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Gingivectomy (oral   
surgery)
Queenie Delgado

Dec. 09, 2018 • 14 likes • 640 views

  10 of 27  

Gingivectomy
Science

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 Gingivectomy (oral surgery)

1. GINGIVECTOMY
2. INTRODUCTION • 80% of Filipinos su!er from dental
problems • Periodontal Disease is prevalent among elders
• GINGIVECTOMY may be performed to heal the e!ects 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
6. CONTRAINDICATIONS • Bone defect cannot be corrected
• Fragile gingiva • Location of the base of the pocket apical
to mucogingival junction
7. TYPES OF GINGIVECTOMY 1. SURGICAL GINGIVECTOMY
2. GINGIVECTOMY BY CHEMOSURGERY 3. GINGIVECTOMY
BY ELECTROSURGERY 4. GINGIVECTOMY BY
CRYOSURGERY 5. GINGIVECTOMY BY LASER
8. 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
9. 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
10. 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
11. 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
12. 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 so" tissue to the tooth
13. • 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 - So"ening 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 so" tissue remnants. - wash
area several times with saline and cover with gauze
sponge
14. • PLACE PERIODONTAL PACK - A"er the bleeding is
control and hemostasis achieved, the gingivectomy
wound is covered with periodontal pack • HEALING AFTER
SURGICAL GINGIVECTOMY
15. Initial response a"er gingivectomy is CLOT
FORMATION Underlying tissue become acutely inflamed
with some necrosis The clot is replaced by granulation
tissue A"er 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
a"er 5 to 14 days
16. 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
17. • Disadvantages 1. Bone necrosis might result 2.
Periodontal abscess might result 3. Delayed wound
healing 4. Subsequent plaque retention 5. Bone
resorption
18. 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
19. 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
20. 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
21. MAINTENANCE AFTER GINGIVECTOMY 1. Prescribe
Chlorhexidine Gluconate rinse 2. Advice patient to
maintain good oral hygiene 3. Recall for professional
cleaning

Editor's Notes

Incomplete gingival remodeling

Delayed epithelialization, CT repair
Increased inflammation a"er chemical
trauma
No control over the depth of action

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