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Gingivectomy and gingivoplasty

ISSN 2398-2950

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Synonym(s): Gingival resection; Gingival contouring

Introduction

  • Gingivectomy refers to removal of some or all gingiva surrounding a tooth; it is contraindicated if less than 2 mm attached gingiva were to remain after tissue resection.
  • Gingivoplasty is a form of gingivectomy performed to restore physiological contours of the gingiva.
  • Gingivectomy and gingivoplasty are accomplished using blades, knives, burs, electrosurgery, or laser.
  • The goals are to completely remove pseudopockets (ie reduced to 0 mm) and establish physiological gingival contours.

Uses

Decision taking

Criteria for choosing test

  • Contraindicated if:
    • Insufficient attached gingiva (less than 2 mm) could be retained around tooth after tissue resection.
    • Teeth have moderate to severe periodontal disease Periodontal disease, requiring creation of a periodontal flap rather then removal of gingival tissue.
    • Patients have potential bleeding complications.

Requirements

Materials required

Minimum equipment

  • Periodontal probe.
  • Scalpel handle with number 15 blade.
  • Adson dressing/tissue forceps.
  • Swabs.
  • Instruments for professional dental cleaning (power scaler, sharp hand scaler/curette, and polishing tools) Dental instruments Dental scaling.

Ideal equipment

  • Minimum equipment as outlined above.
  • Pocket market forceps.
  • Number 11 and 12B scalpel blades.
  • Gingivectomy knives:
    • Kirkland knives for removal of large amounts of fibrous tissue.
    • Orban knives for removal of interproximal gingiva.
  • Electrosurgery unit in fully rectified mode, using loop, needle- or diamond-shaped electrodes (contraindicated in patients with noncompatible pacemakers).
  • Bullet- or egg-shaped 12-fluted bur on a water-cooled high-speed dental handpiece.
  • Carbon dioxide laser.
  • Topical astringent (eg Hemodent).
  • Tissue protectant (eg Tincture of Myrrh and Benzoin).

Preparation

Dietary preparation

  • Fast patient for 12 hours prior to general anesthesia.

Restraint

Technique

Approach

Step 1 - Outlining pocket depths

  • Insert periodontal probe or straight arm of pocket marking forceps into pseudopocket and measure pocket depths Periodontal pockets.
  • Outline pocket depths on external gingival surface by pressing tip of periodontal probe or closing pocket marking forceps whose pointed plier end will penetrate into gingiva.
  • Repeat process every 2 or 3 mm to create a series of bleeding points around entire tooth, thus outlining the planned excision site.

Core procedure

Step 1 - Gingivectomy and gingivoplasty

  • Perform sharp bulk excision with scapel blade with the incision beginning 1-2 mm apical to the bleeding points and directed coronally at a 30-45° angle to allow for removal of excess gingiva to the internal level of the bleeding point while establishing physiological gingival contours.
  • Use loop or other shaped electrodes in fully rectified at minimum power settings to remove and contour gingiva in areas where the bladed is not able to reach.
  • Contour the gingival margin (that should bevel externally) with bullet-shaped 12-fluted bur on water-cooled high-speed dental handpiece.
  • Control hemorrhage with digital pressure and swabs.

Exit

Step 1 - Professional dental cleaning

  • Clean teeth to remove plaque and calculus, using power scaler and sharp hand scaler/curette.
  • Polish teeth to smooth their surface, using fine prophy paste in prophy cup on prophy angle attached to low-speed handpiece.
  • Place topical astringent and tissue protectant on cut gingival surfaces.

Aftercare

Immediate Aftercare

Monitoring

  • Cut gingival surfaces usually heal within a few weeks, with granulation tissue migrating from the wound surface into the coagulum and epithelium proliferating from the basal cell layer of the oral epithelium.

Analgesia

  • Depending on extent of gingival surgery.

Antimicrobial therapy

  • Apply chlorhexidine-containing gel or rinse to surgery sites twice daily for 2 weeks Chlorhexidine.

Potential complications

  • Thermal damage of the crown, root, alveolar bone and soft tissues after contact with electrode and laser.
  • Mechanical damage of the teeth after contact with 12-fluted burs.

Long term Aftercare

Medication

  • Home oral hygiene: daily toothbrushing intiated 2 weeks following surgery.

Follow up

  • Re-examinations: 2 weeks, 2, 6 and 12 months, and then once annually.
  • Need for further anesthetized treatment assessed at re-examination.

Outcomes

Complications

  • Failure to externally bevel margins requires more time to develop physiological gingival contours, thus predisposing to development of gingivitis and recurrence of pseudopockets.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Lewis J R, Reiter A M (2005) Management of gingival enlargement in a dog - Case report and review of the literature. J Vet Dent 22 (3), 160-169 PubMed.