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The International Online Seminar Series on Periodontology in conjunction with

KnE Medicine Scientific Seminar
Volume 2022

Research article

Full Mouth Debridement With Gingival

Curettage a Challenge in Chronic
Periodontitis Treatment: A Case Report
Deniar Faizya Widhawati1 and Vincensia Maria Karina2*
1
Periodontic Specialist Program, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta,
Indonesia
2
Department of Periodontology, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta,
Indonesia
ORCID
Deniar Faizya Widhawati: https://orcid.org/0000-0003-3510-7695

Abstract.
Background: Chronic periodontitis is a condition of inflammation in periodontal tissue.
This condition can be treated by reducing plaque and calculus using full mouth
debridement with gingival curettage.
Corresponding Author: Objective: To reduce inflammation of deep pockets before planning flap surgery.
Vincensia Maria Karina; email:
Case Report: A 49-year-old woman presented with a complaint of bleeding gums and
vincensia.maria.k@mail.
mobility of upper anterior teeth. Probing depths of patient’s upper teeth were at deep
ugm.ac.id
measurements and there was also a mobility of grade 1 and 2 with malposition of teeth.
Published: 25 April 2022 Conclusion: The condition of chronic periodontitis can be treated with full mouth
debridement with gingival curettage as a pretreatment before flap surgery.
Publishing services provided by
Knowledge E Keywords: full mouth debridement, gingival curettage, chronic periodontitis
Deniar Faizya Widhawati and
Vincensia Maria Karina. This
article is distributed under the
terms of the Creative Commons
Attribution License, which
1. Introduction
permits unrestricted use and
redistribution provided that the
Full mouth debridement performed in a single 1 hour appointment of ultrasonic peri-
original author and source are
credited.
odontal therapy was tested as the mechanical treatment of choice rather than scaling
and root planing. Some studies comparing full mouth periodontal debridement to
Selection and Peer-review under
the responsibility of the NaSSiP traditional quadrant or sextant- wise scaling and root planing have shown similar clinical
6 Conference Committee. and microbiological results in patients with chronic periodontitis[1,2]. Furthermore, some
studies have suggested that periodontal therapy performed in one session may prevent
bacterial reinfection when compared to scaling and root
planing performed in a quadrant or sextant-wise manner with a gap of 1 or 2 weeks
between appointments[3].
Procedures for removing the etiologic factor in periodontitis could be performed
with gingival curettage. This treatment was done by scraping of the gingival wall of

How to cite this article: Deniar Faizya Widhawati and Vincensia Maria Karina, (2022), “Full Mouth Debridement With Gingival Curettage a Challenge
in Chronic Periodontitis Treatment: A Case Report” in The International Online Seminar Series on Periodontology in conjunction with Scientific Page 325
Seminar, KnE Medicine, pages 325–332. DOI 10.18502/kme.v2i1.10865
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a periodontal pocket to remove the chronically inflamed tissue. However, when the
root is successfully done by scaling and root planing, and the biofilm and calculus are
removed, the inflammation in the tissue is also automatically resolves without tissue
curettage. Therefore, the use of curettage to eliminate the inflamed granulation tissue
is unnecessary. But some studies also showed that gingival curettage could be act as
initial treatment and preparation before performing advanced periodontal flap to gain
the quality of the tissue, this procedure 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[4].
Based on this controversy, the aim of this case report was to evaluate the procedure of
full mouth debridement with combination of gingival curettage to reduce inflammation
in chronic periodontitis patient.

2. Case Report

A 49-year-old female came to RGSM Prof. Soedomo FKG UGM with a complain of her
upper mobile teeth that could easily bleeding while she was brushing her teeth and this
condition made her feel uncomfortable. This complain was already felt about 3 months
ago and she refuses to check her condition because she was just too afraid of the
pain she felt after the gingival surgery she had been, months before. Patient did not
have bad habits, including smoking or consuming alcohol and she also denied having
a history of systemic illness or allergies.
Objective examination showed that there was inflammation of the gingiva around 16,
13, 12, 11, 23, 24, 25, 27, 35, 34, 33, 32, 31, 41, 42, and 43. There was also tooth mobility
on 12, 11, 23, 24, 35, 34, 33, 32, 31, 41, and 42. Probing depth of the teeth were also
examined and seen as in the table 1 and 2.
Patient’s OHI was examined and classified into fair (4.67) and as seen in the Figure 1
that there was accumulation of plaque and debris around her malposition upper teeth
with some teeth were also missing. There was also some bleeding around her gingiva
after probing index was examined.
A panoramic x-ray has been performed (Figure 2) and showed that there was hor-
izontal bone loss among all the upper and lower region extending to middle third of
root, furcation involvement on
16 and 27 and radices on 22 and 36. Based on the clinical and radiographic exam-
ination of the patients, this could conclude that the patient’s diagnosis was chronic
periodontitis or classified using APP as periodontitis stage III grade B.

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Table 1: Maxillary probing depth of patient’s first visit (September 27, 2021). (*DB: distobuccal; B: buccal;
MB: mesiobuccal; DP: distopalatal; P: palatal; MP: mesiopalatal).

Table 2: Mandibular probing depth of patient’s first visit (September 27, 2021). (*DB: distobuccal; B: buccal;
MB: mesiobuccal; DP: distopalatal; P: palatal; MP: mesiopalatal).

