Definition : “ gingival curettage means the scraping of gingival wall of periodontal pocket to removal inflammated soft tissue.

Gingival curettage : gingival curettage consists of the removal of inflamed soft tissue lateral to pocket wall.

Sub gingival curettage: sub gingival curettage refers to procedure that is performed apical to junctional epithelium in which the connective tissue attachment is severed down to osseous crest.

The aim of curettage is to reduce pocket depth by enhancing gingival shrinkage and new connective tissue attachment.

  1) Curettage can be performed as part of new attachment attempts in moderately deep infrabony pockets.

 2) To reduce inflammation prior to pocket elimination in patients in whom more aggressive surgical techniques are contraindicated owing to age, systemic problems, and psychologic problems.

  3) For recurrent inflammation and pocket deepening.

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Procedure: Curettage does not eliminate the causes of inflammation (e.g. bacterial plaque, calculus) so it should always be preceded by scaling and root planning.

Local anesthetic injection or sprayed into mouth in the area of affected gingival tissues.

The curettage is selected so that cutting edge will be against the tissue. Gracey curettage is used for mesial and distal surface. The instrument is inserted so as to engage the inner lining of pocket wall and is carried along soft tissue. Usually in horizontal stroke.

In sub gingival curettage the tissues attached between the bottom of pocket and alveolar crest are removed with scooping motion of the curette to the tooth surface. Sometimes suturing of separated papillae and application of periodontal pack may be indicated.

Other technique for gingival curettage include the

a)ultrasonic curettage scaler and rod shaped ultrasonic instrument are used for this purpose.

b)Excisional New Attachment Procedure (ENAP)

Internal bevel incision is made with surgical blade from margin of free gingival apically to point below bottom of the pocket. The incision is carried interproximally on both the facial and lingual sides to cut inner portion of soft tissue wall of the pocket all around tooth.

Remove the excised tissue with a curette preserve all connective tissue fibers that remain attached to the root surface. Place suture and periodontal dressing. 

After gingival curettage.

After 1 week: gingival appears reduced in height owing to apical shift in the position of gingival margin.

After 2 week: maintain proper oral hygiene by patient normal color,consistency,surface texture and contour of gingival margin is well adapted to the tooth.