Gingivectomy is a surgical procedure in periodontics

1. GINGIVECTOMY
GUIDED BY-
PRESENTED BY-
DR. HIROJ BAGDE SHATABDI
DUTTA
DR. SHRUTI BHATNAGAR FINAL
YEAR
DR. THANESHWAR PATILA BATCH-F
DR. TAPASWI KAMBLE
DR. SAGORIKA SAHA

2. CONTENTS
• INTRODUCTION
• INDICATIONS
• CONTRAINDICATIONS
• SURGICAL GINGIVECTOMY
• GINGIVECTOMY BY ELECTROSURGERY
• LASER GINGIVECTOMY
• GINGIVECTOMY BY CHEMOSURGERY

3. INTRODUCTION
• THE WORD GINGIVECTOMY MEANS “EXCISION OF THE GINGIVA”
• ACCORDING TO THE WORLD WORKSHOP IN PERIODONTICS(1989),
GINGIVECTOMY IS DEFINED AS “AN EXCISION OF THE SOFT TISSUE WALL OF THE
PERIODONTAL POCKET.”
• BY REMOVING THE POCKET WALL, GINGIVECTOMY PROVIDES VISIBILITY AND
ACCESSIBILITY FOR COMPLETE CALCULUS REMOVAL AND THOROUGH
SMOOTHING OF THE ROOTS.
• THIS CREATES A FAVORABLE ENVIRONMENT FOR GINGIVAL HEALING AND
RESTORATION OF A PHYSIOLOGIC GINGIVAL CONTOUR.

4. INDICATIONS
• ELIMINATION OF SUPRABONY POCKETS, REGARDLESS OF THEIR DEPTH, IF THE
POCKET WALL IS FIRM AND FIBROUS.
• ELIMINATION OF GINGIVAL ENLARGEMENT.
• ELIMINATION OF SUPRABONY PERIODONTAL ABSCESSES
• PERICORONAL FLAP

5. CONTRAINDICATIONS
• THE NEED FOR OSSEOUS SURGERY OR EXAMINATION OF THE SHAPE AND
MORPHOLOGY OF BONE.
• SITUATIONS IN WHICH THE BOTTOM OF THE POCKET IS APICAL TO THE
MUCOGINGIVAL JUNCTION.
• ESTHETIC CONSIDERATIONS, PARTICULARLY IN THE ANTERIOR MAXILLA.

6. TYPES OF GINGIVECTOMY
• SURGICAL GINGIVECTOMY
• ELECTROSURGICAL GINGIVECTOMY
• LASER GINGIVECTOMY
• CHEMOSURGICAL GINGIVECTOMY

7. SURGICAL GINGIVECTOMY
STEP 1:
THE POCKETS ON EACH SURFACE ARE EXPLORED WITH A PERIODONTAL PROBE
AND MARKED WITH A POCKET MARKER.

8. • STEP-2:
PERIODONTAL KNIVES (EG. KIRKLAND KNIFE) ARE USED FOR INCISIONS ON FACIAL AND
LINGUAL SURFACES AND ON THOSE DISTAL TO THE TERMINAL TOOTH IN THE ARCH.
ORBAN PERIODONTAL KNIVES ARE USED FOR INTERDENTAL INCISIONS
BARD PARKER BLADES(NO. 12 AND 15) AS WELL AS SCISSORS ARE USED AS AUXILIARY
INSTRUMENTS.
Kirkland knife Orban knife

9. • THE INCISION IS STARTED APICAL TO THE POINTS MARKING THE COURSE OF
THE POCKETS AND IT IS DIRECTED CORONALLY TO A POINT BETWEEN THE BASE
OF THE POCKET AND THE CREST OF THE BONE.
• IT SHOULD BE AS CLOSE AS POSSIBLE TO THE BONE WITHOUT EXPOSING IT TO
REMOVE THE SOFT TISSUE CORONAL TO THE BONE.
• EITHER INTERRUPTED OR CONTINUOUS INCISIONS MAY BE USED. THE INCISION
SHOULD BE BEVELED AT APPROXIMATELY 450 TO THE TOOTH SURFACE AND IT
SHOULD RECREATE THE NORMAL FESTOONED PATTERN OF THE GINGIVA.
FAILURE TO BEVEL THE INCISION WILL LEAVE A BROAD, FIBROUS PLATEAU THAT
WILL TAKE A LONGER TIME TO DEVELOP A PHYSIOLOGIC CONTOUR. DURING THE
INTERIM, PLAQUE AND CALCULUS MAY LEAD TO THE RECURRENCE OF POCKETS.

