The word curettage means the scraping of the diseased gengival wall of a periodontal pocket to separate disease soft tissue. It consist of the removal of the inflamed soft tissue, lateral to the periodontal pocket wall. Performed in shallow pockets, with the objective of causing tissue shrinkage.
It is different from subgingival curettage. The latter is performed apical to epithelial attachment, upto to the alveolar crest. This is performed in deeper pockets.
Curettage accomplishes removal of the pathological granulation tissue that forms the lateral walls of the periodontal pocket.
This tissue also contains dislodged calculus deposits and bacterial colonies which would interfere with the normal wound healing process.
Indications for curettage are very limited, and can be used after scaling and root planing for the following purposes,
Curettage can be performed in moderately deep intrabony pockets in accessible ares where a close surgery is advisable.
The clinician should opt for this approach, only when other surgical techniques cannot be performed.
Curettage is also frequently performed on recall visits as a miantenance treatment modality.
The basic periodontal therapy, which is scaling and root planing is performed before gingival curettage.
Administration of local anesthesia is required.
The curette is selected such that its cuttin edge will be against the soft tissue. (eg: Gracey# 13-14 for mesial surfaces, Gracy # 11-12 for distal surfaces)
The instrument is inserted so as to engage the inner lining of the pocket wall and is smoothly swept in one single horizontal slope.
The pocket wall should always be supported gently by a finger pressure on the external surface.
The area is flushed to remove debris and the tissue is partly adapted to the tooth surface using gentle finger pressure.
Excisional New Attachment Procedure (ENAP)
After adequate anesthesia, an internal bevel incision from the margin of the free gIngiva apically to a point below the bottom of the pocket is made.
The aim of this incision is to cut the inner portion of the soft tissue wall of the pocket all around the teeth.
After excising the tissue, the exposed cementum is carefully root planned to achieve a smooth surface.
Approximate the wound edges: in case they do not meet passively, recontouring the underlying bone for proper adaptation will be required.
Ultrasonic vibrations disrupt the tissue continuity, and lifts of the epithelium.
It is effective for debriding the epithelial lining of the periodontal pocket and results in a narrow band of nacrotic tissue which can be removed.
The Morse scaler – shaped and rod -shaped ultrasonic instruments are used for this purpose.
Drug such as sodium sulfide, antiformin and Phenol have been proposed for this purpose in the past.
The extent of tissue destruction with these drugs cannot be controlled and may increase the amount of tissue to be removed. Owing to this effect use of caustic drugs is obsolete.