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Vertical bore loss

Horizontal bone loss results in a relative thickening of marginal alveolar bone

Combination

RESECTIVE OSSEOUS SURGERY

BYANISHA MANDAVIA BDS IV YR

DEFINITIONOsseous 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

TYPESResective (subtractive): Procedure directed to restore the form of preexisting alveolar bone to the level existing at the time of surgery or slightly more apical to this level. Reconstructive (additive): Procedures directed at restoring the alveolar bone to its original level.

SELECTION OF TREATMENT TECHNIQUES-

Morphology of osseous defects will determine the treatment technique:

Three-wall defect
Two-wall defect One-wall defect resection Interdental crater resection

both regeneration bone and regeneration resection

RATIONALEThe goal of osseous resective surgery is reshaping of the marginal bone to resemble the alveolar process undamaged by periodontal disease. The technique is performed in combination with apicaly displaced flap, and the procedure eliminates periodontal pocket depth and improve the tissue contour to provide a more easily maintainable environment.

It is proposed that the conversion of the periodontal pocket to a shallow gingival sulcus enhances the patients ability to remove plaque and oral debris from the dentition.

NORMAL ALVEOLAR BONE MORPHOLOGYThe interproximal bone is more coronal in position than labial or lingual/ palatal bone and pyramidal in form. The form of interdental bone is a function of the tooth form and the embrasure width.
More tapered tooth more pyramidal bony form. Wider embrasure more flattened interdental bone mesiodistally and buccolingually.

The position of the bony margin mimics the contours of the cementoenamel junction.

TerminologyMorphologic Bone Forms :

Ideal osseous form:

The bone consistently more coronal on the interproximal surfaces than on the facial and lingual surfaces. Similar interdental height, with gradual, curved slops between interdental peaks.

Flat architecture:
The interdental bone at the same level with radicular bone.

Positive architecture:
The interdental bone at the level coronal to radicular bone.

Negative architecture:
The interdental bone at the level apical to radicular bone.

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. OR Reshaping of bone without removing the supporting bone.

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. OR Reshaping of bone with removal of supporting bone.

PROCEDURESoft tissue palpation. Radiographic examination.

Provide information about the interproximal bone loss, the presence of angular bone loss. It does not identify the presence of periodontitis, not accurately document the extent of bony defect or the number of bony walls remains. It can indicate the presence of intrabony pocket when:
Angular bone loss. Irregular bone loss. Pocket of irregular depth in adjacent areas of the same tooth or adjacent teeth are found.

Probing
It reveals the presence of: Pocket depth greater than that of normal gingival sulcus. The location of the base of pocket relative to the mucogingival junction and attachment level on adjacent teeth. The number of bony walls. The presence of furcation defects.

Trans-gingival probing (sounding):

Under local anesthesia confirms the extent and configuration of the intrabony component of the pocket or furcation defects. The probe walks along the tissue-tooth interface to feel the bony topography. The probe may pass horizontally through the tissue to provide three-dimensional information regarding bony contours.

Apically displaced flap. Osseous resection.

Osseous resection technique-

INSTRUMENTSRongeurs Carbide burs Diamonds burs Interproximal files (Schlugar and Sugarman) Back action chisel Ochsenbein chisel

Bone - Rongeurs

Carbide burs

Diamonds burs

TECHNIQUE-

Resective Osseous Surgery-Steps

Vertical Grooving

Radicular Blending & Flattening

Gradualizing Marginal Bone

1.

Vertical grooving (osteoplasty):

It is the first step because it can define the general thickness and subsequent form of alveolar housing. It is usually done by rotatory instruments as carbide or diamond burs. it is designed to:
Reduce the thickness of the alveolar housing. Provide relative prominence to the radicular aspect of the teeth. Provide continuity from interproximal surface onto the radicular surface.

Indications: Thick, bony margins, shallow crater formations. Areas require maximal osteoplasty and minimal osteoctomy. Contraindication: Areas with close root proximity or thin alveolar housing.

2. Radicular blending (osteoplasty):

It is an attempt to gradualize the bone over the entire radicular surface to provide the best results from vertical grooving. It provides smooth, blended surface for good flap adaptation. Indications: Thick ledges of bone on the radicular surface. Contraindication: Minor vertical grooving or thin, fenestrated radicular bone.

Both vertical grooving and radicular blending may be used for treatment of:
Shallow crater formation. Thick osseous ledges of bone in radicular surface. Class I and early class II furcation involvement.

3. Flattening Interproximal bone (osteoctomy):

Removal of very small amount of supporting bone. Indications: Interproximal bone varies horizontally. One-walled interproximal defect.

4. Gradualizing marginal bone (osteoctomy):

Minimal bone removal to provide a sound, regular base for gingival tissue to follow. Failure to remove the widow peak (Peaks of bone remain at the facial, lingual/ palatal line angles of the teeth) allows the tissue to rise to higher level than the base of the bone loss in the interdental area. Hand instruments as chisel and curette are favorable over rotatory instruments.

Specific osseous reshaping situation

Correction of one walled hemiseptal defect:

The bone should reduce to the level of the most apical portion of the defect. It required removal of some bone on the side with greatest coronal bony height. This result in significant reduction in attachment on relatively unaffected adjacent teeth to eliminate the defect. If the tooth has one wall defect on both its mesial and distal surfaces, the severely affected tooth may be extruded by orthodontics during disease control to minimize the need for resection of bone from the adjacent teeth. If one walled defect occurs next to edentulous area, the edentulous ridge is reduced to the level of the osseous defect.

Exostoses, Malpositioned or Supraerupted tooth-

Osteoplasty to eliminate the exostoses or reduce the buccal/ lingual bulk of bone. It is common to incorporate adegree of vertical grooving during reduction of the bony ledges, since it facilitate the process of blending the redicular bone into interproximal areas. Previous 4 steps.

Exostoses Surgical Planning

In the absence of ledges or exostosesReduction of interdental walls of craters and the one-walled component of angular defects and wells, and grooving into sites of early involvement. The walls of the crater may be reduced at the expense of the buccal, lingual or both walls. The reduction should be made to remove the least amount of alveolar bone required to produce a satisfactory form, prevent furcation and blend the contour with adjacent tooth. The selective reduction of bony defects by ramping the bone to the palatal or lingual to avoid involvement of the furcations.

Preoperative view of the maxillary left buccal.

Post-operative view of the maxillary left buccal.

Preoperative view of the maxillary left palatal.

Post-operative view of the maxillary left palatal.

Preoperative view of the mandibular right buccal

Post-operative view of the mandibular right buccal

Preoperative view of the mandibular right lingual

Post-operative view of the mandibular right lingual

THANK YOU AND HAVE A NICE DAY !!!