Gingivectomy or Gingivoplasty – Per Quad - Dental Procedure Code Description
This dental procedure code is somewhat unique in that it covers more than one specific procedure. While both a gingivectomy and gingivoplasty involve the surgical excision of gum tissue, a gingivectomy is done to remove diseased gum tissue surrounding a gum “pocket,” and a gingivoplasty is performed to reshape gum tissue – sometimes after a gingivectomy, but most often independent of a gingivectomy. This code also covers work done on four adjacent teeth, as opposed to the dental code used for work done on a “per tooth” basis.
Both procedures can also be performed solely for cosmetic reasons, but when done so, are not covered under this code. When these two procedures are covered it is because of a clinical cause, namely, periodontal disease.
Periodontal disease —literally, disease “around the tooth” - affects the gums and the bone to which a tooth is attached. It is an advanced bacterial infection that causes tooth loss and gum recession, and is preceded by gingivitis. Symptoms can include bleeding from the gums, bone loss that displays itself on an X-ray, excessive tooth mobility, gum recession, or the existence of any “exudate,” (pus or clear fluid) along or under, the gumline.
As periodontal disease progresses, the visible markers of the disease (plaque and calculus) migrate down along the side of the tooth into the natural “pocket” between the ridge of the gumline and the tooth's enamel. In doing so, it inflames the gum tissue and widens the naturally slim gap between the tooth and gum. As this gap becomes wider, even more bacteria are allowed access to the sensitive tissue fibers along the root's outer surface, and much damage can be done.
In order to arrest the progression of the disease, a gingivectomy is often prescribed. Likewise, a gingivoplasty which can re-shape the gumline, can be used to combat disease in oddly shaped or overgrown gums.
The procedures for this dental procedure code are fairly straightforward despite their “surgical” nature. In both procedures, your dentist would first thoroughly clean your teeth to ensure the area is free of plaque and calculus from the area (likely, periodontal scaling and root planing), and then administer a local anesthetic to numb the area. Then, with a gingivoplasty, your dentist would shape and remove any portion of gum tissue that was contributing to disease. Gingivoplasty incisions only take a few minutes, and are done with an eye toward aesthetics.
With a gingivectomy, after the area is numb, your dentist would use a probe to determine the depth of the pocket so as to understand where to make the incision. The idea is to remove enough gum tissue to eliminate the pocket, and no more. Therefore, once this depth is determined, the gum tissue is cut at a 45 degree angle to the tooth, with the downward slope of the angle aiming toward the tooth's root. Since this can be difficult to envision, consider the example below.
The cut the dentist makes in this procedure is the same sort of cut you would make if you were wanting to remove a portion of the wood from a pencil to get to a stubby graphite tip. So, if your tooth were the stubby tip that you didn't want to cut off, the cut you would make would slope downward toward the eraser in the pencil example, and in the gingivectomy example, downward toward the root. Dentists refer to this cut as apical. Your dentist will only remove as much tissue as is necessary – remember, tooth pockets are measured in millimeters, not inches.
While most gingivectomies are usually performed with a scalpel, they can also be performed using electrosurgery units, diamond burrs, and lasers. Once the procedure is complete, a surgical dressing would be placed on the gum tissue that has been cut, and you would be given instructions as to how you should care for your mouth in the days following the procedure.