034.gingivectomy

Jаffaя яaza Syзd

Gingivectomy “an excision of the soft tissue wall of the periodontal pocket”. OBJECTIVES

⇓ i. Pocket elimination by gingival resection. ii. Development of physiologic tissue form for disease prevention.


INDICATIONS 1. Eliminate supra-alveolar pockets and abscesses. 2. Remove fibrous or edematous enlargements of the gingiva. 3. Transform rolled or blunted margins to physiologic form. 4. Create more esthetic form in cases in which exposure of the anatomic crown has not fully occurred. 5. Create bilateral symmetry (where the gingival margin of one incisor has receded somewhat more than that of the adjacent incisor). 6. Expose additional clinical crown to gain added retention for restorative procedures (access to subgingival areas, etc.). 7. Correct gingival craters.


CONTRAINDICATIONS 1. In the presence of thick alveolar edges, interdental craters or bizarre crestal bone form. 2. When infrabony pockets are present. 3. If pockets extends till/below the mucogingival junction. 4. Inadequate oral hygiene maintenance by the patients 5. Uncooperative patients. 6. Medically-compromised patients. 7. Dentinal hypersensitivity before the surgical procedure (requires considerable preparation of the patient mentally and is not exactly a contraindication). 8. Esthetically challenging areas, especially in the maxillary anterior region.


TYPES OF GINGIVECTOMY 1. Surgical gingivectomy. 2. Gingivectomy by electrosurgery. 3. Laser gingivectomy. 4. Gingivectomy by chemosurgery


Surgical Gingivectomy Armamentarium: 1. Mouth mirror, probe. 2. Pocket markers, Kirkland and Orban interdentalgingivectomy knives. 3. Surgical blade, Bard Parker handle. 4. Surgical curettes, Gracey curettes, tissue forceps,scissors. 5. Periodontal dressing.

2. Pocket markers, Kirkland and Orban interdental

3. Surgical blade, Bard Parker handle.

4. Surgical curettes, Gracey curettes, tissue forceps,


Healing after Gingivectomy Basically healing is by secondary intention: a. The initial response is the formation of a protective surface clot. b. The clot is then replaced by granulation tissue. c. Within 24 hours, there is an increase in new connective tissue cells mainly angioblasts and by third day numerous fibroblasts are located in this area. The highly vascular granulation tissues grow coronally, creating a new free gingival margin and sulcus. d. Capillaries derived from blood vessels of periodontal ligament migrate into the granulation tissue, and with in two weeks they connect with gingival vessels. Surface epithelialization is generally complete after 5 to 14 days. Initially, keratinization is less than what it was prior to surgery. Complete epithelialization takes about 1 month.


2nd day ⇨ •Clot formation 4th day ⇨ •Clot replaced by granulation tissue • Epithelium without rete pegs extends over part of

the surface • Dense inflammatory infiltration

6th day ⇨ •Wound is covered by stratified squamous epithelium • Collagen formation starts in the connective tissue 16th day ⇨ •Epithelium with rete pegs appear • Dense collagenous connective tissue appears 21st day ⇨ •Epithelial rete pegs well developed, with thickening of stratum corneum • Increased Collagen formation in the connective tissue • Gingiva clinically appear normal


Electrosurgery (Surgical Diathermy) Uses high frequency current of 1.5 to 7.5 million cycles per second. There are three classes of electrodes used: 1. Single wire electrodes for incising and excising. 2. Loop electrodes for planing tissues. 3. Heavy bulkier electrodes for coagulation procedures.


Four types of electrosurgical techniques are available: a. Electrosection: Three procedures are performed incising, excising and planing. b. Electrocoagulation: Used to prevent hemorrhage. c. Electrofulguration: Uses high voltage current. It has limited application in dentistry. d. Electrodesiccation: Uses dehydrating current and least used, as it is a dangerous technique.

Here the active electrode is inserted into the tissue and the tissue surrounding the electrode is mass coagulated in situ.

This procedure is useful only in dermatological and cancer surgeries.


Laser Gingivectomy Most commonly used lasers are

carbon dioxide

Nd:YAG (Neodymium:yttrium-Aluminium-garnet) lasers. Gingivectomy by Chemosurgery Chemicals used are 5 % paraformaldehyde or potassium hydroxide to remove gingiva. Disadvantages 1. Their depth of action cannot be controlled hence it may also injure normal tissues. 2. Gingival remodeling is not possible. 3. Healing is delayed

034.gingivectomy

Health & Medicine