Periodontal Surgery Tray Setup

Key points

• Kirkland knives make the broad external bevel cut of a gingivectomy; Orban knives free the tissue between the teeth.
• Flap surgery reflects the tissue to reach the roots and bone, so it adds periosteal elevators, bone instruments and sutures.
• Knives, curettes and scalers must be sharp before they are packed; a blunt blade drags and tears the gingiva.

Step by step

1. 1

   Measure and map the pockets

   Probe and record pocket depths, bleeding and furcation involvement around each tooth. For a gingivectomy, mark the pocket base on the outer surface of the gingiva as a guide for the incision. Plan from a 6-point pocket chart with each furcation marked; the BSP asks for one in any code 3 sextant after initial therapy, and for the whole mouth after any code 4.

   Periodontal Probes

2. 2

   Anaesthetise

   Give local anaesthetic by infiltration or block from a separate tray, and check soft-tissue anaesthesia with the probe.

   Dental Aspirating Syringes (Dental Anaesthetic Syringes)

3. 3

   Make the incisions

   For a gingivectomy, cut a continuous bevel apical to the marked points with a Kirkland knife, then free each papilla with an Orban knife. For a flap, make sulcular or submarginal incisions with a No. 15 or 12 blade.

   Periodontal Knives (Gingivectomy and Interdental Knives)Dental Scalpel Handles and Blades

4. 4

   Remove tissue or reflect the flap

   Lift away the excised collar of a gingivectomy with a curette or scaler. For flap surgery, reflect a full-thickness flap with the periosteal elevator to expose the roots and bone.

   Periosteal Elevators: Molt 9, Freer, Buser and Other PatternsDental Curettes

5. 5

   Debride the roots

   Remove granulation tissue, calculus and soft deposits with curettes, scalers and hoes, working in short overlapping strokes under direct vision.

   Dental CurettesDental Scalers (Hand Scalers)

6. 6

   Recontour bone where planned

   Reshape bone defects or margins with a bone file, rongeur or chisel when osseous surgery is part of the plan.

   Dental Rongeurs and Bone FilesBone Chisels and Surgical Mallets in Dentistry

7. 7

   Irrigate and check

   Irrigate with sterile saline, check the roots with a probe and remove any tags of tissue with tissue scissors.

   Surgical Suction Tips for Oral SurgeryDental Surgical Scissors

8. 8

   Close or dress the wound

   Reposition and suture the flap with the needle holder and fine tissue forceps, or cover a gingivectomy wound with a periodontal dressing where the operator uses one.

   Dental Needle Holders (Needle Drivers)Dental Tissue Forceps (Toothed and Non-Toothed)

Tray checklist

The tray is the universal surgical tray with a periodontal block added between the examination instruments and the closing instruments. Boyd's periodontal surgical tray opens with a mouth mirror, explorer and cotton forceps before the probes, hoes, knives, bone file, tissue forceps, surgical curette and periosteal elevator; the scissors, blade, haemostat, sutures, needle holder, retractor, mouth prop and a disposable surgical suction tip make up a second row. What each instrument is, and how the patterns differ, is set out in the periodontal instruments guide.

What is the difference between gingivectomy and flap surgery?

A gingivectomy cuts away excess gingiva; a flap procedure lifts the gingiva to reach the roots and bone and then puts it back. Boehm and Kim's StatPearls overview of periodontal surgery notes that gingivectomy suits pockets formed by thick, fibrous gingiva with no bone defect underneath, as in drug-induced overgrowth or altered passive eruption, and that it does not treat bony defects. Michael Newman and Fermin Carranza's Clinical Periodontology covers the incision designs and instruments for both.

In what order is the tray laid out?

Boyd's photographed tray groups the instruments by type, in the sequence given in the checklist above. Many clinics instead lay the periodontal block out in the order the operation runs, and that is the layout described here. Choose one and keep it the same for every case, so the assistant can pass instruments without searching. Set out the examination instruments and probes on the left, then the knives and scalpel, the periosteal elevator, the debridement instruments from the finest curette to the hoes, the bone instruments, and the suturing instruments on the right. Keep the knives and curettes in a rack or slotted cassette so the blades don't touch each other; edges that knock together in a tray go blunt quickly.

What else is needed besides the instruments?

• Local anaesthetic on its own tray, with vasoconstrictor if appropriate for the patient.
• Sterile saline or sterile water for irrigation through a sterile syringe. The CDC's 2003 guidelines count any incision, excision or reflection of tissue that exposes normally sterile areas as oral surgery, which covers both gingivectomy and flap surgery, and call for a sterile irrigant and sterile surgeon's gloves.
• Sutures, most often 4-0 or 5-0, and a periodontal dressing if the operator uses one.
• Sterile gauze, sterile surgeon's gloves, mask, eye protection and gown.
• The periodontal chart and radiographs.

How are periodontal surgery instruments reprocessed?

