Gingivectomy

GingivectomyGingivectomy is excision of the

gingiva

Involves removal of pocket wall :• to provide visibility and accessibility

for complete debridement• Creating a favorable environment

for gingival health• Restoration of a physiologic gingival

contour

IndicationsOld

• Elimination of suprabony pockets

• Elimination of gingival enlargement

• Elimination of suprabony periodontal abscesses

Current Indications

• Treatment of gingival enlargement

• Aesthetic crown lengthening

Contraindications

• Need for bone surgery

• Base of pocket apical to MGJ

• Aesthetic considerations

Techniques

• Conventional surgery (scalpels)

• Elecrtosurgery

• Laser

• Chemicals (historical)

Surgical Gingivectomy

• Pockets explored

• Pockets marked with a pocket marker

Instrumentation

• Kirkland knives

• Orban knives

OR

• Bard-parker blades No 11 & 12

The Incision• External bevel

incision

• Started apical to markings

• Directed coronally 30 º - 45 º to

tooth surface

• Close to bone without exposing it

Incisions

ContinuousDiscontinuous

Continuous

Straight Scalloped

Cutting interdental papilla

Removing detached gingiva

Debridement

• Removal of granulation tissue

• Thorough scaling & root planing

• Periodontal pack

Clinical Case

GingivoplastySame procedure as gingivectomy with the sole purpose to correct gingival shape and establish physiologic gingival contours; when there are no pockets.

Instrumentation

• Scalpel

• Periodontal knife

• Rotary coarse diamond stones

• Ceramic burs

• Electrodes

Procedures

• Tapering the gingival margin• Creating a scalloped marginal

outline• Thinning attached gingiva• Creating vertical interdental

grooves• Shaping interdental papillae

Healing• Protective surface clot

• Acute inflammation in connective tissue

• Clot is replaced by granulation tissue within 24 hrs

• Increase of connective tissue cells & blood vessels

Healing

• The highly vascular granulation tissue grows coronally to produce new gingival margin

• Capillaries from PDL grow and connect the granulation tissue,and within 2 weeks they connect with gingival vessels.

Healing

• After 12-24 hrs, epithelial cells start to migrate over the granulation tissue,sepreating it from the clot.

• Epithelial cells are attached to CT by hemidesmosomes and basement membrane

• Wound completely covered by epithelium within 5-14 days. Complete keratinisation takes 1 month.

Gingivectomy by Electrosurgery

Gingivectomy by ElectrosurgeryUses of electrosurgery:The use of electrosergery should be limited

to superficial procedures that are• Removal of gingival enlargments • Gingivoplasty • Relocation of frenum and muscle

attachments • Incision of periodontal abscesses• Pericoronal flaps

It shouldn’t be used in procedures that involve proximity to the bone, such as flap operations and mucogingival surgery

Advantages:• Permits an adequate contouring of the tissue.• Controls hemorrhage.

Disadvantages:• Cannot be used in patients who have

shielded cardiac pacemakers.• Causes unpleasant odor.• If electro surgery points touch the bone,

irreparable damage can be done.• Can cause tissue damage and loss of

periodontal support when the electrode is used close to the bone.

TechniqueThe removal of gingival enlargments and

gingivoplasty:• Performed with needle, ovoid loop or

diamond shape electrodes

• Blended cutting and coagulating currents is used

• Electrode is moved in shaving motion in all reshaping procedures

In treatment of acute periodontal abscesses:• Incise to establish drainage • Can be made with needle electrode• The incision remain open because the edges is

sealed by the currentFor hemostasis:• The ball electrode is used • The surface is touched with a coagulating current • Bleeding areas interproximally, bar shaped is

used

Frenum and muscle attachments:• The frenum or muscle is stretched and

sectioned with the loop electrodeFor pericoronitis:• For acute pericoronitis, drainage may be

obtained by incising the flap with a bent needle electrode

• When the acute symptoms subside, a loop is used to remove the flap

Healing after electrosurgery

• Some evidences report no significant differences in gingival healing after resection by electrosurgery and resection with periodontal knives; other studies find delayed healing, greater reduction in gingival height, and more bone injury after electrosurgery

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