Gingivectomy: surgical phase of periodontal treatment

What is a gingivectomy?

If the gum takes on more prominence than necessary in a smile -what we call a gummy smile-and the dentition seems short or small in comparison, in addition to being unsightly, it can cause oral problems due to excessive size of the periodontal pockets, the name by which is known as the space between the gum and the tooth as a result of the accumulation of bacterial plaque. In these cases, gingivectomy takes over: it is a surgical technique that, in addition to improving oral health, provides unbeatable aesthetic results.

It consists of performing an excision in the gum surrounding the tooth through which part of the gingival tissue is removed, either for a purely aesthetic matter or to eliminate an injury or reduce the periodontal pocket. But first, we must consider the state of periodontal pockets since, depending on their state, they can destroy the supporting bone and aggravate the periodontal disease.

Gingivectomy does not cause any type of pain to the patient since it is performed under local anesthesia. In addition, the chances of complications arising are very low: sometimes slight bleeding, soft tissue injuries, tears or subsequent infections can occur.

On the other hand, it requires very fine stitches that are removed after a week. Finally, it should be noted that this treatment has one of the best postoperative periods of all oral surgeries.

Difference Between Gingivectomy and Gingivoplasty

Although it is a type of periodontal surgery very similar to gingivectomy. Gingivoplasty has a different objective: it is performed to reshape the gum line to achieve a more aesthetic tooth contour; sometimes, it is performed simultaneously with the gingivectomy. The oral surgeon, in this case, aims to return the contour of the gum when the periodontal pocket has been lost.

Gingivoplasty is performed with different means according to the needs of each patient: manually with a scalpel, with electrodes or with mechanical appliances.

The initial step in this procedure is to polish the gums’ edges to achieve the desired shape. After that, the margins are contoured to reduce the size of the gingiva and leave a more visible tooth surface.

In the last step, the dentition is shaped to the desired appearance. With a clear aesthetic objective, Gingivoplasty gives a smile greater luminosity and beauty.

Gingivectomy Indications

Gingivectomy is indicated for treating periodontal disease in patients whose periodontal pockets are more than 3 millimeters deep. It is also recommended when there is bone loss, and it is necessary to apply bone surgery. Being a very useful technique to solve any type of gums-related problem.

On the other hand, it is prescribed to combat pathologies such as hyperplasia and gum fibrosis, reach inaccessible periodontal pockets, and improve entry into restorative techniques.

Contraindications of gingivectomy

No specific contraindications to undergoing gingivectomy have been detected. However, some special care will be required if the patient has coagulation problems or antibiotic prophylaxis.

On the other hand, it’s important to remember that, although it is a simple intervention -with good healing and excellent results- certain complications can appear, and that must be known:

• Certain adverse effects may arise, such as tears in healthy tissue or nerves near the gums that cause injury.
• Sometimes, infections or bleeding may develop after surgery, but this is very rare.
• There is a low risk of bone being exposed, causing tooth sensitivity.
• Pain may occur during food intake, especially the first 48 or 72 hours after the operation, and bleeding over the next 12 or 24 hours.

Step-by-step gingivectomy

Before performing a gingivectomy procedure, an aesthetic analysis of the smile is carried out to determine the amount of excess gum.

The procedure is painless, given that it is performed under local anesthesia. It consists of the following steps:

• With a periodontal probe, the depth of the periodontal pocket is determined.
• The incision line will be marked through a periodontal probe or a mock-up (study and previous waxing).
• The incision is made on the marked line with a scalpel, starting from the apical to the marked points.
• Excess tissue is removed with a scalpel.
• Smoothing of gingival tissues with a rotary instrument.
• Finally, the operated area is protected with a surgical cement that prevents postoperative problems.

Gingivectomy instruments

The instruments that we will require for this type of surgery are the following:

• Mirror, probe and clamp
• Periodontal probe
• Crane Kaplan forceps
• Brad Parker handles the scalpel
• Kirkland scalpel
• Surgery scissors
• Gracey curettes
• Tile and spatula
• Ejector and hemosuctor
• Sharpening instruments

Laser gingivectomy

Laser gingivectomy is a surgical procedure in which a gum cut is performed for aesthetic and oral health purposes. As it is laser surgery, the intervention is painless, does not require sutures, and is minimally invasive, avant-garde and current.

To develop it, the oral surgeon makes an incision and removal a specific part of the gum tissue. In addition, periodontal pockets are removed when there is a pathology of the gums, such as gingivitis.

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