Gingivectomy

Gingivectomy overview and indications

Gingivectomy, a surgical procedure often used in dentistry, is the process of surgical removal of gum tissue. Gingivectomy can be performed for different reasons, such as treating various gum problems, especially correcting the gum line or adjusting the length of the teeth. Gingivectomy procedure can be applied to provide better access to the root surface of the tooth or for aesthetic concerns. Gingivectomy, which is usually performed under local anesthesia, is a comfortable and practical method.

Gingivectomy is a dental procedure that should be performed by specialist dentists. The gingivectomy procedure is planned and performed in accordance with the patient's needs and general health condition. Thus, it is possible for patients to achieve a healthy gum structure and achieve aesthetically satisfactory results.

Some of the cases in which gingivectomy, a surgical intervention for various dental and gum problems, is performed, are listed below:

• Thanks to gingivectomy, which is a method often used in the treatment of gum diseases, redness, swelling and infections in the gum pockets can be controlled.
• Irregularities in the gum line may occur depending on genetic factors or the teething process. With gingivectomy, these irregularities can be corrected and a more aesthetic gum line can be obtained.
• In cases of excessive growth in the gum line or gum recession, adjusting the tooth length with the gingivectomy procedure can be provided to give the teeth a more balanced and aesthetic appearance.
• Gum pockets may form with the progression of gum diseases. With the gingivectomy procedure, these pockets can be cleaned and better access to the tooth roots can be provided.
• Gingivectomy procedure can also be applied for aesthetic purposes within the scope of smile design. Gingivectomy procedure can be applied to correct the irregularities in the gum line and to obtain a more aesthetic and symmetrical smile.

Contraindications and How Gingivectomy is Performed

The cases in which gingivectomy cannot be performed are as follows:

• Gingivectomy cannot be performed on people who do not have good oral health. If there are decayed teeth and different gum disorders, they should be treated first.
• Gingivectomy is not performed during pregnancy due to the risk of negative impact of the healing process after treatment and changes in the gums.
• People with chronic and uncontrolled health problems are not suitable for gingivectomy treatment.

Gingivectomy is a dental procedure in which gum tissue is surgically removed. Gingivectomy can be performed to correct gum problems and provide smile aesthetics. There are different types of gingivectomy, such as superficial gingivectomy, extender gingivectomy and protective gingivectomy. Superficial gingivectomy is performed to correct the gum line. If there is excess gum tissue on the teeth or if the teeth need to look longer, an extender gingivectomy may be performed. Protective gingivectomy is a type of gingivectomy performed in case of recession of gum tissue or exposure of tooth roots for reasons such as periodontal diseases. Which method will be applied is determined by the dentist specifically for the patient.

Before the procedure, the patient's general health condition is evaluated and local anesthesia is performed. In this way, the patient does not feel pain or soreness during the application. Marking is performed on the gum line and excess gum tissue is removed. Bleeding control is provided thanks to the stitches applied later. With the completion of the procedure, the healing process begins. In order for the healing process to progress quickly and healthily, it is necessary to follow the recommendations of the dentist and regular check-ups should not be neglected.

Treatment Process

1. 01Consultation: Initial examination and needs assessment; imaging where required.
2. 02Treatment: Tissue recontouring with laser or conventional technique.
3. 03Follow-up: Outcome review and aftercare guidance.

How Gingivectomy Is Done with a Scalpel or a Diode Laser

A gingivectomy is done under local anaesthesia in a single sitting: the dentist measures the gum pockets, marks the line the new gum margin should follow, cuts away the excess tissue along that line and controls the bleeding before the area is left to heal. The cut can be made with a scalpel or with a diode laser, and the choice changes how the day feels more than how the gum looks afterwards. A systematic review of seven randomised trials in gum overgrowth caused by fixed braces found significantly less bleeding and pain during and after the procedure with diode laser gingivectomy than with scalpel surgery or non-surgical treatment (PubMed 37738371).

The clinical result of the two techniques looked much the same. In a randomised trial of 60 patients with overgrown gums during orthodontic treatment, scalpel and laser gingivectomy both improved the periodontal measurements at one month compared with cleaning alone, with no significant difference between the two techniques, and part of that gain relapsed in both surgical groups by the three-month check (PubMed 31111882).

That relapse is the reason the cause of the overgrowth is treated alongside the cut. If plaque or a medicine keeps driving the enlargement, the gum can grow back over the new margin. A systematic review including 349 studies found oral hygiene instruction and professional mechanical plaque removal effective at improving gingival enlargement on their own (PubMed 42260319), so a gingivectomy plan normally includes a hygiene phase, and surgery deals with the tissue that does not respond to it.

Benefits, risks and healing in gingivectomy treatment

Gingivectomy, a surgical procedure performed for various gum problems, brings with it many benefits.

• Gingivectomy is an effective solution for gingivitis, swelling or other gum problems.
• It can help to regulate the gum line, thereby achieving an aesthetic smile design.
• In cases of gingival hyperplasia, gingivectomy can be performed to correct overgrown gum tissue.
• Gingivectomy stands out as an effective treatment method against problems caused by periodontal diseases.
• Having a smooth gum line thanks to gingivectomy can help clean the teeth more effectively.

