Efficacy of Gingival Curettage

It is the oldest Treatment methods. It is used to enhance the results of scaling & root planning in selected cases. In 1989 the AAP stated there’s no justifiable application during active therapy stages for chronic adult periodontitis. It has limited usefulness. Curettage is a vague term it means the scraping or debriding soft tissue in body cavity with an instrument.
Closed curettage procedures:
Gingival curettage- debridement of soft tissue wall of pocket with a curet to remove inflamed pocket wall it includes: junctional and pocket epithelium and immediately subjacent diseased Connective tissue.
Subgingival curettage- is more apically to CT. attachment to tooth down to osseous crest w/o incising and reflecting a flap.
Open curettage procedures:
Includes surgical curettage, open curettage, flap curettage, excisional new attachment procedure (ENAP) and modified widman flap.
Done with surgical procedures to excise the inflammated pocket wall and CT. attachment apical to bone to base of pocket to osseous crest. It provides greater visibility and access than closed curettage.
Inadvertent curettage- unintentional and unavoidable removable of position of pocket wall and J.E. during SRP. Done by using opposite cutting edge of curet blade coming in contact with pocket wall.
Hard tissue curettage- smoothing of root surfaces with curet = root planning
Chemical curettage- use of caustic solution to facilitate removal of soft tissue lining of pocket. Example is sodium sulfide, alkaline sodium, hypochlorite solution and phenol. They have largely been discarded because it’s difficult to control and no more effective than gingival curettage alone.
Rational for gingival curettage- is influenced by condition of the tissue comprising the pocket wall- edematous or fibrotic. And influenced whether a definitive or non-definitive and result is likely.
A definitive procedure should result in correction of a defect and elimination of the disease.
Non-definitive results- you would see reduced inflammation but persistence of path deep in pocket.
Edematous pockets- definitive result is expected by a reduction of edema and shrinkage of marginal gingival- may promote healing of pockets by the physical removal of debris and chronically inflamed granulation tissue. In some cases this may hasten healing
By debriding the pocket wall, chronically diseased, ulcerated tissue is converted to an acute surgical wound: hyperemia and vascular stasis are relieved by bleeding and exudation during and after gingival curettage, resulting in shrinkage of edematous, enlarged tissue.
Fibrotic pocket- is a chronic long standing inflammation in pocket wall. These pockets lack the capacity to shrink. w/o this mechanism to give a definitive result, the usual result of gingival curettage for fibrotic pockets is non-definitive.” Reduced inflammation but path is still in pocket”. In fibrotic pockets closure of pocket happens from long JE not from new CT so there is no rational for gingival curettage when treating fibrotic pockets.
Indications for gingival curettage-
- perio. abscesses- remove debris and granulation tissue.
-highly edematous pockets with large amounts of granulation tissue when response to SRP can be expected to be delayed.
-superbony pockets 4 to 6mm
-recurrent inflammation and pocket depths during maintenance.
Contraindications for gingival curettage-
-firm, fibrotic tissue b/c shrinkage will not occur and now new attachments in tissue
-infrabony pockets
-ANUG
-mucogingival involvement b/c- thin, fragile gingival or mucosa can be easily lacerated during instrumentation- it will make it worse.

Reina:
The American Academy of Periodontology’s position on gingival curettage is that short- and long-term clinical trials have confirmed no additional benefits when compared to scaling and root planning alone in terms of probing depth reduction, attachment gain, or inflammation reduction. Routine gingival curettage has been defined as the superficial removal of the epithelium lining of the periodontal pocket and a portion of the adjacent chronically inflamed connective tissue with periodontal curettes whereas chemical gingival curettage is chemical augmentation of routine gingival curettage by the preliminary application of concentrated sodium hypochlorite solution prepared by a standardized formula and neutralization with 5% citric acid. Sodium hypochlorite solution predictably lysed crevicular epithelium, junctional epithelium, and marginal epithelium with 1- or 2-minute applications. Kalkwarf et al. stated that the advantages of chemical gingival curettage compared to routine gingival curettage are:

1. Predictable, uniform removal of the pocket lining
2. Improved comfort of the gingival curettage procedure to the point where local anesthesia is not required
3. Ease of the procedure for the dentist because local anesthesia is not necessary
4. Reduced hemorrhage due to the binding action of the sodium hypochlorite solution allowing better vision and easier tissue management

American Academy of Periodontology. (2002, October). The American Academy of Periodontology statement regarding gingival curettage. Journal of Periodontology, 73(10), 1229-1230.
Kalkwarf, K. L., Tussing, G.J., & Davis, M. J. (1982, February. Histologic evaluation of gingival curettage facilitated by sodium hypochlorite solution. Journal of Periodontology, 53(2), 63-70.

