Of these sources which are indications for perio surgery and which are not - Vitamin C deficiency - Systemic disease - Plasma cell gingivitis - Inflammation - Neoplastic enlargements - Puberty gignivitis - Drug induced - Pregnancy tumor - Pregnanacy gingivitis

- Vitamin C deficiency --> No - Systemic disease --> no - Plasma cell gingivitis--> no - Inflammation --> yes - Neoplastic enlargements--> no - Puberty gignivitis -->no - Drug induced --> yes - Pregnancy tumor --> maybe (yes if the tumor continues to exist after the baby is born) - Pregnanacy gingivitis --> no

2. Gingivectomy/Gingivoplasty Flashcards by Janae Garofalo

Indications for gingivectomy are

Gingival enlargement
Pseudopockets/suprabony pockets
Minor corrective procedures (i.e to gain access to the margin of a prep)
Crown lengthening (gummy smile)

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Causes of gingival enlargement are

Inflammation

Drug induced

Immunosuppressant
Anticonvulsant (dilantin)
Ca channel blocker

Assoc. with systemic diseases

Leukemia
Granulomatous diseases (Wegener’s and sarcoidosis)
Puberty
Pregnancy (tumor, gingivitis)
Vitamin C deficiency
Plasma Cell Gingivitis

Neoplastic enlargements

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What are the two immunosuppressive drugs that can lead to gingival enlargement

Cyclosporin

- Tacrolimus= prograf

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What are the names of the Ca channel blockers that can result in gingival enlargement

-Nifepipine (Adalat, Procardia)

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Of these sources which are indications for perio surgery and which are not

Vitamin C deficiency
Systemic disease
Plasma cell gingivitis
Inflammation
Neoplastic enlargements
Puberty gignivitis
Drug induced
Pregnancy tumor
Pregnanacy gingivitis

Vitamin C deficiency –> No
Systemic disease –> no
Plasma cell gingivitis–> no
Inflammation –> yes
Neoplastic enlargements–> no
Puberty gignivitis –>no
Drug induced –> yes
Pregnancy tumor –> maybe (yes if the tumor continues to exist after the baby is born)
Pregnanacy gingivitis –> no

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T/F pregnancy tumor and gingivitis are both likly to resolve after the birth of the child

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Another name for pregnancy tumor is

pyogenic granuloma

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Wegener’s is associated with _ gingivitis

strawberry

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What can be perscribed to preganant patients to describe the severity of pregnancy gingivitis/tumor

chlorhexidine (reduce plaque) also just stress good OH

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Describe plasma cell gingivitis

allergic reaction- typically to chewing gum (especially cinnamon)

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What Ca channel blocker most commonly is responsible for gingival overgrowth

Nifedipine

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Crhonic inflammation (long term) will result in what changes in the gingival tissue

tissue will become more fibrotic

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People who commonly breath through their mouth are

Obstructive airways
Enlarged tonsils
*Most prominent when humidity is low (dry air)

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How can you teel the difference in gingival enlargement caused by plaque or by mouth breathing

posterior regions of the gingiva are unaffected in mouth breathers

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How can you prevent gingival enlargement as a result of mouth breathing

apply vaseline or coco butter to the gingival tissue to prevent it from drying out and becoming inflammed

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Gingival enlargement caused by drugs tends to look more fibrotic because

the drugs induce fibroblasts

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Recurance of gingival enlargement after perio surgery for patients on dilantin is (common/uncommon)

common

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What must patients undergo before recieving a gingivectomy as a result of drugs

Initial therapy (OHI, SRP)

- Re-eval (<10% plaque on surfaces)

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Where does gingival enlargement (drug induced) begin

papilla (plaque accumulates interproximally) – less enlargement in areas with diastemas

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Describe the apperance of plasma cell gingivitis

Very red

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How do you get rid of gingival enlargement caused by plasma cell gingivitis

not gingivectomy- discontinue the allergen and should resolve

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Describe the difference between gingivectomy and gingivoplasty

Gingivectomy= surgical procedure in which gingival (periodontal) pockets are eliminated by removal of gingival tissue

Gingivoplasty= Surgical recontouring or remodeling of the gingival surface

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What type of bevel can only be used for infrabony pockets

internal bevel

Most common perio surgery is

flap surgery (unternal bevel incision)

