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GINGIVECTOMY

Date: 2012-12-21

Presenter: R2

Instructor: VS

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 edgesdanger 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

Anticonvulsants

Calcium Channel Blockers

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~!!