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Gingivectomy (Gum Pocket Removal)

Definition

Gingivectomy is a procedure involving removal of gingiva and periodontal tissue to achieve healing. It involves surgically removing (excision) of soft tissue walls lining a periodontal pocket. A periodontal pocket is a condition which is characterized by deepening of the gingival sulcus surrounding a tooth. The deep sulcus leads to accumulation of food particles and further problems as the condition progresses. It may lead to periodontal abscess or loosening of the tooth from its socket due to loss of attachment.

Indications

Gingivectomy is generally indicated in the following periodontal conditions :

  • Remove the gingival pockets and promote healing of the periodontium.
  • To excises any fibrous or edematous enlargement present over the gingiva.
  • To achieve cosmetic goals  by exposing the anatomic crown of a tooth which is not completely visible.
  • To achieve a physiological form of gingiva in with rolled, blunt or everted margined area.
  • To create bilateral symmetry in the gingiva in relation to the anterior teeth.
  • To correct gingival craters.
  • Along with few dental restorative procedures to gain additional retention for the restoration.

Contraindications

Contraindications for gingivectomy are as follows :

  • When the pockets have progressed towards the bone forming the tooth sockets.
  • Patients with poor oral hygiene practices.
  • Unusual bone pattern and internal anatomy at the site of surgery.
  • Dentin hypersensitivity (sensitive teeth) adjacent to the site of surgery.
  • Medically compromised or uncooperative patients.

Types

Different methods and types of gingivectomy procedure are available and the most effective and beneficial method is chosen as per the patient’s preference and clinician’s advice. The most commonly used methods for gingivectomy include :

  1. Surgical gingivectomy.
  2. Gingivectomy using electrosurgery.
  3. Laser gingivectomy.
  4. Gingivectomy using chemical substances.

Procedures

Surgical gingivectomy

The procedure is carried out in a dental setup under local anesthesia. The surface of the pocket is explored with periodontal instruments and incision is placed at the desired area over the gingiva. The affected pocket wall is excised along with the gingiva followed by curettage of the remaining infected tissue, debris, plaque calculus and necrotic cementum. The area is then is covered with a periodontal surgical pack which is to be removed after healing occurs. It may also be combined with procedures such as gingivoplasty constituting of recontouring of the gum tissue.

Electrosurgery

Electrosurgical methods used for gingivectomy consists of electrocoagulation and electrosection. Single wire electrodes or loop electrodes are used for excising or coagulating the desired segment of gingiva. The major advantage of his method is control of bleeding within the gum. However, it is associated with unpleasant odor and damage to the cementum of the tooth and can not be used in patients with cardiac pacemakers.

Laser surgery

Lasers used for gingivectomy includes carbon dioxide and Nd: YAG type of lasers. It is effective in the excision of gingival enlargements and overgrowths. However, it has limited application in routine periodontal procedures.

Chemicals

Chemicals used to remove the desired portion of gingiva are 5% paraformaldehyde and potassium hydroxide. The chemical method is associated with delayed healing and tissue injuries.

Video

References :

http://www.webmd.com/oral-health/gingivectomy-for-gum-disease

http://en.wikipedia.org/wiki/Gingivectomy


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