NaSSiP 6

The International Online Seminar Series on Periodontology in conjunction with

KnE Medicine Scientific Seminar
Volume 2022

Research article

Gingival Curettage for the Management of

Chronic Periodontitis: A Case Report
Niken Olivia and Dahlia Herawati*
Periodontics Department, Faculty of Dentistry, Universitas Gadjah Mada, Jl. Denta Sekip Utara,
Sinduadi, Mlati, Sleman Regency, Special Region of Yogyakarta 55281, Indonesia
ORCID
Dahlia Herawati: https://orcid.org/0000-0003-0976-2258

Abstract.
Background: The current therapy for periodontitis entails periodontal debridement,
which involves the removal or disruption of bacterial plaque, its byproducts and retained
calculus deposits from the coronal surfaces, root surfaces and the tissue walls of the
periodontal pocket. Gingival curettage was designed to promote new connective tissue
attachment to root surfaces by removing the pocket lining and junctional epithelium with
a curette.
Objective: This case report discusses the gingival curettage for periodontitis treatment
Corresponding Author: Dahlia on upper right posterior of a 25-year-old female patient with a chief complaint of
Herawati; email: occasional bleeding while brushing the teeth.
[email protected] Case Report: Intraoral examination showed bleeding on probing and 4-mm periodontal
Published: 25 April 2022
pocket on the upper right posterior. Periapical radiographic examination of the upper
right posterior displayed alveolar crest reduction.
Publishing services provided by Conclusion: The accomplishment of the treatment was proven by gingival curettage
Knowledge E
after the second visit.
Niken Olivia and Dahlia
Keywords: chronic periodontitis, curettage, periodontal regeneration
Herawati. This article is
distributed under the terms of
the Creative Commons
Attribution License, which
permits unrestricted use and 1. Introduction
redistribution provided that the
original author and source are
Periodontitis is a disease of the supporting tissues of the teeth involving the gingiva,
credited.
periodontal ligament, cementum, and alveolar bone due to an inflammatory process [1].
Selection and Peer-review under
Inflammation came from untreated gingiva (gingivitis), and if the process continues it will
the responsibility of the NaSSiP
6 Conference Committee. invade the underlying structures so that pockets will form which causes inflammation
to continue and damage the bones and tissues supporting the teeth [1][2]. Bacteria are
the main etiology that can cause periodontal destruction directly through the action
of their components, particularly lipopolysaccharide (LPS present in the cell walls of
gram-negative bacteria) [3].
The severity of periodontitis is proportional to the extent of tissue damage caused
by the host response, environmental or genetic risk factor [4]. Non-surgical periodontal
therapy is the first stage of therapy in a series of procedures that define periodontal

How to cite this article: Niken Olivia and Dahlia Herawati*, (2022), “Gingival Curettage for the Management of Chronic Periodontitis: A Case
Report” in The International Online Seminar Series on Periodontology in conjunction with Scientific Seminar, KnE Medicine, pages 370–376. Page 370
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treatment. The removal of biofilms and mineral deposits from the tooth surface is a
basic and defining aspect of periodontal therapy [5]. Current therapy for periodontitis
involved periodontal debridement, which involves the removal of bacterial plaque and
its products, and calculus deposits that are severed from the coronal surfaces, root
surfaces, and the tissue walls of periodontal pockets [6].
Mechanical root debridement is the basic of periodontal therapy aimed at removed
of subgingival biofilm and calculus, which together with the maintanance patient’s
oral hygiene will prevent bacterial recolonization and supragingival biofilms [7]. For
many years, gingival curettage a popular periodontal-treatment modality. As originally
described, gingival curettage was designed to induce new connective tissue attachment
to root surfaces by removing the pocket lining and junctional epithelium with a curette
[4]. This debridement is usually used with hand instruments (curettes and scalers). This
conventional protocol is gold standard of periodontal therapy for most patients with
chronic periodontitis. Gingival curretage is well documented in many reviews showed
of gains in clinical attachment levels (CAL), reductions in probing pocket depths (PPD),
and in the frequency of bleeding on probing (BOP) [8].

