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Questions and Answers
What is the purpose of removing the pocket wall in gingivectomy?
What is the purpose of removing the pocket wall in gingivectomy?
What is the result of ultrasonic vibrations in ultrasonic curettage?
What is the result of ultrasonic vibrations in ultrasonic curettage?
What is the advantage of ultrasonic curettage over manual method?
What is the advantage of ultrasonic curettage over manual method?
What is the purpose of local anesthesia in ENAP?
What is the purpose of local anesthesia in ENAP?
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What is the purpose of applying periodontal pack after ENAP?
What is the purpose of applying periodontal pack after ENAP?
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What is the disadvantage of using drugs for chemical curettage?
What is the disadvantage of using drugs for chemical curettage?
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What is the purpose of making an internal bevel incision in ENAP?
What is the purpose of making an internal bevel incision in ENAP?
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What is the primary objective of curettage in periodontal pocket reduction surgery?
What is the primary objective of curettage in periodontal pocket reduction surgery?
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What type of anesthesia is typically used for curettage?
What type of anesthesia is typically used for curettage?
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What is the result of excisional new attachment procedure (ENAP)?
What is the result of excisional new attachment procedure (ENAP)?
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What is the primary difference between gingivectomy and gingival curettage?
What is the primary difference between gingivectomy and gingival curettage?
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What is the purpose of undermining the junctional epithelium during curettage?
What is the purpose of undermining the junctional epithelium during curettage?
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What is the benefit of combining curettage with scaling and root planning?
What is the benefit of combining curettage with scaling and root planning?
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What is the purpose of finger pressure on the external surface during curettage?
What is the purpose of finger pressure on the external surface during curettage?
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What is the difference between ultrasonic curettage and surgical curettage?
What is the difference between ultrasonic curettage and surgical curettage?
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When should curettage be performed in relation to scaling and root planning?
When should curettage be performed in relation to scaling and root planning?
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What is the process of replacing the clot with granulation tissue?
What is the process of replacing the clot with granulation tissue?
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How long does it take for epithelial cells to cover the wound?
How long does it take for epithelial cells to cover the wound?
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What is the frequency of the current used in electrosurgery?
What is the frequency of the current used in electrosurgery?
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What is a contraindication for electrosurgery?
What is a contraindication for electrosurgery?
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What is a complication of electrosurgery when the electrode touches the bone?
What is a complication of electrosurgery when the electrode touches the bone?
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What is an advantage of using periodontal knives compared to electrosurgery?
What is an advantage of using periodontal knives compared to electrosurgery?
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What is the wavelength of the carbon dioxide laser beam?
What is the wavelength of the carbon dioxide laser beam?
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Why is precautionary measure necessary when using a laser beam for oral surgery?
Why is precautionary measure necessary when using a laser beam for oral surgery?
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Study Notes
Periodontal Pocket Reduction Surgery
- Limited to gingival tissues only, not involving underlying osseous structures, without flap surgery
- Two types: Gingival curettage and Gingivectomy
Gingival Curettage
- Scraping of the gingival wall of the periodontal pocket (removal of inner surface of soft tissue wall by a curette)
- Performed apical to epithelial attachment
- Types: Surgical curettage, Chemical curettage, Ultrasonic curettage
- Removes chronically inflamed granulation tissue that forms in the lateral wall of the periodontal pocket
- May be performed with scaling and root planning during the same visit or as a separate operation
Gingival Curettage Procedure
- Local anesthesia by topical or infiltration anesthesia
- Curettage is placed so that the cutting edge is against the tissue
- Inserted to engage the inner lining of the pocket wall and carried along the soft tissue in a horizontal stroke
- Pocket wall may be supported by gently finger pressure on the external surface
- Curette is then placed under the cut edge of the junctional epithelium to undermine it
- In subgingival curettage, tissue attached between the bottom of the pocket and the alveolar crest is removed
- Area is flushed to remove debris and tissue is partly adapted to the tooth by gentle finger pressure
Excisional New Attachment Procedure (ENAP)
- Definitive subgingival curettage procedure performed with a knife or scalpel blade
- Internal bevel incision is made from the margin of free gingiva apically below the base of the pocket
- Excised tissue is removed with a curette and the root surface is planed to a smooth hard consistency
- Approximate wound edges and place sutures and a periodontal dressing if necessary
Ultrasonic Curettage
- Uses ultrasonic scalers to disrupt tissue continuity and lift the epithelium off
- Proved to be as effective as the manual method, results in decreased inflammation and less removal of connective tissue
Chemical Curettage
- Uses drugs such as sodium sulfide, antiformin, and phenol to induce chemical curettage of the lateral wall of the pocket
- Disadvantage: Extent of tissue destruction cannot be controlled
Gingivectomy
- Excision of the gingival
- Provides visibility and accessibility for complete calculus removal and thorough smoothing of the roots
- Removes diseased tissue and local irritants, creating a favorable environment for gingival healing and restoration of physiologic gingival contour
Gingivectomy Healing
- Clot is replaced by granulation tissue
- Epithelial cells migrate from the edge of the wound beneath the clot and cover the wound in 7-14 days
- Keratinize in 2-3 weeks
- Formation of a new epithelial attachment may take as long as 4 weeks
Gingivectomy by Electrosurgery
- Uses high frequency current of 1.5 to 7.5 million cycles per second
- Permits adequate contouring of the tissue and control of hemorrhage
- Contraindications: Use in patients with non-compatible or poorly shielded cardiac pacemaker
- Disadvantages: Unpleasant odor, irreparable damage to bone if electrode touches bone, heat generated can cause tissue damage and loss of periodontal support
Laser Gingivectomy
- Uses carbon dioxide (C02) and neodymium: yttrium-aluminum-garnet (Nd: YAG) lasers
- Beam has been used for the excision of gingival overgrowths, although healing is delayed compared to conventional scalpel gingivectomy
- Precautionary measures are necessary to avoid reflecting the beam on instrument surface, which could result in injury to neighboring tissues or the eyes of the operator
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Description
This quiz covers the procedures involved in periodontal pocket reduction surgery, including gingival curettage and gingivectomy, without the use of flap surgery.
