SlideShare a Scribd company logo
1 of 43
Resective Osseous Surgery
-DR AISHWARYA PANDEY
-DEPARTMENT OF PERIODONTOLOGY
-BANARAS HINDU UNIVERSITY
Contents
• Introduction
• Rationale
• Normal Alveolar Bone Morphology
• Terminology
• Objectives
• Factors in Selection of Resective Osseous Surgery
• Advantages
• Disadvantages
• Examination and Treatment Planning
• Osseous Resection Techniques
• Conclusion
• References
Introduction
• Osseous surgery is 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 exostosis and tooth supra
eruption. It is basically a periodontal surgery involving modification of the bony
support of the teeth.
Osseous Surgery
Additive Subtractive
• Additive osseous surgery includes procedures
directed at restoring the alveolar bone to its
original level.
• It brings about the ideal result of periodontal
therapy .
• It implies regeneration of lost bone and
reestablishment of the periodontal ligament,
gingival fibers, and junctional epithelium at a more
BEFORE AFTER
• Subtractive osseous surgery is designed to
restore the form of preexisting alveolar bone to
the level present at the time of surgery or slightly
more apical to this level.
• They provide an alternative to additive methods
and should be used when additive procedures
are not feasible.
BEFORE AFTER
Rationale
• Osseous surgery provides the purest and surest method for reducing pockets with
bony discrepancies that are not overly vertical and also remains one of the
principal periodontal modalities because of its long-term success and
predictability.
• Osseous resective surgery is the most predictable pocket reduction
technique.
• However, more than any other surgical technique, osseous resective surgery is
performed at the expense of bony tissue and attachment level.
• Thus its value as a surgical approach is limited by the presence, quantity, and
shape of the bony tissues and by the amount of attachment loss that is
• The major rationale for osseous resective surgery is based on the tenet
that discrepancies in level and shapes of the bone and gingiva predispose
patients to the recurrence of pocket depth postsurgically.
• The goal of osseous resective therapy is to reshape the marginal bone to
resemble that of the alveolar process undamaged by periodontal
disease.
• The technique is performed in combination with apically positioned flaps,
and the procedure eliminates periodontal pocket depth and improves tissue
contour to provide a more easily maintainable environment.
Normal Alveolar Bone Morphology
Knowledge of the morphology of the bony periodontium in a state of health is
required to perform resective osseous surgery correctly.
The characteristics of a normal bony form are as follows:
1. The interproximal bone is more coronal in position than the labial or
lingual-palatal bone and pyramidal in form.
2. The form of the interdental bone is a function of the tooth form and
the embrasure width. The more tapered the tooth, the more pyramidal is
the bony form. The wider the embrasure, the more flattened is the
interdental bone mesiodistally and buccolingually.
3. The position of the bony margin mimics the contours of the
cementoenamel junction. The distance from the facial bony margin of the
tooth to the interproximal bony crest is flatter in the posterior than the
anterior areas. This “scalloping” of the bone on the facial surfaces and
lingual-palatal surfaces is related to tooth and root form, as well as tooth
position within the alveolus. The molar teeth have less scalloping and a
flatter profile than bicuspids and incisors.
The architecture is “positive” if the radicular bone is
apical to the interdental bone.
The bone has “negative”
architecture if the interdental
bone is more apical than the
radicular bone
Flat architecture is the
reduction of the interdental
bone to the same height as
the radicular bone.
Terminology
• Procedures used to correct osseous defects have been classified in two
groups: osteoplasty and ostectomy.
• Osteoplasty refers to reshaping the bone without removing tooth-supporting
bone.
• Ostectomy, or osteoectomy, includes the removal of tooth-supporting bone.
• Terms that relate to the thoroughness of the osseous reshaping
techniques include “definitive” and “compromise.”
• Definitive osseous reshaping implies that further osseous reshaping would not
improve the overall result.
• Compromise osseous reshaping indicates a bone pattern that cannot be improved
without significant osseous removal that would be detrimental to the overall
result.
OSTEOPLASTY
• The term osteoplasty was introduced by Friedman in 1955.
• The purpose of osteoplasty is to reshape the alveolar bone without
removing any “supporting” bone.
• Examples of osteoplasty are the thinning of thick osseous ledges and the
establishment of a scalloped contour of the buccal (lingual and palatal) bone
crest.
• The leveling of interproximal craters and the elimination (or reduction) of bony
walls of circumferential osseous defects are often referred to as “osteoplasty”
since usually no resection of supporting bone is required.
Thick osseous ledges in a mandibular
molar region area are eliminated
with the use of a round bur to
facilitate optimal flap adaptation.
Leveling of an interproximal bone crater
through the removal of the palatal bone
wall. For esthetic reasons, the buccal
bone wall is maintained to support the
height of the soft tissue.
OSTECTOMY
• In ostectomy, supporting bone, that is bone directly involved in the
