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Gingivectomy is a Dentistry in which a dentist or oral surgeon cuts away part of the gums in the Human mouth (the gingiva).
It is the oldest surgical approach in Periodontology therapy and is usually done for improvement of aesthetics or prognosis of teeth.
By removing the pocket wall, gingivectomy provides visibility and accessibility for complete calculus removal and thorough smoothing of the roots, creating a favourable environment for gingival healing and restoration of a physiologic gingival contour. The procedure may also be carried out so that access to sub-gingival Tooth decay or crown margins is allowed. A common aesthetic reason for gingivectomy is a gummy smile due to gingival overgrowth.
Another cause of gingival enlargement would be a hereditary condition known as gingival fibromatosis. The extensive overgrowth of gingival tissue is usually treated with a gingivectomy, as it produces good aesthetic results. However, recurrence in these cases are unpredictable. This means that those affected face the possibility of undergoing repeated procedures.
Dental/gingival morphologic characteristics and peri-oral variables influence the patient's smile frame. They are essential in achieving a predictable successful rehabilitation of the patient's smile.
In males and females, the mean vertical height of the maxillary central incisors averages 10.6mm and 9.8mm respectively. With the lip line at rest, the mean maxillary incisors display is 1.91mm for men and 3.40mm for women (nearly double the amount). More recent studies have been done to confirm the statistically significant sexual dimorphism relative to the height of visible maxillary incisor crown at rest. The data from a study also clearly indicates that higher smile lines are more common among female, and lower smile patterns among male patients. A high smile line displays the entire crown of the tooth and an abundant amount of gingiva. Thus, this procedure can be viewed subjectively by some people as some degree of gingival display may be aesthetically pleasing and is considered youthful, and vice versa.
Besides that, the harmony of the gingival outline between anterior and posterior segments may be affected. Some people are more prone to expose the maxillary teeth from the second premolar of one side to another side of the second premolar while smiling. Hence, there have been discussions in some cases whereby all teeth between the first molars are included in the procedure, especially in surgical crown lengthening, to achieve an aesthetically pleasing gingival architecture blending in harmoniously the gingival contours of the maxillary anterior and posterior teeth. Apart from that, "black triangles" are likely to develop in areas where there is labial or interproximal soft tissue recession. This leads to the desired outcome.
Electrosurgery may be used where a blood-free environment is required, providing that there is no bone coming into contact with the instrument and good oral hygiene is maintained. The technique is not widely used due to multiple factors including cost and lack of information available on the topic.
It is essential to have the presence of a circuit in an electrosurgical unit, allowing current to flow. By changing the mode of activation of this current, electrosurgery may be used for the cutting or coagulation of soft tissues. The basic types of electrosurgical techniques are coagulation, desiccation, fulguration and electrosection (cutting). The majority of clinical operations are done by electrosection.
There are two main types of electrosurgical units, monopolar and bipolar.
In monopolar units a separate electrode is needed, usually in the form of an indifferent plate behind the patient's back. The current begins in the electrosurgical unit and flows to the oral site through a wire and then to the secondary electrode. Heat is produced on contact with the oral tissues and cutting results. Bipolar devices have two electrodes on their cutting tip and the current travels from one to the other, which removes the need for an indifferent plate. Bipolar devices make a wider cut.
The results of studies which have looked at healing of electrosurgical wounds compared to scalpel wounds vary widely but it has been found that electrosurgerical equipment minimises bleeding and most patients experience very little post-operative pain after the procedure. There may be more damage to adjacent tissues, slower wound healing and more Inflammation than the scalpel technique.
It has been suggested that lasers can give a substantial reduction in bacteria such as Actinobacillus actinomycetemcomitans (Aa) which will reduce inflammation and facilitate the healing process. Laser treatment seems to also have good patient acceptance as patients report minimal pain. Nd:YAG lasers used for curettage of pocket epithelium cause little or no damage to the underlying tissues.
Periodontal health and reattachment of gingival tissues to previously infected root surfaces is the goal of periodontal therapy and this is typically achieved through conventional treatment by scaling, root surface instrumentation and ultrasonic instrumentation. Conventional treatment however does not completely remove plaque and calculus and a laser has been suggested as an effective tool for periodontal treatment because:
It has been suggested that laser treatment results in minimal or no post-operative swelling, bleeding, scar tissue formation or pain.
Regarding wound healing animal studies have shown better response in rat skin after Nd:YAG laser application than following scalpel incisions but this is only valid when energy and frequency parameters were low and higher levels of energy lead to scar formation and delayed wound healing.
The clinical use of a laser for gingivectomy involves repeated lasing and wiping away tissue remnants with moist gauze and this results in a bloodless operating field allowing better visibility and greater ease for the operator. Apart from ablating and Coagulation the laser also sterilizes the tissues and eliminates the need for a post-surgical dressing. One study found that in patients with drug induced gingival overgrowth recurrence was minimal or eliminated when comparing laser gingivectomy to scalpel gingivectomy.
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