2. Case Report

A 25-year-old female patient came to the Periodontics Clinic of Rumah Sakit Gigi dan
Mulut, Universitas Gadjah Mada Prof. Soedomo, Yogyakarta, Indonesia. The patient
feels that her tooth look dirty, bad breath and sometimes bleeding when brushing.
Extra-oral examination showed no significant findings. On intra-oral examination, was
found bleeding on probing and 4 mm periodontal pocket on teeth 15 16 17 (Fig.1). The
patient indicated relatively good oral hygiene (Silness and Loe). Periapical radiographic
examination of the upper right posterior displayed reduction alveolar crest (Fig. 2).
Based on a through examination, the diagnosis of this case was confirmed as chronic
periodontitis e.c plaque and calculus. There are no diagnostic challenges, such as
access to testing, financial, and cultural, in determining the diagnosis.
After guiding a dental health education (DHE) followed by scaling and root plan-
ing at the first visit and control at second visit, a curretage gingival treatment plan
was formulated. After discussing the clinical examination results, treatment plan, and
risks associated with the surgical procedure, the patient gave verbal and written con-
sent as evidenced by signing informed consent. Local infiltration anesthesia (Articaine
hydrochloride 4% and Epinephrine in a ratio of 1:100,000) were administrated in labial
sides (Fig 3). The curette is selected so that the cutting edge is against the tissue

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Figure 1: Intra-oral examination Figure 2. Periapical radiographic examination.

Figure 2: Periapical radiographic examination.

(Gracey no. 11-12 for mesial surfaces, Gracey no. 13-14 for distal surfaces). The instrument
is inserted to engage the inner lining of the pocket wall, and it is then carried along the
soft tissue, usually in a horizontal stroke (Figure 4). The pocket wall may be supported
by gentle finger pressure on the external surface. The curette is then placed under the
cut edge of the junctional epithelium to undermine it. During subgingival curettage, the
tissues attached between the bottom of the pocket and the alveolar crest are removed
with a scooping motion of the curette to the tooth surface. The entire surgical area was
irrigated with saline solution (Fig 5) and adapted the tissue to the tooth by gentle finger
pressure (Fig 6) followed by applying a resorbable periodontal dressing (Resopac) (Fig
7). The patient has prescribed an antibiotic (Amoxicillin 500 mg) every 8 hours for five
days, the analgesic (Mefenamic acid 500 mg) orally if necessary, and the antimicrobial
mouthwash Chlorhexidine 0.12% twice a day for two weeks starting after the periodontal
dressing was absorbed to take care personal oral hygiene status.

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Figure 3: Anasthesia.

Figure 4: Currete is inserted to engage the inner lining of the pocket wall.

3. Discussion

Gingival curettage is a surgical procedure to removal of pocket lining and junctional

epithelium with a curettes. Gingival curettage is a different procedure that may be
performed in conjunction with, or subsequent to, scaling and root planing (SRP) [1].
Many research and review showed clinical advantage of curettage over SRP alone was

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Figure 5: Irrigated with saline solution.

Figure 6: Tissue adapted to the tooth by gentle finger pressure.

Figure 7: Application of periodontal dressing (Resopac).

eliminated when new connective tissue attachment was shown to be an unexpected

goal. Gingival curettage, although surgical in nature, is a closed procedure [4]. Many
research and review have confirmed that gingival curettage give some benefit when

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compared to SRP alone in terms of probing depth reduction, attachment gain, or

inflammation reduction [6].
Curettage resolve the removal of the chronically inflamed granulation tissue that
forms in the lateral wall of the periodontal pocket. This tissue contains components of
granulation and it may also contain pieces of unseen calculus and bacterial colonies [7].
This inflamed granulation tissue is lined by epithelium, and deep strands of epithelium
penetrate into the tissue. The presence of this epithelium is construed as a barrier to
the attachment of new fibers in the area [9].
Curettage can be performed as part of new attachment attempts in moderately deep
intrabony pockets located in accessible areas in which a nonflap type of “closed”
surgery is indicated [8]. Curettage can be attempted as a nondefinitive procedure to
reduce inflammation when aggressive surgical techniques (e.g., flaps). It should be
understood that, in these patients, the goal of pocket elimination is compromised, and
their prognosis is impaired [10]. The clinician should attempt this approach only when the
indicated surgical techniques cannot be performed and both the clinician and the patient
have a clear understanding of its limitations [8].Curettage is also frequently performed on
recall visits as a method of maintenance treatment for areas of recurrent inflammation
and pocket depth, especially where pocket reduction surgery has previously been
performed. Careful probing should establish the extent of the required root planing and
curettage [5].

4. Conclusion

Gingival curettage consists of the removal of the inflamed soft tissue lateral to the pocket
wall and the junctional epithelium. Curettage as a nondefinitive procedure to reduce
inflammation when surgical techniques (e.g., flaps) are contraindicated in patients as a
result of their age, systemic problems, psychologic problems, or other factors. It should
be understood that, in these patients, the goal of pocket elimination is compromised,
and their prognosis is impaired.

References

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