As with all surgical procedures, the gingivectomy procedure also has some risks and harms. Some of them can be listed as follows:

• There is a risk of infection developing in the area where the surgical procedure is performed. Necessary hygiene measures should be taken to eliminate the risk of developing a possible infection.
• There is a risk of bleeding during or after the gingivectomy procedure.
• Temporary or permanent loss of sensation may occur depending on the surgical procedure.
• After gingivectomy, there may be irregularities or unwanted aesthetic changes in the gum line.
• In some patients, there may be a longer recovery time or complications.

Since gingivectomy is a surgical procedure, the wound may be covered with a periodontal dressing for the first days after the operation, and the dentist removes it at the review appointment.

Gingivectomy Recovery Time

Complete healing of a gingivectomy wound usually takes between one and two months, according to a systematic review on wound care after the procedure (PubMed 37583501). The same review pooled six trials that scored healing and pain on days 3 and 7 after surgery and found that low-level laser therapy applied to the wound gave significantly better healing scores and lower pain at both points (PubMed 37583501).

Infection after gum surgery is uncommon. In a review of 1,053 periodontal surgical procedures of several kinds, gingivectomy among them, 22 infections were recorded, an overall rate of 2.09% (PubMed 15857064). Swelling that keeps increasing, or pus at the wound, is a reason to contact the dentist rather than wait for the review.

Where gingivectomy is used to lengthen teeth before crowns or veneers, the gum margin keeps moving after the wound has closed. In pre-restorative crown lengthening, the gingival margin may rebound, largely during the first three postoperative months (PubMed 27535216), so impressions for the final restorations are usually planned after that settling period. For a patient travelling to Istanbul, the surgery itself fits into one visit, while the settled gum line and any veneers or crowns that depend on it belong to a later visit.

Pain During and After Gingivectomy

Under local anaesthesia most patients feel pressure rather than pain during the gingivectomy itself; the soreness comes afterwards, once the anaesthetic wears off. In a split-mouth study of 56 patients with chronic periodontitis, discomfort during treatment did not differ significantly between gingivectomy, flap surgery and scaling, but postoperative pain was significantly higher after gingivectomy than after scaling and root planing or a modified Widman flap (PubMed 18056100). The same study found pain scores fell with increasing age and were higher in patients with more dental anxiety (PubMed 18056100), so anxiety before surgery is worth mentioning to the dentist.

Technique shifts that picture. Across seven randomised trials, diode laser gingivectomy caused less intraoperative and postoperative pain than the scalpel (PubMed 37738371), and low-level laser applied to the wound after surgery lowered pain on days 3 and 7 (PubMed 37583501).

Tooth sensitivity is the other complaint to expect, because removing gum tissue can expose more of the tooth surface to cold and touch. In the split-mouth study, all of the surgical procedures produced significantly more dentine hypersensitivity than non-surgical treatment (PubMed 18056100). Painkillers are prescribed by the dentist for the first days; which medicine suits you depends on your health and the other medicines you take, so check with the dentist before adding anything of your own.

Postoperative considerations after gingivectomy

There are some critical elements that need to be taken into account in order to have a healthy and fast recovery process after gingivectomy operation. Some of these elements can be listed as follows:

• It is very important to ensure oral hygiene after the operation. For this, the surgical area should be kept clean and the dentist's recommendations should be fully followed to reduce the risk of possible infection.
• Medications prescribed by the dentist, such as painkillers and antibiotics, should be used regularly to keep postoperative pain and infection under control.
• Substances such as cigarettes and alcohol that may negatively affect the healing process should not be consumed.
• It is important to get enough rest after gingivectomy and wait for the time needed to recover. It is recommended to avoid excessive physical activity during the recovery process.
• It is necessary to regularly attend the follow-up appointments determined by the dentist. In this way, the healing process can be closely monitored and early detection of possible problems can be possible.
• Avoiding consuming hard foods for the period specified by the dentist after the gingivectomy operation, applying a nutrition program that includes soft and liquid foods is another issue that should be considered.

Gingivectomy and Gingivoplasty in Turkey

The common feature of gingivectomy and gingivoplasty is that both are surgical procedures performed to improve gum health. Although both treatments are performed by a dentist, the procedure of the treatments is different from each other.

Gingivectomy is performed to remove and reshape diseased gum tissue. In cases where there is an excess of gums, similar procedures are followed and the excess can be eliminated.

Gingivoplasty procedure, on the other hand, allows improving the appearance of the gums without any tissue removal process. Gingivoplasty is considered to be an ideal method that can be applied to correct the contours of the gums.

Gingivectomy Prices

Gingivectomy prices may vary depending on factors such as how much gum needs to be corrected, the technique to be applied, the number of teeth to be processed, the dentist's expertise and the pricing policy of the clinic where the application will be performed. At Mosdent in Istanbul, gingivectomy starts from €70 per tooth and gingivoplasty, which reshapes the gum contour, from €60 per tooth. Both are starting prices, not quotes: the number of teeth and the technique are decided at the examination, and the figure that applies to you is written down then.

Many clinics in Turkey, including Mosdent, quote gingivectomy as part of a treatment package that may cover the consultation, the procedure and, for patients travelling in, accommodation. Ask which items a quoted figure covers before comparing two offers.