fox periodontal scissorsFox gingivoplasty diamo...
Presurgical PhaseReduce gross inflammation & remove local factors (calculus, plaque,or overhanging restorations).After ini...
Pocket Marking       www.indiandentalacademy.com
Incisions  Continuous or Discontinuous                                 Scalpel or GV knife                                ...
SURGIAL GINGIVECTOMYwww.indiandentalacademy.com
www.indiandentalacademy.com
Gingivectomy Incision www.indiandentalacademy.com
Ledge and Wedge & Internal Bevel    Gingivectomy Techniques   www.indiandentalacademy.com
www.indiandentalacademy.com
GingivoplastyPurpose is different.Gingivectomy is performed to eliminate periodontal pockets andincludes reshaping as part...
Healing after Surgical GingivectomyClot - granulation tissue.By 24 hours, there is an increase in new connective tissueThe...
During first 4 weeks after gingivectomy, keratinization is less than itwas prior to surgery.Complete epithelial repair tak...
Gingivectomy by ElectrosurgeryAdvantages   Electrosurgery permits an adequate contouring of the tissue   and controls hemo...
Therefore the use o f electrosurgery should be limited to superficialprocedures such as removal of gingival enlargements, ...
Technique The removal of gingival enlargements and gingivoplasty is performed with the needle electrode, supplemented by t...
Healing after ElectrosurgerySome investigators report no significant differences in gingival healingafter resection by ele...
Laser Gingivectomywww.indiandentalacademy.com
Laser GingivectomyThe lasers most commonly are (CO2) and (Nd:YAG), which havewavelengths of 10,600 nm &1064 nm, respective...
The Use of the CO2 Laser for the Removal of Phenytoin Hyperplasia Robert M. Pick,Bernard JP 1985 Aug (492 - 496):Twelve ca...
Gingivectomy by Chemosurgery   5% paraformaldehyde or potassium hydroxide   They are presented here to provide a historica...
ReferencesClinical Periodontology – Carranza - 9 Th EditionClinical Periodontology And Implant Surgery – Jan Lindhe- 4th E...
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Gingival Curettage / /certified fixed orthodontic courses by Indian dental academy

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Gingival Curettage / /certified fixed orthodontic courses by Indian dental academy

  1. 1. Curettage, Gingivoplasty & Gingivectomy INDIAN DENTAL ACADEMY Leader in Continuing Dental Education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. Curettage Contents what is curettage ?Aim & Rationale Curettage & Esthetics IndicationsBasic Technique Other Techniques Healing and appearance after curettage www.indiandentalacademy.com
  3. 3. Introductionwww.indiandentalacademy.com
  4. 4. History(Hirschfeld L Subgingival curettage in periodontal treatment. J AmDent Ass 1952; 44:301-314). www.indiandentalacademy.com
  5. 5. What is curettage ?Curettage in periodontics means the scraping of the gingival wall of aperiodontal pocket to separate diseased soft tissue.closed, definitive surgical procedure - pocket reduction, elimination,reattachment, or new attachment.Scaling and root planing may inadvertentlyIt is performed with sharp curettes in an attempt to remove (1) thesulcular epithelium & epithelial attachment, & (2) the inflamedconnective tissue of the pocket wall www.indiandentalacademy.com
  6. 6. TYPESGingival curettageSubgingival curettageInadvertent curettage www.indiandentalacademy.com
  7. 7. Aim & Rationale o f Curettage Aim is to reduce pocket depth by enhancing gingival shrinkage, newconnective tissue attachment, or both. Rationale Therefore the need for curettage just to eliminate the inflamed granulation tissue appears questionable www.indiandentalacademy.com
