Gingivectomy
From Wikipedia, the free encyclopedia
Gingivectomy is a dental procedure in which a dentist or oral surgeon cuts away part of the gums in the mouth (the gingiva).[1]
It is the oldest surgical approach in periodontal therapy[2] 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 caries or crown margins is allowed.[2] A common aesthetic reason for gingivectomy is a gummy smile due to gingival overgrowth.[3]
Elimination of suprabony fibrous and firm pockets
Gingivectomy is the primary treatment method available in reducing the pocket depths of patients with periodontitis and suprabony pockets.[4][5] In a retrospective comparison between different treatment approach to periodontitis management based on the initial and final gingival health, conventional gingivectomy was proven to be more successful in reducing pocket depths and inflammation compared to non-surgical treatments in pockets measured 3mm or more.[6] Removal of suprabony deep pockets will allow better visibility and access for the removal of calculus. As a result, this provides a suitable environment for the healing of the gingiva and the physiological contour of the gingiva to be restored.[5]
Elimination of gingival enlargement
In cases of gingival enlargement induced by drugs, surgical treatment through a gingivectomy proved to be effective with most patients showing no clinical sign of recurrence after one year.[7] Even though it is the most frequent method of treatment, it is only indicated when overgrowth is severe.[8]
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.[9] However, recurrence in these cases are unpredictable.[9] This means that those affected face the possibility of undergoing repeated procedures.[9]
Increase in clinical crown height
Sub-gingival margins
A gingivectomy can also be done to increase the clinical crown height of teeth. This is suitable in treatment planning for teeth with inadequate tissue for retention of prosthetic restorations as a result of subgingival carious lesions or coronal fractures.[10] Surgical treatment resets the margin while maintaining the biological width and clinical attachment.[10]
Gummy smiles
Up to 3mm of gingival display when smiling is described to be cosmetically acceptable. Gummy smiles are often used to describe smiles where there is more than 3mm of gingival tissue seen clinically and is usually deemed unaesthetic to the individual.[11] Similar to subgingival crevices margins, gingivectomy to increase the crown height can be performed[11] to provide better aesthetics and normal gingival architecture.[5]
Contraindications
- Need for bone surgery
- When bottom of the pocket is apical to the mucogingival junction
- Aesthetic considerations, particularly in anterior region of the maxilla
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.[12]
In males and females, the mean vertical height of the maxillary central incisors averages 10.6mm and 9.8mm respectively.[13] 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).[13] More recent studies have been done to confirm the statistically significant sexual dimorphism relative to the height of visible maxillary incisor crown at rest.[14] The data from a study also clearly indicates that higher smile lines are more common among female, and lower smile patterns among male patients.[14] 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.[12] 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.[15] 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.[12] 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.[12][16]