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.

“What Is Gingival Curettage In Dentistry”

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.

“Importance Of Gingival Curettage For Gum Health”

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.

“Types Of Gingival Curettage Procedures”

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.

“Best Ways To Understand Gingival Curettage Techniques”

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.