DEPARTMENT OF

PERIODONTICS
GINGIVECTOMY
Contents
• Definition

• Indications

• Contra-Indications

• Types of Gingivectomy
 Gingivectomy
• Definition
– Excision of Gingiva by removing the diseased pocket wall
thereby exposing tooth surface which provides the visibility
& accessibility that are essential for the complete removal of
irritating surface deposits & thorough smoothening of the
roots.

• Indications
– Suprabony pocket
– Fibrous enlargement (Pseudo Pocket)
– Crown lengthening
– Perio Aesthetic
– Suprabony periodontal abscess.
 CONTRAINDICATIONS
• Bone defect can not be corrected
• Fragile gingiva
• Location of the base of the pocket apical to
mucogingival junction.

TYPES OF GINGIVECTOMY
• Surgical Gingivectomy
• Gingivectomy by chemosurgery
• Gingivectomy by Electro surgery
• Gingivectomy by Cryosurgery
• Gingivectomy by Laser
 1. SURGICAL GINGIVECTOMY

Instruments Required In Surgical Gingivectomy

• Krane Keplan Pocket Marker

• Kirkland Periodontal knife
• Orban periodontal knife
• Bard – parker handle
• Bard – Parker blades no 11 & 12
• Supra & subgingival scalers
• Curettes
 STEPS IN- SURGICAL
GINGIVECTOMY

• Anaesthetize area
• Mark the pocket
• Resect the gingiva
• Remove granulation tissue
• Remove calculus
• Place periodontal pack
 Pocket Marking
• Pocket on each surface are explored with periodontal probe
and marked with pocket marker at three places on each
tooth on each labial & lingual surfaces.

• Pocket should be marked systematically beginning on distal

surface of the last tooth then moving on the facial surface
and proceeding anteriorly to the midline
INCISION GIVEN INSURGICAL
GINGIVECTOMY
Type of incision :
Internal bevel incision
It may be continuous or discontinuous
A) Discontinuous: From the facial surface at distal angle of last
tooth to distofacial angle of the next tooth. Next incision begins
in the interdental space to distofacial angle of next tooth.
B) Continuous:- Started on the facial surface
from the disto angular region & carried
forward anteriorly following the course of
pocket without interruption. procedure is
repeated on lingual surface.

B) Distal incision: Facial and lingual incision are

joined by an incision across the distal
surface of the last erupted tooth.
 STEPS IN SURGICAL
• Start
GINGIVECTOMY
apical to points marking of the course of
periodontal pocket & is directed coronally to a point
b/w the base of the pocket & crest of the bone.
• Should be close to bone but not exposed it.
• The incision should be beveled at approximately 45
degree to the tooth surface to follow the normal
festooned pattern of the gingiva

• Should not leave diseased Pocket wall.

• The incision should pass completely through soft
tissue to tooth.
 REMOVE RESECTED- GINGIVA
• Remove the marginal & inter dental gingiva
starting from distal surface of last tooth detach
gingiva at the line of incision with the help of
surgical hoes & scalers.
APPRAISE THE FIELD
• Bead like granulation tissue.
• Calculus ruminants.
• A band of light zone on the root surface.
• Softening of root surface resorptions &
cementum protuberances.
 Remove granulation tissue
• The curettes are used for this purpose. The
curette is guided along the tooth surface &
under the granulation tissue.
REMOVE CALCULUS:
• The remaining calculus & necrotic
cementum are to be removed using scalers &
curettes. Check each surface of every tooth
for calculus & soft tissue reminants.
• Wash area several times with saline and
cover with gauze sponge.
 Place Periodontal Pack

• After the bleeding is control and Hemostatis achieved, the Gingivectomy wound is covered with
periodontal pack.

HEALING AFTER SURGICAL GINGIVECTOMY

- The initial response after gingivectomy is Clot formation
- Underlying tissue become acutely inflammed with some necrosis.
- The clot is replaced by granulations tissue.
* After 24 Hrs. increased in new connective tissue cells mainly
angioblasts beneath the surface layer of inflammation& necrosis.
* By 3rd day numerous young fibroblast located in the area.
* Highly vascular granulation tissue grows coronaly, creating new free
gingival margin and sulcus.
* Capillaries derived from blood vessels of periodontal ligament migrates into the
granulation tissue & within two weeks they connect with gingival vessels.

- After 12 to 24 Hrs. epithelial cells at the margin start to migrate over

the granulation tissue separating it from the clot.
- Epithelial cells advance by tumbling action

- Surface epithelization is generally complete after 5 to 14 days.

 2. GINGIVECTOMY BY
CHEMOSURGERY
Agent Used.
• 25% phenol with 75% camphor.
• 5% paraformaldehyde in ZnO eugenol pack.
ADVANTAGES OF CHEMOSURGERY
• No analgesia or anesthesia required for the
procedure.
• Procedure is easy to perform & require less
instruments.
 Disadvantage
• Bone necrosis might result.
• Periodontal abscess might result.
• Delayed wound healing
• Subsequent plaque retention
• Bone resorption
3. Gingivectomy by electro surgery
Advantages:
• Less Bleeding
Disadvantages
• Procedure produces heat which causes necrosis of
adjacent tissue.
• If it transfer to the bone, resorption take place.
 4. Gingivectomy by cryosurgery
• Temperature -50 to -600c is apply to gingiva by means of a
probe.
Advantages
• The procedure does not cause pain & bleeding.
5. Gingivectomy by LASER:
TYPE OF LASER USED:
- Co2 Laser
- Nd: YAG Laser
ADVANTAGES
- Similar to electro surgery more sofasticated, produces no
heat thereby, least necrosis.
- Similar to electro surgery no past operative dressing is
required.
 Clinical Picture
Shows inflammed
GIngiva in lower
anterior region.

Clinical Picture
Shows Removal of
the diseased gingiva
to expose calculus
Pre-operative
Clinical
Photograph

Post Operative
Clinical
Photograph
Maintenance After Gingivectomy

• Prescribe Chlorhexidine gluconate rinses.

• Advice patient to maintain good oral
hygiene.
• Recall for professional cleaning.
References:
• Michel G. Newmann , Henry H. Takel ,
Fermin A. Carranza ; Carranza’ s clinical
periodontology ; 9th edition.

• Jan Lindhe , Thorkild Karring , Niklaus P

Lang ; clinical periodontology & the
implant dentistry ; 4th edition.