attachment of the tooth, is removed to reshape hard tissue deformities
caused by periodontitis.
• Ostectomy is considered to be an important part of surgical techniques
aimed at pocket elimination.
• The objective of bone surgery is thus to establish a “physiologic” anatomy
of the alveolar bone, but at a more apical level.
Combined one‐ and two‐wall osseous
defect on the distal aspect of a
mandibular bicuspid has been
exposed following reflection of
mucoperiosteal flaps. The bone walls
are reduced to a level close to the
base of the defect using rotating
round burs under continuous saline
irrigation.
Osseous recontouring completed.
Note that some supporting bone has
to be removed from the buccal and
lingual aspect of both the second
bicuspid and the first molar in order
to provide a hard tissue topography
which allows a close adaptation of the
covering soft tissue flap.
OBJECTIVES
• Resolution of gingival inflammation.
• Accessibility of instruments to root surface.
• Elimination of periodontal pocket.
• Correct abnormal gingiva and alveolar bone
morphologic characteristics that interfere with plaque
control.
• Regeneration of periodontal apparatus destroyed
by periodontal disease.
• Create environment suitable to restorative and
prosthodontic
treatment.
• Esthetic
improvement.
Factors in Selection of
Resective Osseous Surgery
• The relationship between the depth and configuration of the bony lesion or
lesions with root morphology and the adjacent teeth determines the extent
that bone and attachment are removed during resection.
• The technique of ostectomy is best applied to patients with early to
moderate bone loss (2 to 3 mm) with moderate-length root trunks that
have bony defects with one or two walls.
• Patients with advanced attachment loss and deep intrabony defects are not
candidates for resection to produce a positive contour.
ADVANTAGES
• Reliable
• Short term (8-12 weeks)
• Obtain gingiva-alveolar bone morphology that facilitates
easy maintenance.
DISADVANTAGES
• Attachment loss
• Root exposure
• Compromising esthetics
• Strong possibility of hypersensitivity
• Strong possibility of root surface
caries
• Possibility of phonetic impediment
EXAMINATION AND TREATMENT
PLANNING
• Signs and symptoms of periodontitis, inflamed gingiva with
plaque and calculus, increased flow of GCF and bleeding
on probing and exudation are commonly found in suitable
patients.
• Pocket depth greater than normal gingival sulcus, base of
the pocket relative to the mucogingival junction and the
number of bony walls, presence of furcation defects
should be observed.
Gingival examination:
• Physiologic gingival contour
• Clinical attachment level
• Width of the attached gingiva
• Thickness of the gingiva
• Transgingival probing
• Routine dental radiographs do not accurately document
the extent of bony defects.
• However, well made radiographs provide useful information
about interproximal bone loss, caries, and root trunk length
and root morphology.
• Treatment planning should provide solutions for active periodontal
diseases and correction of deformities that result from periodontitis.
• Planning should also facilitate the performance of other dental
procedures included in a comprehensive dental treatment plan.
• The response to therapy from patient to patient may also vary, as may
the treatment objectives for the patients. Therefore a treatment plan
may encompass a number of steps and combinations of procedures in
the same surgical area.
Osseous Resection Technique
ARMAMENTARIUM
• Rotary instruments are useful for the osteoplastic steps
• Hand instruments provide the most precise and safest results with
ostectomy procedures.
• Piezoelectric surgical techniques have also been used with success for
osseous surgical resective techniques.
(A) The piezoelectric surgical unit
B) Rongeurs (C) Carbide round burs. (D) Diamond burs. (E) interproximal files: Schluger and Sugarman.
(F) Back-action chisels. (G) Ochsenbein chisels.
STEPS FOR RESECTIVE
OSSEOUS SURGERY
 VERTICAL GROOVING
 RADICULAR BLENDING
 HORIZONTAL GROOVING
 GRADUALIZING INTERPROXIMAL BONE
2
Vertical Grooving
• Vertical grooving is designed to reduce the
thickness of the alveolar housing and to provide
relative prominence to the radicular aspects of
the teeth.
• It also provides continuity from the interproximal
surface onto the radicular surface.
• It is the first step of the resective process
because it can define the general thickness and
subsequent form of the alveolar housing.
• This step is usually performed with rotary instruments, such as round
carbide burs or diamonds.
• The advantages of vertical grooving are most apparent with thick
bony margins, shallow crater formations, or other areas that
require maximal osteoplasty and minimal ostectomy.
• Vertical grooving is contraindicated in areas with close roots or
thin alveolar housing.
Radicular Blending
• Radicular blending, the second step of the osseous
reshaping technique, is an extension of vertical grooving.
• It is an attempt to bend the bone over the entire radicular
surface to provide the best results from vertical grooving.
• This provides a smooth, blended surface for good flap
adaptation.
• The indications are the same as for vertical grooving
(i.e., thick ledges of bone on the radicular surface, where
selective surgical resection is desired).
• Naturally, this step is not necessary if vertical grooving is very minor or if
the radicular bone is thin or fenestrated.