  8. 8. Removal of granulation tissue Flap surgery - technical ratherCurettage than biologic reasons www.indiandentalacademy.com
  9. 9. Curettage in treatment of gingivitis ?? Reconstitution of a normal gingival plexus of bl.vessels in tissues …. altered by chronic inflammation. May not allow for normal metabolic interchange Curettage …resolve ….optimal revascularization ….regenerated gingiva Not supported(Loe, Theilade , Tensen – Experimental gingivitis in man JP: 36 : 177 : 1965 ) www.indiandentalacademy.com
  10. 10. Curettage & EstheticsCurrently, esthetics is a major consideration of therapy (anterior & requires preservation of the interdental papilla)When regenerative therapy is not possible, every effort should bemade to minimize shrinkage - avoiding gingival curettagePapilla Preservation TechniqueRoot planing apical to the base of the pocket - removal of the JE &disruption of CT attachment. www.indiandentalacademy.com
  11. 11. INDICATIONSAs part of new attachment attemptsAs a nondefinitive procedure to reduce inflammation prior to pocketelimination & Compromised patientsRecall visits as a method of maintenance treatment for areas of recurrent inflammation www.indiandentalacademy.com
  12. 12. Indications & ContraindicationsIndications 1. Edematous and inflamed tissues 2. Shallow pockets 3. Suprabonypockets 4. As part of initial preparation prior to open surgical procedures in an attempt to achieve tissue quality that can be handled easily 5. Progressive attachment or alveolar bone loss 6. Increased levels of pathogenic microorganismsContraindications 1. Fibrotic tissue 2. Deep pockets 3. Furcation involvements 4. Treatment of underlying osseous defects www.indiandentalacademy.com
  13. 13. Procedure for CurettageBasic Technique Does not eliminate the causes of inflammation (i.e., bacterial plaque and deposits).- preceded by SRP Gingival curettage always requires some type of local anesthesia. The curette is selected so that the cutting edge will be against the tissue (e.g., the Gracey No. 13-14 is used for mesial surfaces and the Gracey No. 11-12 for distal surfaces).4R-4L Columbia Universal curette Engage the inner lining of the pocket wall - horizontal stroke Pocket wall - supported by gentle finger pressure www.indiandentalacademy.com on the external surface.
  14. 14. In subgingival curettage, the tissues attached between the bottom ofpocket and alveolar crests are removed with a scooping motion ofcurette to the tooth surfaceThe area is flushed to remove debris, and the tissue is partly adaptedto the tooth by gentle finger pressure.Sometimes suturing of separated papillae and application of aperiodontal pack may be indicated. www.indiandentalacademy.com
  15. 15. www.indiandentalacademy.com
  16. 16. www.indiandentalacademy.com
  17. 17. Other Techniques1) Excisional new attachment procedure (ENAP)2) Ultrasonic curettage3)Chemical curettage4 ) Laser curettage www.indiandentalacademy.com
  18. 18. Excisional New Attachment Procedure(ENAP) U.S. Naval Dental Corps Yukna et al. (1976), ..attempt to overcome limitations of closed gingival curettage & gain new attachment in areas of suprabony pockets. The E.N.A.P, unlike scaling and curettage, was developed to ensure complete removal of sulcular epithelium, epithelial attachment, granulated & inflamed connective tissue, subgingival calculus, & softened cementum. Basically, it is curettage with a surgical blade, which increases access www.indiandentalacademy.com & visibility with minimal tissue reflection.
