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Perio--Surgical (Spring) > 2. Gingivectomy/Gingivoplasty > Flashcards

2. Gingivectomy/Gingivoplasty Flashcards

1
Q

Indications for gingivectomy are

A
  • 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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2
Q

Causes of gingival enlargement are

A

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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3
Q

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

A
  • Cyclosporin

- Tacrolimus= prograf

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4
Q

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

A

-Nifepipine (Adalat, Procardia)

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5
Q

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
A
  • 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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6
Q

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

A

t

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7
Q

Another name for pregnancy tumor is

A

pyogenic granuloma

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8
Q

Wegener’s is associated with _ gingivitis

A

strawberry

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9
Q

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

A

chlorhexidine (reduce plaque) also just stress good OH

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10
Q

Describe plasma cell gingivitis

A

allergic reaction- typically to chewing gum (especially cinnamon)

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11
Q

What Ca channel blocker most commonly is responsible for gingival overgrowth

A

Nifedipine

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12
Q

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

A

tissue will become more fibrotic

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13
Q

People who commonly breath through their mouth are

A
  • Obstructive airways
  • Enlarged tonsils
  • *Most prominent when humidity is low (dry air)
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14
Q

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

A

posterior regions of the gingiva are unaffected in mouth breathers

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15
Q

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

A

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

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16
Q

Gingival enlargement caused by drugs tends to look more fibrotic because

A

the drugs induce fibroblasts

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17
Q

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

A

common

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18
Q

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

A
  • Initial therapy (OHI, SRP)

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

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19
Q

Where does gingival enlargement (drug induced) begin

A

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

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20
Q

Describe the apperance of plasma cell gingivitis

A

Very red

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21
Q

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

A

not gingivectomy- discontinue the allergen and should resolve

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22
Q

Describe the difference between gingivectomy and gingivoplasty

A

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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23
Q

What type of bevel can only be used for infrabony pockets

A

internal bevel

24
Q

Most common perio surgery is

A

flap surgery (unternal bevel incision)

25
Q

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

A

F- there is only coronal movement of the gingival margin

26
Q

Describe the difference between a suprabony and infrabony pocket

A

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

27
Q

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

A

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

28
Q

Contraindications of gingivectomy are

A
  • Inadequate attached gingiva
  • Infrabony pocket
  • Exostoses
29
Q

Why are infrabony pockets a contraindication for gingivectomy

A
  • You can’t exise all of the sulcular epithelium this way without exposing the alveolar bone
  • Exposure of bone can lead to alveolitis (painful)
30
Q

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

A
  • internal bevel

- Reverse bevel

31
Q

Why are exostoses contraindicated with gingivectomies

A

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

32
Q

Exostoses are most often seen where

A

Maxillary posterior

Mandibular anterior

33
Q

Advantages and disadvantages of gingivectomy

A

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
34
Q

Flap surgery heals with (primary/secondary) intention

A

primary

35
Q

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

A

0.5 mm

36
Q

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

A

apical

37
Q

Procedure for gingivectomy

A
  • 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
38
Q

How are the pocket depths marked

A

-Bleeding points

39
Q

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

A

apical

40
Q

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

A
  • Blocks/infiltrations with 2% lido and 1:100,000 epi

- Interproximal with 2% lido and 1:50,000 epi

41
Q

Why is a periodontal dressing required

A
  • Can’t get primary closure of the wound (heals by secondary intention)
  • Flap surgery doesn’t require a dressing
42
Q

How long does the dressing stay on the wound for

A

7-10 days

43
Q

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

A

zinc oxide eugenol

44
Q

Why do you inject anestesia interproximally

A

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

45
Q

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

A

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

46
Q

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

A

45… gingival margin? Apical to the JE

47
Q

What is the second incision in a gingivectomy

A

45 degree incision interproximally with a buck knife

48
Q

Why is the dressing left on for 7-10 days

A

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

49
Q

How do the dressings stay in place

A

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

50
Q

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

A

Advantages

  • Better visibility (no bleeding)
  • Less wound contraction (less scarring)

Disadvantage

  • Delayed epithelialization, collagen production and inflammation
  • Lower initial tensile strength
51
Q

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

A

no

52
Q

Diode lasers
630 nm= ?
810 nm= ?

A

630 nm= laser pointer

810 nm= cutting laser

53
Q

What mode is used on diode lasers for gingivectomy

A

continuous wave mode

54
Q

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

A
  • Short 2-3 mm strokes
  • Light contact with tissue
  • ~1mm/sec speed
55
Q

Diode laser gingivectomy heals with (primary/secondary) intention

A

secondary

56
Q

Indications for gingivectomy

A
  • 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
57
Q

Contraindications for gingivectomy

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

Perio--Surgical (Spring) (8 decks)

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