Dentaltown September 2021 - 56

Technique
Initial incisions for gingivectomies are similar to those created when using a blade with an
external bevel approach. The distance of the incision from the coronal gingival margin is based on
pocket depth and amount of existing attached gingiva. A gingival chamfer (beveled edge) is achieved,
rather than a direct right angle into the gingiva (Figs. 2a-2c, p. 55). The initial cut is made slightly
apically to the pocket depth measurement. A slow, unidirectional hand motion is used, moving the
tip at an external bevel toward the tooth structure.
Determine where the excision should be outlined from the distance of the coronal gingival
margin without compromising the attached gingivae.
The angle of the excision as an external bevel should be based on the thickness of gingivae. With
very thin gingivae, the excision can be more perpendicular to the long axis of the tooth (Fig. 3a).
If the gingivae lies within normal limits, an obtuse angle can be utilized (Fig. 3b). However, with
thick gingivae, the excision angle should be more acute to the long access of the tooth (Fig. 3c).
This can create a wide-beveled edge with thick gingivae. We desire parabolic margins that blend
with the new gingival margin.
Several passes may be necessary to excise the tissue to the tooth surface. The action should be
slow and done in a unidirectional hand motion. The collar then can be removed with a curette.
Gingivectomy instrumentation
Since the beginning of the gingivectomy, several instrumentation devices have been implemented
including knives, blades, scissors, chemicals, diamonds, rotary burs, electrosurgery and, more recently,
dental lasers. As we move from the gingivectomy being a procedure for periodontal disease to more
of a procedure for restorative access and aesthetics, devices will continue to change.
Knives and blades: The advantage of utilizing manual cutting instruments is that they are
plentiful and inexpensive. The primary essential periodontal knives are the Kirkland 15/16 and the
Orban 1/2 (Fig. 4). The Kirkland is more for gross excisions, especially on the straight buccal and
lingual/palatal area, and is a pointed kidney-shaped knife. The Orban 1/2 is thinner in width, angled
and provides great access to interproximal posterior areas for excision of gingivae. Some clinicians
prefer to lead with the Kirkland knife and retrace the excision with the Orban knife. The Orban
can separate the collar in the interproximal area and remove the gingival collar intact. Both knives
are angled and double-ended for access.
The greatest disadvantage of the manual knife is that it requires repeated sharpening. If not
razor-sharp, cutting effi ciency is compromised, which not only affects time it takes to perform a
procedure, but also can result in irregular tissue margins. While vasoconstriction can be achieved with
Fig. 3
Fig. 4a
Fig. 4b
Fig. 5
a
b
c
Fig. 3: The bevel is dependent on the thickness of the gingival biotype. a. Thin, b. Normal, c. Thick
Figs. 4a and 4b: Gingivectomy manual cutting instruments. (4a: Kirkland 15/16. 4b: Orban 1/2.)
Fig. 5: Charring of tissue after using a diode laser at high power in a continuous mode.
56 SEPTEMBER 2021 // dentaltown.com
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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
Dentaltown September 2021 - 48
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
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