T/F There is apical migration of the JE in pseudopocket formation

F- there is only coronal movement of the gingival margin

Describe the difference between a suprabony and infrabony pocket

Suprabony= the back of the pocket (JE) is coronal to the alveolar crest

What is another way to get rid of a gummy smile other than crown lengthening

-Increasing the depth of vestibule (increasing the amount of alveolar mucosa) to lower the lip line

Contraindications of gingivectomy are

- Inadequate attached gingiva - Infrabony pocket - Exostoses

Why are infrabony pockets a contraindication for gingivectomy

- You can't exise all of the sulcular epithelium this way without exposing the alveolar bone - Exposure of bone can lead to alveolitis (painful)

what are the names of the two incisions that can be used to treat infrabony pockets

- internal bevel | - Reverse bevel

Why are exostoses contraindicated with gingivectomies

don't allow for the correct angle and will expose bone

Exostoses are most often seen where

Maxillary posterior | Mandibular anterior

Advantages and disadvantages of gingivectomy

Advantages - Technically simple - Complete pocket elimination - Predictable result (will know what the contours will look like because the CT will be covered in epithelium) Disadvantages - Reduce attached gingiva - Large wound- painful - Healing by secondary intention (0.5 mm/day) - Danger of exposing bone (esp at alveolar crest) - Exposed root (sensitivity and susceptible to caries) - Phonetic/esthetic problems in anterior cases

Flap surgery heals with (primary/secondary) intention

primary

Epithelium migrates over the wound of an external bevel incision at a rate of _/day

0.5 mm

With an external bevel incision you want the cut to en (at/apical/coronal) to the JE

apical

Procedure for gingivectomy

- Anesthesia - Mark pocket depths - Incision at 45 degree angle to tooth apical to JE - SRP - Smooth the incision edge, contour gingiva (gingivoplasty) - Place periodontal dressing

How are the pocket depths marked

-Bleeding points

The blade enters (at/apical/coronal) to the bleeding points

apical

What are the different types of LA injections that should be given

- Blocks/infiltrations with 2% lido and 1:100,000 epi | - Interproximal with 2% lido and 1:50,000 epi

Why is a periodontal dressing required

- Can't get primary closure of the wound (heals by secondary intention) - Flap surgery doesn't require a dressing

How long does the dressing stay on the wound for

7-10 days

What kinds of dressings shouldn't be used because they are painful

zinc oxide eugenol

Why do you inject anestesia interproximally

increases pressure on the tissue and makes it easier to excise because it becomes firmer

What is the name of the knife used to make the external bevel incision

gingivectomy knife or kirklin knife (Can also use a 12 or 15 blade)

External bevel incision is made at a _ degree angle relative to

45... gingival margin? Apical to the JE

What is the second incision in a gingivectomy

45 degree incision interproximally with a buck knife

Why is the dressing left on for 7-10 days

that is the time it takes for re-epithelialization to occur (rate of 0.5 mm/day)

How do the dressings stay in place

they are not adhesive they lock in mechanically in the interproximals of the teeth

What are the advantages of using lasers for gingivectomy? Disadvantages?

Advantages - Better visibility (no bleeding) - Less wound contraction (less scarring) Disadvantage - Delayed epithelialization, collagen production and inflammation - Lower initial tensile strength

Do you place a dressing over a gingivectomy done with a laser

Diode lasers 630 nm= ? 810 nm= ?

630 nm= laser pointer | 810 nm= cutting laser

What mode is used on diode lasers for gingivectomy

continuous wave mode

Describe the speed and length of strokes that should be used when performing a gingivectomy with a diode laser

- Short 2-3 mm strokes - Light contact with tissue - ~1mm/sec speed

Diode laser gingivectomy heals with (primary/secondary) intention

secondary

Indications for gingivectomy

- Treat horizontal bone loss with increased pocket depth - Reduce gingival overgrowth from medsor genetics - Remove soft tissue craters resulting from previous surgical procedures - Crown lengthening when ostectomy isn't required

Contraindications for gingivectomy

- Presence of osseous defects - Inadequate attached gingiva - Base of pocket apical to MGJ - Inadequate vestibule depth - Inadequate OH