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CASE REPORT |
https://doi.org/10.5005/jp-journals-10062-0173
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Gingivectomy for Surgical Exposure of Canine for Orthodontic Correction: A Case Report
1–3Department of Periodontics, College of Dental Sciences, Davanagere, Karnataka, India
Corresponding Author: Deeksha D Pai, Department of Periodontics, College of Dental Sciences, Davanagere, Karnataka, India, Phone: +91 9869678033, e-mail: deekshapai96@gmail.com
How to cite this article: Pai DD, Vijayapremakumar VK, Prakash S. Gingivectomy for Surgical Exposure of Canine for Orthodontic Correction: A Case Report. J Oral Health Comm Dent 2023;17(3):102–104.
Source of support: Nil
Conflict of interest: None
Received on: 19 September 2023; Accepted on: 05 December 2023; Published on: 31 January 2024
ABSTRACT
Objectives: The aim of this article is to provide an idea for interdisciplinary approach for surgical management of enlarged gingival tissue for orthodontic correction.
Methodology: A 21-year-old male patient referred to the Department of Periodontics for surgical correction and orthodontic treatment exposure of his palatally placed upper left front tooth . Surgical approach was carried out using external bevel gingivectomy technique using no. 12 blade.
Results: One week and 1 month revaluation of the patient revealed satisfactory results and healing of the surgical site with complete exposure of the crown on buccal aspect.
Conclusion: A collaborative approach between orthodontist and periodontist at the appropriate time is an important key for minimal visit and better periodontal result. Periodontal health is best restored without postsurgical complications in an orthodontic case if intervened at the right time.
Keywords: Case report, Esthetics, Gingivectomy, Orthodontic treatment need.
PURPOSE
The purpose of this article is to provide an idea for surgical management of enlarged gingival tissue for orthodontic correction.
BACKGROUND
Gingivectomy is a minor surgical procedure done to excise a part of the gingiva or to reduce the soft tissue wall of the periodontal pocket,1 whereas gingivoplasty consists of plastic reshaping of marginal and interproximal gingiva to recapture good physiologic form and maintain a shallow gingival sulcus.2
Orthodontically treated patients have often been shown to clinically present with gingival enlargement/hyperplasia3 associated with few etiological factors that may include poor oral hygiene with increased plaque/calculus deposition, disequilibrium between the periopathogens and host’s immune responses, gingival irritation by bands mechanically or by cements chemically, impaction of food, etc; however, the exact mechanism is not clearly understood.4 Non-surgical and surgical periodontal treatment options are available to eliminate or reduce these etiological factors. However, non-surgical periodontal treatment is not always effective in orthodontic patients and an additional treatment such as gingivectomy4 is needed in order to eliminate pockets, restore physiologic gingival contour and facilitate the placement of braces.5
Therefore, the aim of this study was to provide idea for surgical management of enlarged gingival tissue for orthodontic correction.
CASE DESCRIPTION
A 21-year-old male patient was referred to the Department of Periodontics for surgical correction and exposure of upper left front tooth for orthodontic treatment. The tooth was palatally placed and was planned to bring in the arch by orthodontic correction. He was systemically healthy. The patient had undergone extraction of retained deciduous tooth in the same area 6 years back and was currently undergoing orthodontic treatment from our institute.
Examination Findings
Intraoral examination showed melanotically pigmented, firm, and resilient gingiva present coronal to cementoenamel junction (CEJ) and covering the buccal aspect of 13. Orthodontic band placement was found to impinge on this enlarged gingiva with 13 and required surgical correction (Fig. 1). A probing pocket depth of 6 mm was seen using UNC-15 probe (Fig. 2).
Fig. 1: Preoperative photograph
Fig. 2: Measuring probing pocket depth using UNC 15 probe
The patient was advised for routine blood investigation of complete blood count with bleeding and clotting time and RBC, all of them were reported to be normal. An informed consent was obtained from the patient before treatment.
