After medication substitution and improved oral hygiene fail to adequately resolve significant drug-induced gingival overgrowth, what is the preferred surgical treatment?

A gingivectomy is the preferred surgical treatment for significant drug-induced gingival enlargement that does not resolve with conservative measures. The procedure excises excess fibrotic gingival tissue, restores normal gingival contours, eliminates pseudopockets, and improves the patient's ability to maintain oral hygiene. Scaling and root planing are essential adjuncts to reduce plaque-induced inflammation that exacerbates enlargement, but cannot remove the hyperplastic fibrotic tissue. Guided bone regeneration and osseous resection are not indicated as the bony architecture is typically not affected in pure DIGE. If the drug cannot be substituted, recurrence after gingivectomy is common.