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Questions and Answers
What is the primary goal of gingival curettage in periodontal treatment?
What is the primary goal of gingival curettage in periodontal treatment?
Which of the following correctly describes subgingival curettage?
Which of the following correctly describes subgingival curettage?
What is a significant consideration when performing curettage during scaling and root planing?
What is a significant consideration when performing curettage during scaling and root planing?
What type of tissue is primarily targeted for removal during the curettage process?
What type of tissue is primarily targeted for removal during the curettage process?
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Which statement regarding the barrier created by epithelium in the healing process is accurate?
Which statement regarding the barrier created by epithelium in the healing process is accurate?
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What is the primary reason for the removal of granulation tissue during flap surgery?
What is the primary reason for the removal of granulation tissue during flap surgery?
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What has been demonstrated regarding the effectiveness of scaling and root planing combined with curettage?
What has been demonstrated regarding the effectiveness of scaling and root planing combined with curettage?
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Which statement regarding the effects of curettage on epithelial tissues is true?
Which statement regarding the effects of curettage on epithelial tissues is true?
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Why is the elimination of the pocket a concern in periodontal therapy with respect to aesthetics?
Why is the elimination of the pocket a concern in periodontal therapy with respect to aesthetics?
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What is the primary impact of thoroughly planed roots on bacteria and tissue changes?
What is the primary impact of thoroughly planed roots on bacteria and tissue changes?
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Study Notes
Gingival Curettage
- Curettage is the scraping of the gingival wall of a periodontal pocket to remove diseased soft tissue.
- Scaling removes deposits from the root surface.
- Root planing smooths the root to remove infected and necrotic tooth substance.
- These are distinct yet sometimes overlapping procedures.
- Gingival curettage removes inflamed soft tissue adjacent to the pocket.
- Subgingival curettage is done apically to the junctional epithelium, severing connective tissue attachment.
- Some curettage is unintentional during scaling and root planing.
Rationale
- Curettage removes chronically inflamed granulation tissue in the periodontal pocket.
- This tissue contains inflammation, calculus fragments, and bacterial colonies.
- The granulation tissue epithelium prevents new fiber attachment.
- Thorough root planing removes most bacteria, thus reducing the need for curettage.
- Remaining bacteria are eliminated by the host's defense mechanisms.
- Removing inflamed tissue is not always necessary, especially if the surrounding root tissue is healthy.
- Curettage for removing bleeding granulation tissue is primarily surgical, not restorative.
Indications
- Curettage is limited, used after scaling and root planing for some instances.
- Moderately deep intrabony pockets in accessible areas, with nonflap surgical options.
- Aggressive surgical techniques might be avoided for systemic or psychological factors.
- Recurrent inflammation in areas needing maintenance after previous pocket reduction surgery.
Procedure
- Preceded by scaling and root planing, as it addresses inflammation causes.
- Local anesthesia typically required.
Techniques
- Direct, horizontal curettage strokes against inflamed tissue .
- Excisional new attachment procedure using a knife to remove pocket lining and junctional epithelium.
- Ultrasonic curettage used to disrupt tissue and lift off epithelium (also involves microcauterization of tissues).
Caustic Drugs
- Historically used for curettage, but found ineffective and destructive.
Healing After Procedure
- Blood clot fills the area post-curettage.
- Granulation tissue proliferation with capillary decrease follows.
- Epithelial lining regeneration follows that process, generally taking 2-7 days.
Aesthetics
- Aesthetic concerns are now major factors in modern periodontal therapy, especially in the maxillary anterior area.
- Efforts are made to minimize gingival tissue shrinkage, preserve interdental papilla.
- Compromise therapy (root planing without damaging connective tissue) can be considered.
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Description
This quiz covers the various aspects of gingival curettage, including its procedures, rationale, and effects on periodontal health. You will learn about the differences between scaling, root planing, and subgingival curettage. Test your understanding of how these techniques contribute to removing diseased tissue and promoting healing in periodontal pockets.
