RESECTIVE OSSEOUS SURGERY

Osseous surgery may be defined as the procedure by which changes in the alveolar bone can be accomplished to rid it of deformities induced by the periodontal disease process or other related factors, such as exostoses and tooth supra eruption

Additive Or Subtractive ???

Additive Osseous Surgery includes procedures directed at estoring the alveolar bone to its original level; where as Subtractive Osseous Surgery is designed to restore the form of preexisting alveolar bone to the level existing at the time of surgery or slightly more apical to this level.

Additive Osseous Surgery brings about the ideal result of periodontal therapy regeneration of lost bone and reestablishment of the periodontal ligament, gingival fibers, and the junctional epithelium at a more coronal level. Subtractive Osseous Surgeries are done when the other method is not feasible Selection Based on Morphology of Defects: One wall Angular > Surgical recontouring 3 Wall, Narrow & Deep > New Attachment & Bone Regeneration 2 Wall Angular > Depending on depth,width & Configuration

Terminology
Osteoplasty & Ostectomy Osteoplasty refers to reshaping the bone without removing tooth supporting bone Ostectomy or Osteoectomy includes the removal of tooth supporting bone Morphologic Bone Forms : Positive If Radicular Bone Is Apical To The Interdental Bone Or Negative Architecture If ViceVersa Flat Architecture Same Height

TransGingival Probing Or Sounding

Osseous resective surgery is the combined use of both osteoplasty and ostectomy to reestablish the marginal bone morphology around the teeth to resemble normal bone with a positive architecture, albeit at a more apical position. By definition, normal bone with a positive architecture means that the surface of interdental bone is coronal to that of the facial and lingual radicular bone. The endpoints of osseous resective surgery are minimal probing depths and a gingival tissue morphology that enhances good selfperformed oral hygiene and periodontal health

STEPS IN RESECTIVE OSSEOUS SURGERY

VERTICAL GROOVING RADICULAR BLENDING FLATTENING INTERPROXIMAL BONE GRADUALIZING MARGINAL BONE

Resective Osseous Surgery-Steps

Vertical Grooving

Radicular Blending & Flattening

Gradualizing Marginal Bone

Exostoses Surgical Planning

Osseous Contouring In Interdental Craters - I

Osseous Contouring In Interdental Craters - II

Osseous Contouring In Exostoses - I

Osseous Contouring In Exostoses - II

Osseous Contouring In One Wall Vertical Defect - I

Osseous Contouring In One Wall Vertical Defect I I

Rationale, Advantages, Limitations

Resective Osseous Surgery is the most predictable pocket reduction technique But it is performed at the expense of bony tissue and attachment level So 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: bone removal to get physiologic contour of the bone itself and gingiva overlying it. The bone removal is not part of the attachment apparatus. Ostectomy: the bone removed to get physiologic contour is part of the attachment apparatus of one or more teeth. The amount of bone to be removed is an important criterion for its use.

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

Ostectomy indications:
Ostectomy isutilized to treat shallow (12 mm deep) to medium (34 mm deep) intrabony and hemiseptal osseous defects and correct reversals in the osseous topography Interproximal craters in bone: shallow and wide craters are not favorable for reattachment while deep and narrow are. When ostectomy is the procedure of choice one of the spines is removed and the bone is ramped to the other side. Extremely deep interproximal pockets where the neighbor areas are intact or minimally affected. Shallow infrabony defects (interproximal), and where reattachment has failed

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 premolar And first molar, hemiseptal defect between the two premolars and lingual exostosis. C. Osseous resective surgery eliminated the interproximal osseous defects by ramping to the lingual, corrected the reversed osseous topography and removed the osseous ledges. D. Normal scalloped gingival morphology and good health 6 months after osseous resective surgery

Resective Periodontal Surgery Used To Correct Gummy Smile

Pre-Surgical Photograph

Resective Periodontal Surgery Used To Correct Gummy Smile

Pre-Surgical Photograph IntraOral Maxillary Anteriors with short clinical crowns

Resective Periodontal Surgery Used To Correct Gummy Smile

Immediate Post Surgical Apically positioned flap sutured after osseous resective surgery

Resective Periodontal Surgery Used To Correct Gummy Smile

Post Surgical Photograph 1 Year

Resective Periodontal Surgery Used To Correct Gummy Smile

Pre-Surgical Photograph

Post Surgical 1Year

Points To Remember !!!

Definition:

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