Gingivectomy

GINGIVECTOMY

Presenter: R2 鄭瑋之 Instructor: VS 陳娟娟

Date: 2012-12-21

Definition

• A surgical procedure in which gingival pockets are eliminated by removal of gingiva.

Indications

1. Gingival enlargement or overgrowth

2. Idiopathic gingival fibromatosis

3. Pseudopockets

4. Shallow suprabony pockets modified Widman

5. Areas with difficult access

6. Minor corrective procedures

Contraindications

1. Narrow or absent attached gingiva

2. Infrabony pockets

3. Thicking of marginal alveolar bone

Advantages

1. Technically simple; good visual access

2. Complete pocket elimination

3. Predictable morphological result

Disadvantages

1. Very limited indications2. Gross wound; postoperative pain3. Healing is by secondary intention (ca. 0.5 mm/day)4. Danger of exposing bone5. Loss of attached gingiva6. Exposes cervical area of tooth (sensitivity, esthetics,

caries)7. Phonetic and esthetic problems in anterior area

Principle of the Operation

1. Continuous incision at 45° angle at the base of the pocket

2. Sharp dissection of tissues in the interdental area3. Smoothing of the incision edge4. Contouring the gingival surface (GP)5. Scaling and root planing6. Wound coverage (periodontal dressing)

Instruments

• Size, shape and angulation of the working tip, and also by the comfortable handle

• Gingivectomy knife + papilla knife, singly or doubly angled

Pocket marking forceps

• Paired (L & R)• Use: indicate the location of the base of

the pocket

Pocket marking forceps

Gingivectomy knives

• GV knife (Kirkland, L & R)• Papilla knife (Orban, L & R)• Universal knife

Sharpness!Arkansas stone + oil

Gingivectomy knives

45° angle to the tooth long axis Anterior area: single-bend Less accessible area: double-bend

Electrosurgery apparatus and tips

• Use: gingiplasty, papillectomy, smooth out abrupt edges, expose the margins of a tooth preparation before taking the impressions or seating a restoration

• Hemostatic effect• Not recommended for primary gingivectomy injury to

the root, periosteum or bone

Electrosurgery apparatus and tips

To reduce the bulbous marginal gingival contour

Periodontal Dressings & Tissue Adhesives

• Reduce postaperative pain• Prevent colonization of plaque• Left in situ for 7~10 days• A second dressing may be indicated if

healing is inadequate.• Only eugenol-free dressings are

recommended.

• Peripac: ready-to-use, gypsum base + acrylic, sets quickly when contacting with saliva, hard edgesdanger of pressure aphthous ulcer

• Coe-pak: 2 component (zinc oxide + fatty acids), pliable after setting

• CHX power: reduce plaque formation

• Tissue adhesives (Cyanoacrylate): Histoacryl, Bucrylate

• Use: minor GV/GP wounds, instead of sutures• Applied by plastic tubes, brushes or cannulate

Operative Procedure

Drug-induced Gingival Overgrowth

1. Antihypertensive drugs for angina or peripheral vascular disease

2. Nifedipine first in early 1980s

3. Diltiazem, verapamil

4. Amlodipine, felodipine rare

1. Phenytoin for seizure

2. Valpronic acid, carbamazepine, phenobarbitone rare

3. Vigabatrin new

Anti-convulsants1

Calcium Channel Blockers

2Immuno-suppressants

31. Cyclosporin A for

prevention of transplant rejection, autoimmune like rheumatoid arthritis limited by renal, cardiac, and gingival fibrosis

J Periodontol 2004;75:1424-1431.

Prevalence

J Periodontol 2004;75:1424-1431.

children

Prevalence

J Periodontol 2004;75:1424-1431.

GV/GP - Phenytoin-inducedgingival overgrowth

References

1. Color Atlas of Dental Medicine: Periodontology: Periodontology. Herbert F. Wolf, Klaus H. Rateitschak

2. Informational Paper - Drug-Associated Gingival Enlargement, J Periodontol 2004;75:1424-1431.

MERRY CHRISTMAS~!!

Gingivectomy

Health & Medicine

Transcript of Gingivectomy