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Gingivectomy, a periodontal tried and true classic, is the surgical excision of the gingiva. The procedure is often performed to remove
infected gum tissue and improve aesthetics or functional outcomes, such as
crown lengthening or periodontal pocket reduction. The gingivectomy knife, a
most sophisticated surgical blade designed specifically to give the maximum
amount of control, cleanliness, and speed for soft tissue cutting, is the key
to the accuracy and success of the operation.
The gingivectomy knife performs a mechanical but structural function that impacts healing reactions, patient comfort, and results of procedures. Here we shall present all you should be familiar with anything from evolution for centuries to the newest happenings and trends in practice.
Gingivectomy has been greatly affected, most significantly
by advances in surgical instrumentation like knives and electrosurgical
devices. Availability of gingivectomy knives actually brought an end to the crudeness of previous manual scalpel-type resections.
• Pre-knife period: The first procedures utilized
plain surgical blades without regard for ergonomic considerations or tissue
preservation.
• Development of Kirkland and Orban knives: These
transformed everything by offering curved blades that conformed to gingival
contours.
• Proceed to laser and electrosurgical techniques: Though knives are still the norm, newer energy-based techniques are now sometimes supplemented to in place.
Gingivectomy knives are surgical knives designed
specifically to be used to excise excess or infected gingival tissue when a
gingivectomy is performed.
• Constructed from high-quality surgical alloys or stainless
steel.
• Ergonomic in design.
• Has special types of knives to operate on parts of the mouth.
Each is designed in some specific manner for access,
visibility, and preservation of tissue.
• Treated:
+
Kidney-shaped
+ For use
in external bevel incisions
+ For
labial and palatal gingiva
•Orban
Knife
+
Spear-shaped
+ For use
in interdental areas
+ Enables
vertical incisions
•Buck
Knife
+ Straight,
tapered blade
+ For
posterior regions
• 12D
Scalpel Blade
+
Double-edge curved blade
+ Cuts
cleanly on gingival margins
• Electrosurgical
loop knives
• Laser-tipped knives (diode or CO2-based)
• Disposable gingivectomy knives for single sterility
Gingivectomy is indicated both aesthetically and
therapeutically.
Therapeutic Uses:
• Treatment of gingival hyperplasia
• Chronic pseudopocket periodontitis
• Suprabony pocket removal
• Drug-induced gingival overgrowth (cyclosporine, phenytoin,
nifedipine)
Aesthetic and Prosthetic Uses:
• Crowns lengthening
• Smile designing and gingival zenith placement
• Gummy smile correction
The knife is an important determinant of the success of such results, with precise incision and minimal trauma.
5. Anatomy of a Gingivectomy Knife
Understanding the shape of the knife anatomically ensures
proper handling and care.
•Handle: Normally textured for hold
•Shank: Transfers pressure from the handle to the blade.
•Blade: Working end for cutting; usually detachable in disposables.
The following is a general progression of how knives are
utilized during gingivectomy surgery:
•Preoperative pocket depth measurement and marking
•External bevel incision with Kirkland knife
•Interdental excision with Orban knife
•Tissue removal and hemostasis
•Smoothing gingival contours
•Placement of periodontal dressing if necessary.
Despite having laser and electrosurgery tools, traditional
knives remain the standard.
•Low cost
•Tactile feedback
•Low equipment dependency
•High precision in skilled hands
•Better visual control of incision line
Just like any tool utilized for surgery, there are some
drawbacks linked with knives as well.
•Requirement of a firm hand and high expertise.
•Increased bleeding compared to electrosurgery.
•Moderately long recovery time.
•Partially used in patients with bleeding disorders.
Use proper sterilization to avoid cross-contamination.
•Air-drying of the instrument after surgery.
•Washing with warm water, autoclaving, and disinfection with
an antimicrobial solution.
•Avoid blunting the cut by correctly handling it with cutting boards.
•Make arrangements for regular checkups for wear and tear.
•Laser: Reduced hemorrhage, good healing, costly.
•Knife: Cost-effective, more control, mild causes trauma.
•Electrosurgery: Faster with coagulative benefits.
•Knife: Optimal preservation of natural tissue architecture.
Advances in technology have enhanced the strength,
ergonomics, and sharpness of knives.
•Titanium-nitride-coated blades for durability.
•Ergonomically weighted handles for comfort.
•Disposable blade designs to avoid infection.
•Integration into digital surgical guides for accuracy.
Special care must be taken when employing gingivectomy
knives in children or geriatric patients.
In Pediatrics:
•Smaller blade sizes
•Magnification accuracy
•Minimum tissue trauma emphasis
In Geriatrics:
•Comorbidities such as diabetes and bleeding disorders to be
remembered
•Gentle pressure usage
•Healing would be slower
Skill in the Gingivectomy knife depends upon hard practice
training.
Skill acquisition includes:
•Typodont simulated training.
•Soft tissue handling courses.
•Live surgical demonstration.
•Peer-reviewed feedback.
Post-operative care includes:
•Use of chlorhexidine mouthwash.
•Management with analgesics and anti-inflammatory drugs.
•Mechanical brushing across the region to be avoided.
•Tissue inspection for healing on 7, 14, and 21-day periods.
Orban and Kirkland's knife gingivectomy was used in a case report in 2024 for nifedipine-induced severe gingival hyperplasia. The application of manual technique allowed better control in the fibrotic tissue and satisfactory aesthetic restoration in 4 weeks. (Şükür & Dede, 2024).
Patients will have little post-op discomfort despite it
being an invasive treatment when knife methods are used.
Patient benefits are:
• Quick return to normal
• Perceived aesthetic benefits
• No heat trauma, such as electrosurgery
The gingivectomy knife also has the potential to integrate
with integration to:
• Robotic surgery systems
• Artificial intelligence following tissue
• Smart blades with bleeding control
• Always mark pocket depths before incision
• Execute a firm but controlled stroke
• Put your hand behind the adjacent teeth
• Pull on the tissue as little as possible
• Always use sharp, sterilized blades
Gingivectomy knives are still the most valuable assets a periodontist carries in his or her pocket. That their applications still survive is a testament to a combination of dexterity, frugality, and clinical competence. With new technology, there are some other advantages, but gingivectomy knives in experienced hands still possess unequaled reliability and economy.
Written by: Beauty Teck
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