GINGIVECTOMY AND GINGIVOPLASTY

GINGIVECTOMY & GINGIVOPLASTYDR. MUZAMMIL MOIN AHMED

ASSISTANT PROFESSOR DIVISION OF PERIODONTICS

DEPARTMENT OF PREVENTIVE DENTAL SCIENCES BURAYDAH COLLEGE OF PHARMACY AND DENTISTRY

BURAIDAH, AL-QASSIM, KSA.DR MUZAMMIL MOIN AHMED, BURAYDAH COLLEGES, KSA

DR MUZAMMIL MOIN AHMED, BURAYDAH COLLEGES, KSA

GINGIVECTOMY AND GINGIVOPLASTY

Gingivectomy means excision of the gingiva.

Gingivoplasty is a reshaping of the gingiva to create physiologic gingival

contours with the sole purpose of recontouring the gingiva in the absence of

pockets.

DR MUZAMMIL MOIN AHMED, BURAYDAH COLLEGES, KSA

INDICATIONS OF GINGIVECTOMY

Elimination of suprabony pockets, regardless of their depth, if the pocket wall

is fibrous and firm.

Elimination of gingival enlargements.

Elimination of suprabony periodontal abscesses.

DR MUZAMMIL MOIN AHMED, BURAYDAH COLLEGES, KSA

DR MUZAMMIL MOIN AHMED, BURAYDAH COLLEGES, KSA

DR MUZAMMIL MOIN AHMED, BURAYDAH COLLEGES, KSA

CONTRAINDICATIONS OF GINGIVECTOMY

The need for bone surgery or examination of the bone shape and morphology.

Situations in which the bottom of the pocket is apical to the mucogingival

junction.

Esthetic considerations, particularly in the anterior maxilla.

DR MUZAMMIL MOIN AHMED, BURAYDAH COLLEGES, KSA

VARIOUS TECHNIQUES OF GINGIVECTOMY

Surgical gingivectomy

Gingivectomy by electrosurgery

Laser gingivectomy

Gingivectomy with chemosurgery

DR MUZAMMIL MOIN AHMED, BURAYDAH COLLEGES, KSA

SURGICAL GINGIVECTOMY

STEP1:

The pockets on each surface are explored with a periodontal probe and

marked with a pocket marker.

Each pocket is marked in several areas to outline its course on each surface.

STEP 2:

Periodontal knives (e.g., Kirkland knives) are used for incisions on the facial

and lingual surfaces and those distal to the terminal tooth in the arch.

Orban periodontal knives are used for interdental incisions. Bard-Parker blades

#12 and #15, as well as scissors, are used as auxiliary instruments.DR MUZAMMIL MOIN AHMED, BURAYDAH COLLEGES, KSA

The incision is started apical to the points marking the course of the pockets

and is directed coronally to a point between the base of the pocket and the

crest of the bone.

Either interrupted or continuous incisions may be used.

The incision should be beveled at approximately 45 degrees to the tooth

surface and recreate the normal festooned pattern of the gingiva.

STEP 3:

Remove the excised pocket wall, clean the area, and closely examine the root

surface.DR MUZAMMIL MOIN AHMED, BURAYDAH COLLEGES, KSA

STEP 4:

Carefully curette the granulation tissue and remove any remaining calculus

and necrotic cementum to leave a smooth and clean surface.

STEP 5:

Cover the area with a surgical pack.

DR MUZAMMIL MOIN AHMED, BURAYDAH COLLEGES, KSA

PERIODONTAL KNIVES

DR MUZAMMIL MOIN AHMED, BURAYDAH COLLEGES, KSA

DR MUZAMMIL MOIN AHMED, BURAYDAH COLLEGES, KSA

DR MUZAMMIL MOIN AHMED, BURAYDAH COLLEGES, KSA

DR MUZAMMIL MOIN AHMED, BURAYDAH COLLEGES, KSA

DR MUZAMMIL MOIN AHMED, BURAYDAH COLLEGES, KSA

GINGIVECTOMY BY ELECTROSURGERY

ADVANTAGES:

Control of hemorrhage.

Adequate contouring of the tissue.

DISADVANTAGES:

Cannot be used in patients who have poorly shielded cardiac pacemakers.

Treatment causes unpleasant odor.

If the electrosurgery point touches the bone, irreparable damage can be done.DR MUZAMMIL MOIN AHMED, BURAYDAH COLLEGES, KSA

The heat generated by injudicious use can cause tissue damage and loss of periodontal

support when the electrode is used close to the bone

when electrode touches the root, areas of cementum burn are produced.

TECHNIQUE:

Removal of gingival enlargements and gingivoplasty is performed with the needle

electrode.

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.DR MUZAMMIL MOIN AHMED, BURAYDAH COLLEGES, KSA

DR MUZAMMIL MOIN AHMED, BURAYDAH COLLEGES, KSA

LASER GINGIVECTOMY

The lasers most often used in dentistry are the carbon dioxide (CO2) and

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.DR MUZAMMIL MOIN AHMED, BURAYDAH COLLEGES, KSA

LASER GINGIVECTOMY

The lasers most often used in dentistry are the carbon dioxide (CO2) and

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.DR MUZAMMIL MOIN AHMED, BURAYDAH COLLEGES, KSA

HEALING AFTER GINGIVECTOMY

Initially, formation of a protective surface clot.

Underlying tissue becomes acutely inflamed, with some necrosis.

The clot is then replaced by granulation tissue.

By 24 hours, there is an increase in new connective tissue cells mainly

angioblasts, below the surface of inflammation.

By the third day, numerous young fibroblasts are located in the area.

This highly vascularized connective tissue grows coronally, creating a new,

free gingival margin and sulcus.DR MUZAMMIL MOIN AHMED, BURAYDAH COLLEGES, KSA

After 12 to 24 hours, epithelial cells at the margins of the wound start

migrating over the granulation tissue.

Epithelial activity reaches a peak in 24 to 36 hours.

After 5 to 14 days, surface epithelialization is generally complete.

Complete repair takes about 1 month.

DR MUZAMMIL MOIN AHMED, BURAYDAH COLLEGES, KSA

GINGIVOPLASTY

Gingivoplasty is a reshaping of the gingiva to create physiologic gingival contours with

the sole purpose of recontouring the gingiva in the absence of pockets.

Gingival and periodontal disease often produces deformities in the gingiva that is

conducive for plaque accumulation and food debris, which prolongs and aggravates the

disease process.

Such deformities include (1) gingival clefts and craters, (2) craterlike interdental

papillae caused by acute necrotizing ulcerative gingivitis, and (3) gingival enlargements.DR MUZAMMIL MOIN AHMED, BURAYDAH COLLEGES, KSA

Gingivoplasty may be accomplished with a periodontal knife, a scalpel, rotary

coarse diamond stones, or electrodes.

The technique resembles that of festooning of a artificial denture, which

consists of tapering the gingival margin, creating a scalloped marginal outline,

thinning the attached gingiva , creating vertical interdental grooves, and

shaping the interdental papillae.

DR MUZAMMIL MOIN AHMED, BURAYDAH COLLEGES, KSA

THANK YOU

DR MUZAMMIL MOIN AHMED, BURAYDAH COLLEGES, KSA