Gingival hyperplasia also known as gingival enlargement or overgrowth, is a common clinical finding that can stem from a variety of local and systemic causes. While the condition may appear benign, it can significantly impact oral hygiene, esthetics, and restorative treatment planning. A key decision clinicians must make is when a gingivectomy is truly necessary, and when conservative management will suffice. This article examines the pathophysiology of gingival hyperplasia, the step-wise therapeutic approach, and the clinical thresholds for performing a gingivectomy, all while highlighting how tools such as the Mr. Bur Gingivectomy Kit can optimise outcomes.
Understanding Gingival Hyperplasia: Etiology and Classification
Gingival hyperplasia is characterised by an increase in gingival volume usually due to abnormal proliferation of epithelial and connective tissues. It can be classified into several categories:
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Inflammatory gingival enlargement – often associated with plaque accumulation and poor hygiene.
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Drug-induced gingival overgrowth (DIGO) – linked to medications such as phenytoin (anticonvulsant), cyclosporine (immunosuppressant) and calcium channel blockers (e.g., nifedipine, amlodipine).
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Hereditary gingival fibromatosis – a rare genetic condition characterised by slow fibrotic enlargement.
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Systemic-related enlargement – seen during hormonal changes (puberty, pregnancy) or in systemic conditions such as leukemia.
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Idiopathic cases – where no clear aetiology is identified.
Regardless of origin, persistent gingival overgrowth leads to pseudo-pocket formation, plaque retention, and secondary inflammation, which further compromise periodontal health.
Step-wise Management: Conservative Before Surgical
Before proceeding to surgical intervention, clinicians should always implement non-surgical periodontal therapy to control etiologic factors and assess tissue response.
1. Initial Phase Therapy
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Thorough scaling and root-planing of the enlarged tissues and adjacent teeth.
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Reinforcement of oral hygiene — instruct patients on effective brushing, interdental cleaning, and particularly care around the enlarged gingiva.
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Use of adjunctive antimicrobials (e.g., chlorhexidine rinse) to reduce inflammation.
2. Drug Evaluation
In cases of DIGO, collaboration with the patient’s physician is essential to review or adjust the offending medication. If the drug is discontinued or substituted, many gingival enlargements regress without the need for surgery.
3. Observation Period
Allow for a 4–8 week healing window following non-surgical therapy. Many mild inflammatory enlargements regress during this period. Should the gingiva remain persistently thickened, fibrotic, or symptomatic, the need for surgical correction becomes more likely.
Recommended Kit:
When a Gingivectomy Becomes Necessary
A gingivectomy becomes the treatment of choice when conservative approaches fail or when the gingival overgrowth significantly impairs function or esthetics.
Clinical Indications for Gingivectomy
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Persistence of gingival enlargement despite effective plaque control and cessation/substitution of medication.
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Presence of pseudo-pockets without true attachment loss where the enlarged tissue traps debris and harbours bacteria.
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Soft tissue interference with mastication, speech, prosthetic or restorative procedures (for example, inability to expose restorative margins).
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Esthetic concerns, e.g., excessive gingival display (‘gummy smile’) due to overgrown tissue or irregular gingival contours.
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Fibrotic tissue that is resistant to mechanical debridement and prevents access for hygiene or restorative care.
The goal of gingivectomy is to restore physiologic gingival architecture, eliminate pseudo-pockets, allow self-cleansing, and facilitate hygiene access.
Gingivectomy Techniques: Modern Minimally-Invasive Approaches
While traditional scalpel gingivectomy remains effective, newer technologies allow for more precise, comfortable, and efficient outcomes for patients.
Scalpel Technique
– Offers tactile feedback and direct visibility.
– However, it may lead to greater bleeding, longer healing, and more postoperative discomfort.
Laser Gingivectomy
– Diode or CO₂ lasers offer reduced bleeding, minimal instrumentation, and faster recovery.
– Cost and operator-learning curve may limit routine adoption in some practices.
Rotary Instrument Approach with the Mr. Bur Gingivectomy Kit
A modern alternative is rotary tissue trimming using specialised burs. The Mr. Bur Gingivectomy Kit is a set of 10 stainless-steel burs specifically designed for gingivectomy procedures, including soft-tissue contouring and sub-gingival caries access.
Why integrate this kit into your clinical workflow?
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The burs are crafted to use friction-generated heat to cut and coagulate soft tissue in one step, enhancing hemostasis.
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They allow fine-tuning of gingival margins, better exposure for restorative margins, and precision tissue removal in one efficient sequence.
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Compared with ceramic burs and lasers, these burs offer cost efficiency, ease of sterilisation, compatibility with standard FG (friction grip) handpieces, and a familiar tactile feel.
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Especially useful when you are managing gingival hyperplasia cases in your practice: once you’ve determined a gingivectomy is indicated, the Gingivectomy Kit supports a streamlined surgical workflow.
Incorporating the Gingivectomy Kit allows clinicians to deliver precise gingival contouring that aligns with both periodontal and restorative objectives.
Post-operative Management and Healing
Following gingivectomy, successful outcomes depend on optimal wound management and patient education.
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Apply a protective periodontal dressing or gel to minimise discomfort and microbial infiltration.
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Prescribe a chlorhexidine rinse during the initial healing phase to control plaque.
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Reinforce oral hygiene instructions once primary healing (around days 7–10) has occurred.
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Schedule recall visits every 3–6 months — especially important in cases of drug-induced or hereditary overgrowth where recurrence risk exists.
Histologic studies show that wound healing proceeds via epithelial proliferation and migration from wound margins, followed by connective tissue maturation, typically within two weeks under ideal conditions.
Prognosis and Long-Term Considerations
The long-term success of gingivectomy in hyperplastic cases depends heavily on maintenance care and elimination of causative factors. Patients who continue on medications known to induce gingival overgrowth or who fail to maintain adequate plaque control may experience recurrence of enlargement.
Therefore, a multidisciplinary approach is key: coordinate with prescribing physicians, periodontists, and restorative specialists as needed to ensure durable outcomes. Using the Gingivectomy Kit from Mr. Bur ensures you have the right instrumentation in your surgical armamentarium to perform efficient, predictable soft-tissue contouring.
Conclusion
In summary, gingivectomy is not automatically necessary for every case of gingival hyperplasia. However, it becomes essential when:
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Conservative therapy (scaling, hygiene, drug substitution) fails to reduce the overgrowth,
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The tissue impairs oral hygiene, function, or esthetics, or
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Fibrotic or dense tissue resists mechanical debridement and maintains pseudo-pockets.
For dental professionals, identifying these thresholds ensures treatment decisions are appropriately timed and avoid overtreatment. When surgical intervention is mandated, integrating a modern, efficient instrument set, such as the Mr. Bur Gingivectomy Kit enables precise gingival contouring, improved hemostasis, faster healing, and ultimately enhances both patient comfort and clinical outcomes.
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