HANDS-ON & DISCUSSION

GINGIVAL CURETTAGE:
From Diagnosis to Treatment

DIMAS ILHAM HUTOMO

FROM DIAGNOSIS TO TREATMENT

01 AAP 2017
CLASSIFICATION 02 GINGIVAL
CURETTAGE
How to diagnose How to perform adequate
periodontal patient with subgingival
AAP 2017 classification? instrumentation including
curettage?
AAP 2017
CLASSIFICATION
SOURCES
The “evolution” of periodontitis diagnosis

Adult & STAGING &

Early onset GRADING

1993 2017

1989 1999
Adult & Early onset Chronic & Agressive
(Prepubertal,
Juvenile, Rapidly
progressive)
 AAP 2017.. WHAT’S THE MAJOR CHANGES?

1. Periodontal & gingival health

2. No more chronic and aggressive periodontitis
3. Staging and grading for periodontitis

A staging and grading system for periodontitis

that is based primarily upon attachment and
bone loss.
Classifies the disease into four stages based on
severity (I, II, III or IV) and three grades based on
disease susceptibility (A, B or C).
A PATIENT IS A PERIODONTITIS CASE IF

1. Interdental CAL is detectable at ≥2 non-

adjacent teeth, or
2. Buccal or oral CAL ≥3 mm is detectable at ≥2
teeth
STEP 1
NEW PATIENT
STEP 2
PATIENT
SUSPECT OF
PERIODONTITIS
STEP 3a
PATIENT IS A
PERIODONTITIS
CASE WHOSE
STAHE NEEDS TO
BE ESTABLISHED
STEP 3b
STAGE III AND IV
VERSUS
STAGE I AND II
STEP 3c
STAGE I, II, III,
AND IV
STEP 4a
GRADING WHEN
THERE ARE NO
EXISTING
RECORDS
STEP 4b
GRADING WHEN
THERE ARE
EXISTING
RECORDS
GINGIVAL
CURETTAGE
Removal of granulation tissue in the
periodontal pocket wall that act as
barrier to the attachment of new fibers
in the area
 No evidence that gingival
curettage has any therapeutic
benefit in the periodontitis
treatment
 INDICATION

1. Moderate suprabony /
infrabony pocket in accessible
area
2. When aggressive surgical
technique are
contraindicated
3. Maintenance treatment
4. When referral to periodontist
is not possible*
INSTRUMENTATION – why curette??

Sickle Curette

Subgingival adaptation
around the root is better
with the curette than sickle
INSTRUMENTATION
UNIVERSAL GRACEY LUCAS
UNIVERSAL VS GRACEY

UNIVERSAL GRACEY
GRACEY CURETTE

1/2 & 3/4 Anterior

5/6 Anterior & premolar

7/8 & 9/10 Facial & lingual posterior

11/12 Mesial posterior

13/14 Distal posterior

IMPLANT CURETTE

Different material

• Titanium
• Plastic
• Carbon
CORRECT ANGULATION
WHAT WE HAVE TO REMOVE

PLAQUE
CALCULUS
NECROTIC TISSUE
GRANULATION TISSUE
E xcisional
N ew
A ttachment
P rocedure
Outcome of CURRETAGE
 HEALING
AFTER CURRETAGE

BASELINE 1ST WEEK 2ND WEEK

Hyperemia still occur Normal color &
Reduced in height consistency
Well adapted
THANKS
DO YOU HAVE ANY QUESTIONS?

@dimas.hutomo

dimashutomo91@gmail.com

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CREDITS: This presentation template was created
by Slidesgo, including icons by Flaticon,
infographics & images by Freepik