midterm 2 - lecture 2

Question 1

the excision of the soft tissue wall of a periodontal pocket

Answer 1

gingivectomy

Old procedure
Used now on localized basis - simple

Excision procedure

Beveled excision - fairly big wound
More predictable and conservative technique now (Flap)

approach from apical to coronal

Question 2

_ indications
~remove gingival enlargement
~hyperplatic tissue
~suprabony pockets - minimal attachment loss and suprabony periodontal abscesses

Answer 2

gingivectomy

Ca over fxn

Minimal aloss with suprabony pockets if doing gingivectomy

Question 3

contraindictions to _
~tx of pockets that extend beyond MJG
~pockets with sig furcation involvement
~tx of osseous defect

Answer 3

gingivectomy

dont do in patients with bone loss

can do it when JE is at level of CEJ with no aloss

Question 4

reshaping of gingiva
recreating physiological contours

External thinning of gingiva to make it look more normal in contour -

Answer 4

gingivoplasty

Gingivectomy usulally done in concert with gingiplasty(reshaping of gingiva)mm - immediately AFTER the gingivectomy because left bevel doesn’t look good

Question 5

general approaches of gingivectomy
_-excise tissue with an external beveled incision

_ vaporize tissue, Removes it fairly quickly, have to be careful

_ vaporize tissue, Photons are aimed at tissue and some molecule (water, peptide bond, pigmented tissue) absorbs the enerygy and vapes the tissue
aser easy to control but slow

Answer 5

surgical gingivectomy - excise soft tissue external bevel - 2nd fastest

electrosurgery - fast

laser gingivectomy - slow - gingivectomy and gingivoplasty can be done with laser

~all techniques little bleeding LA for surgical and Denatures proteins and seals up the vasculature, for vaporizeers, all need anesthesia

Question 6

surgical gingivectomy steps 1-6

Answer 6

1. mark depth of pocket with blood spot under anesthesia
2. external bevel- start apical to blood mark and end excsion there
3. interprox incisions with a Buck knife, orban knife or 12Bscalpel
4. tissue removal and root planning
5. gingivoplasty-course diamond, periodontal knife,
6. application of the dressing as necessary

Question 7

the reshaping of the gingiva to create physiological gingival contours - typically this procedure is not utilized at sites that have periodontal pockets

Answer 7

gingivoplasty

elimination of thick gingiva
reshape

Question 8

healing after gingivectomy is by _ intention

clot formation
clot replace by _ tissue
surface epi over a course of 5-14 days
complete epithelial repair requires _ weeks
complete repair of the connective tissue requires about _ weeks

Answer 8

secondary retention

clot formation
clot replace by granulation tissue
surface epi over a course of 5-14 days
complete epithelial repair requires 4 weeks
complete repair of the connective tissue requires anout 7 weeks

Question 9

anestheisa technique with gingivectomy

Answer 9

Local anesthsia - with perio surgery 2 ways region nerve block and
Go back and infiltrate into the tissue that we are going to be working on - pocket area - interprox dense CT - low volume but Epi gets in and causes vasoconstriction - reducing intraoperative blood loss

Question 10

gingivectomy excision - external bevel - in the removal process we leave behind _ source of postop bleedding - may actually cause complication

Answer 10

small “tissue tags” -

want to go back and remove

Question 11

surgical gingivectomy primary and secondary cutting

Answer 11

primary - scalloped gingivectomy incision - external bevel

secondary - half to release interprox soft tisse and remove exposing roots and debride them

Question 12

in the gingivectomy the _ bevel is made with Solt or Kirkland knives - can be resharpened and sterilized after each patient

Answer 12

external bevel from apical to coronal

Question 13

healing after gingivectomy / gingiplasty?

Answer 13

secondary intention

open wound
sometimes have to remove healthy tissue

2 weeks the gingival epi at the margin of the wound migrates completely over the CT and contacts the tooth - so the external looks pretty normla

Month - nornmal keratinizedation- completely healed

6-7 weeks - for the underlying CT to start healing

Periodontal dressing
Post op - stays on for a week
Protects from post op sensitivity
Sometime come back and change then go another week

Question 14

Literature says even if you cut all of the keratinized tissue off with the gingivectomy
Some of it still comes back because _

Answer 14

the bone resorbs exposing PDL and fibroblast that form CT that induces keratiniized

Question 15

while doing a gingivectomy with the _technique osteonecrosis can be an adverse effect

Answer 15

electrtosurgery