Gingivoplasty

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Gingivoplasty
ICD-9-CM 24.2
MeSH D005893

Gingivoplasty is the process by which the gingiva are reshaped to correct deformities. Gingivoplasty is similar to gingivectomy but with a different objective. This is a procedure performed to eliminate periodontal pockets along with the reshaping as part of the technique. This procedure is followed to create physiological gingival contours with the sole purpose of recontouring the gingiva in the absence of the pockets. [1]

Gingivectomy is a dental procedure in which a dentist or oral surgeon cuts away part of the gums in the mouth.

Gingival and periodontal disease often produces deformities in the gingiva that are conducive to the accumulation of plaque and food debris, which prolong and aggregate the disease process.

A gingival disease is the term given to any disorder primarily affecting the gingiva.

Periodontal disease human disease of the tissues surrounding the teeth

Periodontal disease, also known as gum disease, is a set of inflammatory conditions affecting the tissues surrounding the teeth. In its early stage, called gingivitis, the gums become swollen, red, and may bleed. In its more serious form, called periodontitis, the gums can pull away from the tooth, bone can be lost, and the teeth may loosen or fall out. Bad breath may also occur.

Dental plaque is a biofilm or mass of bacteria that grows on surfaces within the mouth. It is a sticky colorless deposit at first, but when it forms tartar, it is often brown or pale yellow. It is commonly found between the teeth, on the front of teeth, behind teeth, on chewing surfaces, along the gumline, or below the gumline cervical margins. Dental plaque is also known as microbial plaque, oral biofilm, dental biofilm, dental plaque biofilm or bacterial plaque biofilm. Bacterial plaque is one of the major causes for dental decay and gum disease.

Such deformities include the following:-

  1. Gingival clefts and craters
  1. Crater- like interdental papilla caused by acute necrotizing ulcerative gingivitis
  1. Gingival enlargements

Gingivoplasty is accomplished with a periodontal knife, a scalpel, rotary coarse diamond stones, electrodes or laser. [2] The technique resembles that of the festooning of an artificial denture, which consists of tapering the gingival margin, creating a scalloped marginal outline, thinning the attached gingiva, creating the vertical interdental grooves and shaping the interdental papillae.

A dental laser is a type of laser designed specifically for use in oral surgery or dentistry.

Gingival margin

The free gingival margin is the interface between the sulcular epithelium and the epithelium of the oral cavity. This interface exists at the most coronal point of the gingiva, otherwise known as the crest of the marginal gingiva.

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Gums mucosal tissue that lies over the mandible and maxilla inside the mouth

The gums or gingiva, consist of the mucosal tissue that lies over the mandible and maxilla inside the mouth. Gum health and disease can have an effect on general health.

A periodontal probe is an instrument in dentistry commonly used in the dental armamentarium. It is usually long, thin, and blunted at the end. The primary purpose of a periodontal probe is to measure pocket depths around a tooth in order to establish the state of health of the periodontium. There are markings inscribed onto the head of the instrument for accuracy and readability.

Gingival graft

A gingival graft, also called gum graft or periodontal plastic surgery, is a generic name for any of a number of periodontal surgical procedures in which the gum tissue is grafted. The aim may be to cover exposed root surfaces or merely to augment the band of keratinized tissue.

Gingival sulcus

The gingival sulcus is an area of potential space between a tooth and the surrounding gingival tissue and is lined by sulcular epithelium. The depth of the sulcus is bounded by two entities: apically by the gingival fibers of the connective tissue attachment and coronally by the free gingival margin. A healthy sulcular depth is three millimeters or less, which is readily self-cleansable with a properly used toothbrush or the supplemental use of other oral hygiene aids.

Gingival and periodontal pocket

Gingival and periodontal pockets are dental terms indicating the presence of an abnormal depth of the gingival sulcus near the point at which the gingival tissue contacts the tooth.

Scaling and root planing removing or eliminating etiologic agents from the teeth

Scaling and root planing, also known as conventional periodontal therapy, non-surgical periodontal therapy, or deep cleaning, is a procedure involving removal of dental plaque and calculus and then smoothing, or planing, of the (exposed) surfaces of the roots, removing cementum or dentine that is impregnated with calculus, toxins, or microorganisms, the etiologic agents that cause inflammation. This helps to establish a periodontium that is in remission of periodontal disease. Periodontal scalers and periodontal curettes are some of the tools involved.

Gingival enlargement Human disease

Gingival enlargement is an increase in the size of the gingiva (gums). It is a common feature of gingival disease. Gingival enlargement can be caused by a number of factors, including inflammatory conditions and the side effects of certain medications. The treatment is based on the cause. A closely related term is epulis, denoting a localized tumor on the gingiva.

