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Gingivectomy
Gingivectomy is excision of the gingiva
Involves removal of pocket wall :
to provide visibility and accessibility
for complete debridement
Creating a favorable environment for
gingival health
Restoration of a physiologic gingival
contour
Indications
Old
Current Indications
Treatment of gingival
enlargement
Aesthetic crown
lengthening
Contraindications
Need for bone surgery
Base of pocket apical to MGJ
Aesthetic considerations
Techniques
Conventional surgery
(scalpels)
Elecrtosurgery
Laser
Chemicals (historical)
Surgical Gingivectomy
Pockets explored
Pockets marked
with a pocket
marker
Instrumentation
Kirkland knives
Orban knives
OR
Bard-parker blades
No 11 & 12
The Incision
External bevel
incision
Started apical to
markings
Directed coronally
30 - 45 to
tooth surface
Close to bone
without exposing it
Incisions
Discontinuous
Continuous
Continuous
Straight
Scalloped
Debridement
Removal of
granulation tissue
Thorough scaling &
root planing
Periodontal pack
Clinical Case
Gingivoplasty
Same procedure as gingivectomy with the sole
purpose to correct gingival shape and
establish physiologic gingival contours; when
there are no pockets.
Instrumentation
Scalpel
Periodontal knife
Rotary coarse diamond stones
Ceramic burs
Electrodes
Procedures
Healing
Protective surface clot
Acute inflammation in
connective tissue
Clot is replaced by
granulation tissue within 24
hrs
Increase of connective
tissue cells & blood vessels
Healing
The highly vascular
granulation tissue
grows coronally to
produce new gingival
margin
Capillaries from PDL
grow and connect
the granulation
tissue,and within 2
weeks they connect
with gingival vessels.
Healing
After 12-24 hrs, epithelial cells start to
migrate over the granulation
tissue,sepreating it from the clot.
Epithelial cells are attached to CT by
hemidesmosomes and basement membrane
Wound completely covered by epithelium
within 5-14 days. Complete keratinisation
takes 1 month.
Gingivectomy by Electrosurgery
Gingivectomy by Electrosurgery
Uses of electrosurgery:
The use of electrosergery should be limited to
superficial procedures that are
Removal of gingival enlargments
Gingivoplasty
Relocation of frenum and muscle attachments
Incision of periodontal abscesses
Pericoronal flaps
Advantages:
Permits an adequate contouring of the tissue.
Controls hemorrhage.
Disadvantages:
Cannot be used in patients who have shielded
cardiac pacemakers.
Causes unpleasant odor.
If electro surgery points touch the bone,
irreparable damage can be done.
Can cause tissue damage and loss of periodontal
support when the electrode is used close to the
bone.
Technique
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