Dentaltown September 2021 - 55

Fig. 1
Fig. 2a
Fig. 2b
Fig. 2c
Fig. 1: To ensure biologic width, the zone of attached gingivae should be 2-3 mm.
Fig. 2: Incision made with external bevel for crown length. (2a: Preoperative view with clinically short lateral. 2b: Initial incision. 2c: Excised collar removed.)
Indications
While there may be a perception of relative simplicity of the gingivectomy procedure, there are
major contraindications.
Compromising attached gingivae. Creating an excision that eliminates or signifi cantly reduces
the zone of attached gingivae truly compromises the periodontium and the ensuing periodontal
health. The zone of attached keratinized tissue is immovable and fi brous, surrounding the neck
of each tooth. It extends from the free gingival margin to the mucogingival junction. This tissue
is resistant to recession from oral hygiene, mastication and trauma. Alveolar mucosa composed of
elastic fi bers cannot resist most trauma or even normal oral hygiene because of its mobility. The
respective sulcus can also be a reservoir for biofi lm. When deciding between a fl ap or gingivectomy,
if the gingivectomy is chosen, one must maintain at least 3 mm of attached gingivae after the excision
(Fig. 1). The option of utilizing an apically repositioned fl ap is preferred any time the attached
gingivae zone may be compromised.
Encroachment on supracrestal attached tissues. Supacrestal attached tissues (as biologic width
is now called by the American Academy of Periodontology) are composed of the junctional epithelium
and the supracrestal connective tissue attachment. There can be a signifi cant variability in this width.
However, placement of restorative materials within this zone is associated with infl ammation. Most
would agree that there must be a distance of 2.5 mm between a restorative margin and the height
of crestal bone. When gingival crown lengthening is performed as in orthodontics, excision of
gingivae without adherence to this " zone " will result in the relapse/rebound of the gingivae, which
will move coronally from the surgical position. A technique for sounding the osseous levels including
the relationship to the cementoenamel junction is to probe under topical or local anesthesia. That
measurement determines how much gingivae can be removed or whether a fl ap with osseous crown
length is the preferred procedure.
In summary, if a clinician is presented with a patient condition demonstrating adequate attached
gingivae, and there is no need to have access to perform osseous recontouring, a gingivectomy is
often the preferred procedure.
dentaltown.com \\ SEPTEMBER 2021 55
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Dentaltown September 2021

Table of Contents for the Digital Edition of Dentaltown September 2021

Table of Contents
Howard Speaks: Dentistry is a Numbers Game
Professional Courtesy: Joyful Dentistry
Continuing Education Update
Industry News
New Products
Townie Poll: Lasers
Show Your Work: Warm Up To Something New by Dr. Ron Kaminer
Message Board: Oral Pathology
Message Board: Endodontic Healing
Industry Insights: Ivoclar Vivadent
Office Visit: Dr. Grant Olson
Dueling Lasers by Dr. Samuel B. Low
Rolling Back 'The Cloud' by Andrew Malcolmson
Ad Index
Keep Your Story Straight by Paul Edwards
Play Your Cards Right by Dr. Jason Annan
Staffing Up by Jay Geier
Dentally Incorrect
Dentaltown September 2021 - EdgeEndo_CT
Dentaltown September 2021 - Cover1
Dentaltown September 2021 - Cover2
Dentaltown September 2021 - 1
Dentaltown September 2021 - 2
Dentaltown September 2021 - 3
Dentaltown September 2021 - Table of Contents
Dentaltown September 2021 - 5
Dentaltown September 2021 - 6
Dentaltown September 2021 - 7
Dentaltown September 2021 - 8
Dentaltown September 2021 - 9
Dentaltown September 2021 - Howard Speaks: Dentistry is a Numbers Game
Dentaltown September 2021 - 11
Dentaltown September 2021 - Professional Courtesy: Joyful Dentistry
Dentaltown September 2021 - 13
Dentaltown September 2021 - Continuing Education Update
Dentaltown September 2021 - 15
Dentaltown September 2021 - Industry News
Dentaltown September 2021 - 17
Dentaltown September 2021 - New Products
Dentaltown September 2021 - 19
Dentaltown September 2021 - Townie Poll: Lasers
Dentaltown September 2021 - 21
Dentaltown September 2021 - Show Your Work: Warm Up To Something New by Dr. Ron Kaminer
Dentaltown September 2021 - 23
Dentaltown September 2021 - 24
Dentaltown September 2021 - 25
Dentaltown September 2021 - Message Board: Oral Pathology
Dentaltown September 2021 - 27
Dentaltown September 2021 - 28
Dentaltown September 2021 - 29
Dentaltown September 2021 - 30
Dentaltown September 2021 - 31
Dentaltown September 2021 - 32
Dentaltown September 2021 - 33
Dentaltown September 2021 - Message Board: Endodontic Healing
Dentaltown September 2021 - 35
Dentaltown September 2021 - 36
Dentaltown September 2021 - 37
Dentaltown September 2021 - Industry Insights: Ivoclar Vivadent
Dentaltown September 2021 - 39
Dentaltown September 2021 - Office Visit: Dr. Grant Olson
Dentaltown September 2021 - 41
Dentaltown September 2021 - 42
Dentaltown September 2021 - 43
Dentaltown September 2021 - 44
Dentaltown September 2021 - 45
Dentaltown September 2021 - 46
Dentaltown September 2021 - 47
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Dentaltown September 2021 - 49
Dentaltown September 2021 - 50
Dentaltown September 2021 - 51
Dentaltown September 2021 - 52
Dentaltown September 2021 - 53
Dentaltown September 2021 - Dueling Lasers by Dr. Samuel B. Low
Dentaltown September 2021 - 55
Dentaltown September 2021 - 56
Dentaltown September 2021 - 57
Dentaltown September 2021 - 58
Dentaltown September 2021 - 59
Dentaltown September 2021 - Rolling Back 'The Cloud' by Andrew Malcolmson
Dentaltown September 2021 - 61
Dentaltown September 2021 - 62
Dentaltown September 2021 - 63
Dentaltown September 2021 - 64
Dentaltown September 2021 - Ad Index
Dentaltown September 2021 - Keep Your Story Straight by Paul Edwards
Dentaltown September 2021 - 67
Dentaltown September 2021 - 68
Dentaltown September 2021 - 69
Dentaltown September 2021 - 70
Dentaltown September 2021 - 71
Dentaltown September 2021 - Play Your Cards Right by Dr. Jason Annan
Dentaltown September 2021 - 73
Dentaltown September 2021 - 74
Dentaltown September 2021 - 75
Dentaltown September 2021 - Staffing Up by Jay Geier
Dentaltown September 2021 - 77
Dentaltown September 2021 - 78
Dentaltown September 2021 - 79
Dentaltown September 2021 - Dentally Incorrect
Dentaltown September 2021 - Cover3
Dentaltown September 2021 - Cover4
Dentaltown September 2021 - SI_1
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