Dr.

Deby Johnson
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota

Gingival Surgical Procedures

GINGIVAL SURGICAL ! limited to the gingival and not

TECHNIQUES involving underlying osseous
structures
! Gingival Curettage
! Gingivectomy

! Gingivoplasty

! Gingival Flap

Gingival Curettage Gingival Curettage

! Curettage - removal of the gingival wall of
a periodontal pocket to separate diseased
soft tissue ! Theory
! Inadvertent curettage –Unintentional ! Reduces inflamed granulation tissue in
currettage performed the soft tissue wall
when scaling and ! removes epithelium lining allowing
root planing healing with connective tissue
attachment
! Reduced the bacteria

AAP Position Paper on Gingival AAP Position Paper on Gingival

Curettage Curettage
! Reality ! Academy Statement –J. Perio 2002
! No new attachment occurs with gingival ! “Gingivalcurettage has no theraputic
curettage healing is by long junctional benefit in treatment of chronic
epithelium periodontitis and concludes that the
! Result do not differ from results
dental community as a whole regards
obtained by S/RP alone gingival curettage as a procedure with
! Code for Gingival Curettage dropped
NO clinical value.”
from AAP codes

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 Dr. Deby Johnson
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota

Gingival Curettage by any other

Gingivectomy
name
! Excisional New Attachment Procedures ! Indications
(ENAP)
! Elimination of suprabony pockets in firm
! Ultrasonic curettage fibrous pockets
! Caustic drugs
! Elimination of gingival enlargements

! Elimination of suprabony abscesses

Also has no clinical value

Definition: Treatment Planning Considerations

Current Dental Terminology (CDT-3) - Revised & Limitations - Begin with the End in Mind
D4210 – Gingivectomy or
gingivoplasty: …. for suprabony
! How much
pockets which need access for
keratinized tissue
restorative dentistry, when is present?
moderate gingival enlargements or
! Can keratinized
aberrations are present, and when
tissue be
there is asymmetrical, or unesthetic sacrificed?
gingival topography.

Mucogingival
Junction
KG–probe depth=
Attached
Keratinized
Gingivectomy Technique
Gingiva
Gingiva
PD Measure pocket depth
Mark with bleeding
points
Initial incision
Apical to bleeding points
45 degree bevel to the
root

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 Dr. Deby Johnson
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota

Healing after Gingivectomy

! Initial response-formation of
protective clot, underlying
tissue has acute PMN
infiltrate and some necrosis
! Clot replaced by granulation
tissue
! 24 hours increase CT and
angioblast below surface
layer
! 12-24 hours epithelial cells at
margin migrate into the
granulation tissue, beneath
the necrotic tissue

Esthetically/Functionally Short
Healing after Gingivectomy
Crowns
! After 5-14 days surface epithelization is
complete, but keratinization is incomplete
! Vasodilation and vascularity begin to
! Gummy Smile
decrease about the 4th day and appear
normal by about 16 days. Epithelium ! Delayed
grows about 0.5 mm per day. passive
! Complete repair of the connective tissue eruption
takes about 7 weeks
Dr. Russ Dylla

Smiling

Centrals = 25% wider than

laterals and 10% wider
than canines
8 mm

Centrals + Canines = 20%

longer than laterals

Ratio= 1.2/1.0

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 Dr. Deby Johnson
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota

Surgical Stent

11mm

Can the biologic width affect the

position of the gingival margin?
! Important in
esthetic areas
! Help prevent
coronal rebound
of the gingival
margin
following
surgery

Biologic Rationale
Gargiulo et al.: J Periodont 32: 261-267, 1961

! Supra-alveolar Sulcus = 0.69 mm

Tissues or Depth
Dentogingival Epi.
Junction – 2.73 mm Attach. = 0.97 mm
! Biologic Width or CT = 1.07 mm
attachment apparatus Attach
– 2.04 mm 2.73 mm

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 Dr. Deby Johnson
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota

11 mm

Attachment apparatus = ~2.04mm

Vertical Mattress sutures

Dr. Russ Dylla

Gingivectomy by Electrosurgery Gingivectomy by Chemosurgery

! Advantage-hemorrhage control ! Difficult to control depth of action

! Disadvantage-contraindicated in patients ! Healing is slower
with poorly shielded cardiac pacemakers
! NOT RECOMMENDED
! Can cause bone necrosis if tip touches
bone and areas of cementum can be
burned if tip touches those area
! Must be limited to superficial procedures

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 Dr. Deby Johnson
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota

Gingivectomy
! LIMITING FACTORS : Treatment of Gingival
! Amount of keratinized gingival
! Maintenance of esthetics
Enlargement
! Require access to osseous defects for
definitive defect correction
! Freq less post operative pain with
procedure that will allow primary
closure
! Heavy pigmentation may contraindicate
treatment

Techniques for reduction of gingival

Chronic Inflammmatory Enlargement enlargement

Edematous tissue -treated with S/RP #Gingivectomy

"

IF extremely fibrous and interferes $#Flap operation-APF

with access, surgical removal may be %#Combined Techniques
indicated

Gingivectomy
Can recon tour at margin if adequate KG Flap operation
Can be used with soft friable tissue Need firmer tissue
Conserves KG

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 Dr. Deby Johnson
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota

Combined Techniques:
Gingivectomy and Gingiveplasty

Downloaded from: Carranza’s Clinical Periodontology (on 10 August 2006 04:54 PM)
© 2005 Elsevier

Downloaded from: Carranza’s Clinical Periodontology (on 10 August 2006 04:54 PM)
© 2005 Elsevier

Treatment Planning Considerations

& Limitations - Begin with the End in Mind

Functional or esthetic
compromise of involved
or adjacent teeth
! Opening interdental
spaces
! Creating excessively

“long” teeth

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 Dr. Deby Johnson
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota

Gingival Diseases-Dental Plaque 1. Gingival Disease

Induced ! Dental plaque-induced gingival diseases
! Gingival Diseases modified by
medications
! Drug-influenced gingival diseases
! Drug-influenced gingival enlargements
! Drug-influenced gingivitis

! Oral contraceptive associated

! Other

Esthetically/Functionally Short
Crowns

! Inflammatory
drug induced
hyperplasia

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 Dr. Deby Johnson
Periodontology III
Spring Semester, 2009
School of Dentistry
University of Minnesota

Drugs causing overgrowth

& Nifedipine

& Cyclosporine

& Phenytoin (Dilantin)

credits

! Dr. James Le
! Dr. Allen Todd

! Coury Staadecker

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