5.+Efficacy+of+Gingival+Curretage

Efficacy of Gingival Curretage

Yelena Bobova #23

Scaling, root planning, and gingival curettage are different procedures with different rationales and indications. Scaling is removal of deposits from root surface. Planning is removing deposits and necrotic and infected cementum from root surface. The purpose of curettage is scraping of the gingival wall of periodontal pocket. Gingival curettage is used to remove chronically inflamed tissue from the wall of the pocket. Indications for curettage include moderately deep infrabony pockets; before surgical procedures to reduce inflammation; and as a method to maintain areas of recurrent inflammation and pocket depth. Curettage always has to be performed after scaling and root planning, and always requires local anesthesia. The cutting age of the instrument has to be against the tissue (13, 14 for mesial surface; 11, 12 for distal surface). The strokes have to be long and horizontal.

Allen, E. P. (2005). USE AND ABUSE OF LASERS IN PERIODONTICS. //Journal Of Esthetic & Restorative Dentistry//, //17//(6), 329-331.

The big idea of my article is that gingival curettage does not promote a healthy connective tissue and re-attachment to the tooth. The article states that gingival curettage only promotes a longer junctional epithelium which is the same results one would get from scaling and root planning alone. The article expresses its concern with new laser technology and how lasers are advertised as being beneficial used for gingival curettage. The authors stance is that gingival curettage is not an effective method regardless if used with an instrument or laser and thus should not be performed.

Carranza states the purpose of gingival curettage is to remove chronically inflammed granulation tissue on the lateral walls of the periodontal pocket. Carranza also notes that gingival curettage can also remove dislodged calculus and bacteria in the pocket. However, Carranza does note that because when scaling and root planning is done correctly the major irritant is removed and thus there is no need to remove the granulation tissue by curettage. Carranza does note that because of this curratage is better suited for the elimination of granulation tissue during flap surgery that obstruct the view and prevents the view of of the rooth surface during bone morphology. (Carranza p.909-916).

KR32

Ainslie, P. T., & Caffesse, R. G. (1981). A Biometric Evaluation of Gingival Curettage (II). //Quintessence International//, //12//(6), 609-614.

There are two different types of curettage that can be performed, gingival curettage, which is the removal of inflammed soft tissue lateral to the pocket wall. There is also subgingival curettage, which refers to the removal of tissue below the epithelial attachment down to the crest of the osseous. There are limited used for ginigval curettage and should only be followed after scaling and root planing have been performed. Gingival curettage should only be done in an attempt to gain attachement in moderately deep intrabony pockets. After gingival curettage, a blot clot is formed in the pocket and leads to the formation of new long juctional epithelium. -Elina Sandoval #34

Shoukry, M., Ben Ali, L., Abdel Naby, M., & Soliman, A. (2007). Repair of experimental plaque-induced periodontal disease in dogs. //Journal Of Veterinary Dentistry//, //24//(3), 152-165.

Gingival curettage, when utilized only in certain situations, can result in a reduction of pocket depths and inflammation. These circumstances include post-phase I therapy in areas where there is recurrent inflammation and failure of pocket resolution, especially if flap surgery or pocket reduction has already been performed. Also, because the body is fully capable of getting rid of granulation tissue remaining after SRP, the benefits of gingival curettage are not really superior to the benefits that thorough SRP can accomplish. AH28

According to Carranza the use of ultrasonic devices has been recommended for gingival curettage and can be effective for deriding the epithelial lining of periodontal pockets. Specific rod shape ultrasonic instruments are used for this purpose but resulted in less inflammation and less removal of the underlying connective tissue. My article talks about the use of sonic and ultrasonic devices can achieve gingival curettage but there is no benefit for the treatment of periodontitis. Monica Gutierrez#27**

Gingival curettage is used to remove diseased and inflammed tissue from the wall of a pocket. There are two forms: gingival and subgingival. Gingival removes inflamed tissue on the wall of the periodontal pocket; whereas in subgingival the scraping goes beyond the epithelial attachment to the crest of the bone. The indications for gingival curettage after SRP are in attempts of new attachment in deep intrabony pockets, to reduce inflammation before pocket pocket elimination, and as a method of maintenance treatment for areas of recurrent inflammation and pocket depth.

Gold, SI., Vilardi, MA. (1994). Pulsed laser beam effects on gingiva. Journal of Clinical Periodontology, 21: 391-396.

According to my article, they compare the use of Nd: YAG laser versus hand curettage. The results between the laser and hand curettage where similar. The difference is that the laser has analgesic effects and hemostatic properties. It also mentioned the Nd: YAG laser could be a safe and effective alternative to mechanical curettage. ES33

Pollack, R. P. (1984). Curettage: A New Look at on Old Technique. //International Journal Of Periodontics & Restorative Dentistry//, //4//(5), 24-35.