• Both vertical grooving and radicular blending are purely osteoplastic
techniques that do not remove supporting bone.
• In most situations, these two procedures compose the bulk of resective
osseous surgery.
• Classically, shallow crater formations, thick osseous ledges of bone on the
radicular surfaces, and class I and early class II furcation involvements are
treated almost entirely with these two steps.
Flattening Interproximal Bone
• Flattening of the interdental bone requires the
removal of very small amounts of supporting bone.
• It is indicated when interproximal bone levels vary
horizontally.
• By definition, most of the indications for this step are
one-walled interproximal defects or hemiseptal
defects. The omission of flattening in such cases
results in increased pocket depth on the most apical
side of the bone loss.
• This step is typically not necessary with interproximal crater
formations or flat interproximal defects.
• It is best used in defects that have a coronally placed, one-walled
edge of a predominantly three-walled angular defect, and it can be
helpful in obtaining good flap closure and improved healing in the
three-walled defect.
• The limitation of this step is in the treatment of advanced lesions.
Large hemiseptal defects would require removal of inordinate
amounts of bone to provide a flattened architecture, and the
procedure would be too costly in terms of bony support.
Gradualizing Marginal Bone
• The final step in the osseous resection technique is also an
ostectomy process.
• Bone removal is minimal but necessary to provide a sound,
regular base for the gingival tissue to follow.
• This step of the procedure also requires gradualization and
blending on the radicular surface.
• The two ostectomy steps should be performed with great
care so as not to produce nicks or grooves on the roots.
• When the radicular bone is thin, it is extremely easy to overdo this step, to
the detriment of the entire surgical effort.
• For this reason, various hand instruments, such as chisels and curettes,
are preferable to rotary instruments for gradualizing
marginal bone.
Flap Placement and Closure
• After performing resection, the clinician positions and sutures the flaps.
• Flaps may be replaced to their original position, to cover the new bony
margin, or they may be apically positioned.
• Replacing the flap in areas that previously had deep pockets may result
initially in greater postoperative pocket depth, although a selective
recession may diminish the depth over time.
• Positioning the flap apically to expose marginal bone is one method of
altering the width of the gingiva (denudation). However, such flap
placement results in more postsurgical resorption of bone.
• Positioning the flap to cover the new margin minimizes postoperative
complications and results in optimal postsurgical pocket depths.
• Suturing may be accomplished using a variety of different suture
materials and suture knots.
• The sutures should be placed with minimal tension to co-apt the flaps,
prevent their separation, and maintain the position of the flaps. Sutures
placed with excessive tension rapidly pull through the tissues.
Postoperative Maintenance
• Non resorbable sutures such as silk are usually removed after 1 week of
healing, although some of the newer synthetic materials may be left for up
to 3 weeks or longer without adverse consequences.
• Resorbable sutures maintain wound approximation for varying periods of 1
to 3 weeks or more, depending on the type of suture material.
• At the suture removal appointment the periodontal dressing, if present, is
removed, and the surgical site is gently cleansed of debris with a cotton
pellet dampened with saline.
• Non resorbable sutures are then cut and removed.
• If sutures of a resorbable material were used, the area should be inspected
carefully to ensure that no suture fragments remain.
• Suture removal should be accomplished without dragging contaminated
portions of the suture through the periodontal tissues.
• After suture removal the surgical site is examined carefully, and any
excessive granulation tissue is removed with a sharp curette.
• The patient is provided with postsurgical maintenance instructions to
maintain the surgical site in a plaque free state.
• A second postoperative visit is often performed at the second or third
week, and the surgical site is lightly debrided for optimal results.
• Professional prophylaxis for complete plaque removal should be done
every 2 weeks until healing is complete or the patient is maintaining
appropriate levels of plaque control.
• Healing should proceed uneventfully, with the attachment of the flap to the
underlying bone completed in 14 to 21 days.
• It is usually advisable to wait at least 6 weeks after completion of healing
of the last surgical area before beginning dental restorations.
Conclusion
• The results from osseous resective surgery are technique sensitive.
• It has limited use in treating cases with very deep intrabony or hemiseptal
defects, which should be treated with a different surgical approach.
• If osseous resective surgery is used in advanced lesions, a compromise
in the amount of probing depth reduction should be expected.
• Yet, osseous resective surgery provides the surest method of reducing
pockets.
• Osseous resective surgery has been and remains one of the principal
References
• Carranza,12th Edition
• Lindhe, 6th Edition
resective osseous surgeryyy.pptx

