GINGIVAL CURETTAGE
Definition
• Curettage means the scraping the inner surface of lateral
wall of the pocket to remove the sulcular epithelium and the
inflammed tissue.
• Done along with root planning
Types
CURETTAGE
Gingival
Curettage
Sub gingival
Curettage
Inadvertent
Curettage
1. Gingival curettage: Removal of the inflammed soft tissue lateral
to pocket wall
2. Sub gingival curettage - It is performed apical to the epithelial
attachment, severing the connective tissue attachment down to
the osseous crest.
. Inadvertent curettage: Curettage done
unintentionally when scaling and root planing
is performed.
Rationale:
The removal of pocket epithelium along with
granulation tissue and removal of all surface
deposit from the root surface would result in new
connective tissue attachment.
Indications
• Performed along with root planning in an attempt to achieve new
attachment in moderate to deep intra bony pockets located in accessible
area.
• Done to reduce inflammation of the lateral wall of the pocket prior to more
aggressive therapy.
• In patients to whom more aggressive surgical techniques (eg) flaps, are
contra indicated owing to age, Systemic problems, psychologic problems.
• Also performed during recall visits as a part of maintenance programe in
case treated with pocket elimination procedures earlier.
Procedure:
– Area is anaesthetised
– Curette (Gracey or columbia universal curette) is selected
according to area being treated.
– Blade of the instrument is introduced into the pocket. cutting
edge is against the tissue .(Angulation > 90° for gingival
curettage)
• Currete is then adapted so that the cutting edge of the blade engages the
inner linning of the lateral wall of the pocket.
• Move in a horizontal stroke along the soft tissue wall of the pocket
• The pocket wall is supported by gentle finger pressure on external surface.
• Pocket is then flushed with normal saline and examined.
• Lateral wall of the pocket is adapted well to the root surface with finger
pressure
• Occasionally suturing done
• periodontal pack is placed
•
Analgesics for pain
• Other techniques
• Excisional new attachment procedure - (ENAP)
– developed by US Naval dental corps
– it is a definitive sub gingival curettage performed with a knife.
• Procedure: • Area is Anaesthesia
• Internal bevel incision- from margin of free gingiva
apically to a point below the bottom of the pocket.
• Excised tissue remove the with curette and the
root surface is planned well. Pocket is flushed with normal saline
• The wound edges are approximate with finger pressure.
periodontal dressing;
Place sutures and
Ultrasonic curettage
-
use of ultrasonic devices are recommended
LASER CURETTAGE
- Nd:YAG (NEODYMIUM : YTTRIUM –ALUMINIUM –GARNET LASER)
- Patients with periodontal pocket of 3 to 7 mm are indicated
CAUSTIC DRUGS
• It is used to induce a chemical curettage of lateral wall of pocket
• Sodium sulfide ,alkaline sodium hypochlorite (anti formin) & phenol
• It is discarded after their ineffectiveness ,like uncontrolled extent of tissue
destruction
GINGIVECTOMY
Gingivectomy
Gingivectomy means excision of the gingiva.
Indications
1.Elimination of suprabony pockets, if the pocket wall is
fibrous and firm.
2.Elimination of gingival enlargements.
3.Elimination of suprabony periodontal abscesses.
Contraindications
1.Need for bone surgery
2. Bottom of pocket apical to MGJ.
3.Esthetic considerations, particularly in the anterior maxilla.
Methods
• Scalpels
• Electrodes
• Lasers
• chemicals
Surgical gingivectomy
• Step 1: pockets are explored with a periodontal probe and marked with
a pocket marker.
• Step 2: incisions is started apical to the points marking the course of
pockets and is directed coronally to a point between the base of the
pocket and the crest of the bone.
• Discontinuous or continuous incisions may be used. The incision
should be beveled at approximately 45 degrees to the tooth surface and
should recreate , as far as possible, the normal festooned pattern of the
gingiva.
• Step3.Remove the excised
pocket wall, clean the area, and
closely examine the root
surface.
• Step 4: carefully curette the
granulation tissue, and remove
any remaining calculus and
necrotic cementum so as to
leave a smooth and clean
surface.
• Step 5:cover the area with a
surgical pack.
Gingivectomy by electrsurgery
Advantages
• Permits adequate contouring of the tissue
• Controls haemmorhage.
Disadvantages
• Cannot be used in patients with poorly shielded cardiac
pacemakers
• Unpleasent odor
• Irreparable damage to bone.
• Cementum burns
Laser Gingivectomy
The CO2 laser is used for the excision of gingival growths,
although healing is delayed compared with conventional
scalpel gingivectomy.
Gingivectomy by Chemosurgery
5% paraformaldehyde have been used in the past.
Disadvantages
Depth of action can not be controlled.
Gingival remodeling cannot be accomplished effectively
Gingivoplasty
• is reshaping of the gingiva to create physiologic gingival
contours.
Indications
• Gingival clefts and craters
• Shelflike interdental papillae caused by ANUG.
• Gingival enlargements.