1 / 23

G INGIVAL CURETTAGE

G INGIVAL CURETTAGE. Definition and Types Rationale Indications Procedure Healing after scaling & curettage Clinical appearance after scaling & curettage. DEFINITIONS.

shanda
Download Presentation

G INGIVAL CURETTAGE

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. GINGIVAL CURETTAGE

  2. Definition and Types • Rationale • Indications • Procedure • Healing after scaling & curettage • Clinical appearance after scaling & curettage

  3. DEFINITIONS Scaling: Scaling is aprocess by which plaque and calculus are removed from both supragingival & subgingival tooth surface. Root Planing:- It is a process by which residual embedded calculus and portion of cementum are removed from the roots to produce a smooth, hard & clean surface. Curettage:- The word curettage is used in periodontics to mean the scraping of gingival wall of a periodontal pocket to separate diseased soft tissue.

  4. TYPES Gingival Curettage:- It consists of the removal of inflamed, soft tissue lateral to the pocket wall. Subgingival curettage:- Refers to the procedure that is performed apical to the epithelial attachment severing the connective tissue attachment down to the osseous crest. Inadvertent curettage:- Some degree of curettage is done unintentionally while scaling & root planingis performed. Types

  5. RATIONALE Curettage accomplishes the removal of the chronically inflamed granulation tissue that forms in the lateral wall of periodontal pocket. This tissue contains fibroblastic, angioblastic proliferation and have pieces of dislodged calculus and bacterial colonies, which may perpetuate the pathologic features of the tissue and hinder healing. This inflamed granulation tissue is lined by epithelium and deep strands of epithelium penetrate into the tissue. The presence of this epithelium is constructed as a barrier to attachment of necrotic debris in the area.

  6. The dilemma now is Is it justified to do curettage, just to eliminate the inflamed granulation tissue? Because when root is thoroughly planed the major source of bacteria disappears and pathologic changes in the periodontal pocket disappears without any need for curettage.

  7. On the other hand curettage may also eliminate all or most of the epithelium lining the pocket wall & underlying junctional epithelium, though there are different opinions regarding this. The purpose of curettage is still valid in pre surgical phase where there is persistant gingival inflammation even after repeated scaling & root planing.

  8. INDICATIONS • Can be performed as a part of new attachment in moderately deep infrabony pockets located in accessible areas where a type of closed surgery is adviced. • Can be done as non-definitive procedure to reduce inflammation prior to pocket elimination procedures like flap surgeries. • It can be performed in patients where extensive surgical procedures are contraindicated . • Curettage is frequently performed on recall visits as a method of maintenance treatment for areas of recurrent inflammation & pocket depth, particularly where pocket reduction surgery has previously been performed.

  9. PROCEDURES • Surgical procedure • Ultrasonic Curettage • Caustic drugs

  10. Curettage Procedure: After adequate local anesthesia, the correct curette is selected (eg: Gracey No 13-14 is used for mesial surfaces, Gracey no 11-12 for distal surfaces). Curettage can also be performed USING 4R-4L Columbia Universal curette. The instrument is inserted so as to engage the inner lining of the pocket wall & is carried along the soft tissue wall usually in horizontal stroke. The pocket wall may be supported by gentle finger pressure on external surface.

  11. Columbia #4R-4L universal curette Gracey #3-4 Gracey #11-12 Gracey #13-14

  12. Extent of gingival curettage (white arrow) and subgingival curettage (black arrow).

  13. Gingival curettage performed with a horizontal stroke of the curette.

  14. In subgingival curettage, the tissue attached between the bottom of pocket and the Alveolar crest is removed with a scooping motion of the curette to the tooth surface. The area is flushed to remove debris. It is necessary sometimes to put sutures & place a pack.

  15. Subgingival curettage. A, Elimination of pocket lining. B, Elimination of junctional epithelium and granulation tissue. C, Procedure completed.

  16. ENAP (Excisional New Attachment Procedure): It was developed by United States Naval corps. It is a definitive subgingival curettage procedure performed with a knife.

  17. ENAP SURGICAL TECHNIQUE • After adequate local anesthesia, an internal bevel incision is made from margin of free gingiva apically below the base of pocket, it is carried all around the tooth surface, attempting to retain as much interdental tissue as possible. • The excised tissue is then removed with a curette & the root surface is planed to a smooth hard consistency. • Approximate wound edges if necessary, place sutures & periodontal- dressing.

  18. Excisional new attachment procedure. A, Internal bevel incision to point below bottom of pocket. B, After excision of tissue, scaling and root planing are performed.

  19. -> ULTRASONIC CURETTAGE: Ultrasonic scalers are used for ultrasonic curettage, here ultrasonic vibrations disrupt tissue continuity, & the epithelium is lifted off. It also alters the morphologic features of fibroblast nuclei. This method has proved to be as effective as the manual method and results in decreased inflammation & less removal of connective tissue. -> CAUSTIC DRUGS: Drugs such as sodium sulfide, Antiformin & phenol have been used to induce chemical curettage of the lateral wall of pocket. Disadvantage is the extent of tissue destruction with these drugs cannot be controlled.

  20. Healing after Scaling & Curettage Immediately after curettage, • a blood clot fills the pocket area • hemorrhage is also present in the tissues. • dilated capillaries and increase in PMN cells appear on wound surface. • rapid proliferation of granulation tissue occurs shortly thereafter with a decrease in the number of blood vessels. • restoration & epithelializationof sulcustakes place in 2 to 7 days.

  21. Clinical appearance after scaling & curettage Immediately after curettage, the gingiva appears hemorrhagic & bright red. After 1 week, the gingiva appears reduced in height with apical shift. The redness is slightly reduced. After 2 weeks, with the proper oral hygiene the gingiva comes back to normal.

  22. CONCLUSION Nowadays curettage is not generally preferred because when root is thoroughly planed, the major source of bacteria disappears and pathologic changes in periodontal pocket disappears without any need for curettage.

  23. DISCUSSION

More Related