More Related Content

Similar to resective osseous surgeryyy.pptx

Introduction to Oral Implantology
Introduction to Oral ImplantologyIntroduction to Oral Implantology
Introduction to Oral Implantology
Mohamed Fouda
 
Resorbed ridge seminar koto
Resorbed ridge seminar kotoResorbed ridge seminar koto
Resorbed ridge seminar koto
Kushal Singh
 
coticotomy.doc
coticotomy.doccoticotomy.doc
coticotomy.doc
Dr.Mohammed Alruby
 

Similar to resective osseous surgeryyy.pptx (20)

Biologic width
Biologic widthBiologic width
Biologic width
 
Resective osseous surgery
Resective osseous surgeryResective osseous surgery
Resective osseous surgery
 
Periodontally Accelerated Osteogenic Orthodontics with Piezoelectric Surgery...
 Periodontally Accelerated Osteogenic Orthodontics with Piezoelectric Surgery... Periodontally Accelerated Osteogenic Orthodontics with Piezoelectric Surgery...
Periodontally Accelerated Osteogenic Orthodontics with Piezoelectric Surgery...
 
Periodontic Orthodontic relationship
Periodontic Orthodontic relationshipPeriodontic Orthodontic relationship
Periodontic Orthodontic relationship
 
Preprosthetic surgery; Prosthodontic consideraration
Preprosthetic surgery; Prosthodontic consideraration Preprosthetic surgery; Prosthodontic consideraration
Preprosthetic surgery; Prosthodontic consideraration
 
Preprosthetic surgery.ppt
Preprosthetic surgery.pptPreprosthetic surgery.ppt
Preprosthetic surgery.ppt
 
Methods to improve com[lete denture foundation 2
Methods to improve com[lete denture foundation 2Methods to improve com[lete denture foundation 2
Methods to improve com[lete denture foundation 2
 
RCT fixed expert 23-24pptx.pdf second part
RCT fixed expert 23-24pptx.pdf second partRCT fixed expert 23-24pptx.pdf second part
RCT fixed expert 23-24pptx.pdf second part
 
Prosthetic considerations for implant patients
Prosthetic considerations for implant patientsProsthetic considerations for implant patients
Prosthetic considerations for implant patients
 
An altered cast procedure to improve tissue support
An altered cast procedure to improve tissue supportAn altered cast procedure to improve tissue support
An altered cast procedure to improve tissue support
 
Introduction to Oral Implantology
Introduction to Oral ImplantologyIntroduction to Oral Implantology
Introduction to Oral Implantology
 
Resorbed ridge seminar koto
Resorbed ridge seminar kotoResorbed ridge seminar koto
Resorbed ridge seminar koto
 
Perio-Ortho interrelationships - Dr.Malvika
Perio-Ortho interrelationships - Dr.MalvikaPerio-Ortho interrelationships - Dr.Malvika
Perio-Ortho interrelationships - Dr.Malvika
 
Osseous surgery
Osseous surgeryOsseous surgery
Osseous surgery
 
Implants : An Overview, Biomechanics & Treatment Planning
Implants : An Overview, Biomechanics & Treatment PlanningImplants : An Overview, Biomechanics & Treatment Planning
Implants : An Overview, Biomechanics & Treatment Planning
 
coticotomy.doc
coticotomy.doccoticotomy.doc
coticotomy.doc
 
Diagnosis and treatment planning in implants 2. / dental implant courses by ...
Diagnosis and treatment planning in implants 2.  / dental implant courses by ...Diagnosis and treatment planning in implants 2.  / dental implant courses by ...
Diagnosis and treatment planning in implants 2. / dental implant courses by ...
 
IMPLANT SITE PREPARATION.pptx
IMPLANT SITE PREPARATION.pptxIMPLANT SITE PREPARATION.pptx
IMPLANT SITE PREPARATION.pptx
 
Periodontal regeneration
Periodontal regeneration Periodontal regeneration
Periodontal regeneration
 
Respective osseous surgery power point presentation
Respective osseous surgery power point presentationRespective osseous surgery power point presentation
Respective osseous surgery power point presentation
 

More from Dr. AISHWARYA PANDEY

More from Dr. AISHWARYA PANDEY (10)

Genetic aspects.pptx
Genetic aspects.pptxGenetic aspects.pptx
Genetic aspects.pptx
 
Important values to remember in periodontology.pptx
Important values to remember in periodontology.pptxImportant values to remember in periodontology.pptx
Important values to remember in periodontology.pptx
 
Treatment plan.pptx
Treatment plan.pptxTreatment plan.pptx
Treatment plan.pptx
 
DESQUAMATIVE GINGIVITS.pptx
DESQUAMATIVE GINGIVITS.pptxDESQUAMATIVE GINGIVITS.pptx
DESQUAMATIVE GINGIVITS.pptx
 
BIOFILM.pptx
BIOFILM.pptxBIOFILM.pptx
BIOFILM.pptx
 
Perio-Prostho.pptx
Perio-Prostho.pptxPerio-Prostho.pptx
Perio-Prostho.pptx
 
Perio-Ortho.pptx
Perio-Ortho.pptxPerio-Ortho.pptx
Perio-Ortho.pptx
 
perio-endo.pptx
perio-endo.pptxperio-endo.pptx
perio-endo.pptx
 
ORAL MALADOR.pptx
ORAL MALADOR.pptxORAL MALADOR.pptx
ORAL MALADOR.pptx
 
BONE LOSS AND PATTERNS OF BONE DESTRUCTION.pptx
BONE LOSS AND PATTERNS OF BONE DESTRUCTION.pptxBONE LOSS AND PATTERNS OF BONE DESTRUCTION.pptx
BONE LOSS AND PATTERNS OF BONE DESTRUCTION.pptx
 

