Phase II Periodontal Therapy principals of periodontal surgery الفرقة الخامسة- امراض لثة- 12/4/2020 Gingival Surgical Techniques 1. Gingival Curettage 2. Excisional new attachment procedure (ENAP) 3. Gingivectomy 1. Gingival Curettage • Definition : • The term "gingival curettage" implies directing an operative instrument against the gingival wall of the periodontal pocket in order to remove the ulcerated epithelium covering the sulcus. 1. Gingival Curettage • The curettes is used to scraping of the gingival wall of a periodontal pocket to separate diseased soft tissue. 1. Gingival Curettage • TYPES 1. Gingival Curettage • II. Surgical curettage, • III. Chemical curettage, • IV. ultrasonic curettage. • V. Laser Tx 1. Gingival Curettage • INDICATIONS 1. ? 1. Gingival Curettage • However, the need for curettage to eliminate the inflamed granulation tissue appears to be questionable. 2. Excisional new attachment procedure (ENAP) • A surgical procedure in which the sulcular and junctional epithelium is resected. The aim of the procedure is to remove the diseased tissue and allow healing of the dentogingival and periodontal attachments. 2. Excisional new attachment procedure (ENAP) • advantages over traditional subgingival curettage is the definitive, clean excision of the junctional epithelium and the subjacent tissue with a greater probability of new clinical attachment 2. Excisional new attachment procedure (ENAP) • Indications 2. Excisional new attachment procedure (ENAP) • Contraindictions 2. Excisional new attachment procedure (ENAP) • Advantages • Disadvantages 3. Gingivectomy • gingivectomy means “excision of the gingiva.” By removing the pocket wall, • gingivectomy provides visibility and accessibility for complete calculus removal and the thorough smoothing of the roots 3. Gingivectomy • Types: 3. Gingivectomy Step 1. bleeding points: 3. Gingivectomy • Step 2. The primary incision on the facial and lingual surfaces:(Kirkland knives or a scalpel blade 12 or 15) 3. Gingivectomy • Step 3. the secondary incision interproximal soft tissue is separated from the interdental periodontium by a using an Orban knife 3. Gingivectomy • Step 4. The incised tissues are carefully removed by means of a curette or a scaler 3. Gingivectomy • Step 5. Cover the area with a surgical pack 3. Gingivectomy • Indications: 3. Gingivectomy • Contraindications to gingivectomy Gingivoplasty • Gingivoplasty is similar to gingivectomy, but its objective is different. • Gingivectomy is performed to eliminate periodontal pockets, and it includes reshaping as part of the technique. • Gingivoplasty is a reshaping of the gingiva to create physiologic gingival contours with the sole purpose of recontouring the gingiva in the absence of pockets Classification of Flaps Periodontal Incisions .