ENLARGEMENT GINGIVA TREATMENT

ON TEETH 11 AND 21: A CASE REPORT

Pembimbing :
Dr.drg. Dahlia Herawati, M.Kes, Sp. Perio (K)
SILVA ELIANA ASPRIYANTI 09297 - NURUL PRESTIKASURI 09444 - MUHAMMAD AL FATIH 09436
 BASED ON ETIOLOGICAL FACTORS &
PATHOLOGICAL CHANGES

INFLAMMATORY DRUG INDUCED SYSTEMIC DISEASE

Chronic and Acute Phenitoin, Cyclosporin Leukimia, Granolomatous

SPECIAL CONDITION NEOPLASTIC ENLARGEMENT/

Pregnancy, Pubertal, Vit.C, Cell GINGIVAL TUMOR
gingivitis plasma, non spesifik Benign tumor, Mallignant tumor,
(piogenic granuloma) false enlargement
 TREATMENT OF
ENLARGEMENT GINGIVA
INFLAMMATORY NON-INFLAMMATORY
Scaling and Root Planing Gingivectomy & gingivoplasty

BASED ON LOCATION AND

DISTRIBUTION
 Localize
 Generalize
 Marginal (Papilary, Diffuse, Discrete)
 GINGIVECTOMY AND THE
ADVANTAGES
“Removal of Gingiva tissue to
eliminate pocket wall”
INDICATION
 Eliminate supraboni pocket
 false pocket
 crown lengtening
 perio esthetics
 Visibility and accessibility
 Smoothing the root surface
 Healing process
 Physiologic contour
CONTRA-INDICATION
 Bone surgery required
 Boneshape/morphology
 Base pocket (apikal than
mucogingival junction)
GINGIVOPLASTY AND TOOLS

“Eliminate periodental pockets and reshaping gingiva

(recontour gingiva)”

 Periodental Knifes
 Scalpe
 Diamond Store / Electrodes
 Kirkland/Orban
CASE REPORT (1)
CASE REPORT “Girl, 24 years old”
 Swelled maxilla front teeth gum
 Feel disturbed in appearance
 Gums still enlarged after scaling

INTRAORAL
Soft consistency and shiny rounded gingiva :
12, 16, 26, 27, 28
 Stippling : (-)
 Pitting Test : (+)
 Premature Contact : 26 & 36, 27 & 37
RADIOGRAPH
Horizontal resorption alveolar bone in teeth :
 PlaqueCASEscoreREPORT
: 52% (2)
25, 26, 27, 34, 35, 36, 37, 45, 46
EXTRAORAL
No Abnormality
Dx/ local chronic periodontics 25, 26, 27, 34, 35, 36, 45, 46
No Systemic disorder
accompanied by inflammatory of gingival enlargement 11, 21
 OPERATION
CASE REPORT (1)
PROCEDURE

Preparation of the patient,

operator, operator assistant,
tools and materials and Plaque scores and prophylaxis
informed consent. (PCR <10)
 Intra-oral aseptic action by closure of the patient’s face using
using 10% betadine solution a perforated sterile towel except
the area of operation
local anesthesia by local infiltration block anesthesia on nasopalatine nerve by
technique 11, 21 anathetic liquid as many as 0.1-0.2 cc
doing probing and marking with pocketKirkland knife : facial surface and lingual as
marker to make an outline for insisition well as distal.

Orban periodontal knife : inter- dental

interception.
Pemotongan sebelah apikal dari marker
insision begin from apical of point
marking to the point between
based pocket and bone peak
Insision is conducted as close as
the bone without
causing bone exposed.
take off the exsision pocket
surface and clean that area.
tissue’s smoothing using diamond
bar with 2 cm in diameter
 The next, take the granulated if the bloody occurs, solved by
tissue, necritic cement and pressing the tampon that was full of
remained calculus by Gracey adrenaline solution (added with
curete until the bone surface is aquades) in operated area.
clean and smooth, irigated with Operated area irrigated with NaCl
NaCl 0.9% saline solution and phisiologist 0.9% and H2O2 3%.
H2O2 3% Clean and dry the operated area
with sterile tampon
Note : H2O2 antibakteri, harus cepet di hilangkan agar jaringan yg lain tidak rusak
Cover the operated area with periodontal
pack. Instruction for post operation and
prescription.
CONTROL I, II and III

1 week control 2 weeks control 1 month control

In inflammatory gingival enlargement, clinical evalution post gingivectomy

surgery performed optimum healing, without any inflammation signs
 DISSCUSION
INITIAL PHASE
 Eliminate and control plaque
 Remove local factor ethiology : habit, traumatic occlusion, tumpatan overhanging, karies ditumpat
sementara, pemberian antibiotik, pemakaian protesa diperiksa.
CORRECTIVE PHASE
Bedah, tumpatan-tumpatan permanen
Kontrol bedah hingga selesai
before operation, evaluation of plaque control (1 week) --> home care, for teeth and mouth cleanliness --
> no complication, prognosa is optimum.
healing : a week pasca operation --> tissue regeneration and gingival contour advance in the operated
area. The healing of gingival tissue conduct for 3-4 weeks in 1 week control and in 1 month, the
patient’s gingival performs a significant healing

MAINTENANCE PHASE
Ketika semua operasi selesai
Kalau ada radang, kembali semula, mulai lagi dari initial, corrective
CONCLUSION

Periodontal surgery must be considered to

Maintain keratin tissue in
gingiva : seluruh Minimal loss gingival
permukaan gingiva, tidak tissue to keep the
boleh banyak hilang elasticity

Minimalize some Enough way in

discomfort and blood conducting repairment of
loss after operation osseous damage

Jaringan keratin tinggi : vestibulum tinggi, kalau infraboni tdk bisa karena jaringan keratin banyak hilang
 DISSCUSION
KEGAGALAN ?
 Bisa dari operator dan pasien
 Opeator saat pemotongan gingiva tidak benar/kurang, penandaan di o=pocket
marker saah
 Skor O'leary <10
Tidak semua pembesaran gingiva bisa di gingivektomi ?
 Pembesaran gingiva dan abses, abses tidak boleh dilakukan gingivektomi, abses di
drainase, incisi.
 TANYA-JAWAB

• KEGAGALAN GINGIVEKTOMI KARENA APA?

FATIH : KONTROL PLAK PERLU DIJAGA, KALAU MASIH KOTOR BISA JADI DELAY HEALING, SULIT SEMBUH, PROSES REGENERASI
TERHAMBAT

NURUL : KESALAHAN OPERATOR MISALNYA PENANDAAN PADA POKET MARKER SALAH, PEMASANGAN PERIODONTAL PACK KURANG
BENAR SEHINGGA MUDAH LEPAS

SILVA : CROWDING

DIAN : PEMBESARAN KARENA INFLAMASI VS NON INFLAMASI

SILVA :

NURUL : NON INFLAMASI --> ALAT ORTO