**5. Surgical techniques for correction of gingival enlargement**

#### **5.1 Gingivectomy**

Gingivectomy implies to the excision of gingival. The pocket wall (or enlarged tissue) is removed for accessibility.

Indications [38]: (1) elimination of suprabony pockets if the pocket wall is fibrous and firm, (2) elimination of gingival enlargements and (3) elimination of suprabony periodontal abscesses.

Contraindications to gingivectomy include the following: (1) access to bone required (2) narrow zone of keratinized tissue (3) esthetics particularly in the anterior maxilla (4) patients with high postoperative risk of bleeding (5) situations in which the bottom of the pocket is apical to the mucogingival junction.

Advantages: ease and simplicity of the procedure.

Disadvantages: more postoperative discomfort, increased chance of postoperative bleeding, sacrifices keratinized tissue and does not allow for osseous recontouring [3].

#### *5.1.1 Gingivectomy procedures*

In the latter part of the nineteenth century Robicsek (1884) pioneered gingivectomy procedure. Grant (1979) defined gingivectomy as being "the excision of the soft tissue wall of a pathologic periodontal pocket". The surgical procedure included

**103**

*Treatment of Gingival Enlargement*

a different technique [3].

Goldman (**Figures 11**–**16**) [3]

the interproximal spaces.

*5.2.1 Gingivectomy by electrosurgery*

**5.2 Technique**

*DOI: http://dx.doi.org/10.5772/intechopen.82664*

elimination of pocket as well as osseous recontouring. Zentler (1918) later described

The gingivectomy procedure as it is employed today was described in 1951 by

• After anesthesia of the affected area, the depths of pathological pockets are assessed using a periodontal probe. Bottom of the pocket is assessed and bleeding points are marked with a probe. Alternatively a pocket marker is used and bottom of the pocket is marked using the toothed end. The calibrated end is inserted into and measures the pocket. The bleeding points are used to guide

• The incision is given using scalpel or a Kirkland knife No. 15/16, maintaining the scalloping and festooning of the gingiva. The area with more bulky tissue will have more apically placed incision. In areas of thin gingival a less accentuated bevel is needed. The angulation of the incision is eternal bevel (45 degree towards the coronal portion). The incision is directed towards the base of the pocket and crest of the bone. Care should be observed to avoid exposure of bone. Physiologic contour of gingival should be established. Incision may be continuous or interrupted.

• After completing the incision, the interdental soft tissue is separated by a secondary incision using an Orban knife (No. 1 or 2) or a Waerhaug knife (No. 1 or 2; a saw-toothed modification of the Orban knife). Tissues are then separated using a curette. Tissue nippers are used to remove tissue tags and obtain smooth margins. Scaling and root planning is done to remove plaque and calculus.

• Probing should be done to assess for any remaining pockets if present. Rotatory instruments may be used to correct gingival contour, if necessary.

• Dressing should be given for 7 days. If necessary (depending on the healing and area of wound) dressing should remain in position for 10–14 days. Postoperative antibiotics and analgesics should be advised. Chlorhexidine gluconate (0.2%) mouthwash should be prescribed for oral hygiene.

Gingivectomy can be done using electrosurgical unit. It provides hemostasis and proper contouring of the tissue. Use of electrosurgery also facilitates easy tissue incision accompanied with a strong hemostatic effect [39]. However, it is contraindicated in patients with cardiac pacemaker. Any contact to bone or cementum has to

• Periodontal dressing is applied for protection of the surgical area. The dressing should be closely adapted to the buccal and lingual wound surfaces as well as to

the incision and to determine the depth of the tissue to be resected.

Robicsek described a straight line incision to resect the gingival tissue while Zentler advocated a scalloped incision, first on the labial and then on the lingual surface of each tooth, the diseased tissue should be loosened and lifted out by means of a hook-shaped instrument. The soft tissues are removed and alveolar bone is exposed. The bone is scraped and debrided. The wound is then covered with some kind of antibacterial gauze or be painted with disinfecting solutions. Eradication of the deepened periodontal pocket and an area which can be easily maintained is expected [3].

## *Treatment of Gingival Enlargement DOI: http://dx.doi.org/10.5772/intechopen.82664*

elimination of pocket as well as osseous recontouring. Zentler (1918) later described a different technique [3].

Robicsek described a straight line incision to resect the gingival tissue while Zentler advocated a scalloped incision, first on the labial and then on the lingual surface of each tooth, the diseased tissue should be loosened and lifted out by means of a hook-shaped instrument. The soft tissues are removed and alveolar bone is exposed. The bone is scraped and debrided. The wound is then covered with some kind of antibacterial gauze or be painted with disinfecting solutions. Eradication of the deepened periodontal pocket and an area which can be easily maintained is expected [3].
