GINGIVECTOMY

Date: 2012-12-21

Presenter: R2 鄭瑋之

Instructor: VS 陳娟娟

Definition
• A surgical procedure in which gingival pockets are eliminated by removal of gingiva.

Indications
1. Gingival enlargement or overgrowth
2. Idiopathic gingival fibromatosis 3. Pseudopockets 4. Shallow suprabony pockets  modified Widman 5. Areas with difficult access

6. Minor corrective procedures

Contraindications
1. Narrow or absent attached gingiva
2. Infrabony pockets 3. Thicking of marginal alveolar bone

Advantages
1. Technically simple; good visual access
2. Complete pocket elimination 3. Predictable morphological result

Disadvantages
1. 2. 3. 4. 5. 6. Very limited indications Gross wound; postoperative pain Healing is by secondary intention (ca. 0.5 mm/day) Danger of exposing bone Loss of attached gingiva Exposes cervical area of tooth (sensitivity, esthetics, caries) 7. Phonetic and esthetic problems in anterior area

Principle of the Operation
1. Continuous incision at 45° angle at the base of the pocket 2. Sharp dissection of tissues in the interdental area 3. Smoothing of the incision edge 4. Contouring the gingival surface (GP) 5. Scaling and root planing 6. Wound coverage (periodontal dressing)

Instruments
• Size, shape and angulation of the working tip, and also by the comfortable handle Gingivectomy knife + papilla knife, singly or doubly angled

Pocket marking forceps

• •

Paired (L & R) Use: indicate the location of the base of the pocket

Pocket marking forceps

Gingivectomy knives

Sharpness!
Arkansas stone + oil

• • •

GV knife (Kirkland, L & R) Papilla knife (Orban, L & R) Universal knife

Gingivectomy knives

 45° angle to the tooth long axis  Anterior area: single-bend  Less accessible area: double-bend

Electrosurgery apparatus and tips

• • •

Use: gingiplasty, papillectomy, smooth out abrupt edges, expose the margins of a tooth preparation before taking the impressions or seating a restoration Hemostatic effect Not recommended for primary gingivectomy  injury to the root, periosteum or bone

Electrosurgery apparatus and tips

 To reduce the bulbous marginal gingival contour

Periodontal Dressings & Tissue Adhesives
• • • • Reduce postaperative pain Prevent colonization of plaque Left in situ for 7~10 days A second dressing may be indicated if healing is inadequate. Only eugenol-free dressings are recommended.

• Peripac: ready-to-use, gypsum base + acrylic, sets quickly when contacting with saliva, hard edgesdanger of pressure aphthous ulcer • Coe-pak: 2 component (zinc oxide + fatty acids), pliable after setting

• CHX power: reduce plaque formation

• Tissue adhesives (Cyanoacrylate): Histoacryl, Bucrylate • Use: minor GV/GP wounds, instead of sutures • Applied by plastic tubes, brushes or cannulate

Operative Procedure

Operative Procedure

Operative Procedure

Operative Procedure

Operative Procedure

Operative Procedure

Operative Procedure

Operative Procedure

Operative Procedure

Operative Procedure

Operative Procedure

Operative Procedure

Operative Procedure

Operative Procedure

Operative Procedure

Operative Procedure

Operative Procedure

Operative Procedure

Operative Procedure

Operative Procedure

Operative Procedure

Operative Procedure

Operative Procedure

Operative Procedure

Operative Procedure

Drug-induced Gingival Overgrowth

1

Anticonvulsants

2

Calcium Channel Blockers

3

Immunosuppressants

1. Phenytoin for seizure 2. Valpronic acid, carbamazepine, phenobarbitone rare 3. Vigabatrin new

1. Antihypertensive drugs for angina or peripheral vascular disease 2. Nifedipine first in early 1980s 3. Diltiazem, verapamil 4. Amlodipine, felodipine rare

1. Cyclosporin A for prevention of transplant rejection, autoimmune like rheumatoid arthritis  limited by renal, cardiac, and gingival fibrosis

J Periodontol 2004;75:1424-1431.

Prevalence

children

J Periodontol 2004;75:1424-1431.

Prevalence

J Periodontol 2004;75:1424-1431.

GV/GP - Phenytoin-induced gingival overgrowth

GV/GP - Phenytoin-induced gingival overgrowth

GV/GP - Phenytoin-induced gingival overgrowth

References
1. Color Atlas of Dental Medicine: Periodontology: Periodontology. Herbert F. Wolf, Klaus H. Rateitschak 2. Informational Paper - Drug-Associated Gingival Enlargement, J Periodontol 2004;75:1424-1431.

MERRY CHRISTMAS~!!

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