1. Gingivectomy
   1. Removal of pocket wall
      1. Pocket elimination surgery
   2. Performed by various ways
      1. 1) Hand Instruments —> Kirkland knife: 15 & 16 , B & L incision —> Orbans Knife : Interdental incision
         1. Steps: 1. External bevel incision 2. Bevel is created on gingiva 45 degree to tooth surface
         2. Note: Reflection of Bone is undesirable
         3. Orban’s knife
      2. 2) Electrosurgery—> Radio surgery High frequency Electric current (1.5-7.5 millions cycles/sec or mega Hz)
         1. 3 Electrodes
         2. 1. Single wire electrode—> Incision/ Excision
         3. 2. Loop electrode—> For flamming tissues
         4. 3. Heavier electrode—> Coagulation
         5. For Electrosurgery fully rectified current is used in shaving motion
      3. 4 Types of Technique
         1. Electrosection/ Electrotomy —> Used for incision & Excision & Tissue Planning Commonly used for Periodontal surgery
         2. Electrocoagulation —> Stop bleeding
         3. Electrofulguration
         4. Electrosection
      4. Drugs—> 5% Paraformaldehyde & KOH
   3. Healing after gingivectomy
      1. 5-14 days —> Surface epithelization is complete
      2. 1 month—> Complete epithelial repair occur
      3. 7 weeks—> Complete Repair of connective tissue
   4. External & Internal bevel gingivectomy
      1. External bevel gingivectomy : used in case of abnormally dense overgrowth of gingiva. is more aggressive treatment involving full removal of enlarged tissue
      2. Internal bevel gingivectomy : performed when intense removal of excess tissue is not required
2. Gingivoplasty
   1. Reshaping of the gingiva to create physiologic gingival contours with the sole purpose of recontouring the gingiva in absence of pockets
   2. Indications
      1. 1. Correcting the grossly thickened gingival margin 2. Correction of deformities like craters, clefts & gingival enlargements 3. Varying levels of gingival margins
3. Surgical Instruments
   1. 1) Surgical curettes & sickle Scalers
      1. Prichord curette & Ball Scaler B2- B3
      2. Kirkland knife
      3. Heavy curette
   2. 2) Surgical chisel
      1. a. Back Action chisel e.g Rhodes chisel—> Used in pull motion
      2. b. Straight chisel—> Push motion e.g Wiedel stad chiesel Oschsenbein #1-2 chisel
   3. 3) Tissue forcep
      1. Holding tissue during suturing e.g. De- Backey forceps
   4. 4) Goldman fox #16 Scissor
      1. Remove granulation tissue
   5. 5) Castro Viejo Scissor & Needle Holder
4. ENAP ( Excisional new attachment procedure)
   1. Technique : 1. Internal bevel incision 2. Remove the excised tissue with a curette & preserve the connective tissue 3. Approximate the wound edges
   2. Indications 1. Suprabony pockets 2. Adequate keratinized tissue 3. When esthetics are unimportant 4. Gingival enlargement
   3. Contraindication 1. Pockets exceed MGJ 2. Edematous tissue 3. Lack of keratinized tissue 4. Osseous defects have to be treated 5. Furcation involvement
5. Curettage
   1. Pocket reduction surgery
      1. Pocket lining is removed
      2. It does not remove cause of inflammation i.e bacterial plaque & deposits on tooth surface
      3. Curettage should always be precedded by scaling & Root planing
   2. Can be done using
      1. a. Curettes : Horizontal stroke & scooping motion
      2. b. ENAP ( Excision New attachment procedure) : Sharp incision is given by blade to remove the pocket lining. An internal bevel incision is given
      3. c. Drugs —> Sodium sulfide —> Alkaline NaOCl ( Antiformin) —> Phenol
   3. Healing after curettage
      1. 1) 2-7 days —> Restoration & Re-epithelization of sulcus
      2. 2) 5 days —> Restoration of JE
      3. 3) 21 days —> Immature collagen fibres are formed