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Gingivectomy

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

Elimination of suprabony pockets


Elimination of gingival enlargement
Elimination of suprabony periodontal
abscesses

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

Cutting interdental papilla

Removing detached gingiva

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

Tapering the gingival margin


Creating a scalloped marginal outline
Thinning attached gingiva
Creating vertical interdental grooves
Shaping interdental papillae

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

It shouldnt be used in procedures that


involve proximity to the bone, such as
flap operations and mucogingival surgery

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

The removal of gingival enlargments and


gingivoplasty:
Performed with needle, ovoid loop or diamond
shape electrodes

Blended cutting and coagulating currents is used


Electrode is moved in shaving motion in all
reshaping procedures

In treatment of acute periodontal abscesses:


Incise to establish drainage
Can be made with needle electrode
The incision remain open because the edges is sealed
by the current
For hemostasis:
The ball electrode is used
The surface is touched with a coagulating current
Bleeding areas interproximally, bar shaped is used

Frenum and muscle attachments:


The frenum or muscle is stretched and sectioned
with the loop electrode
For pericoronitis:
For acute pericoronitis, drainage may be obtained
by incising the flap with a bent needle electrode
When the acute symptoms subside, a loop is used
to remove the flap

Healing after electrosurgery


Some evidences report no significant
differences in gingival healing after resection
by electrosurgery and resection with
periodontal knives; other studies find delayed
healing, greater reduction in gingival height,
and more bone injury after electrosurgery

Thank you

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