  19. 19. ENAPIndications 1. Suprabony pockets 2. Adequate keratinized tissue 3. When esthetics are unimportantAdvantages 1. Improved root visualization 2. Complete removal of sulcular epithelium & epithelial attachment 3. Minimal gingival trauma 4. No loss of keratinized gingiva www.indiandentalacademy.com
  20. 20. ENAPDisadvantages 1. Difficult to determine apical extent of epithelial attachment 2. Does not result in new attachmentContraindications 1. Pockets exceed Mucogingival junction 2. Edematous tissue 3. Lack of keratinized tissue 4. Osseous defects have to be treated 5. Hyper plastic tissue 6. Close root proximity 7. Furcation involvement www.indiandentalacademy.com
  21. 21. Technique – ENAP Internal bevel incisionRemove the excised tissue with acurette, & RP…preserve the ctApproximate the wound edges www.indiandentalacademy.com
  22. 22. www.indiandentalacademy.com
  23. 23. www.indiandentalacademy.com
  24. 24. www.indiandentalacademy.com
  25. 25. Modified E.N.A.P. Technique DIAG In 1977, Fredi and Rosenfeld modified the technique…… partial-thickness, inverse beveled incision down to the crest of the bone to completely remove tissue about the periodontal ligament The flaps were then sutured at the presurgical height The technique is basically the same in all other aspects. www.indiandentalacademy.com
  26. 26. Ultrasonic Curettage.Ultrasonic vibrations disrupt tissue continuity, lift off epithelium,dismember collagen bundles, & alter the morphologic features offibroblast nuclei.debriding the epithelial lining of pdl pockets - narrow band of necrotictissue (microcauterization), which strips off the inner lining of thepocket.The Morse scaler-shaped and rod-shaped instrumentsUltrasonic instruments to be as effective as manual instruments ……lessinflammation and less removal of underlying CT www.indiandentalacademy.com(sanderson :curettage by hand & ultrasonics inst- a histologic comparison . JP 1966 : 37 :279 )
  27. 27. CHEMICAL CURETTAGE Drugs such as sodium sulfide, alkaline sodium hypochlorite solution (Antiformin), & phenol have been proposed & then discarded after studies showed their ineffectivenes.(Beube: Exp study of sodium sulphide sol in treatment of PDL pockets. Texas Dent Jr 1953)(Glickman : Effect of antiformin on soft tissue wall of PDL pockets . JAMA 1955: 344) The extent of tissue destruction …..cannot be controlled, may increase rather than reduce the amount of tissue to be removed by enzymes and phagocytes. www.indiandentalacademy.com
  28. 28. Laser curettagewww.indiandentalacademy.com
  29. 29. Laser curettage The goals …are epithelial removal, as with previous methods & in addition, bacterial reduction. A short-term study reported that Nd:YAG laser treatment did not produce statistically significant bacterial reduction .(Radvar, Mc Farlane : An evaluation of Nd:YAG laser treatment in PDL pocket therapy ; BDJ 1996 ) Confirmed in a multicenter study of laser curettage, which reported that bacterial reduction was not often achieved. Only 1 of the 3 centers reported a advantage in bacterial reduction over SRP alone. One pilot and follow-p study did report bacterial reduction with a diode laser; however, the laser treatment was repeated, while the SRP was not. (Greenwell, Harris et al :Clinical evaluation of Nd:YAG laser curettage on periodontitis : JDR 1999 : Abs 2833 )(Neill , Mellonig : Clinical efficacy of Nd:YAG laser for combination PDL therapy : Pract Periodontics www.indiandentalacademy.com Aesthetics Dent 1997 : 9 : 1-5)
  30. 30. Laser ENAPA recent commercial advertisement describes a "revolutionary . .breakthrough in periodontal surgery that regenerates new attachment"through the application of "a Laser ENAP procedure."Despite FDA approval for sulcular debridement, the use of lasers for ENAPand gingival curettage as proposed in the advertisement and several recentjournal articles should be evaluated in light of the available evidence. www.indiandentalacademy.com
  31. 31. Statement Regarding Use of Dental Lasers forExcisional New Attachment Procedure (ENAP)The Academy is not aware of any published data that indicates that theENAP laser procedure is any more effective for these purposes thantraditional scaling and planing.To date, there are only four published human studies involving a total of 57patients that have evaluated the effects of subgingival laser application.All four papers report reductions in putative periodontal pathogenicmicrobes following laser treatment. Two of the papers also reported laserinduced root damage. The remaining two papers did not evaluate treatedteeth for root damage. www.indiandentalacademy.com