The knives, scalpel, curettes, scalers, elevators and bone instruments enter soft tissue or bone, so the CDC classes them as critical items to be cleaned and then heat-sterilised; the probes go through the same cycle. Clean first, in an ultrasonic cleaner or washer-disinfector, with hinged instruments open. Then inspect the knives, curettes and scalers for sharpness, sharpen if needed, and pack them with a chemical indicator. Sharpen after cleaning, so the stone never touches a contaminated blade. Retire knives and curettes whose blades have become thin or lost their shape. Follow each manufacturer's ISO 17664-1 instructions and, in England, HTM 01-05. Carry the set in an instrument cassette so the edges stay protected; the full routine is in the sterilisation guide.

What are the common mistakes?

• Starting a gingivectomy with a blunt Kirkland knife, which shreds the tissue instead of cutting a clean bevel.
• Choosing gingivectomy where there is a bone defect or too little attached gingiva to remove.
• Leaving tissue tags in the interdental area, where they delay healing.
• Letting knives and curettes rattle together loose in the tray.
• Forgetting the furcation probe, so furcation involvement is missed before the flap is raised.

Build this tray with Equate

Equate's catalogue lists the periodontal knives in its restorative and operative family: 5 Kirkland gingivectomy knives (including 13K/14K and 15K/16K), 3 Orban knives, 11 Goldman-Fox knives, Widman, Towner and Crane-Kaplan knives, and 2 Sanders interdental knives. There are 3 Pritchard and 6 Goldman-Fox periosteal elevators, bone files in Schluger 9/10 and Sugarman patterns alongside bone file rasps, and 7 furcation probes. Closure is covered by 8 gum scissors (Goldman-Fox, La Grange and Dean double-curved) and 16 needle holders in Castroviejo, Boynton and Kalt patterns. Equate does not list a back-action hoe; the nearest equivalent is the Rhodes back-action chisel among its bone chisels.

Instruments are passivated stainless steel, ultrasonically cleaned, shape-, boil- and performance-tested and individually packed, and designed in Finland. Clinics can request samples and a quote.

Equate Periodontal Surgery Tray Setup options

Nabers Furcation Probe - Solid Handle 6mm

EI-0131

Furcation Probe - Double-Ended Hollow Handle

EI-0882

Nabers Probe (Ball-End) - Double-Ended Hollow Handle

EI-0883

Furcation Probe - Double-Ended, Premium Textured Silicone Handle

EI-1102

Nabers Probe (Ball-End) - Double-Ended, Premium Textured Silicone Handle

EI-1103

Furcation Probe - Orange Slim Silicone Handle

EI-1184

Nabers Probe (Ball-End) - Orange Slim Silicone Handle

EI-1185

Kirkland Gingivectomy Knife Fig. 15K/16K - Titanium-Coated Solid Handle

EI-0056

Kirkland 13K/14K Gingivectomy Knife - Hollow Handle

EI-0071

Widman Curved Periodontal Knife

EI-0228

Kirkland 13K-TG Gingivectomy Knife - Solid Handle 6mm

EI-1900

Kirkland Knife - Solid Handle 6mm

EI-1957

Buying in your market

• UK & Ireland
• North America
• DACH
• Nordics & Scandinavia
• Baltics
• GCC
• Turkey

Frequently asked questions

References

1. Newman MG, Takei HH, Klokkevold PR, Carranza FA. Newman and Carranza's Clinical Periodontology, 13th edition. Elsevier, 2018
2. Boehm TK, Kim CS. Overview of Periodontal Surgical Procedures. StatPearls, StatPearls Publishing, 2024
3. Kohn WG, Collins AS, Cleveland JL, Harte JA, Eklund KJ, Malvitz DM. Guidelines for Infection Control in Dental Health-Care Settings, 2003. MMWR Recommendations and Reports 52(RR-17), Centers for Disease Control and Prevention, 2003
4. Department of Health. Health Technical Memorandum 01-05: Decontamination in primary care dental practices, 2013 edition (NHS England)
5. ISO 17664-1:2021. Processing of health care products — Information to be provided by the medical device manufacturer for the processing of medical devices — Part 1: Critical and semi-critical medical devices
6. Boyd LB. Dental Instruments: A Pocket Guide, 7th edition. Saunders/Elsevier, 2020. Chapter 16, Periodontal Instruments and Periodontal Surgical Instruments (photographs used under licence)
7. Baghani Z, Kadkhodazadeh M. Periodontal Dressing: A Review Article. J Dent Res Dent Clin Dent Prospects 2013;7(4):183–191
8. Koyuncuoglu CZ, Yaman D, Kasnak G, Demirel K. Preference of Suture Specifications in a Selected Periodontal and Implant Surgeries in Turkey. Eur J Dent 2019;13(1):108–113
9. British Society of Periodontology. Basic Periodontal Examination (BPE), 2019

Related

• Periodontal Instruments Explained: Probes, Hoes, Knives and Files
• Periodontal Knives (Gingivectomy and Interdental Knives)
• Periosteal Elevators: Molt 9, Freer, Buser and Other Patterns
• Dental Curettes
• Periodontal Probes
• Oral Surgery Tray Setup
• Dental Scalers (Hand Scalers)
• Surgical Curettes (Bone Curettes) for Oral Surgery
• Dental Rongeurs and Bone Files
• Bone Chisels and Surgical Mallets in Dentistry

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