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45
Gingivectomy
Shalu Bathla
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Historical Perspective
Definition
Objectives
Indications
Contraindications
Limiting Circumstances
Drawbacks
HISTORICAL PERSPECTIVE
History of gingivectomy can be dated back to 1742, when
Fauchard describe the procedure to remove excessive
tissue. Robicsek in 1884, later on described the so called
gingivectomy procedure as straight incision technique
in which the tissues were excised and the granulation
tissue eliminated. Pickerills book Stomatology in
General Practice, published in 1912, described the
procedure and very reasonably named the operation
gingivectomy. Zentler in 1918 gave scalloped incision
technique for gingivectomy. Gingivectomy is thought to
be introduced as an official periodontal therapy when
the idea of periodontal etiology shifts from bone to soft
tissue. This is mainly due to Kronfeld in 1935, who
emphasized that periodontal disease is not the disease
of the bone. Gingivectomy was later defined by Grant et
al in 1979 as being the excision of the soft tissue wall of a
pathologic periodontal pocket.
8. Gingivoplasty
9. Types of Gingivectomy Procedure
Surgical Gingivectomy
Laser Gingivectomy
Gingivectomy by Electrosurgery
Gingivectomy by Chemosurgery
10. Healing After Gingivectomy
OBJECTIVES
i. Pocket elimination by gingival resection.
ii. Development of physiologic tissue form for disease
prevention.
INDICATIONS
i.
ii.
iii.
iv.
DEFINITION
According to the World Workshop in Periodontics (1989),
gingivectomy is defined as an excision of the soft tissue
wall of the periodontal pocket.
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PERIODONTICS REVISITED
LIMITING CIRCUMSTANCES
1. Palatal aspects of maxillary posterior teeth: When the
palatal vault is shallow and the depth of periodontal
involvement is near or enters the vault area,
gingivectomy on the palatal aspect of maxillary
posterior teeth may result in elimination of most if
not all of the palatal gingiva, placing the gingival
margin at or near a level of coincident with that of
the roof of the mouth.
2. Mandibular retromolar lesions: When an incision is
made on movable and delicate mucosa, this tissue
often cuts poorly, bleeds profusely and may be
difficult to resect and shape. The use of the distal
wedge procedure, often simplifies the management
of retromolar tissue.
3. Maxillary tuberosity areas: When soft tissue is so great,
relative to the depth of periodontal involvement on
the distal aspect of the last molar, that its level
resection would bring about surgical entry into the
mucosa of the hamular notch. It may be more
appropriate to perform a distal wedge procedure to
eliminate diseased tissue immediately adjacent to the
distal portion of the molar.
4. Cases of emotional stress: With age, diminish patient
cooperation and motivation, retarded healing, etc.
have a direct bearing upon the desirability of the
surgical therapy. Such patient is a poor surgical risk
and requires therapeutic modification.
DRAWBACKS
1. Tissue wound heals by secondary intention.
2. Alveolar bone defects are not revealed and therefore
cannot be treated adequately.
3. Gingivectomy is a radical procedure in which zone
of attached gingiva is compromised/may be
eliminated. Thus, attached gingiva is wasted.
4. Clinical crown are lengthened considerably and need
to be explained to the patient before surgery.
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348 SECTION 6: Treatment: A. Non-surgical Therapy and B. Surgical Therapy
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CHAPTER 45: Gingivectomy . d349
Laser Gingivectomy
PERIODONTICS REVISITED
Advantages
i. Laser offers an almost completely dry, bloodless
surgery.
ii. Because of dried field, surgical time may be reduced.
iii. There is instant sterilization of the area, decreasing
the chances of bacteremia.
iv. This is noncontact surgery, thus no mechanical
trauma to the surgical site.
v. There is prompt healing with minimal postoperative
swelling and scarring.
vi. Postoperative pain appears to be greatly reduced.
B
Figs 45.3: Incisions: (A) Discontinuous incision;
(B) Continuous incision
Disadvantages
i. There is loss of tactile feedback in using the
instrument.
ii. It is imperative that all operating room personnel
wear safety glasses for protection of their eyes.
iii. There is the necessity for hospitalization.
iv. High cost of the equipment.
Gingivectomy by Electrosurgery
Instruments: Needle electrode (thickness varying from
0.0075 inch to 0.015 inch), small ovoid loop/diamond
shaped electrodes.
PERIODONTICS REVISITED
Fig. 45.4: Mark the depth of pocket with pocket marker and give
external bevel incision apical to the bleeding point making 45 angle
to the long axis of tooth
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350 SECTION 6: Treatment: A. Non-surgical Therapy and B. Surgical Therapy
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CHAPTER 45: Gingivectomy . d351
6th day
Contraindication
16th day
21st day
POINTS TO PONDER
9 Failure to produce beveled incision leaves a broad
plateau which takes more time than ordinarily
required to develop the physiologic contour of
gingiva, thus the incision should be beveled at
approximately 45 to the tooth surface.
9 The granulomatous tissue is removed first and then
thorough scaling is attempted on the tooth, so that
hemorrhage from the granulomatous tissue should
not obscure the scaling during surgical procedure.
BIBLIOGRAPHY
1. Carranza FM, The gingivectomy technique. In, Newman, Takei,
Carranza. Clinical Periodontology, 9th ed Saunders 2003;749-53.
2. Electrosurgical Management of soft tissues and restorative
dentistry. Dent Clin North Am 1980;24(2):247-69.
3. Genco RJ, Rosenberg ES, Evian C. Periodontal surgery. In, Genco
RJ, Goldman HM, Cohen DW. Contemporary Periodontics. CV
Mosby 1999;554-84.
PERIODONTICS REVISITED
Clot formation
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352 SECTION 6: Treatment: A. Non-surgical Therapy and B. Surgical Therapy
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PERIODONTICS REVISITED
2. A
3. D
4. C
5. A
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