Diem
Gingival curettage is used to remove granulation on soft tissue and helps improved on inflammation. However, the AAP position paper does not support gingival curettage because this "old fashion" technique does not have any benefit alone or combining with SRP. Gingival curettage does have some immediate effects, but not in the long term treatments or maintenance. This technique does not remove the etiological factor on periodontal tissue, so it does not have any different result when using it with or without SRP. Gingival curettage does not recommend to medical compromised pts because it may harm the pts more than benefit them due to open up the blood vessels when scaling. Because of its in-effectiveness, insurance companies no longer pay for gingival curettage. However, some studies still believe in gingival curettage, but they are unable to prove its positive effect with solid evident based researches.

Ferris

Gingival curettage has been around since the early 1900's and its popularity rose in the 50's and 60's.

Gingival curettage was a therapy once commonly used and billed for but due to the evidence that there is no support that gingival curettage actually has better long term effects over scaling and root planing alone this code has been deleted by the ADA. Because insurances are not able to bill for it the popularity has faded and is not as widely used.

Although the use of laser technology has become a new option for gingival curettage it poses some danger as having the potential to cause irreversible damage to root surfaces.

Gingival curettage can be followed with solutions, such as sodium hypochlorite, to provide chemolysis and aid in the healing process. The benefits of gingival curettage include rapid healing after 4-6 weeks but do not provide superior long term effects over scaling and root planing alone.

Some considerations discussed for rational of using gingival curettage are for patients who are medically compromised and have a weakened immune system. Overall, the dental community and the AAP do not support the use of gingival curettage as adjunct therapy to scaling and root planing but it is still used and may be observed in the dental field.

Jennifer
Some people believe in gingival curettage as others do not. Current research shows that the short term outcome of scaling and root planning along with curettage has a better outcome , but as for the long term outcome scaling and root planning only is comparable to scaling root planning and curettage. Although no longer supported by the AAP some still find it beneficial to the patient. There have been advances in curettage such as chemical and laser curettage. The chemical technique seems to be very time consuming. The laser technique if not done correctly has the potential to do irreversible damage to the tooth structure. After our class discussion we came to find that there may be cases in which the granulation tissue may need to be removed such as an immune compromised patient.

Dorinda
Gingival curettage has no benefit to periodontal disease. Many studies have been done regarding gingival curettage and there is no evidence to support the benefits of this procedure versus the standard scaling and root planning that dental hygienists provide to their patients. The procedure was once thought to be of benefit but we have come to see that it is not.
Noo:

Gingival curettage has been around since the early 1900's and its popularity rose in the 50's and 60's.

Gingival curettage was a therapy once commonly used and billed for but due to the evidence that there is no support that gingival curettage actually has better long term effects over scaling and root planing alone this code has been deleted by the ADA. Because insurances are not able to bill for it the popularity has faded and is not as widely used.

Although the use of laser technology has become a new option for gingival curettage it poses some danger as having the potential to cause irreversible damage to root surfaces.

Gingival curettage can be followed with solutions, such as sodium hypochlorite, to provide chemolysis and aid in the healing process. The benefits of gingival curettage include rapid healing after 4-6 weeks but do not provide superior long term effects over scaling and root planing alone.

Some considerations discussed for rational of using gingival curettage are for patients who are medically compromised and have a weakened immune system. Overall, the dental community and the AAP do not support the use of gingival curettage as adjunct therapy to scaling and root planing but it is still used and may be observed in the dental field.

Ceri:
Gingival Curettage

Gingival curettage removes the soft tissue lining of the periodontal pockets in order to completely eliminate bacteria and diseased tissue. It may be used along with scaling and root planing, but achieves a deeper and more complete cleaning. Evidence indicates, however, that it does not contribute any additional benefits beyond simple scaling and planing.

Research, Science and Therapy Committee. (2004). Treatment of plaque induced gingivitis, chronic periodontitis and other clinical conditions. American Academy of Pediatric Dentistry. 253-262.

Dederich, D. N. and Drury, G. I. (2002, May). Laser Curettage: Where do we stand? Journal of the California Dental Association.

Natalie
Although gingival curettage has a long history, it is not supported by the ADA and is rarely used today. There is not conclusive evidence that gingival curettage has long term benefits over scaling and root planing. When used, gingival curettage can be followed with solutions, such as sodium hypochlorite, to provide chemolysis and aid in the healing process. Patients who are medically compromised or who have a weakened immune system may be a candidate for gingival curettage; however, this should be determined on a case by case basis. Generally speaking, the dental community and the AAP do not support the use of gingival curettage as adjunct therapy to scaling and root planing but it is still used occasionally and may be observed in the dental office. As a dental hygienist, it is important to understand this procedure and explain to our patient’s current research so they can make an informed decision regarding their treatment.


