Resective Osseous Surgery__Oral Surgery

RESECTIVE OSSEOUS SURGERYRESECTIVE OSSEOUS SURGERY

Osseous surgery may be defined as Osseous surgery may be defined as the procedure by which changes in the procedure by which changes in

the alveolar bone can be the alveolar bone can be accomplished to rid it of deformities accomplished to rid it of deformities induced by the periodontal disease induced by the periodontal disease

process or other related factors, such process or other related factors, such as exostoses and tooth supra as exostoses and tooth supra

eruptioneruption

Additive Or Subtractive ???

• Additive Osseous SurgeryAdditive Osseous Surgery includes procedures directed at estoring the alveolar bone to it’s original level; where as Subtractive Osseous SurgerySubtractive Osseous Surgery is designed to restore the form of pre-existing alveolar bone to the level existing at the time of surgery or slightly more apical to this level.

Additive Osseous Surgery brings about the Additive Osseous Surgery brings about the ideal result of periodontal therapy – ideal result of periodontal therapy – regeneration of lost bone and regeneration of lost bone and reestablishment of the periodontal reestablishment of the periodontal ligament, gingival fibers, and the junctional ligament, gingival fibers, and the junctional epithelium at a more coronal level.epithelium at a more coronal level.

Subtractive Osseous Surgeries are done Subtractive Osseous Surgeries are done when the other method is not feasiblewhen the other method is not feasible

Selection Based on Morphology of Defects:Selection Based on Morphology of Defects:• One wall Angular > Surgical recontouringOne wall Angular > Surgical recontouring• 3 Wall, Narrow & Deep > New Attachment & 3 Wall, Narrow & Deep > New Attachment &

Bone Regeneration Bone Regeneration• 2 Wall Angular > Depending on depth,width 2 Wall Angular > Depending on depth,width

& Configuration& Configuration

TerminologyTerminology

• Osteoplasty & OstectomyOsteoplasty & OstectomyOsteoplastyOsteoplasty refers to reshaping the bone without removing refers to reshaping the bone without removing

tooth supporting bonetooth supporting boneOstectomy or OsteoectomyOstectomy or Osteoectomy includes the removal of tooth includes the removal of tooth

supporting bonesupporting boneMorphologic Bone Forms :Morphologic Bone Forms :• Positive – If Radicular Bone Is Apical To The Interdental Positive – If Radicular Bone Is Apical To The Interdental

Bone Bone • Or Negative Architecture – If ViceVersaOr Negative Architecture – If ViceVersa• Flat Architecture – Same HeightFlat Architecture – Same Height

• TransGingival Probing Or TransGingival Probing Or SoundingSounding

Osseous resective surgery is the combined use Osseous resective surgery is the combined use of both osteoplasty and ostectomy to re-of both osteoplasty and ostectomy to re-establish the marginal bone morphology establish the marginal bone morphology around the teeth to resemble ‘‘normal bone around the teeth to resemble ‘‘normal bone with a positive architecture’’, albeit at a more with a positive architecture’’, albeit at a more apical position.apical position.

By definition, ‘‘normal bone with a positive By definition, ‘‘normal bone with a positive architecture’’ means that the surface of architecture’’ means that the surface of interdental bone is coronal to that of the facial interdental bone is coronal to that of the facial and lingual radicular bone. The endpoints of and lingual radicular bone. The endpoints of osseous resective surgery are minimal osseous resective surgery are minimal probing depths and a gingival tissue probing depths and a gingival tissue morphology that enhances good self-morphology that enhances good self-performed oral hygiene and periodontal healthperformed oral hygiene and periodontal health

STEPS IN RESECTIVE OSSEOUS STEPS IN RESECTIVE OSSEOUS SURGERYSURGERY

•VERTICAL GROOVING•RADICULAR BLENDING•FLATTENING INTERPROXIMAL

BONE•GRADUALIZING MARGINAL

BONE

Resective Osseous Surgery-Steps

Vertical GroovingVertical Grooving

Radicular Blending & Radicular Blending & FlatteningFlattening

Gradualizing Marginal Gradualizing Marginal BoneBone

Exostoses – Surgical Planning

Osseous Contouring In Interdental Craters - IOsseous Contouring In Interdental Craters - I

Osseous Contouring In Interdental Craters - IIOsseous Contouring In Interdental Craters - II

Osseous Contouring In Exostoses - Osseous Contouring In Exostoses - II

Osseous Contouring In Exostoses - Osseous Contouring In Exostoses - IIII

Osseous Contouring In One Wall Vertical Defect - IOsseous Contouring In One Wall Vertical Defect - I

Osseous Contouring In One Wall Vertical Defect – I IOsseous Contouring In One Wall Vertical Defect – I I

Rationale, Advantages, LimitationsResective Osseous Surgery is the most predictable pocket

reduction techniqueBut it is performed at the expense of bony tissue and

attachment levelSo limited by the presence, quantity and shape of bony

tissues and by the amount of attachment loss that is acceptable

The Goal of Osseous Resective Therapy is reshaping the marginal bone to resemble the alveolar process undamaged by periodontal disease

Done in combination with apically displaced flaps, and the procedure eliminates pocket depth and improves tissue contour to provide a more easily maintainable environment.