Recently uploaded

CAD CAM DENTURES IN PROSTHODONTICS : Dental advancements
CAD CAM DENTURES IN PROSTHODONTICS : Dental advancementsCAD CAM DENTURES IN PROSTHODONTICS : Dental advancements
CAD CAM DENTURES IN PROSTHODONTICS : Dental advancements
Naveen Gokul Dr
 
Connective Tissue II - Dr Muhammad Ali Rabbani - Medicose Academics
Connective Tissue II - Dr Muhammad Ali Rabbani - Medicose AcademicsConnective Tissue II - Dr Muhammad Ali Rabbani - Medicose Academics
Connective Tissue II - Dr Muhammad Ali Rabbani - Medicose Academics
MedicoseAcademics
 

Recently uploaded (20)

Gross Anatomy and Histology of Tongue by Dr. Rabia Inam Gandapore.pptx
Gross Anatomy and Histology of Tongue by Dr. Rabia Inam Gandapore.pptxGross Anatomy and Histology of Tongue by Dr. Rabia Inam Gandapore.pptx
Gross Anatomy and Histology of Tongue by Dr. Rabia Inam Gandapore.pptx
 
Report Back from SGO: What’s the Latest in Ovarian Cancer?
Report Back from SGO: What’s the Latest in Ovarian Cancer?Report Back from SGO: What’s the Latest in Ovarian Cancer?
Report Back from SGO: What’s the Latest in Ovarian Cancer?
 
Top 10 Most Beautiful Russian Pornstars List 2024
Top 10 Most Beautiful Russian Pornstars List 2024Top 10 Most Beautiful Russian Pornstars List 2024
Top 10 Most Beautiful Russian Pornstars List 2024
 
Tips and tricks to pass the cardiovascular station for PACES exam
Tips and tricks to pass the cardiovascular station for PACES examTips and tricks to pass the cardiovascular station for PACES exam
Tips and tricks to pass the cardiovascular station for PACES exam
 
Overview on the Automatic pill identifier
Overview on the Automatic pill identifierOverview on the Automatic pill identifier
Overview on the Automatic pill identifier
 
Treatment Choices for Slip Disc at Gokuldas Hospital
Treatment Choices for Slip Disc at Gokuldas HospitalTreatment Choices for Slip Disc at Gokuldas Hospital
Treatment Choices for Slip Disc at Gokuldas Hospital
 
Storage of Blood Components- equipments, effects of improper storage, transpo...
Storage of Blood Components- equipments, effects of improper storage, transpo...Storage of Blood Components- equipments, effects of improper storage, transpo...
Storage of Blood Components- equipments, effects of improper storage, transpo...
 
Renal Replacement Therapy in Acute Kidney Injury -time modality -Dr Ayman Se...
Renal Replacement Therapy in Acute Kidney Injury -time  modality -Dr Ayman Se...Renal Replacement Therapy in Acute Kidney Injury -time  modality -Dr Ayman Se...
Renal Replacement Therapy in Acute Kidney Injury -time modality -Dr Ayman Se...
 
Hi Fi * Surat ℂall Girls Surat Dumas Road 8527049040 WhatsApp AnyTime Best Su...
Hi Fi * Surat ℂall Girls Surat Dumas Road 8527049040 WhatsApp AnyTime Best Su...Hi Fi * Surat ℂall Girls Surat Dumas Road 8527049040 WhatsApp AnyTime Best Su...
Hi Fi * Surat ℂall Girls Surat Dumas Road 8527049040 WhatsApp AnyTime Best Su...
 
ESC HF 2024 Spotlights Day-2.pptx heart failure
ESC HF 2024 Spotlights Day-2.pptx heart failureESC HF 2024 Spotlights Day-2.pptx heart failure
ESC HF 2024 Spotlights Day-2.pptx heart failure
 
JOURNAL CLUB PRESENTATION TEMPLATE DOCUMENT
JOURNAL CLUB PRESENTATION TEMPLATE DOCUMENTJOURNAL CLUB PRESENTATION TEMPLATE DOCUMENT
JOURNAL CLUB PRESENTATION TEMPLATE DOCUMENT
 
CAD CAM DENTURES IN PROSTHODONTICS : Dental advancements
CAD CAM DENTURES IN PROSTHODONTICS : Dental advancementsCAD CAM DENTURES IN PROSTHODONTICS : Dental advancements
CAD CAM DENTURES IN PROSTHODONTICS : Dental advancements
 
The Clean Living Project Episode 24 - Subconscious
The Clean Living Project Episode 24 - SubconsciousThe Clean Living Project Episode 24 - Subconscious
The Clean Living Project Episode 24 - Subconscious
 
Lachesis Mutus- a Homoeopathic medicinel.pptx
Lachesis Mutus- a Homoeopathic medicinel.pptxLachesis Mutus- a Homoeopathic medicinel.pptx
Lachesis Mutus- a Homoeopathic medicinel.pptx
 
Histopathological staining techniques used in liver diseases
Histopathological staining techniques used in liver diseasesHistopathological staining techniques used in liver diseases
Histopathological staining techniques used in liver diseases
 
