Gingival curettage involves scraping diseased soft tissue from periodontal pockets. It can be performed with a curette as an open procedure following a gingival incision or as a closed procedure. Scaling removes deposits from tooth and root surfaces while root planing smoothens roots to remove infected tissue. Curettage is indicated for shallow pockets, as part of new attachment attempts, or for maintenance treatment of recurrent inflammation, but is contraindicated for acute infections, fibrous gingival enlargement, or pockets extending beyond the mucogingival junction. Healing after curettage involves blood clot formation, leukocyte occupation of the wound, and regeneration of epithelium, connective tissue,

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Gingival Curettage
scraping of gingival wall of a periodontal pocket to separate diseased soft tissue
Scaling
refers to removal of deposits from tooth/ root surface
Root Planing
smoothening the root to remove infected and necrotic tooth surface

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TYPES
I. Gingival curettage:
Consists of removal of inflamed soft tissue lateral to pocket wall
a. Subgingival curettage:
It is a procedure that is performed apical to epithelial attachment
b. Inadvertent curettage:
Curettage that is done unintentionally during scaling and root planing.
II. Surgical curettage,
III. Chemical curettage,
IV. ultrasonic curettage.
V. Laser Tx

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INDICATIONS
1. In patients whom extensive surgery is contraindicated owing to systemic disease or
psychologic problems.
2. Shallow pocket depths with an adequate width and thickness of gingival tissue.
3. It can be performed as a part of new attachment attempts in moderately deep
intrabony pockets located in accessible areas.
4. Curettage can be performed on recall visits as a method of maintenance treatment
for areas of recurrent inflammation.
5. In suprabony pockets which do not extend beyond the mucogingival junction.

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CONTRAINDICATIONS
1. Presence of acute infections such as necrotizing ulcerative gingivitis (NUG).
2. Fibrous enlargement of gingiva such as phenytoin hyperplasia.
3. Extension of the base of the pocket apical to the mucogingival junction.
4. If the patient is medically compromised, the benefits versus the risks of the surgical
procedure should be carefully weighed before commiting the patient to the procedure.

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PROCEDURE
Curettage can be accomplished as a
open procedure with a gingival incision followed by root planing (ENAP)
Basic Technique (With Curette)
Curettage can be accomplished as a closed procedure with a sharp curette or as an
gingival incision followed by root planing (ENAP)
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with a sharp curette or as an
gingival incision followed by root planing (ENAP).

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Excisional New Attachment Procedure (ENAPExcisional New Attachment Procedure (ENAP)
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Ultrasonic Curettage
Sound energy absorbed at tissue junctions that take the form of heat, results in
coagulation. The coagulated epithelium is then removed by mechanical action of the
vibrations of ultrasonic instrument.
Chemical Curettage
Sodium sulphide, phenol, camphor, antiformin, and sodium hypochlorite have been
used for chemical curettage.
Solution applied for 1 minute. Then 5% citric acid solution is introduced into the pocket
for 1 minute to neutralize the sodium hypochlorite. The coagulated tissue is then
removed with a curette and pocket is flushed with saline to remove the remnants of the
connective tissue.
The extent of chemical penetration to the tissue cannot be controlled and thus,
chemical curettage is discarded.

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Laser
Nd:YAG laser treatment
HEALING AFTER CURETTAGE
Gingival sulcus filled by blood clot immediately after curettage.
Abundant polymorphonuclear leukocytes occupy the wound site.
followed by rapid proliferation of granulation tissue.
Epithelium:  Sulcular epithelium is restored between 2 to 7 days
junctional epithelium:  as early as 5 days after curettage.
Connective tissue:  Immature collagen fibers appear within 21 days.

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