Osteoplasty:Osteoplasty: bone removal to get bone removal to get physiologic contour of the bone itself and physiologic contour of the bone itself and gingiva overlying it. The bone removal is gingiva overlying it. The bone removal is not part of the attachment apparatus. not part of the attachment apparatus.

Ostectomy:Ostectomy: the bone removed to get the bone removed to get physiologic contour is part of the physiologic contour is part of the attachment apparatus of one or more teeth. attachment apparatus of one or more teeth. The amount of bone to be removed is an The amount of bone to be removed is an important criterion for its use.important criterion for its use.

Osteoplasty indications:Osteoplasty indications:Osteoplasty is used to treat buccal and lingual bonyOsteoplasty is used to treat buccal and lingual bonyledges or tori, shallow lingual or buccal intrabony ledges or tori, shallow lingual or buccal intrabony defects, thick interproximal areas and incipient defects, thick interproximal areas and incipient furcationfurcationinvolvements that do not necessitate removing involvements that do not necessitate removing supporting bonesupporting boneDeep interproximal pockets on posterior teeth involving Deep interproximal pockets on posterior teeth involving the buccal interdental bone: the cone-shaped the buccal interdental bone: the cone-shaped interdental bone should be reinstituted by means of interdental bone should be reinstituted by means of grooving. grooving. Pockets on the buccal, lingual, and palatal surfaces Pockets on the buccal, lingual, and palatal surfaces where resorption of bone results in thick ledges. where resorption of bone results in thick ledges. Tilted lower second molar adjacent to non-replaced Tilted lower second molar adjacent to non-replaced extracted first molar.extracted first molar.

Ostectomy indications:Ostectomy indications:Ostectomy isutilized to treat shallow (1–2 mm deep) to Ostectomy isutilized to treat shallow (1–2 mm deep) to medium (3–4 mm deep) intrabony and hemiseptal medium (3–4 mm deep) intrabony and hemiseptal osseous defects and correct reversals in the osseous osseous defects and correct reversals in the osseous topographytopographyInterproximal craters in bone: shallow and wide craters Interproximal craters in bone: shallow and wide craters are not favorable for reattachment while deep and are not favorable for reattachment while deep and narrow are. When ostectomy is the procedure of choice narrow are. When ostectomy is the procedure of choice one of the spines is removed and the bone is ramped to one of the spines is removed and the bone is ramped to the other side. the other side. Extremely deep interproximal pockets where the Extremely deep interproximal pockets where the neighbor areas are intact or minimally affected. neighbor areas are intact or minimally affected. Shallow infrabony defects (interproximal), and where Shallow infrabony defects (interproximal), and where reattachment has failedreattachment has failed

Interproximal osseous ramping. A. Presurgical view with 6 mm probing depth on Interproximal osseous ramping. A. Presurgical view with 6 mm probing depth on mesial of first molar. B. Deep two-wall intrabony defect between the second mesial of first molar. B. Deep two-wall intrabony defect between the second premolar And first molar, hemiseptal defect between the two premolars and lingual premolar And first molar, hemiseptal defect between the two premolars and lingual exostosis. C. Osseous resective surgery eliminated the interproximal osseous exostosis. C. Osseous resective surgery eliminated the interproximal osseous defects by ramping to the lingual, corrected the reversed osseous topography and defects by ramping to the lingual, corrected the reversed osseous topography and removed the osseous ledges. D. Normal scalloped gingival morphology and good removed the osseous ledges. D. Normal scalloped gingival morphology and good health 6 months after osseous resective surgeryhealth 6 months after osseous resective surgery

Resective Periodontal Surgery Used To Correct Resective Periodontal Surgery Used To Correct Gummy SmileGummy Smile

Pre-Surgical PhotographPre-Surgical Photograph


Pre-Surgical Photograph – IntraOral Pre-Surgical Photograph – IntraOral ––Maxillary Anteriors with short clinical crowns


Immediate Post SurgicalApically positioned flap sutured after osseous resective surgery


Post Surgical Photograph – 1 YearPost Surgical Photograph – 1 Year


Post Surgical – 1YearPost Surgical – 1YearPre-Surgical PhotographPre-Surgical Photograph

Points To Remember !!!• Definition:

• Positive, Negative, Flat Architectures• Transgingival Probing Or Bone Sounding• Steps :

Resective Osseous Surgery__Oral Surgery

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