Treatment
After anesthetizing the area in relation to 13 with local infiltration of 1:80,000 lignocaine along with adrenaline, the bleeding points were marked with Crane Kaplan Pocket marker (Fig. 3). Hand scaling was performed and external bevel gingivectomy was performed using no. 12 blade by placing continuous incision (Fig. 4).
Fig. 3: Marking bleeding points using pocket marker
Fig. 4 Placement of incision for gingivectomy using no. 12 blade
RESULTS
One week and 1 month revaluation of the patient revealed satisfactory results and healing of the surgical site with complete exposure of the crown on buccal aspect (Fig. 5).
Figs 5A and B: Postoperative surgical crown exposure—(A) Immediate, and; (B) 1 month
DISCUSSION
It has been known from existing literature that orthodontic appliances influence plaque accumulation around its fixed components and the teeth and lead to periodontal pathogenic colonization. It may result in the development of inflammation and gingivitis, gingival hyperplasia or ginigival enlargement. This gingival enlargement may vary from mild interdental papillary enlargement to segmental/uniform enlargement affecting maxillary or mandibular arch. These results in poor oral hygiene maintenance, plaque accumulation, etc. ultimately leading to gingival enlargement.4 However, in this case, the long-standing irritation using orthodontic bracket along the palatally placed canine may have been the etiology.6
Gingivectomy indications are elimination suprabony pockets, gingival enlargement and eliminate suprabony periodontal abscess. Its contraindication includes infrabony pockets treatment, pockets extending below the mucogingival junction, presence of minimal amounts of attached keratinized tissue and procedures requiring access to alveolar bone.7,8 It improves visibility and accessibility to remove calculus, facilitate root planing, create an optimal environment for healing and restore the gingival physiologic contour.8
Various techniques are known to perform gingivectomy that may include conventional scalpels, electrosurgery, chemosurgery, and laser. The scalpel method is commonly considered because of its ease of use, accuracy, and minimal tissue damage.4
In noninflammatory gingival hyperplasia, gingivectomy is indicated with either external bevel (facially placed incised tissue surface) or internal bevel (incised edge positioned submarginally in the sulcus).9,10 External bevel gingivectomy is the most preferred technique for gingivectomy to restore the gingival physiologic contour.
CONCLUSION
A collaborative approach between orthodontist and periodontist at the appropriate time is an important key to successful treatment with minimal visit and optimal result. Early diagnosis and a well-planned treatment plan aids in better results and increased patient compliance in the long run.
Clinical Significance
This case report provides an idea for surgical management of enlarged gingival tissue for orthodontic correction using external bevel gingivectomy. It emphasizes the need for collaborative approach between orthodontist and periodontist for early diagnosis and prompt treatment to aid in better results and increased patient compliance in long run.
ORCID
Deeksha D Pai https://orcid.org/0000-0002-2144-7245
REFERENCES
1. Glossary of Periodontal Terms 4rth Edition. The American Academy of Periodontology.
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4. Lione R, Pavoni C, Noviello A, et al. Conventional versus laser gingivectomy in the management of gingival enlargement during orthodontic treatment: A randomized controlled trial. Eur J Orthod 2020;42(1):78–85. DOI: 10.1093/ejo/cjz032.
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7. American Academy of Periodontology. Guidelines for periodontal therapy. AAP 2001;72:1624–1628.
8. Newman M, Takei H, Klokkevold PCF, et al. Newman and Carranza’s clinical periodontology. 13th edition. Philadelphia: Elsevier; 2019.
9. Benoist HM, Ngom PI, Seck-Diallo A, et al. L’hypertrophie gingivale au cours du traitement orthodontique: Apport de la gingivectomie à biseau externe. Rapport de cas [Gingival hypertrophy during orthodontic treatment: Contribution of external bevel gingivectomy. Case report]. Odontostomatol Trop 2007;30(120):42–46. French.
10. Rosenberg ES, Torosian J. Esthetics and periodontics. Esthetic Dentistry, 3rd edition, 2015.
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