Top 10 Most Beautiful Chinese Pornstars List 2024
Top 10 Most Beautiful Chinese Pornstars List 2024Top 10 Most Beautiful Chinese Pornstars List 2024
Top 10 Most Beautiful Chinese Pornstars List 2024
 
Stereochemistry & Asymmetric Synthesis.pptx
Stereochemistry & Asymmetric Synthesis.pptxStereochemistry & Asymmetric Synthesis.pptx
Stereochemistry & Asymmetric Synthesis.pptx
 
Connective Tissue II - Dr Muhammad Ali Rabbani - Medicose Academics
Connective Tissue II - Dr Muhammad Ali Rabbani - Medicose AcademicsConnective Tissue II - Dr Muhammad Ali Rabbani - Medicose Academics
Connective Tissue II - Dr Muhammad Ali Rabbani - Medicose Academics
 
Drug development life cycle indepth overview.pptx
Drug development life cycle indepth overview.pptxDrug development life cycle indepth overview.pptx
Drug development life cycle indepth overview.pptx
 
Varicose Veins Treatment Aftercare Tips by Gokuldas Hospital
Varicose Veins Treatment Aftercare Tips by Gokuldas HospitalVaricose Veins Treatment Aftercare Tips by Gokuldas Hospital
Varicose Veins Treatment Aftercare Tips by Gokuldas Hospital
 

