Periodontal and restorative considerations in rotary gingival curettage

A relatively new surgical gingival retraction technique has been discussed from a periodontal point of view. This technique provides a method of enlarging the gingival sulcus so preparation margins for cast restorations can be visualized and accurately recorded in impression material. The preoperative health of the periodontium is an important consideration when selecting this technique. The attachment apparatus must be free of inflammation and the marginal gingiva must have an acceptable width and a high degree of keratinization. If these criteria are met, a hemorrhage-free opened gingival trough will be easily and consistently obtained. The following restorative sequence was suggested and should be used and completed one step at a time: pulp therapy, buildup restoration, supragingival casting preparation, rotary gingival curettage, reversible hydrocolloid wet field impression technique, indirect provisionalization, placement of final cast restoration. These recommendations were based on the compatibility with the periodontal tissues. Such periodontal compatibility is evident in consistent postoperative tissue healing. There is minimal or no change in the position of the epithelial attachment and location of the crest of the free marginal gingiva. Histological and longitudinal clinical research studies are needed on the rotary gingival curettage technique. Clinical studies on the reversible hydrocolloid wet field technique would also be helpful. Until such evidence is available, my clinical experience indicates that rotary gingival curettage is an excellent technique producing predictable and gratifying results if the treatment planning and restorative sequence suggested in this paper are followed.