Determining the diagnosis and treatment plan are using the result of clinical and
radiographic examination. For this case, the initial therapy was reducing the inflamma-
tion around the gingiva by full mouth debridement and remove occlusal trauma, then
the corrective phase was to remove the infection by gingival curettage and open flap
debridement (flap surgery), but before that patient was also explained to extract her
radices as this could act as a focal infection, and the last was to designing metal frame
partial denture for her missing teeth and to decrease the mobility of her teeth. Patients
had been explained about the treatment planing and refuses to undergo the extraction
procedure as she was too afraid of the treatment she had been done on the previous
months. She agreed to do the full mouth debridement and gingival curettage as the first
treatment to reduce the inflammation before planing for the advanced flap surgery. The
first week of her visit was to do full mouth debridement with scaling and root planning
of the deep pocket and debridement using povidone iodine. After treatment, patient

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Figure 1: (A) anterior view: (B) palatal view; (C) right angle: (D) left angle.

Figure 2: Panoramic x-ray of patient.

was given chlorhexidine mouthwash to be used twice a day and scheduled to control
after a week.
Gingival curettage on region 1 was done after 2 weeks and region 2 after 3 weeks
post full mouth debridement as seen on Figure 3. The treatment had been agreed by
patient’s approval. This procedure of region 1 was done on 16, 13, 12, 11 and region 2 on
23, 25, and 27. The preparation of patient by vital sign assessment was done and asepsis
technique was performed in the operating region. Anesthesia using lidocaine HCl 2%
was injected at the apical area of the teeth for patient’s comfort. Gingival curettage
was done using Gracey curettage to remove the necrotic and granulation tissue on
infected gingiva. Scaling and root planning was also performed again at this treatment
to remove the remain calculus and smooth the root. Debridement was also done with
saline irrigation and application of metronidazole gel to the infected deep pocket. After
finishing the procedure, the operation area was dried and pressed with sterile gauze

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then covered with periodontal pack using Resopack. Post-operative instruction and
medication was given to the patient, including mefenamic acid if necessary for a week
and continue to use the mouth rinse.

Figure 3: (A) gingival curettage of 17; (B) gingival curettage of 12; (C) granulation tissue of the infected
pocket; (D) application of metronidazole gel; (E) adapting of gingiva; (F) covered with Resopack.

One week after the surgery, patient came to undergo the next region of gingival curet-
tage (region 2) and to examine the condition of inflamed gingiva after operation done
(Figure 4). The pack has completely disappeared and there was a slight inflammation on
the operation area but a little better from her previous visit. Visual examination showed
there was a shrinkage of her margin gingiva. Examination of the probing depth was
done after 2 weeks post-operative and seems to decrease in probing depth of region
1, from the previous probing depth of 13 (distobuccal from 3,5 to 3 mm; mesiobuccal
from 6,5 to 4,5 mm;, mesiopalatal from 6 to 4 mm); 12 (distobuccal from 6,5 to 4
mm; mesiobuccal from 6,5 to 4 mm); 11 (distobuccal from 6,5 to 4 mm; 1, 3, mesiobuccal,
mesiopalatal and distopalapatal from 4 to 3,5 mm). The patient still had a mobility of
her upper teeth and refer to do advanced periodontal flap following metal frame partial
denture appliance for further treatment.

3. Discussion

This case illustrates the periodontal treatment of a patient with chronic periodontitis
with malposition teeth. Subgingival calculus and plaque can be removed by full mouth
debridement by scaling and root planing with addition of povidone iodine debridement
and chlorhexidine mouth rinse, creating a favourable microenvironment for periodontal
tissue healing. In this case, initial nonsurgical periodontal therapy did not reduced
deep pocket depths. The deep subgingival pocket need to be treated with advanced

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Figure 4: (A) patient’s first visit (B) patient’s post full mouth debridement; (C) patient’s post-operative.

periodontal flap but in this case, reducing inflammation of the pocket should be done
before. Although full mouth debridement had been done with the patient, there was
only a slight reduction in inflammation of the gingiva, so that gingival curettage was a
choice as a preparation treatment before performing advanced periodontal flap to gain
the quality of the tissue[4].
The gingival curettage showed a reduction in gingival inflammation in this patient
and also showed a difference in pocket probing depth after 2 weeks. This could be
reported also in some studies
that healing of the epithelial lining of the pocket after periodontal debridement and
gingival curettage can be expected for 5 to 12 days[5], while another study said that
restoration and epithelization of the sulcus requires 2 to 7 days[4]. This difference of
probing depth is also due to the shrinkage of the gingival margin as some studies also
evaluated that, curettage could reduced pocket depth by developing new connective
tissue attachment and tissue shrinkage[6].
This procedure was a controversy because it was not applied anymore in some
dental school as their routine dental activity, as it also had been deleted on their 1989
World workshop in Clinical Periodontic[7]. However, some studies also showed that
curettage could make tissue attachment by reduction of periodontal attachment loss.
It means leaving or deleting curettage from the basic periodontal therapy should be

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aimed mainly to the mastered clinical periodontist since their hand skill in doing fully
mechanical debridement[8].
Gingival curettage as seems in this study could be done as a good preparation
treatment before doing the flap surgery to reduce in inflammation and probing depth,
and also, it should be combined with full mouth debridement by scaling and root planing
and not as a single treatment.

4. Conclusion

This case report shows that full mouth debridement with gingival curettage procedure
could be a choice of treatment with deep periodontal pockets to reducing inflammation
before undergo the flap surgery, but this procedure should not be done alone without
full mouth debridement.

5. Acknowledgements

The author thank the following individuals for the guidance and assistance in writing
the manuscript.

References

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Periodontology. 2008;35:789–798.
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