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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
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DR MUZAMMIL MOIN AHMED, BURAYDAH COLLEGES, KSA
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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
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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
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DR MUZAMMIL MOIN AHMED, BURAYDAH COLLEGES, KSA
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DR MUZAMMIL MOIN AHMED, BURAYDAH COLLEGES, KSA
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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
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VARIOUS TECHNIQUES OF GINGIVECTOMY
Surgical gingivectomy
Gingivectomy by electrosurgery
Laser gingivectomy
Gingivectomy with chemosurgery
DR MUZAMMIL MOIN AHMED, BURAYDAH COLLEGES, KSA
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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
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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
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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
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PERIODONTAL KNIVES
DR MUZAMMIL MOIN AHMED, BURAYDAH COLLEGES, KSA
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DR MUZAMMIL MOIN AHMED, BURAYDAH COLLEGES, KSA
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DR MUZAMMIL MOIN AHMED, BURAYDAH COLLEGES, KSA
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DR MUZAMMIL MOIN AHMED, BURAYDAH COLLEGES, KSA
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DR MUZAMMIL MOIN AHMED, BURAYDAH COLLEGES, KSA
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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
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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
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DR MUZAMMIL MOIN AHMED, BURAYDAH COLLEGES, KSA
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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
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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
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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
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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
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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
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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
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THANK YOU
DR MUZAMMIL MOIN AHMED, BURAYDAH COLLEGES, KSA