2. OUTLINE
• Types of gingivectomy
• Indications
• Contraindications
Definition
• GingivoplastySurgical gingivectomy
• electrosurgical gingivectomy
• Laser gingivectomy
• Chemical gingivectomy
Other methods
Conclusion about gingivectomy
Periodontal dressings
Post operative instructions
References
3. DEFINITION
• Gingivectomy means “ excision of the gingiva”
Removal of
pocket wall
Visibility &
accessibility for
complete
calculus
removal
Proper
smoothening of
roots
Favourable
environment
for gingival
healing
Restoration of
physiologic
gingival contour
5. INDICATIONS
– INDICATIONS
1. Elimination of suprabony and pseudo pockets , regardless of depth but
when wall is fibrous and firm .
2. Elimination of fibrotic gingival enlargements
3. Elimination of suprabony periodontal or gingival abscess.
4. When base of pockets are at the same level but the margins are at a
different level.
5. Create more esthetic forms in which exposure of anatomic crown has not
fully occurred example : defective passive eruption
6. CONTRAINDICATIONS
– CONTRAINDICATIONS
1. Infrabony pockets
2. Inadequate zone of attached gingiva
3. Osseous surgery is indicated , examination of shape and morphology of bone
4. When base of pocket is apical to mucogingival junction
5. Aesthetics considerations (ant maxilla )
6. Patients with systemic problems leading to contra indication of surgical
procedures example uncontrolled diabetes , blood dyscrasias
7. Patient suffering from gout taking colchicine .
8. ARMAMENTARIUM
• Pocket marking forceps
• Gingivectomy knifes :
1. Kirkland knives (incisions on facial
and lingual surfaces on those distal
to the terminal tooth in arch )
2. Orban periodontal knives
(interdental incisions )
3. Bard parker blades (12 and 15)
• Scissors (auxillary )
9. STEP1
•Explore the pockets
•Pocket marking using a pocket marker
STEP2
•Interrupted or continuous incisions ,beveled at 45 degrees to tooth surface are made starting apically to marked points and
directed coronally to a point between the base of the pocket and crest of the bone.
•Incision should be close to the bone but not exposing it .
•Removal of soft tissue coronal to the bone .
STEP3
•Remove excised pocket wall , clean the area , examine root surface.
•Apically : a band like zone where tissues were attached is seen
•Coronally :calculus remnants , root caries , resorption pattern is seen
•Granulation tissues seen on excised soft tissue.
STEP4
•Curette the granulation tissue
•Remove the calculus remnants , necrotic cementum
STEP5
•Cover with surgical pack
10.
11. HEALING AFTER SURGICAL
GINGIVECTOMY
– Initial response =
1. blood clot formation,
2. underlying tissue is acutely inflamed and necrotic and soon replaced by the granulation tissue
– 24 hours later=
1. increased ct cells ( mainly angioblasts)
2. epithelial cells at the margins of the wound start migrating over the granulation tissue. Epithelial activity reaches a peak in 24 to
36 hours.
– 3 days later =
1. Young fibroblasts are seen
2. highly vascular granulation tissue grows coronally creating free gingival margin and sulcus
– 2 weeks =
1. Capillaries from vessels of periodontal ligament migrate into connective tissue and connect with gingival margins
2. After 5 to 14 days, surface epithelialization is generally complete.
3. Complete repair takes about 1 month.
– Connective tissue repair in 7 weeks and the pigmentation is diminished .
13. GINGIVOPLASTY
– Similar to gingivectomy but has a different purpose
– Done to eliminate pockets and reshaping as well to create physiologic gingival contours with
sole purpose of recontouring the gingiva in absence of pockets
– Gingival and periodontal diseases often create deformities in gingiva that interfere with
normal food excursion
collect plaque and food debris
prolong and aggravate disease process
– NUG causes shelf like interdental papilla , gingival clefts and craters
– May be done with periodontal knife , rotary coarse diamond stones or electrodes
– Consists of tapering gingival margins , creating escalloped marginal outline , thinning
attached gingiva , creating vertical interdental grooves , shaping interdental papilla .
15. ELECTROSURGICAL
GINGIVECTOMY
– ADVANTAGES
• Adequate contouring of tissue and controls
haemorrhage
– DISADVANTAGES
• Poor or noncompatible pacemaker
• Unpleasant odour
• Bone touching causes irreplaceable
damage
• Heat causes periodontal damage and tissue
loss
• On touching cementum burns are
produced
– INDICATIONS
– Superficial procedures like
Gingival enlargements
Gingivoplasty
Relocation of muscle and frenum
Incision of periodontal claps and pericoronal
abscess
16. TECHNIQUE
– Removal of gingival enlargements and gingivoplasty is performed with the needle
electrode. Fully rectified current is used .
Small, ovoid loop or the diamond shaped electrodes are used for festooning.
In all reshaping procedures, electrode is activated and moved in a concise “shaving”
motion.
– For hemostasis, the ball electrode is used. Firstly controlled by direct pressure then
coagulating current is used
– For Acute Periodontal Abscess Drainage with needle electrode without exerting
painful pressure is done . Followed by regular procedure
– Frenum and muscles can be relocated using Loop electrode
– Acute Pericornitis – Bent needle electrode is used for incision
17. HEALING AFTER
ELECTROSURGERY
1. Delayed healing
2. Greater reduction in gingival height
3. Bone injury
4. Necrosis
5. Sequestration and Loss of bone height
6. furcation exposure
7. tooth mobility
NOT AS FAVOURABLE AS THAT IN SURGICAL GINGIVECTOMY
19. LASER GINGIVECTOMY
The lasers most often used in dentistry are the
– carbon dioxide (CO2 )
– neodymium:yttrium:aluminum-garnet (Nd:YAG)
– with the wavelength of 10,600nm and 1064nm respectively.
