3. Gingivectomy
• Definition
– Surgical excision of Gingiva by removing the diseased p
ocket wall thereby exposing tooth surface which provides t
he visibility & accessibility that are essential for the com
plete removal of irritating surface deposits & thorough s
moothening of the roots.
5. CONTRAINDICATIONS
• Bone defect can not be corrected
• Fragile gingiva
• Location of the base of the pocket apical to mucogin
gival junction.
TYPES OF GINGIVECTOMY
• Surgical Gingivectomy
• Gingivectomy by chemosurgery
• Gingivectomy by Electro surgery
• Gingivectomy by Cryosurgery
• Gingivectomy by Laser
8. STEPS IN- SURGICAL GINGIV
ECTOMY
• Anaesthetize area
• Mark the pocket
• Resect the gingiva
• Remove granulation tissue
• Remove calculus
• Place periodontal pack
9. Pocket Marking
• Pocket on each surface are explored with p
eriodontal probe and marked with pocket
marker at three places on each tooth on ea
ch labial & lingual surfaces.
10. INCISION GIVEN INSURGICAL GI
NGIVECTOMY
Type of incision :
Internal bevel incision
It may be continuous or discontinuous
A) Discontinuous: From the facial surface at dist
al angle of last tooth to distofacial angle of th
e next tooth. Next incision begins in the interde
ntal space to distofacial angle of next tooth.
11. B) Continuous:- Started on the facial surfa
ce from the distoangular region & carrie
d forward anteriorly following the course
of pocket without interruption. procedure
is repeated on lingual surface.
C) Distal incision: Facial and lingual incisio
n are joined by an incision across the d
istal surface of the last erupted tooth.
12. STEPS IN SURGICAL GINGIV
ECTOMY
• Should be close to bone but not exposed it.
• The incision should be beveled at approximate
ly 45 degree to the tooth surface to follow the n
ormal pattern of the gingiva
• Should not leave diseased Pocket wall.
• The incision should pass completely through
soft tissue to tooth.
13. REMOVE RESECTED- GINGIVA
• Remove the marginal & inter dental gingi
va starting from distal surface of last tooth
detach gingiva at the line of incision with th
e help of surgical hoes & scalers.
14. Remove granulation tissue
• The curettes are used for this purpose. The
curette is guided along the tooth surface &
under the granulation tissue.
REMOVE CALCULUS:
• The remaining calculus & necrotic cementu
m are to be removed using scalers & curett
es. Check each surface of every tooth for cal
culus & soft tissue reminants.
• Wash area several times with saline and cov
er with gauze sponge.
15. Place Periodontal Pack
• After the bleeding is control and Hemostatis ac
hieved, the Gingivectomy wound is covered with p
eriodontal pack.
• The initial response after gingivectomy is Clot
formation
•
16.
17. 2. GINGIVECTOMY BY CHEMOSURG
ERY
Agent Used.
• 25% phenol with 75% camphor.
• 5% paraformaldehyde in ZnO eugenol pack.
ADVANTAGES OF CHEMOSURGERY
• No analgesia or anesthesia required for the procedure.
• Procedure is easy to perform & require less instruments.
Disadvantage:
• Bone necrosis might result.
• Periodontal abscess might result.
• Delayed wound healing
• Subsequent plaque retention
• Bone resorption
18. 3. Gingivectomy by electro surgery:
Advantages:
• Less Bleeding
Disadvantages
• Procedure produces heat which causes necrosis of ad
jacent tissue.
• If it transfer to the bone, resorption take place.
4. Gingivectomy by cryosurgery:
• Temperature -50 to -600c is apply to gingiva by means of a pro
be.
Advantages
• The procedure does not cause pain & bleeding.
19. 5. Gingivectomy by LASER:
TYPE OF LASER USED:
- Co2 Laser
- Nd: YAG Laser
ADVANTAGES:
- Similar to electro surgery no bleeding, produces no heat ther
eby, least necrosis.
- Similar to electro surgery no past operative dressing is requir
ed.
20.
21. Maintenance After Gingivectomy
• Prescribe Chlorhexidine gluconate rinse
s.
• Advice patient to maintain good oral hygi
ene.
• Recall for professional cleaning.
