Efficacy+of+Gingival+Curretage

**1. The efficacy of gingival curettage with laser treatment verses hand instrumentation. RK 7** 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 planning, but achieves a deeper and more complete cleaning. Evidence indicates, however, that it does not contribute any additional benefits beyond simple scaling and planning.

After complete scaling (removing) and root planning (smoothing) of calculus, gingival curettage may be necessary in order to remove chronically inflamed granulation tissue that forms the lateral wall of the periodontal pocket. According to perio.org, the goal of laser curettage is epithelial removal, as with previous methods, and, in addition, bacterial reduction. A short-term study reported that Nd:YAG laser treatment did not produce statistically significant bacterial reduction. This was subsequently confirmed in a multicenter study of laser curettage, which reported that bacterial reduction was not often achieved. Only 1 of the 3 centers reported an advantage in bacterial reduction over SRP alone.

A study was conducted in order to compare the efficacy of gingival curettage with laser treatment verses hand instrumentation, without the use of anesthesia. It consisted of 18 participants with signs of periodontal degradation, whose quadrants were randomly selected by a split mouth design. Each quadrant was either treated with an 810-nm diode laser or hand instruments. The data collected during the study included: plaque index, gingival index, sulcus bleeding index, pocket depth, clinical attachment level, and a visual analog scale. These assessments were gathered prior to and 4 weeks after the treatment. At the second reading both groups showed a significant reduction in gingival index, sulcus bleeding index, and pocket depth and a gain in clinical attachment levels. The study concluded that the diode lasers sub-gingival curettage showed significant improvements in the previously mentioned areas, in addition the participants experienced less discomfort and a decrease in treatment time compared to traditional hand instrument gingival curettage.

In conclusion, with conflicting research on the efficacy of laser curettage vs. hand curettage more studies must be conducted.

Reference Lin, J, Bi, L, Wang, L, Song, Y, & Ma, W. (2009, September 30). Gingival curettage study comparing a laser treatment to hand instruments. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/19789937

**2. Gingival curettage after scaling and root planing has not been proven to be more effective than scaling and root planing by it self on the periodontal tissues. MC3** The purpose of curettage is to seperate healthy tissue from disease tissue by scaping the wall that is diseased. There are different procedures to achieve this purpose one of which includes gingival curettage. Gingival curettage consist of the removal of inflamed tissue lateral to the pocket wall. The other technique is subgingival curettage which consist of removing disease tissue apical to the epithelial attachement.Gingival curettage has been used following scaling and root planning in an attempt to promote healing and health of the periodontal tissues. However, studies have not shown a significant difference between scaling and root planing and gingival curretage and SRP by itself. One of the studies that supports this idea was done by Echeverria (1983) the study gathered the initial baseline of probing depths, inflammation, and location of the gingival margin for both groups. At 4 weeks the same assessments were gathered and all three showed a reduction in both the scaling and root planning group and the SRP and curettage group. There was no significant evidence to support that gingival curettage has any added benefilts to scaling and root plannning.

3. Ultra sonic devices may also be used for gingival curettage with the use of a Morse scaler shape and rod shaped tip. KT4
The ultra sound of the scaler effectively debrids the epitheleal lining of periodontal pockets resulting in microcauterization that removes the inner linning of the pocket. The use of ultra sonic devices for cutettage was found to be as effective as manual instrument. It was found that less inflammation and less removal of underlying conective tissue occured with the use of the ultra sonic scaler.

Scaling and root planing is the physical removal of calculus and plaque located on the teeth. Scaling refer to the removal of calculus deposits. As root planing is the removal of calculus and endotoxins that are embedded into cementum and dentin. There are four objectives of gingival curettage: remove all calculus, remove granulation tissue, cause hemorrhage to reduce edema and remove epithelial lining of the pocket. Literature showed that the only one objective that showed benefits to the patient was removal of calculus that is completed with scaling and root planing. With new technology researchers begin to explore the usage of lasers to complete gingival curettage after SRP. Though results showed that the usage of laser for gingival curettage also showed no benefits therefore concluding that gingival curettage is not necessary for proper healing after SRP.
 * 4. Laser curettage following traditional scaling and root planing shows no added benefits. LM # 11**

ENAP has been developed and used by the U.S Navel Dental Corps. This procedure is a definitive subgingival curettage that is performed with a knife. The procedure consists of making an incision from the margin of the free gingiva apically to the point below the pocket. The excised tissue is removed with a curettage The purpose of this is to remove the chronically inflamed granulation tissue that forms in the lateral wall of the periodontal pockets Studies have shown this procedure to be effective by reducing PD and AL because of the better access to the root surfaces.
 * 5. Excisional new attachment procedure may also be used for ginigval currettage with the use of a knife GE#6.**

Caustic chemical agents, such as sodium sulfide, alkaline sodium hypochlorite, and phenol, were used to induce curettage of the tissues lining the periodontal pocket. Although different agents have been tried, they have not been found to be beneficial to the patient. Rather, they have been shown to cause more tissue damage, and often create more inflamed tissue to be removed.
 * 6. Early periodontal methods utilized caustic drugs for the purposes of gingival curettage. MW 19**

Gingival curettage is a closed procedure so that it does not allow better access for debridement or better visibility for scaling and removing plaque, does not have any additional benefits over scaling and root planning and has no application for therapy of chronic periodontitis. Also lasers have been shown to reduce the pathogens in pockets. Although there is reduction in bacteria there was no evidence of pocket depths decreasing.
 * 7. Gingival curettage does not have any additional benefits over scaling and root planning and has no application for therapy of chronic periodontitis. AP12**

Gingival curettage can be done through hand instrumentation, ultrasonic, caustic drugs, lasers and ENAP. Despite all the methods that can be used, gingival curettage has no benefit to the patient that scaling and root planing can do alone. In addition, gingival curettage may even interfere with the healing and normal cell attachment.
 * 8. Gingival curettage, the removal of diseased gingival tissue of the lateral wall of the periodontal pocket, can be done in several methods, however it is considered to offer no benefits that cannot be accomplished through periodontal therapy alone. TL8**


 * 9****. Performing a gingival curettage has be done to promote connective tissue, but this treatment has not been clinically proven.** Many studies have been performed to address this along with other treatments and it has not shown to improve the treatment outcome of the patient. There are special circumstances that this may be used for, but it will not provide improvement in patient pocket depths. SR14

**10. The removal of granulation tissue during surgery is done for technical reasons rather than biologic reasons.** Gingival curretage is performed during surgery to remove the bleeding tissue that obstructs the view and prevents the necessary examination of the root surface and bone morphology. MT18

Curettage may be done as a nondefinitive procedure to reduce inflammation when other, more invasive procedures are contraindicated. Examples include age, systemic conditions, psychological problems, or other existing conditions. It is important that the patient understands the prognosis prior to the procedure and does not have false expectations.
 * 11. Indications for curettage are limited due to research on efficacy over scaling a root planing alone, however, there are some cases where curettage may be beneficial. CE5**

12. Even though studies state that gingival curettage have no beneficial effects and outcomes over scaling and root planing, gingival curettage could be the method of choice versus a more aggresive procedure such as flap surgery. In this cases, gingival curettage should be considered when considering a patient's age, systemic conditions, or psychological problems. LL #9.