Jackie
Gingival curettage, “The scraping of the gingival wall of a periodontal pocket to separate diseased soft tissue” (Carranza, 2006). Gingival curettage is the removal of disease tissue and bacteria from the soft tissue lining the periodontal pocket, however, studies have revealed that the benefit is not greater than only scaling and root planning. Gingival Curettage is done by using a sharp curette with a horizontal stroke to remove the tissue. Subgingival curettage removes the junctional epithelium, bacteria, and granulation tissue from inside the pocket with the use of a sharp curette with the cutting edge away from the tooth structure. Since gingival curettage does not remove the cause of inflammation, scaling and root planning should always be done together with gingival curettage.
Question:
Since root planning and scaling removes the etiological factor behind disease gingival epithelium, why perform gingival curettage if it does not remove the etiology of the problem?
Jackie
Electronic reference on Periodontal Disease (2004). Retrieved April 3rd, 2009, from http://www
Adam.about.om/reports/000024_7.htp
Taylor, G. (2003). The effects of periodontal treatment on diabetes. Journal of the American Dental Association, 134 (4), 41S-48S.

Marcia-
Gingival curettage is procedure used in conjunction with scaling and root planning. It use to be more popular, however studies have concluded that the procedure does not long term benefits. There is resolution in re-evaluations of patients who had the procedures but no long term results. This procedure may benefit patients who are immune compromised. The idea behind the gingival curettage is that there are deposits of calculus left behind on the wall of the periodontal pocket. After scaling the tooth surface the blade of the instrument would then slightly remove any calculus impeded in the tissue that was in conjunction to the pieces of calculus. There are still offices that provide this service. Dental insurance do not cover the procedure. Sodium chloride has been suggested to help reduce the bacteria count in the periodontal pockets after the gingival curettage to get better results. The popularity of gingival curettage seems to be getting better since it can now be delivered through lasers. Lasers have been gaining a lot of popularity and gingival curettage is one of its procedures.
Dederich, D. N., Drury, D. I. (2002). Laser Curettage: Where do we stand? Journal of the California Dental Association. Retrieved on May1, 2009 from C:\Documents and Settings\Student\Desktop\Gingival curettage.mht

Newman, M. G., Takei, H. H., Klokkevold, P. R., Carranza, F. A. (2006). Carranza’s
clinical Periodontology. St.Louis, Missouri: Saunders Elsevier


Drina:
Gingival curettage is the removal of soft tissue lining from the periodontal pocket with a curet. According to the AAP statement gingival curettage has no therapeutic benefit in the treatment of chronic periodontitis. There is also gingival curettage with the use of lasers and some evidence shows that there is also no benefit with laser gingival curettage.
Reference:
Dederich, D.N., & Drury, G.I. (2002, May). Laser curettage: Where do we stand? Journal of the California Dental Association.

Periodontal Disease Treatment. Retrieved on 5/1/09 from
http://www.healthcentral.com/ency/408/guides/000024_8_2.html

Efficacy of Gingival Curettage
Gingival curettage is the removal of soft tissue epithelium from the lining of a periodontal pocket. What remains after removal of the soft tissue is the connective tissue and it was thought that this would allow for attachment of a long junctional epithelium. Studies have shown that gingival curettage is no more effective than scaling and root planing alone at creating the attachment of a long junctional epithelium. The use of lasers for gingival curettage has been a current modality to reduce bacteria numbers and aid in the formation of attachment and decrease inflammation and probing depths. Once again, studies have shown that gingival curettage is no more effective than scaling and root planning. Therefore, gingival curettage would not be a viable treatment option for chronic periodontitis. However, there is one patient that gingival curettage would be beneficial for and that is the medically compromised patient. Gingival curettage would be performed as an alternative to periodontal flap surgery as to prevent possible infection from surgery.
Reference:

Dederich, D. N. & Bushick, R. D. (2004, January). Lasers in dentistry: Separating science from hype. Journal of the American Dental Association, 135(2), 204-212. http:www.perio.org Retrieved April 30, 2009.

Newman, M. G., Takei, H. H., Klokkevold, P. R., & Carranza, F. A. (2006). Carranza’s clinical Periodontology. St.Louis, MO: Saunders Elsevier.

The American academy of periodontology statement regarding gingival curettage. (2002). The Journal of Periodontology, 73 (10), 1229-1230.