resective osseous surgeryyy.pptx

  • 1. Resective Osseous Surgery -DR AISHWARYA PANDEY -DEPARTMENT OF PERIODONTOLOGY -BANARAS HINDU UNIVERSITY
  • 2. Contents • Introduction • Rationale • Normal Alveolar Bone Morphology • Terminology • Objectives • Factors in Selection of Resective Osseous Surgery • Advantages • Disadvantages • Examination and Treatment Planning • Osseous Resection Techniques • Conclusion • References
  • 3. Introduction • Osseous surgery is 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 exostosis and tooth supra eruption. It is basically a periodontal surgery involving modification of the bony support of the teeth. Osseous Surgery Additive Subtractive
  • 4. • Additive osseous surgery includes procedures directed at restoring the alveolar bone to its original level. • It brings about the ideal result of periodontal therapy . • It implies regeneration of lost bone and reestablishment of the periodontal ligament, gingival fibers, and junctional epithelium at a more BEFORE AFTER
  • 5. • Subtractive osseous surgery is designed to restore the form of preexisting alveolar bone to the level present at the time of surgery or slightly more apical to this level. • They provide an alternative to additive methods and should be used when additive procedures are not feasible. BEFORE AFTER
  • 6. Rationale • Osseous surgery provides the purest and surest method for reducing pockets with bony discrepancies that are not overly vertical and also remains one of the principal periodontal modalities because of its long-term success and predictability. • Osseous resective surgery is the most predictable pocket reduction technique. • However, more than any other surgical technique, osseous resective surgery is performed at the expense of bony tissue and attachment level. • Thus its value as a surgical approach is limited by the presence, quantity, and shape of the bony tissues and by the amount of attachment loss that is
  • 7. • The major rationale for osseous resective surgery is based on the tenet that discrepancies in level and shapes of the bone and gingiva predispose patients to the recurrence of pocket depth postsurgically. • The goal of osseous resective therapy is to reshape the marginal bone to resemble that of the alveolar process undamaged by periodontal disease. • The technique is performed in combination with apically positioned flaps, and the procedure eliminates periodontal pocket depth and improves tissue contour to provide a more easily maintainable environment.
  • 8. Normal Alveolar Bone Morphology Knowledge of the morphology of the bony periodontium in a state of health is required to perform resective osseous surgery correctly. The characteristics of a normal bony form are as follows: 1. The interproximal bone is more coronal in position than the labial or lingual-palatal bone and pyramidal in form. 2. The form of the interdental bone is a function of the tooth form and the embrasure width. The more tapered the tooth, the more pyramidal is the bony form. The wider the embrasure, the more flattened is the interdental bone mesiodistally and buccolingually.
  • 9. 3. The position of the bony margin mimics the contours of the cementoenamel junction. The distance from the facial bony margin of the tooth to the interproximal bony crest is flatter in the posterior than the anterior areas. This “scalloping” of the bone on the facial surfaces and lingual-palatal surfaces is related to tooth and root form, as well as tooth position within the alveolus. The molar teeth have less scalloping and a flatter profile than bicuspids and incisors.
  • 10. The architecture is “positive” if the radicular bone is apical to the interdental bone. The bone has “negative” architecture if the interdental bone is more apical than the radicular bone Flat architecture is the reduction of the interdental bone to the same height as the radicular bone.
  • 11. Terminology • Procedures used to correct osseous defects have been classified in two groups: osteoplasty and ostectomy. • Osteoplasty refers to reshaping the bone without removing tooth-supporting bone. • Ostectomy, or osteoectomy, includes the removal of tooth-supporting bone. • Terms that relate to the thoroughness of the osseous reshaping techniques include “definitive” and “compromise.” • Definitive osseous reshaping implies that further osseous reshaping would not improve the overall result. • Compromise osseous reshaping indicates a bone pattern that cannot be improved without significant osseous removal that would be detrimental to the overall result.
  • 12. OSTEOPLASTY • The term osteoplasty was introduced by Friedman in 1955. • The purpose of osteoplasty is to reshape the alveolar bone without removing any “supporting” bone. • Examples of osteoplasty are the thinning of thick osseous ledges and the establishment of a scalloped contour of the buccal (lingual and palatal) bone crest. • The leveling of interproximal craters and the elimination (or reduction) of bony walls of circumferential osseous defects are often referred to as “osteoplasty” since usually no resection of supporting bone is required.
  • 13. Thick osseous ledges in a mandibular molar region area are eliminated with the use of a round bur to facilitate optimal flap adaptation. Leveling of an interproximal bone crater through the removal of the palatal bone wall. For esthetic reasons, the buccal bone wall is maintained to support the height of the soft tissue.
  • 14. OSTECTOMY • In ostectomy, supporting bone, that is bone directly involved in the attachment of the tooth, is removed to reshape hard tissue deformities caused by periodontitis. • Ostectomy is considered to be an important part of surgical techniques aimed at pocket elimination. • The objective of bone surgery is thus to establish a “physiologic” anatomy of the alveolar bone, but at a more apical level.
  • 15. Combined one‐ and two‐wall osseous defect on the distal aspect of a mandibular bicuspid has been exposed following reflection of mucoperiosteal flaps. The bone walls are reduced to a level close to the base of the defect using rotating round burs under continuous saline irrigation. Osseous recontouring completed. Note that some supporting bone has to be removed from the buccal and lingual aspect of both the second bicuspid and the first molar in order to provide a hard tissue topography which allows a close adaptation of the covering soft tissue flap.
  • 16. OBJECTIVES • Resolution of gingival inflammation. • Accessibility of instruments to root surface. • Elimination of periodontal pocket. • Correct abnormal gingiva and alveolar bone morphologic characteristics that interfere with plaque control. • Regeneration of periodontal apparatus destroyed by periodontal disease. • Create environment suitable to restorative and prosthodontic treatment. • Esthetic improvement.
  • 17. Factors in Selection of Resective Osseous Surgery • The relationship between the depth and configuration of the bony lesion or lesions with root morphology and the adjacent teeth determines the extent that bone and attachment are removed during resection. • The technique of ostectomy is best applied to patients with early to moderate bone loss (2 to 3 mm) with moderate-length root trunks that have bony defects with one or two walls. • Patients with advanced attachment loss and deep intrabony defects are not candidates for resection to produce a positive contour.
  • 18. ADVANTAGES • Reliable • Short term (8-12 weeks) • Obtain gingiva-alveolar bone morphology that facilitates easy maintenance.
  • 19. DISADVANTAGES • Attachment loss • Root exposure • Compromising esthetics • Strong possibility of hypersensitivity • Strong possibility of root surface caries • Possibility of phonetic impediment
  • 20. EXAMINATION AND TREATMENT PLANNING • Signs and symptoms of periodontitis, inflamed gingiva with plaque and calculus, increased flow of GCF and bleeding on probing and exudation are commonly found in suitable patients. • Pocket depth greater than normal gingival sulcus, base of the pocket relative to the mucogingival junction and the number of bony walls, presence of furcation defects should be observed.
  • 21. Gingival examination: • Physiologic gingival contour • Clinical attachment level • Width of the attached gingiva • Thickness of the gingiva