  32. 32. In conclusion, The Academy is not aware of any randomized blinded controlled longitudinal clinical trials, cohort or longitudinal studies, or case-controlled studies indicating that "laser ENAP" or "laser curettage" offers any advantageous clinical result not achieved by traditional periodontal therapy.Moreover, published studies suggest that use of lasers for ENAP procedures and/or gingival curettage could render root surfaces and adjacent alveolar bone incompatible with normal cell attachment and healing.(Millennium Dental Technologies, Inc. Dent Prod Report 1999;33 (May):40. Epstein SR. Curettage revisited: laser therapy. Pract Periodontic Aesthet Dent 1992;4:27-32.Gold SI, Vilardi MA. Pulsed laser beam effects on gingiva. J Clin Periodontol 1994;21:391-396.Ben Hatit Y, Blum R, Severin C, Maquin M, Jabro MH. The effects of a pulsed Nd:YAG laser on subgingival bacterial flora www.indiandentalacademy.com and on cementum: an in vivo study. J Clin Laser Med Surg 1996;14:137-143. )
  33. 33. Laser gingivectomy www.indiandentalacademy.com
  34. 34. HEALING AFTER SCALING AND CURETTAGE Immediately after curettage - a blood clot Hemorrhage ….polymorphonuclear leukocytes appear shortly Rapid proliferation of granulation tissue Restoration and epithelialization of the sulcus require 2 to 7 days Restoration of the JE - 5 days after treatment. Immature collagen fibers - 21 days. www.indiandentalacademy.com
  35. 35. CLINICAL APPEARANCE AFTER CURETTAGE Immediately after curettage, the gingiva appears hemorrhagic and bright red. After 1 week, the gingiva appears reduced in height - apical shift in the position of the gingival margin. The gingiva is also slightly redder than normal After 2 weeks - normal color, consistency, surface texture, and contour of the gingiva are attained www.indiandentalacademy.com
  36. 36. The American Academy of Periodontology StatementRegarding Gingival Curettage The actual result ……..long JE, which is the same result with SRP alone. The theoretical clinical advantage of curettage over SRP alone was eliminated when new CT attachment was shown --unattainable goal. Short- and long-term clinical trials have confirmed that gingival curettage provides no additional benefit when compared to SRP alone in terms of PD reduction, attachment gain, or inflammation reduction. www.indiandentalacademy.com
  37. 37. The American Academy of Periodontology StatementRegarding Gingival Curettage The consensus report of the Proceedings of the World Workshop in Clinical Periodontics (1989) concluded : "Gingival curettage as a separate procedure has no justifiable application during active therapy for chronic adult periodontitis. While gingival curettage is defined as being performed with a curet, other methods have been reported. … same goal – no clinical or microbial advantage – Chemical , Ultrasonic & Laser curettage www.indiandentalacademy.com
  38. 38. The American Academy of PeriodontologyStatement Regarding Gingival Curettage ADA has deleted the code from the fourth edition of Current Dental Terminology (CDT-4). In addition, the American Academy of Periodontology, in its Guidelines for Periodontal Therapy did not include gingival curettage as a method of treatment. This indicates that the dental community as a whole regards gingival curettage as a procedure with no clinical value. www.indiandentalacademy.com
  39. 39. Gingivectomy and Gingivoplasty www.indiandentalacademy.com
  40. 40. ContentsHistoryDefinition & RationaleIndications & ContraindicationsSurgical GingivectomyGingivoplastyHealing after Surgical GingivectomyGingivectomy by ElectrosurgeryHealing after ElectrosurgeryGingivectomy by ChemosurgeryLaser Gingivectomy www.indiandentalacademy.com
  41. 41. IntroductionWhat happens if your teeth look too small,too wide, too short or are not symmetricalin size?Do you have a "gummy smile"? www.indiandentalacademy.com
  42. 42. HistoryROBICSEC (1884)GRANT ET AL (1979) – Excision of the soft tissue wall of pathologicperiodontal pocketROBICSEC (1884) & ZENTLER (1918)Stern IB; Everett FG; S. Robicsek - a pioneer in the surgical treatmentof periodontal disease. J Periodontol 1965; 36:265-268Goldman HM The development of physiologic gingival contours bygingivoplasty. Oral Surg Oral Med Oral Pathol 1950; 3:879-888 www.indiandentalacademy.com