The healing is delayed compared with healing after conventional scalpel
gingivectomy.
Requires precautions to avoid reflecting the beam on instrument surfaces, which
could result in injury to neighboring tissues and eyes of the operator
21. CHEMOSURGICAL
GINGIVECTOMY
– Gingivectomy By Chemosurgery
– 5 % paraformaldehyde
– Pottasium hydroxide
– Disadvantages:
– • Depth of action cannot be controlled hence healthy tissue maybe injured
– • Gingival remodelling cannot be accomplished
– • Epithelialization & reformation of JE along with reestablishment of alveolar crest
fibre system occurs slowly
– • Not recommended
22. CONCLUSION ABOUT
GINGIVECTOMY
– The procedure has been in use for long time and maybe used for removal of
redundant gingival tissue removal many limiting factors must be considered .
– Periodontal surgery must consider :
1. Conservation of keratinised gingiva
2. Minimal gingival tissue loss to maintain esthetics
3. Adequate access to the osseous defect for correction
4. Minimal post surgery discomfort
24. PERIODONTAL PACKS
– In general, dressings have no curative properties;
– they assist healing by protecting the tissue rather than providing
healing factors
– O Benefits of periodontaldressing:
1. Minimizes post operative infection and haemorrhage
2. Prevents surface trauma during mastication
3. Protects against pain induced by contact of wound with food or thetongue
25. IDEAL PROPERTIES
The dressing should be soft, but still have enough plasticityand flexibility to facilitate its placement
in theoperated area and to allow proper adaptation.
Thedressing should harden within a reasonable time.
After setting, thedressing should be sufficiently rigid to prevent fracture and dislocation.
Thedressing should have a smoothsurface after setting to prevent irritation to the cheeks andlips.
The dressing should preferably have bactericidal properties to preventexcessive plaque formation.
The dressing must notdetrimentally interfere withhealing.
26. Noneugenol packs
• Metallic oxide and
fattyacids reaction
based(Coe-Pak)
• Cyanoacrylates
(Barricade)
• Tissue conditioners
Zinc oxideeugenol
packs
• Developed by Ward
in1923
• Supplied as liquid
and powder
• eugenol may induce
an allergic reaction
and burning pain in
some patients
28. ANTIBACTERIAL
PROPERTIES OF PACKS
– Baer et al. And frailgh et al. Studied Bacitracin and neomycin
incorporated packs in clinical trials, butall produced hypersensitivity
reactions
– In a study of Romanov et al., the emergence of resistant organisms and
opportunistic infection has beenreported
– But, Carranza suggests incorporation of tetracyclin powder in Coe-Pak is
recommended, when long and traumatic surgeries areperformed
29. PREPARATION AND
APPLICATION OF DRESSING
– Equal length of thetwo paste
placed on a paper pad
– Mixed with a woodentongue
depressor for 2-3 minutes until
paste loses itstackiness and is
uniform colored
– Capsule of tetracycline is added
– Paste is placed in a papercup of
waterat room temperature and is
workable for 15 minutes
30. – Pack rolled into 2 strips
– Strip of pack is hooked around last molar and pressed into place
anteriorly
– Lingual pack is joined to facial strip at the distal surface of last
molar and fitted into place anteriorly
– Gentle pressure on the facial and lingual surfaces jointhe pack
interproximally
– Continuous pack even in edentulous spaces
– Split flaps = tin foil is used to cover sutures before pack
– Pack shouldn’t interfere with the occlusion and should not be
overextended as it tends to break
– DURATION FOR PACK = 1 WEEK
31. FINDINGS AFTER PACK
REMOVAL
In case of Gingivectomy
Cut surface iscovered with a friable meshwork of new epithelium, which shouldn't bedisturbed
If calculus has not been completely removed,red, beadlike protuberances of granulation tissue will persist ,This granulation tissue
must be removed with a curette
In case of Flap surgery:
Facial and lingual mucosa may be covered with grayish yellow or granular whitish layer of food debris that has seeped under the
pack
This is easilyremoved with a moistcotton pellet
Areas corresponding to the incisions are epithelialized but may bleed readily when touched and shouldn’t be touched
Pockets shouldn't be probed
Tooth mobility,
Tooth mobility is increased immediately aftersurgery
But, it diminishes below the pre-treatment level by the fourth week-
32. REPACKING
– Only in patients with
1. Low pain threshold uncomfortable on pack removal
2. Extensive periodontal involvement
3. Heal slowly
34. POST OP INSTRUCTIONS
1) Instruct the patient to take two paracetamol/ibuprofen tabs. Every 8 hours forfirst24 hours (do not take aspirin)
2) Don't brush over thepack Rinse with 0.12% CHX gluconate twice daily until normal plaque control technique can
be resumed
3) Avoid hot foods during first 24 hours
4) Try to chew on the non-operated sideof the mouth (semisolid foods aresuggested)
5) avoid alcohol, citrus fruits or juices, spicedfoods( food supplements or vitamins are generally notnecessary)
6) Don't smoke
7) Swelling is normal, particularly in areas thatrequired extensive surgicalprocedures
8) During the first day,apply ice intermittently onthe faceoveroperated area (or to suck icecubes intermittently)
9) Occasionally, blood may be seen in the saliva for the first 4 to 5 hours, this is not unusual and will correct itself
10) Pack should remain in place until it is removed inthe at the nextappointment
