Sumber: Fermin A. Carranza. GINGIVAL CURETTAGE. GINGIVECTOMY http://uqu.edu.sa/files2/tiny_mce/plugins/filemanager/files/4290655/21%20Gingival%20Surgical%20Techniques.

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GINGIVECTOMY
Gingivectomy means excision of the gingiva. By removing the pocket wall, gingivectomy provides visibility and accessibility for complete calculus removal and thorough smoothing of the roots (Figure 62-5), creating a favorable environment for gingival healing and restoration of a physiologic gingival contour. The gingivectomy technique was widely performed in the past. Improved understanding of healing mechanisms and the development of more sophisticated flap methods have relegated the gingivectomy to a lesser role in the current repertoire of available techniques. However, it remains an effective form of treatment when indicated (see Figure 62-5).

Indications and Contraindications

The gingivectomy technique may be performed for the following indications16: 1. Elimination of suprabony pockets, regardless of their depth, if the pocket wall is fibrous and firm. 2. Elimination of gingival enlargements. 3. Elimination of suprabony periodontal abscesses. Contraindications to gingivectomy include the following: 1. The need for bone surgery or examination of the bone shape and morphology. 2. Situations in which the bottom of the pocket is apical to the mucogingival junction. 3. Esthetic considerations, particularly in the anterior maxilla. The gingivectomy technique may be performed by means of scalpels, electrodes, lasers, or chemicals. All these techniques are reviewed here, although the surgical method is the only technique recommended.

Surgical Gingivectomy
Step 1 The pockets on each surface are explored with a periodontal probe and marked with a pocket marker (Figures 62-6 and 62-7). Each pocket is marked in several areas to outline its course on each surface. Step 2 Periodontal knives (e.g., Kirkland knives) are used for incisions on the facial and lingual surfaces and those distal to the terminal tooth in the arch. Orban periodontal knives are used for supplemental interdental incisions, if necessary, and Bard-Parker knives #11 and #12 and scissors are used as auxiliary instruments. The incision is started apical to the points marking the course of the pockets 48,56 and is directed coronally to a point between the base of the pocket and the crest of the bone. It should be as close as possible to the bone without exposing it, to remove the soft tissue coronal to the bone. Exposure of bone is undesirable. If it occurs, healing usually presents no problem if the area is adequately covered by the periodontal pack. Discontinuous or continuous incisions may be used (Figure 62-8). The incision should be beveled at approximately 45 degrees to the tooth surface and should recreate, as far as possible, the normal festooned pattern of the gingiva. Failure to bevel leaves a broad, fibrous plateau that takes more time than usually required to develop a physiologic contour. In the interim, plaque and food accumulation may lead to recurrence of pockets. Step 3 Remove the excised pocket wall, clean the area, and closely examine the root surface. The most apical zone consists of a bandlike light zone where the tissues were attached, and coronally to it some calculus remnants, root caries, or root resorption may be found. Granulation tissue may be seen on the excised soft tissue (Figure 62-9). Step 4 Carefully curette the granulation tissue, and remove any remaining calculus and necrotic cementum so as to leave a smooth and clean surface.

Step 5 Cover the area with a surgical pack (see Chapter 60).