In my article, soft tissue curettage was believed to have predictability and stated the same rationale of clinical application as stated in Carranza; used after scaling & root planning as part of gaining new attachment in moderately deep intrabony pockets, where “closed” surgery is indicated. The technique described in my article coincides with Carranza’s definition of the basic technique with instruments and also with the use of an ultrasonic scaler, as used in the cases in my article. However, Carranza states that it has been shown that scaling and root planning with additional curettage do not improve the condition of the periodontal tissues beyond the improvement resulting from scaling and root planning alone, but goes on to state that curettage in eliminating all or most of the epithelium that lines the pocket wall and the underlying junctional epithelium is still a valid purpose when an attempt is made at new attachment, as in intrabony pockets; this was the aim in the cases in my article. Arlene

Lin, J., Bi, L., Wang, L., Song, Y., Ma, W., Jensen, S., & Cao, D. (2011). Gingival curettage study comparing a laser treatment to hand instruments. //Lasers In Medical Science//, //26//(1), 7-11. Retrieved March 13, 2012 from: [].

In this article they conducted a study to test the efficacy of gingival curettage with a laser vs gracey instruments. Four weeks post treatment the results showed that there was a significant reduction in GI, SBI, and PD and a gain in CAL in both the groups and no significant differences between the two groups. Although, the discomfort and time of procedure was a lot less in the test group (laser) than the control group (currette). Carranza mentions that gingival curettage is the removal of the chronically inflammed soft tissue lateral to the pocket wall. Carranza also demostrates how to perform gingival curettage using gracey's 13/14 for mesial surfaces and 11/12 for distal surfaces. Also the use of ultrasonic devices are also effective in gingival curettage. Natalie Baeza #22 -- Ainstie, P. T., & Caffesse, R. G. (1981). A Biometric Evaluation of Gingival Curettage (I). //Quintessence International//, //12//(5), 519-529.

After reading my article and Carranza the big Idea is that SRP alone can remove most of the pathologic organisms within the pocket and gingival curettage has no added health benefits. A Yanez 37 ___

Dederich, D. N., & Drury, G. I. (2002, May). Laser curettage: Where do we stand//?.// //Journal of//

//the California Dental Association//, Retrieved from

http://www.cda.org/library/cda_member/pubs/journal/jour0502/dederich.html

The article discusses the goals of subgingival curettage, which include: removal of all calculus, granulation tissue, and epithelial lining of the pocket, also to cause hemorrhage to reduce edema. Carranza discusses the difference between gingival curettage; which is the removal of inflamed soft tissue lateral to the pocket wall and Subginigival curettage which severs the connective tissue attachment down by the osseous crest. The rationale is for the removal of inflamed granulation tissue and bacteria. Carranza states if the scaling and root planing is done thoroughly the granulation tissue will resolve and that curettage alone is questionable. My article also states that scaling and root planing or scaling, root planing, and curettage resulted in similar reduction of pocket depths and there wasn’t a significance difference in tissue improvement. Lauren #38

====The results from my article reveal that open flap curettage is not effective in reducing inflammation in patients that have infra alveolar defects. Carranza states that gingival curettage is the removal of inflamed soft tissue lateral to the pocket walls. It is also stated that gingival curettage in used to remove granulation tissue and can reduce edema. However is scaling and root planning are done correctly the same results can be achieved.====

==== Bahat, O., Glover, M. E., & Ammons, J. F. (1984). The Influence of Soft Tissue on Interdental Bone Height after Flap Curettage II. Histological Findings after Six Months. International Journal Of Periodontics & Restorative Dentistry, 4(2), 24-31. ====

According to Carranza cureattage is the scrapping of the gingival wall in the periodontal pocket to remove dieses soft tissue. This tissue may contain debris of calculus and bacteria that needs to be removed for proper healing. They believe that the purpose of curettage is valid when new attachment epithelial in needed in areas of infaboney defects or when flap surgery in contraindicated on a patient that has systemic issues.CA20

__Echeverria, J., & Caffesse, R. (1983). Effects of gingival curettage when performed 1 month after root instrumentation. A biometric evaluation. //Journal Of Clinical Periodontology //, //10 //(3), 277-286. __

__The big idea of my article was to discuss gingival curettage, and how effective it is compared to scaling and root planing alone. This articles definition of curettage is the removal of granulomous tissue with a curette in order to shrink the gingiva. In Carranza, it also mentions the same thing but also mentions that the tissue may even have pieces of dislodged calculus and bacteria in this gingiva. Carranza also states that when scaling and root planing, that the additional gingival curettage does not improve the tissues which correlates with the big idea of my article, discussing that the study that was done, showed that there was no significant difference if gingival curettage was performed in addition to scaling and root planing. __

__SF 25 __ __

This week I was the moderator so I didn’t have a specific article. But the big idea that I got from gingival curettage is that it can help in the periodontal healing by removing granulation tissue from pocket lining in an effort to help the junctional epithelium re-attach and to promote bleeding in the area to help with healing. It also helps to remove periodontal pathogens present near the tissue of the pocket. It would just depend on the patient to determine if it is necessary because it really isn’t used that much today. Amber Starnes 36