The document discusses gingival curettage, which involves scraping diseased soft tissue from periodontal pockets. It describes different types of curettage including surgical, chemical, ultrasonic, and laser. Indications for curettage include shallow pockets and as maintenance treatment for recurrent inflammation. Contraindications include acute infections and pockets extending beyond the mucogingival junction. The procedure involves scraping the pocket wall with a curette. Excisional new attachment procedure is also discussed, which uses gingival incision followed by root planing. Healing after curettage involves blood clot formation, leukocyte proliferation, and re-epithelialization within 7 days.

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Gingival Curettage
scraping of gingival wall of a periodontal pocket to separate diseased soft tissue
Scaling
refers to removal of deposits from tooth/ root surface
Root Planing
smoothening the root to remove infected and necrotic tooth surface

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TYPES
I. Gingival curettage:
Consists of removal of inflamed soft tissue lateral to pocket wall
a. Subgingival curettage:
It is a procedure that is performed apical to epithelial attachment
b. Inadvertent curettage:
Curettage that is done unintentionally during scaling and root planing.
II. Surgical curettage,
III. Chemical curettage,
IV. ultrasonic curettage.
V. Laser Tx

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INDICATIONS
1. In patients whom extensive surgery is contraindicated owing to systemic disease or
psychologic problems.
2. Shallow pocket depths with an adequate width and thickness of gingival tissue.
3. It can be performed as a part of new attachment attempts in moderately deep
intrabony pockets located in accessible areas.
4. Curettage can be performed on recall visits as a method of maintenance treatment
for areas of recurrent inflammation.
5. In suprabony pockets which do not extend beyond the mucogingival junction.

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CONTRAINDICATIONS
1. Presence of acute infections such as necrotizing ulcerative gingivitis (NUG).
2. Fibrous enlargement of gingiva such as phenytoin hyperplasia.
3. Extension of the base of the pocket apical to the mucogingival junction.
4. If the patient is medically compromised, the benefits versus the risks of the surgical
procedure should be carefully weighed before commiting the patient to the procedure.
5. Deep pockets ≥ 5mm
6. Furcation Involvement

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PROCEDURE
Curettage can be accomplished as a closed procedure with a sharp curette or as an
open procedure with a gingival incision followed by root planing (ENAP).
Basic Technique (With Curette)

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Excisional New Attachment Procedure (ENAP)
Indications
1. Suprabony pockets
2. Adequate keratinized tissue
3. When esthetics are unimportant
Contraindictions
1. Pockets exceed mucogingival junction
2. Edematous tissue
3. Lack of keratinized tissue
4. Osseous defects must be treated
5. Hyperplastic tissue
6. Close root proximity
7. Furcation involvement
8. Probing depths of 3 mm or less

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Advantages
1. Improved root visualization
2. Complete removal of sulcular epithelium and epithelial attachment
3. Minimal gingival trauma
4. No loss of keratinized gingiva
Disadvantages
1. Difficult to determine apical extent of epithelial attachment
2. Does not result in new attachment

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Ultrasonic Curettage
Sound energy absorbed at tissue junctions that take the form of heat, results in
coagulation. The coagulated epithelium is then removed by mechanical action of the
vibrations of ultrasonic instrument.
Chemical Curettage
Sodium sulphide, phenol, camphor, antiformin, and sodium hypochlorite have been
used for chemical curettage.
Solution applied for 1 minute. Then 5% citric acid solution is introduced into the pocket
for 1 minute to neutralize the sodium hypochlorite. The coagulated tissue is then
removed with a curette and pocket is flushed with saline to remove the remnants of the
connective tissue.
The extent of chemical penetration to the tissue cannot be controlled and thus,
chemical curettage is discarded.

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Laser
CO2 and Nd:YAG laser treatment
HEALING AFTER CURETTAGE
Gingival sulcus filled by blood clot immediately after curettage.
Abundant polymorphonuclear leukocytes occupy the wound site.
followed by rapid proliferation of granulation tissue.
Epithelium:  Sulcular epithelium is restored between 2 to 7 days
junctional epithelium:  as early as 5 days after curettage.
Connective tissue:  Immature collagen fibers appear within 21 days.

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