The junctional epithelium (JE) is that epithelium which lies at, and in health also defines, the base of the gingival sulcus. The probing depth of the gingival sulcus is measured by a calibrated periodontal probe. In a healthy-case scenario, the probe is gently inserted, slides by the sulcular epithelium (SE), and is stopped by the epithelial attachment (EA). However, the probing depth of the gingival sulcus may be considerably different from the true histological gingival sulcus depth.

A gum lift is a cosmetic dental procedure that raises and sculpts the gum line. This procedure involves reshaping the tissue and/or underlying bones to create the appearance of longer or symmetrical teeth, thereby making the smile more aesthetically pleasing. This procedure is typically done to reduce excessively gummy smiles or to balance out an asymmetrical gum line. The procedure, also known as crown-lengthening, has historically been used to treat gum disease. It is only within the past three to five years that dentists have commonly used this procedure for aesthetic purposes. The practice of cosmetic gum lifts was first developed in the late 1980s, but there were few oral surgeons and dental practitioners available to perform the procedures. Gum lifts can also include bone shaping to reduce the prominence of the upper jaw and even out the tooth and gum ratio. This method provides permanent results, while simple gum contouring may result in relapse or regrowth of the gingiva.

Laser-assisted new attachment procedure (LANAP) is a surgical therapy for the treatment of periodontitis, intended to work through regeneration rather than resection. This therapy and the laser used to perform it have been in use since 1994. It was developed by Robert H. Gregg II and Delwin McCarthy. A systematic review published by the American Academy of Periodontlogy (AAP) in 2015 discusses LAR ; states that specifically when using an Nd:YAG laser that regeneration is achievable on a previously disease root surface.

Gingivitis Human disease

Gingivitis is a non-destructive disease that causes inflammation of the gums. The most common form of gingivitis, and the most common form of periodontal disease overall, is in response to bacterial biofilms that is attached to tooth surfaces, termed plaque-induced gingivitis. Most forms of gingivitis are plaque-induced.

Debridement (dental) removal of plaque and calculus

In dentistry, debridement refers to the removal by dental cleaning of accumulations of plaque and calculus (tartar) in order to maintain dental health.

Periodontal abscess

A periodontal abscess, is a localized collection of pus within the tissues of the periodontium. It is a type of dental abscess. A periodontal abscess occurs alongside a tooth, and is different from the more common periapical abscess, which represents the spread of infection from a dead tooth. To reflect this, sometimes the term "lateral (periodontal) abscess" is used. In contrast to a periapical abscess, periodontal abscesses are usually associated with a vital (living) tooth. Abscesses of the periodontium are acute bacterial infections classified primarily by location.

Clinical attachment loss (CAL) is the predominant clinical manifestation and determinant of periodontal disease.

Angularis nigra Small triangle-shaped gap which often occurs between the teeth, near the gums

Angularis nigra, Latin for black angle, also known as open gingival embrasures, and colloquially known as black triangle, is the space or gap seen at the cervical embrasure, below the contact point of some teeth. The interdental papilla does not fully enclose the space, leading to an aperture between adjacent teeth. This gap has many causes including gingival recession, and gingival withdrawal post orthodontic work. Interdental "black triangles" were rated as the third most disliked aesthetic problem below caries and crown margins. Treatment of angularis nigra often requires an interdisciplinary approach, involving of periodontal; orthodontic and restorative treatment. Possible treatments to correct angularis nigra include addition of composite resin in the space, veneer placement, or gum graft. Angularis nigra is generally only treated based on the aesthetic preference of the patient.

Hereditary gingival fibromatosis (HGF), also known as idiopathic gingival hyperplasia, is a rare condition of gingival overgrowth. HGF is characterized as a benign, slowly progressive, nonhemorrhagic, fibrous enlargement of keratinized gingiva. It can cover teeth in various degrees, and can lead to aesthetic disfigurement. Fibrous enlargement is most common in areas of maxillary and mandibular tissues of both arches in the mouth. Phenotype and genotype frequency of HGF is 1:175,000 where males and females are equally affected but the cause is not entirely known. It mainly exists as an isolated abnormality but can also be associated with a multi-system syndrome.

References

  1. Barrington, Erwin P. (September 1981). "An Overview of Periodontal Surgical Procedures". Journal of Periodontology. 52 (9): 518–528. doi:10.1902/jop.1981.52.9.518. PMID   7026757.
  2. Bellows, Jan (2014-08-18). "CO2 Laser Gingivoplasty for Orthodontic Care - Aesculight". Veterinary Practice News. Retrieved 2017-12-04.