Definition & Overview
Gingivectomy is the surgical removal of the gingiva or gum tissue. This procedure is done to treat gum disease and eliminate deep pockets that result when the gum detaches from the teeth.
Gingivectomy is also known as periodontal flap surgery.
Periodontal or gum disease is a common condition afflicting many adults worldwide. It is characterised by gum tissue inflammation. If left unattended or untreated, the condition could lead to damaged soft tissues and bones resulting in tooth loss. The condition typically starts with the invasion of plaque-producing bacteria. Exacerbating factors include a weak immune system and inadequate oral hygiene. Smoking and diabetes are also known to increase the chances of gum disease and could also worsen it once infection has set in. The disease progresses until there is a need to completely remove the infected gum and the microbial agents causing it.
In some cases, the patient undergoes gingivoplasty right after gingivectomy. Gingivoplasty involves the reshaping of gums to make it look better. Most of the time, this procedure includes the addition of tissue to the gum line to make them look as natural as possible. Tissue and bone grafts are also used to encourage the regeneration of gum attachment to the underlying bone structures.
Who Should Undergo and Expected Results
Patients diagnosed with gingivitis are suitable candidates for gingivectomy. This condition is characterised by the formation of plaque produced by bacteria. The plaque hardens over time and becomes tartar or calculus. The gum becomes inflamed, and there is a loose connection around the tooth. In its advanced state, calculus can no longer be removed by brushing or flossing the teeth. Bleeding can also occur. Gingivectomy is indicated if the condition does not improve even after a manual deep cleaning process called curettage. This involves scraping off the plaque and planing the tooth at the root.
Those who suffer from periodontitis can also undergo gingivectomy. This condition is also caused by bacterial infection that causes the gum to become inflamed. Periodontitis often leads to tooth loss and damage to the underlying bone structure if left untreated. In some cases, the gum can become so infected that antibiotic treatment alone cannot resolve it.
Gingivectomy is considered a safe procedure and is usually performed in a dentist’s office. It also has high success and satisfaction rates. The patient is usually advised to rest for a few days to encourage healing. Soft food diet is also required following gingivectomy.
The procedure is performed one quadrant at a time. For those with extensive tartar buildup, several sessions of gingivectomy may be required to complete the treatment. The patient is also prescribed with antibiotics to prevent infection. Regular checkup with the dentist is also required to monitor and prevent any subsequent tartar build-up. Good oral hygiene should also be practiced all the time.
This procedure also helps prevent tooth loss and preserve the integrity of underlying bone structure. After several days, tissue regrowth and surface epithelial growth are achieved.
How is the Procedure Performed?
Prior to the surgical procedure, the patient has to undergo gingiva scaling and root planing to remove as much plaque as possible. There are several techniques used to perform gingivectomy. All techniques involve the use of local anaesthesia to make the procedure as painless as possible for the patient.
To perform surgical gingivectomy, the dentist first probes the pockets created by loose gum tissue. These pockets are also marked. Small incisions are made in the gum to evaluate the tooth and the underlying bone structure. The gingival flap is lifted away from the tooth to allow the dentist to expose the root. The diseased gum tissue, along with a margin of healthy tissue is then excised. Granulation tissue is then removed using curette. Using the same instrument, any deep calculus or tartar buildup is also removed. The surgical site is washed with sterile saline solution and covered with gauze. Once the dentist is satisfied that all diseased gum tissue has been removed and bleeding is controlled, a periodontal pack is placed over the wound. This surgical dressing encourages healing and tissue recovery.
Some dentists prefer to use laser when performing gingivectomy. A carbon dioxide or Nd:YAG laser can be utilised to accurately cut the diseased gum tissue away. Laser beams also seal any affected blood vessel, reducing the chances of bleeding.
Another technique used in gingivectomy is electrosurgery. The dentist uses high-frequency electric current to deliver thermal energy to the gum tissue. This initiates the process of desiccation until the tissues are all dried up. The cells disintegrate and the diseased gum tissue is cut away.
Gingivectomy is also performed with the use of caustic substances known to break down cells. This procedure is known as chemosurgery and has been proven to be effective in removing gingival pockets. Examples of chemicals used are phenol solution and paraformaldehyde.
Cryosurgery can also be used to perform this procedure. A probe is placed in the gingival pocket to introduce temperature ranging from -50 to -60 degrees Celsius. The extremely cold temperature induces cell death and necrosis. The diseased tissue is then removed using a scalpel.
Possible Risks and Complications
Gingivectomy is associated with the following risks and complications:
- Bleeding, which can occur during and after the procedure
- Pain and swelling of gums
- Infection at the surgical site. In some rare cases, the infection could travel into the bloodstream and sepsis could occur.
- Blood clot
- Bone necrosis can occur in chemosurgery patients
- Abscess in the periodontal area
- Damage to the surrounding healthy cells if electric current or chemicals are used
- Damage to the nearby nerves
- Tooth sensitivity to cold temperature
Plaque buildup recurrence, especially if the diseased gum tissue was not totally removed
Newman, MG; Takei, HH;Klokkevold, PR; Carranza, FA; editors: Carranza’s Clinical Periodontology, 10th Edition. Philadelphia: W.B. Saunders Company, 2006. page 912-916.