gingival curettage

1. Gingival Curettage
Wilkins, chapter

2. Learning Objectives
• Distinguish between gingival and
subgingival curettage
• Identify the indications &
contraindications for gingival
curettage
• Describe the procedure
• Describe the healing that takes place
following curettage

3. Introduction
• Refers to the scraping of the pocket
wall
• Separates diseased soft tissue
• Inadvertent curettage occurs with
periodontal debridement

4. Definitions
• Gingival Curettage:
– Removal of inflamed soft tissue
• Removes diseased sulcular & junctional
epithelium
– Indications: pseudopockets, shallow
true pockets
– Objective: gingival shrinkage

5. Definitions
• Subgingival Curettage:
– Performed apical to epithelial
attachment
• Removes connective tissue attachment
down to alveolar crest
– Indications: deep pockets
– Objectives: reattachment

6. Rationale
• Removes granulation tissue
– Within granulation tissue we find:
• Areas of chronic inflammation
• Bacteria, calculus
– Epithelial tissue lines granulation tissue
• May pose barrier to new fiber attachment

7. Rationale
• However,
– Granulation tissue slowly resorbs
following debridement
– Bacteria eliminated
– Tissue heals
• Questionable:
– Whether curettage significantly
improves health of tissue beyond what
is seen with periodontal debridement

8. Indications
• Generally limited:
– Moderately deep infrabony pockets
where new attachment attempted
• Closed surgery advised
• Technically difficult procedure
• Inadequate accessibility
– When surgical techniques not advised
• Due to age, systemic problems
• Goal of pocket elimination compromised

9. Indications
• Maintenance therapy
– In areas of chronic inflammation,
especially if client has had pocket
reduction surgery

10. Basic Technique
• Periodontal debridement performed
prior to curettage
• Tissues anaesthesized
• Appropriate selection of instruments
– Curettes, universal curette
• Curette blade placed against tissue
– Horizontal stroke

11. Basic Technique
• Irrigate tissues to flush out debris
• Gentle finger pressure applied to
adapt tissues
• Separated interdental papillae may
require sutures
• Surgical dressing may be indicated

12. Other Techniques
• Excisional New Attachment
Procedure
• Ultrasonic Curettage
• Chemical Curettage
• Laser Fiber Curettage
• Students can do their own research
on the above techniques

13. Healing Following Debridement
& Curettage
• Uneventful healing
• Formation of long junctional
epithelium
• No significant differences when
compared to debridement therapy
alone

14. Curettage using Laser Fiber
Fiber tip slowly inserted into pocket
& kept parallel to tooth
Usually painless
Moved apically until pocket base
reached
Vaporizing of pocket
epithelium, subgingival
plaque & some granulation
tissue occurs

15. Curettage using Laser Fiber
Fiber, held in contact with root
surface, is slowly moved
coronally & withdrawn
This vaporizes microbial debris
on root surface
Any remaining deposits can be
removed with a curette

16. Results of Curettage - Laser
Fiber
Before treatment –
pockets measure 7-8
mm

17. Results of Curettage - Laser
Fiber
Just after treatment
3 months after
treatment – 3 mm
pockets