  • 23. • Routine dental radiographs do not accurately document the extent of bony defects. • However, well made radiographs provide useful information about interproximal bone loss, caries, and root trunk length and root morphology.
  • 24. • Treatment planning should provide solutions for active periodontal diseases and correction of deformities that result from periodontitis. • Planning should also facilitate the performance of other dental procedures included in a comprehensive dental treatment plan. • The response to therapy from patient to patient may also vary, as may the treatment objectives for the patients. Therefore a treatment plan may encompass a number of steps and combinations of procedures in the same surgical area.
  • 25. Osseous Resection Technique ARMAMENTARIUM • Rotary instruments are useful for the osteoplastic steps • Hand instruments provide the most precise and safest results with ostectomy procedures. • Piezoelectric surgical techniques have also been used with success for osseous surgical resective techniques.
  • 26. (A) The piezoelectric surgical unit B) Rongeurs (C) Carbide round burs. (D) Diamond burs. (E) interproximal files: Schluger and Sugarman. (F) Back-action chisels. (G) Ochsenbein chisels.
  • 27. STEPS FOR RESECTIVE OSSEOUS SURGERY  VERTICAL GROOVING  RADICULAR BLENDING  HORIZONTAL GROOVING  GRADUALIZING INTERPROXIMAL BONE 2
  • 28. Vertical Grooving • Vertical grooving is designed to reduce the thickness of the alveolar housing and to provide relative prominence to the radicular aspects of the teeth. • It also provides continuity from the interproximal surface onto the radicular surface. • It is the first step of the resective process because it can define the general thickness and subsequent form of the alveolar housing.
  • 29. • This step is usually performed with rotary instruments, such as round carbide burs or diamonds. • The advantages of vertical grooving are most apparent with thick bony margins, shallow crater formations, or other areas that require maximal osteoplasty and minimal ostectomy. • Vertical grooving is contraindicated in areas with close roots or thin alveolar housing.
  • 30. Radicular Blending • Radicular blending, the second step of the osseous reshaping technique, is an extension of vertical grooving. • It is an attempt to bend the bone over the entire radicular surface to provide the best results from vertical grooving. • This provides a smooth, blended surface for good flap adaptation. • The indications are the same as for vertical grooving (i.e., thick ledges of bone on the radicular surface, where selective surgical resection is desired).
  • 31. • Naturally, this step is not necessary if vertical grooving is very minor or if the radicular bone is thin or fenestrated. • Both vertical grooving and radicular blending are purely osteoplastic techniques that do not remove supporting bone. • In most situations, these two procedures compose the bulk of resective osseous surgery. • Classically, shallow crater formations, thick osseous ledges of bone on the radicular surfaces, and class I and early class II furcation involvements are treated almost entirely with these two steps.
  • 32. Flattening Interproximal Bone • Flattening of the interdental bone requires the removal of very small amounts of supporting bone. • It is indicated when interproximal bone levels vary horizontally. • By definition, most of the indications for this step are one-walled interproximal defects or hemiseptal defects. The omission of flattening in such cases results in increased pocket depth on the most apical side of the bone loss.
  • 33. • This step is typically not necessary with interproximal crater formations or flat interproximal defects. • It is best used in defects that have a coronally placed, one-walled edge of a predominantly three-walled angular defect, and it can be helpful in obtaining good flap closure and improved healing in the three-walled defect. • The limitation of this step is in the treatment of advanced lesions. Large hemiseptal defects would require removal of inordinate amounts of bone to provide a flattened architecture, and the procedure would be too costly in terms of bony support.
  • 34. Gradualizing Marginal Bone • The final step in the osseous resection technique is also an ostectomy process. • Bone removal is minimal but necessary to provide a sound, regular base for the gingival tissue to follow. • This step of the procedure also requires gradualization and blending on the radicular surface. • The two ostectomy steps should be performed with great care so as not to produce nicks or grooves on the roots.
  • 35. • When the radicular bone is thin, it is extremely easy to overdo this step, to the detriment of the entire surgical effort. • For this reason, various hand instruments, such as chisels and curettes, are preferable to rotary instruments for gradualizing marginal bone.
  • 36. Flap Placement and Closure • After performing resection, the clinician positions and sutures the flaps. • Flaps may be replaced to their original position, to cover the new bony margin, or they may be apically positioned. • Replacing the flap in areas that previously had deep pockets may result initially in greater postoperative pocket depth, although a selective recession may diminish the depth over time. • Positioning the flap apically to expose marginal bone is one method of altering the width of the gingiva (denudation). However, such flap placement results in more postsurgical resorption of bone.
  • 37. • Positioning the flap to cover the new margin minimizes postoperative complications and results in optimal postsurgical pocket depths. • Suturing may be accomplished using a variety of different suture materials and suture knots. • The sutures should be placed with minimal tension to co-apt the flaps, prevent their separation, and maintain the position of the flaps. Sutures placed with excessive tension rapidly pull through the tissues.
  • 38. Postoperative Maintenance • Non resorbable sutures such as silk are usually removed after 1 week of healing, although some of the newer synthetic materials may be left for up to 3 weeks or longer without adverse consequences. • Resorbable sutures maintain wound approximation for varying periods of 1 to 3 weeks or more, depending on the type of suture material. • At the suture removal appointment the periodontal dressing, if present, is removed, and the surgical site is gently cleansed of debris with a cotton pellet dampened with saline. • Non resorbable sutures are then cut and removed.
  • 39. • If sutures of a resorbable material were used, the area should be inspected carefully to ensure that no suture fragments remain. • Suture removal should be accomplished without dragging contaminated portions of the suture through the periodontal tissues. • After suture removal the surgical site is examined carefully, and any excessive granulation tissue is removed with a sharp curette. • The patient is provided with postsurgical maintenance instructions to maintain the surgical site in a plaque free state.
  • 40. • A second postoperative visit is often performed at the second or third week, and the surgical site is lightly debrided for optimal results. • Professional prophylaxis for complete plaque removal should be done every 2 weeks until healing is complete or the patient is maintaining appropriate levels of plaque control. • Healing should proceed uneventfully, with the attachment of the flap to the underlying bone completed in 14 to 21 days. • It is usually advisable to wait at least 6 weeks after completion of healing of the last surgical area before beginning dental restorations.
  • 41. Conclusion • The results from osseous resective surgery are technique sensitive. • It has limited use in treating cases with very deep intrabony or hemiseptal defects, which should be treated with a different surgical approach. • If osseous resective surgery is used in advanced lesions, a compromise in the amount of probing depth reduction should be expected. • Yet, osseous resective surgery provides the surest method of reducing pockets. • Osseous resective surgery has been and remains one of the principal