Gingivectomy

UIC College of Dentistry

Dept. of Post-graduate Periodontics
Paul Jang
Objectives of the lecture
 Should be able to discuss indications and
contraindications of gingivectomy
 Etiological factors of gingival enlargement
 Surgical technique and steps involved in
gingivectomy procedure
 Healing process after gingivectomy
 How to prevent recurrence of gingival
enlargement
 Patient at presentation
Gingival Enlargement
Gingival Enlargement

 Etiology:
1. Plaque induced
2. Drug-induced
Drug-induced gingival
overgrowth
 3 commonly used drug types:
– Anticonvulsant used to treat epilepsy:
Phenytoin.
– Immunosuppressive agent used to
prevent organ transplant rejection:
Cyclosporine.
– Calcium channel blocker: Nifedipine.
(exact mechanism for all 3 drugs is
unknown)
 Patient at presentation

868 869 8 4 7
649 87
10
Gingivectomy

 Definition:
– Excision of the gingiva by removing the
diseased pocket wall that obscures the
tooth surface.
– Provides visibility and accessibility
necessary for complete removal of
surface deposits and thorough smoothing
of the roots.
Gingivectomy vs.
Gingivoplasty
 Gingivectomy
– To eliminate periodontal pockets and
includes reshaping as part of the
technique.
 Gingivoplasty
– To reshape and recontour the gingiva to
create physiologic gingival contours in the
absence of pockets.
 Gingivectomy

Indications Contra-indications

 Gingival  If access to
overgrowth alveolar bone is
 Other gingival needed
conditions which  If there is
require insufficient
recontouring attached gingiva
The gingivectomy
technique is a method
of excising unwanted gingival tissue
Armamentarium

 Periodontal knives (Kirland and Orban)

 Bard-Parker blades, no. 15
 Scissors
 Curettes
 Gauze
 Periodontal dressing/pack
 Kirkland and Orban knife
Orban knife Kirkland knife
Steps in the gingivectomy
technique
 Establish local anesthesia
– regional or local anesthesia. 1;50,000
epinephrine is often used to help
control bleeding
Surgical Procedure
 1. Pockets explored and marked with a
pocket marker. Each pocket is marked in
several areas to outline its course on each
surface.
 2. Periodontal knives and Blades 15 are
used for incisions:
– Incision should be beveled at ~45 degrees to
the tooth surface and should re-create the
normal festooned pattern of the gingiva.
(continued…)
Surgical Procedure
– Incision is started apical to base of the
pockets and is directed coronally to a
point between the base of the pocket and
the crest of the bone.
 3. Remove the excised pocket wall
 4. Remove any remaining calculus to
leave a smooth and clean root surface
 5. Cover the area with a periodontal
dressing
Step 1: determine probing depth

Step 2: incision
 Step 3: removal of tissue

Step 4: hemostasis

Step 5: periodontal pack

Patient presentation
“I would like to get
braces…”
Radiographic examination
Altered passive eruption?
“Gummy smile”
“Gummy smile”
Presence of calculus
Healing after the
gingivectomy
 Formation of blood clot
 Replacement of clot by granulation tissue
 Granulation tissue grows coronally forming new
gingival margin and sulcus
 After 12 to 24 hours epithelial cells at wound
margins migrate over granulation tissue
 Surface epithelialization is usually complete by 5 to
14 days.
 Complete epithelial repair is complete in ~ 1 month
 Complete repair of connective tissue take ~ 7 weeks
Healing after gingivectomy
 Primary intention: Covering the
exposed surgical wound area with a
flap by suturing.

 Secondary intention: Surgical

area is not sutured and allowed to
heal by surface epithelialization
Periodontal
Dressing/Pack
Periodontal Dressing
 Content: Zinc oxide, an oil (for plasticity), a
gum (for cohesiveness), and bithionol (a
fungicide), resin, coconut fatty acids and
chlorothymol (a bacteriostatic agent).
 Function: acts as a physical and protective
barrier. No curative properties.
 As it sets it becomes retentive
 Should be removed after ~ 7 days
2 week post-op
Before

After
Prevention of recurrence

 Eliminate local factors: Plaque and

calculus.
 Periodontal maintenance therapy and
Oral Hygiene instructions.
Treatment Plan
 Instructions in oral hygiene
Toothbrushing
Flossing
Use of mouthwash (Chlorhexidine
gluconate)
 Scaling
 Gingivectomy
 Supportive Periodontal Therapy
Referral

 The patient should be referred to a

periodontist for treatment
 Supportive Periodontal Therapy
could be shared by periodontist
and general dentist
Other methods:
 Electrosurgery: For minor gingivoplasty
 Laser gingivectomy: not recommended

 All three methods are NOT recommended

 For gross removal of gingival mass,
surgical gingivectomy is the preferred
method and is very predictable.