11. STEP-3
REMOVE THE EXCISED POCKET WALL, CLEAN THE AREA, CLOSELY EXAMINE THE
ROOT SURFACE.
THE MOST APICAL ZONE CONSISTS OF A LIGHT BAND LIKE ZONE WHERE THE
TISSUES WERE ATTACHED. CORONALLY, CALCULUS REMNANTS, ROOT CARIES OR
RESORPTION MAY BE FOUND.
GRANULATION TISSUE MAY BE SEEN ON THE EXCISED SOFT TISSUE.
STEP-4
CAREFULLY CREATE THE GRANULATION TISSUE AND REMOVE ANY REMAINING
CALCULUS AND NECROTIC CEMENTUM TO LEAVE A SMOOTH AND CLEAN
SURFACE.
STEP-5
COVER THE AREA WITH SURGICAL PACK

12. HEALING AFTER GINGIVECTOMY

13. ELECTROSURGICAL GINGIVECTOMY
INSTRUMENTS:
NEEDLE ELECTRODE(THICKNESS VARYING FROM 0.0075-0.015 INCH), SMALL
OVOID LOOP, OR DIAMOND-SHAPED ELECTRODES.

14. ADVANTAGES:
• IT PROVIDES A CLEAR OPERATING AREA WITH LITTLE OR NO BLEEDING.
• LACK OF PRESSURE TO INCISED TISSUE, THUS ALLOWING A MORE PRECISE
INCISION THAN IS OBTAINED BY A SCALPEL.
• MINOR TISSUE LOSS AFTER HEALING.
• GREATER EASE FOR THE PATIENT AS WELL AS FOR THE OPERATOR.
DISADVANTAGES:
• IT CAUSES AN UNPLEASANT ODOR.
• IF ELECTROSURGERY POINT TOUCHES THE BONE, IRREPARABLE DAMAGE CAN
OCCUR.
• WHEN THE ELECTRODE TOUCHES THE ROOT, AREAS OF CEMENTUM BURNS ARE
PRODUCED.

15. LASER GINGIVECTOMY
THE LIGHT AMPLIFICATION BY STIMULATED EMISSION OF RADIATIONS MOST
COMMONLY USED FOR GINGIVECTOMY ARE CARBON DIOXIDE AND ND:YAG.
ADVANTAGES:
• LASER OFFERS AN ALMOST COMPLETELY DRY, BLOODLESS SURGERY.
• BECAUSE OF THE DRIED FIELD, SURGICAL TIME MAY BE REDUCED.
• THERE IS INSTANT STERILIZATION OF AREA.
• NON CONTACT SURGERY THUS NO MECHANICAL TRAUMA.
• PROMPT HEALING WITH MINIMAL POST OPERATIVE SCARRING AND SWELLING.
DISADVANTAGES:
• HIGH COST OF EQUIPMENT
• LOSS OF TACTILE FEEDBACK

16. CHEMOSURGICAL GINGIVECTOMY
5% PARAFORMALDEHYDE OR KOH WERE THE CHEMICALS TO PERFORM
GINGIVECTOMY WHICH IS NO LONGER IN USE BECAUSE THE DEPTH OF CHEMICAL
ACTIONS CANNOT BE CONTROLLED.
DISADVANTAGES:
• THE DEPTH OF CHEMICAL ACTION CANNOT BE CONTROLLED.
• GINGIVAL REMODELING CANNOT BE ACCOMPLISHED EFFECTIVELY.
• EPITHELIALIZATION AND REFORMATION OF THE JUNCTIONAL EPITHELIUM, THE
REESTABLISHMENT OF THE ALVEOLAR CREST FIBER SYSTEM ARE SLOWER IN
CHEMICALLY TREATED GINGIVAL WOUNDS THAN IN THOSE PRODUCED BY THE
SCALPEL.