  43. 43. Definition Gingivectomy is the Excisional removal of gingival tissue for pocket reduction or elimination. Gingivoplasty is the reshaping of the gingiva to attain a more physiologic contourGingivectomy and gingivoplasty are usually performed at the same time www.indiandentalacademy.com
  44. 44. Rationale 1. Pocket elimination for root accessibility 2. Establish physiologic gingival contoursIndications 1. Suprabony pockets 2. An adequate zone of keratinized tissue 3. Pockets greater than 3 mm 4. When bone loss is horizontal and no need exists for osseous surgery 5. Gingival enlargements 6. Areas of limited access 7. Unaesthetic or asymmetrical gingival topography 8. For exposure of soft-tissue impaction to enhance eruption 9. To facilitate restorative dentistry www.indiandentalacademy.com
  45. 45. Contraindications 1. An inadequate zone of keratinized tissue 2. Pockets that extend beyond the Mucogingival line 3. The need for osseous resection or inductive techniques 4. Highly inflamed or edematous tissue 5. Areas of esthetic compromise 6. Shallow palatal vaults and prominent external oblique ridges. 7. Treatment of intrabony pockets 8. Patients with poor oral hygiene www.indiandentalacademy.com
  46. 46. Advantages 1. Predictability 2. Simplicity 3. Ease of pocket elimination 4. Good access 5. Favorable esthetic resultsDisadvantages 1. Healing by secondary intention 2. Bleeding postoperatively 3. Loss of keratinized gingiva 4. Inability to treat underlying osseous deformities www.indiandentalacademy.com
  47. 47. Gingivectomy Technique www.indiandentalacademy.com
  48. 48. InstrumentsLocal anesthetic syringes, needles & anesthetic solutionGoIdman-Fox periodontal scissorsFox gingivoplasty diamond bursCotton surgical spongesPeriodontal mirrorCotton pliersPeriodontal probeCrane-Kaplan periodontal pocket markersKirkland 17 broad bladed GV knifeOrban sharp bladed GV knifeColumbia 4R 4Lor 2 R/2L curettesGoldman-Fox tissue nippersMinnesota surgical retractorSurgical aspirator tip www.indiandentalacademy.com
  49. 49. Presurgical PhaseReduce gross inflammation & remove local factors (calculus, plaque,or overhanging restorations).After initial healing, zone of attached tissue can be assessed properly.Adequate local anesthesia is given. ….. vasoconstrictor.Pockets are probed ..check depth and make sure they do not extendbeyond the Mucogingival junctionBy sounding, the osseous topography is determined and the need forosseous surgery determined www.indiandentalacademy.com
  50. 50. Pocket Marking www.indiandentalacademy.com
  51. 51. Incisions Continuous or Discontinuous Scalpel or GV knife Bevel of 45 www.indiandentalacademy.com
  52. 52. SURGIAL GINGIVECTOMYwww.indiandentalacademy.com
  53. 53. www.indiandentalacademy.com
  54. 54. Gingivectomy Incision www.indiandentalacademy.com
  55. 55. Ledge and Wedge & Internal Bevel Gingivectomy Techniques www.indiandentalacademy.com
  56. 56. www.indiandentalacademy.com
  57. 57. GingivoplastyPurpose is different.Gingivectomy is performed to eliminate periodontal pockets andincludes reshaping as part of the technique.Gingivoplasty is a reshaping of the gingiva to create physiologicgingival contours, with the sole purpose of recontouring the gingiva intheabsence of pockets.Gingivoplasty may be done with a periodontal knife, a scalpel, rotary www.indiandentalacademy.com
  58. 58. Healing after Surgical GingivectomyClot - granulation tissue.By 24 hours, there is an increase in new connective tissueThe highly vascular granulation tissue grows coronally, creating anew free gingival margin and sulcus. Capillaries ..and within 2 weeksthe connect with gingival vessels .After 12 to 24 hours, epithelial cells at the margins of the wound start tomigrate over the granulation tissueEpithelial activity at the margins reaches a peak in 24 to 36 hours.The epithelialcells advance by a tumbling action, with the cells becoming fixed to thesubstrate by hemidesmosomes and a new basement laminaSurface epithelization is generally complete after 5 to 14 days. www.indiandentalacademy.com
  59. 59. During first 4 weeks after gingivectomy, keratinization is less than itwas prior to surgery.Complete epithelial repair takes about 1 month. Vasodilation andvascularity begin to decreaseComplete repair of the connective tissue takes about 7 weeks. gingivalfluid in humans is initially increased after gingivectomy & diminishesas healing progresses.Maximal flow is reached after 1 weekPostgingivectomy healing are the same in all individuals, the timerequired for complete healing varies depending on the area of the cutsurface and interference from local irritation and infection. www.indiandentalacademy.com
