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How safe is gingivectomy in the disto-lingual area without the risk of traumatising/severing the lingual nerve?

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This question was submitted by a general dentist: 15-year old patient with partially erupted 37, 47. Deep pockets 6 mm, small residual pericoronal flap and slight inflammation. How safe is it to do gingivectomy (laser/electrocautery) in this disto-lingual area without the risk of traumatising/severing the lingual nerve?

Dr. Gordon Schwartz from GumDocs provided this quick initial answer: 

1. Evaluate the position of the wisdom teeth as that might be the underlying cause.

2. Make sure to stay in the area of keratinized tissue.

3. As long as one stays towards the occlusal, it should be safe.

4. Our experience is primarily with scalpels (we have a laser); however, if one is working mostly on the occlusal, the others should be OK.

Nothing should go apical to the crown of the tooth.

Follow-up: What further information would you like on this topic? Email us at jcdaoasis@cda-adc.ca

Readers are invited to comment on this initial response and provide further insights by posting in the comment box which you will find by clicking on “Leave a reply“ below. You are welcome to remain anonymous and your email address will not be posted.

4 Comments

  1. Jon Mahn March 20, 2013

    What is meant specifically by “staying towards the occlusal” in the third point?

    Does this mean not traversing the occlusal third of the tooth within the tissue distal to it?

    Thanks in advance!

    Reply
    1. Chris March 20, 2013

      There is a well known O/S paper discussing the relative position of the lingual N – its frquency in certainn position with respect to height and lingual position relative to the third mlar.
      Should be easy to reference.

      1. JCDA Oasis March 20, 2013

        Hi Chris, can you please identify the article and we will certainly reference it. Thanks.

  2. Dan March 20, 2013

    I believe that this paper from j Perio can be of some help.

    The significance of the lingual nerve during periodontal/implant surgery.
    Chan HL, Leong DJ, Fu JH, Yeh CY, Tatarakis N, Wang HL.
    J Periodontol. 2010 Mar;81(3):372-7. doi: 10.1902/jop.2009.090506.
    PMID: 20192863 [PubMed – indexed for MEDLINE]
    Related citations

    Reply

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