Gingival

Curettage
 Outline
 Rationale
 Indications
 Procedure
 Healing after Scaling & Curettage
 Clinical Appearance after Scaling &
Curettage
 Rationale
 Curettage & Esthetics
Extent of Gingival Curettage
 Indications
 1. Performed as part of new attachment
attempts in moderately deep intrabony
pockets located in accessible areas where a
type of “Closed” surgery is deemed advisable.

However, technical difficulties & inadequate

accessibility frequently contraindicate such
surgery.
 2. Can be done as a nondefinitive procedure to reduce
inflammation before pocket elimination using other
methods or when more aggressive surgical techniques
(e.g., flaps) are contraindicated in because of their age,
systemic problems, or other factors.

It should be understood that in these patients, the goal of

pocket elimination is compromised & prognosis is
impaired.

The clinician should resort to this approach only when the

indicated surgical techniques can’t be performed, & both
the Clinician & the Patient must have a clear
understanding of its limitations.
 3. Is also frequently performed on recall visits
as a method of maintenance treatment for all
areas of recurrent inflammation & pocket
depth, particularly where pocket reduction
surgery has previously been performed.

Careful probing should establish the extent of

the required root planing & Curettage to
avoid unnecessary shrinkage, pocket
formation, or both.
 Procedure
 A) Basic Technique
 B) Other Techniques
 1. ENAP
 2. Ultrasonic Curettage

 3. Caustic Drugs
 Basic Technique
 Curettage should always be preceded by SRP
 It always requires some type of L.A.
 The selected Curette cutting edge will be
against the pocket wall
e.g., Gracey # 13-14 for mesial surfaces
Gracey # 11-12 for distal surfaces
 Curettage can also be performed with a 4R-
4L Columbia Universal Curette
Gingival Curettage performed with
a horizontal Stroke of the Curettage
Subgingival Curettage
 ENAP
 It has been developed & used by the U.S. Naval Dental
Corps.
 It is a definitive subgingival curettage procedure
performed with a knife.
STEPS
1. After adequate L.A., make an internal bevel incision
from the margin of the free gingiva apically to a point
below the bottom of the pocket.
Carry the incision interproximally on both the facial
& lingual side, attempting to retain as much
interproximal tissue as possible.
The intention is to cut the inner portion of the soft
tissue wall of the pocket, all around the tooth.
ENAP
2. Remove the excised tissue with a Curette, & carefully
perform root planing on all exposed cementum to
achieve a smooth, hard consistency.

Preserve all connective tissue fibers that remain

attached to the root surface.

3. Approximate the wound edges; if they do not meet

passively, recontour the bone until good adaptation of
the wound edges is achieved.

Place sutures & a periodontal dressing.

 Ultrasonic Curettage
 Ultrasonic vibrations disrupt tissue continuity, lift
off epithelium, dismember collagen bundles, & alter
the morphologic features of fibroblast nuclei.

 Ultrasound is effective for debriding the epithelial

lining of Periodontal pockets; it results in a narrow
band of necrotic tissue (microcauterization), which
strips of the inner lining of the pocket.

 The Morse Scaler-shaped & rod-shaped ultrasonic

instruments are used for this purpose.
 Caustic Drugs
 The use of Caustic drugs has been recommended to
induce a chemical curettage of the lateral wall of
the pocket or even the selective elimination of the
epithelium.

 Drugs such as Sodium Sulfide, alkaline sodium

hypochlorite solution ( Antiformin), & Phenol have
been proposed & then discarded after studies
showed their ineffectiveness.

 The extent of tissue destruction with these drugs

cannot be controlled, & they may increase rather
than reduce the amount of tissue to be removed by
enzymes & phagocytes.
 Healing after Scaling & Curettage
 Immediately after Curettage, a blood clot fills
the pocket area, whih is totally or partially
devoid of epithelial lining.
 Hemorrhage is also present in the tissues
with dilated capillaries, & abundant PMNs
appear shortly thereafter on wound surface.
This is followed by a rapid proliferation of
granulation tissue, with a decrease in the no.
of small blood vessels as the tissue matures.
 Restoration & epithelialization of the sulcus
generally requires 2to 7 days
 Restoration of the J.E. occurs as early as 5 days
after treatment.
 Immature collagen fibers appear within 21 days.
 Healthy gingival fibers inadvertantly severed from
the tooth & tears in the epithelium are repaired in
the healing process.
 Healing results in the formation of a long, thin J.E.
with no no new C.T. attachment.
 In some cases, this long epithelium is interrupted by
“windows” of C.T. attachment.
Clinical Appearance after Scaling &
Curettage
Immediately after scaling & curettage the
gingiva appears hemorrhagic & bright red.
After 1 Week:
The Gingiva appears reduced in height
because of an apical shift in the position of
Gingival margin.
The Gingiva is slightly redder than normal,
much less so than on previous days.
 After 2 weeks:
With proper oral hygiene by the patient, the
normal color, consistency, surface texture, &
contour of the gingiva are attained, & the gingival
margin is well adapted to the tooth.