Gingival Curettage: Types, Techniques, Indications, and Contraindications

Gingival Curettage

Curettage is the scraping of gingival wall of periodontal pocket to separate diseased soft tissue.

Rationale

• To reduce the pocket depth.
• To improve the probing attachment levels
• To maintain the aesthetics
• To provide the periodontal therapy I systemically compromised patients.

Types of Curettage

Curettage is of three types, i.e.

• Gingival curettage: It is the removal of soft tissue lateral to pocket wall.
• Subgingival curettage: It is performed apical to epithelial attachment, serving the connective tissue attachment down to the osseous crest.
• Inadvertant curettage: It is the curettage which is done unintentionally when scaling and root planning procedure is performed.

Various gingival curettage techniques are conventional technique, ENAP, ultrasonic curettage, use of caustic drugs.

Conventional Technique

• Give local anesthesia before commencing with gingival curettage.
• Select a curette so that the cutting edge will be against the tissue (e.g., Gracey No 13-14 for mesial surfaces and Gracey No 11-12 for distal surfaces). Curettage can also be performed with a 4R-4L Columbia Universal curette.
• Insert the instrument to engage the inner lining of the pocket wall and is carried along the soft tissue, usually in a horizontal stroke.
• Pocket wall may be supported by gentle finger pressure on the external surface. The curette is then placed under the cut edge of the junctional epithelium to undermine it.
• In subgingival curettage, the tissues attached between the bottom of the pocket and the alveolar crest are removed with a scooping motion of the curette to the tooth surface.
• Flush the area to remove debris, and the tissue is partly adapted to the tooth by gentle finger pressure.
• In some of cases, suturing of separated papillae and application of a periodontal pack may be indicated.

Indications of Curettage

• In cases with moderately deep intrabony pockets which are located in accessible areas.
• In the patients in whom because of their age, systemic problems or other factors, when the more aggressive surgical techniques are contraindicated.
• It is performed as a maintenance therapy which is performed in the areas of recurrent inflammation and pocket depth on recall visits.

Contraindications of Curettage

• In presence of acute infections such as necrotizing ulcerative gingivitis.
• Fibrosis of soft tissue wall.
• Extension of base of pocket apical to the mucogingival junction.
• If patient is medically compromised, the benefits versus the risk of surgical procedure should be carefully weighed before committing the patient to procedure.