  60. 60. Gingivectomy by ElectrosurgeryAdvantages Electrosurgery permits an adequate contouring of the tissue and controls hemorrhageDisadvantages Noncompatible or poorly shielded cardiac pacemakers. Unpleasant odor. If the electrosurgery point touches the bone, irreparable damage can be done Cementum burn. www.indiandentalacademy.com
  61. 61. Therefore the use o f electrosurgery should be limited to superficialprocedures such as removal of gingival enlargements, gingivoplasty,relocation of frenum and muscle attachments, and incision ofperiodontal abscesses and pericoronal flaps; extreme care should beexercised to avoid contacting the tooth surface.It should not be used for procedures that involve proximity to thebonesuch as flap operations, or mucogingival surgery. www.indiandentalacademy.com
  62. 62. Technique The removal of gingival enlargements and gingivoplasty is performed with the needle electrode, supplemented by the small ovoid loop or the diamond-shaped electrodes for festooning. A blended cutting and coagulating (fully rectified) current is used. In all reshaping procedures, the electrode is activated and moved in a concise "shaving" motion. For hemostasis, the ball electrode is used. Electrosurgery is helpful for the control of isolated bleeding points. Bleeding areas located www.indiandentalacademy.com interproximally are reached with a thin, bar shaped
  63. 63. Healing after ElectrosurgerySome investigators report no significant differences in gingival healingafter resection by electrosurgery and resection with periodontal knives;other researchers find delayed healing, greater reduction in gingivalheight, and more bone injury after electrosurgery.There appears to be little difference in the results obtained aftershallow gingival resection with electrosurgery and that withperiodontal knives. However, when used for deep resections close tobone, electrosurgery can produce gingival recession, bone necrosisand sequestration, loss o f bone height, furcation exposure, and toothmobility, which do not occur with the use of periodontal knives www.indiandentalacademy.com
  64. 64. Laser Gingivectomywww.indiandentalacademy.com
  65. 65. Laser GingivectomyThe lasers most commonly are (CO2) and (Nd:YAG), which havewavelengths of 10,600 nm &1064 nm, respectively, both in the infraredrangeThe CO2 laser beam has been used for the excision of gingival growths,although healing is delayed when compared with healing afterconventional scalpel gingivectomy.The use of laser beam for oral surgery requires precautionary measures toavoid reflecting the beam on instrument surfaces, which could result ininjury to neighboring tissues and the eyes of the operator.At present, the use of lasers for periodontal surgery is not supported by www.indiandentalacademy.com
  66. 66. The Use of the CO2 Laser for the Removal of Phenytoin Hyperplasia Robert M. Pick,Bernard JP 1985 Aug (492 - 496):Twelve cases using the CO2 surgical laser for the removal of phenytoin (Dilantin) hyperplasia have been performedSurgical Treatment of Cyclosporine A- and Nifedipine-InducedGingival Enlargement: Gingivectomy Versus Periodontal Flap.JP1998 : 69 : 791(Andrea Pilloni, Paulo M. Camargo, Mauro Carere,and Fermin A. Carranza, Jr.)An evaluation of ND ; YAG laser to improve clinical andmicrobiological paraeters of periodontal disease ( BDJ : 1996 ) www.indiandentalacademy.com
  67. 67. Gingivectomy by Chemosurgery 5% paraformaldehyde or potassium hydroxide They are presented here to provide a historical perspective.Disadvantages: 1. The depth of action cannot be controlled 2. Gingival remodeling cannot be accomplished effectively. 3. 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. www.indiandentalacademy.comThe use of chemical methods therefore is not recommended.
  68. 68. ReferencesClinical Periodontology – Carranza - 9 Th EditionClinical Periodontology And Implant Surgery – Jan Lindhe- 4th Edition.Position Papers – American Academy of PeriodontologyPeriodontology & Periodontics : Sigurd P RamfjordPeriodontics : Louise Rose , Brian MealeyPeriodontal Therapy – Clinical Approaches And Evidence OfSuccess – James Mellonig & Myron NevinsGuide To Periodontics-2 Edition – W W M JenkinsNet references www.indiandentalacademy.com

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