Gingival Curettage Procedures

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.