Gingivectomy is a procedure to remove a portion of gum tissue to treat gum disease or correct gum conditions around the teeth. It involves making incisions along the gumline and removing diseased gum tissue using scalpels or lasers. This helps reduce gum pockets and allows proper cleaning under the gumline. Gingivectomy can be done surgically using scalpels or via other methods like chemotherapy, electrosurgery, cryosurgery or lasers. Maintaining good oral hygiene is important after gingivectomy for proper healing and prevention of future gum problems.

1. GINGIVECTOMY

2. INTRODUCTION
• 80% of Filipinos suffer from dental problems
• Periodontal Disease is prevalent among elders
• GINGIVECTOMY may be performed to heal the effects of periodontal
disease or to correct a gum condition involving the structures around
the teeth

3. WHAT IS GINGIVECTOMY?

4. • Total removal of a portion
of a gingiva (gum) from in
and around the tooth in
order to treat gum disease
or to lengthen the height
or width of a teeth or
section of teeth
• one of a few procedures
that can help reverse
periodontal issues.

5. INDICATIONS
• Suprabony pocket
• Fibrous enlargement (pseudo pocket)
• Crown lengthening
• Perio aesthetic
• Suprabony periodontal abscess

7. CONTRAINDICATIONS
• Bone defect cannot be corrected
• Fragile gingiva
• Location of the base of the pocket apical to
mucogingival junction

8. TYPES OF GINGIVECTOMY
1. SURGICAL GINGIVECTOMY
2. GINGIVECTOMY BY CHEMOSURGERY
3. GINGIVECTOMY BY ELECTROSURGERY
4. GINGIVECTOMY BY CRYOSURGERY
5. GINGIVECTOMY BY LASER

9. SURGICAL GINGIVECTOMY
Instruments required in Surgical Gingivectomy
1. Crane Keplan Pocket marker
2. Kirkland periodontal knife
3. Orban periodontal knife
4. Bard- parker handle
5. Bard – parker blades no. 11&12
6. Supra and Subgingival Scalers
7. Curettes

11. STEPS IN SURGICAL GINGIVECTOMY
1. Anaesthetize the area
2. Mark the pocket
3. Resect the gingiva
4. Remove the granulation tissue
5. Remove calculus
6. Place periodontal pack

12. WHAT IS POCKET MARKING?
• Pocket on each surface are explored
with periodontal probe and marked
with the pocket marker at three
places on each tooth on each labial
and lingual surfaces
• Pocket should be marked
systematically beginning on distal
surface of the last tooth the moving
on the facial surface and proceeding
anteriorly to the midline

13. TYPES OF INCISION
INTERNAL BEVEL INCISION
A. Discontinuous – from the facial surface at distal angle of last tooth to
distofacial angle of the next tooth. Next incision begins in the
interdental space to distofacial angle of next tooth
B. Continuous – started on the facial surface from the disto angular
region and carried forward anteriorly following the course of the
pocket without interruption. Procedure is repeated on the lingual
surface
C. Distal Incision – facial and lingual incision are joined by an incision
across the distal surface of the last erupted tooth

15. STEPS IN SURGICAL GINGIVECTOMY
1. Start apical to points marking of the course of periodontal pocket and
is directed coronally to a point between the base of the pocket and
crest of the bone
2. Should be closed to bone but DO NOT exposed it
3. The incision should be beveled at approx. 45 degree to the tooth
surface to follow the normal festooned pattern of the gingiva
4. Should not leave diseased Pocket wall
5. The incision should pass completely through soft tissue to the tooth

16. • REMOVE RESECTED- GINGIVA
- Remove the marginal and interdental gingiva starting from distal surface of last tooth detached
gingiva at the line of incision with the help of surgical hoes and scalers
• APPRAISE THE FIELD
- Bead like granulation tissue
- Calculus remnants
- A band of light zone on the root surface
- Softening of root surface resorptions and cementum protuberances
• REMOVE GRANULATION TISSUE
- The curettes are used for this purpose. The curette is guided along the tooth surface and under
the granulation tissue
• REMOVE CALCULUS
- The remaining calculus and necrotic cementum are to be removed using scalers and curettes.
Check each surface of every tooth for calculus an soft tissue remnants.
- wash area several times with saline and cover with gauze sponge

17. • PLACE PERIODONTAL PACK
- After the bleeding is control and hemostasis achieved, the gingivectomy wound is covered with
periodontal pack
• HEALING AFTER SURGICAL GINGIVECTOMY

18. Initial response after gingivectomy is CLOT FORMATION
Underlying tissue become acutely inflamed with some necrosis
The clot is replaced by granulation tissue
After 12-24 hours epithelial cells at the margin start to migrate over the
granulation tissue separating it from the clot
Epithelial cells advanced by TUMBLING action
Surface epithelization is generally completed after 5 to 14 days

19. GINGIVECTOMY BY CHEMOSURGERY
Agent used
1. 25% phenol with 75% camphor
2. 5% paraformaldehyde in ZnO eugenol pack
Advantages:
1. No analgesia or anesthesia required for the procedure
2. Procedure is easy to perform & require less instruments

20. • Disadvantages
1. Bone necrosis might result
2. Periodontal abscess might result
3. Delayed wound healing
4. Subsequent plaque retention
5. Bone resorption

21. GINGIVECTOMY BY ELECTRO SURGERY
Advantages:
1. Less bleeding
Disadvantages:
1. Procedure produces heat which causes necrosis of adjacent tissue
2. If it transfer to the bone, resorption take place

23. GINGIVECTOMY BY CRYOSURGERY
- Temperature -50 to -60˚c id applied
to gingiva by means of a probe
Advantages:
1. The procedure does not cause pain
and bleeding

24. GINGIVECTOMY BY LASER
Types of laser used:
1. CO2 laser
2. ND: YAG Laser
Advantages:
1. Similar to electrosurgery more sophisticated, produces no heat thereby,
least necrosis
2. Similar to electrosurgery no post operative dressing is required

27. MAINTENANCE AFTER GINGIVECTOMY
1. Prescribe Chlorhexidine Gluconate rinse
2. Advice patient to maintain good oral hygiene
3. Recall for professional cleaning