Dr. Sharashchandra., MDS Professor and HOD

1. Presented by
Dr. Sharashchandra, MDS
Prof and HOD

2. DEFINITION
The procedure by which changes in the
Al .bone can be accomplished to rid it of
deformities induced by periodontal disease
or other related factors, such as exostosis
and tooth supra eruption

3. TWO TYPES
ADDITIVE SUBTRACTIVE

4. ADDITIVE
Restoring the Al .bone to its original level

5. SUBSTRACTIVE
Restore the form of pre-existing alveolar bone
to the level existing at the time of surgery
or slightly more apical to this level

6. SELECTION OF TREATMENT TECHNIQUE
ONE - WALL DEFECTS
Re-contoured surgically
THREE - WALL DEFECTS
New - attachment & bone regeneration
TWO – WALL DEFECTS
Treated either method

7. RATIONALE
LIMITED APPLICABILITY
Deep intrabony or hemiseptal defects
GOAL
To shape the marginal bone to resemble that of
alveolar process undamaged by periodontal disease

8. TECHNIQUE
Performed in combination with apically positioned flaps
ELIMINATES
Periodontal pocket depth
Improves tissue contour

9. NORMAL ALVEOLAR BONE MORPHOLOGY
1 The inter proximal bone is more coronal in position
than the labial or lingual/palatal and pyramidal in form

10. 2 The form of interdental bone depends on
Tooth form
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

11. 3 The position of the bony margin mimics the
contours of the cemento-enamel junction
The distance from the facial bony margin of the
tooth to the interproximal bony crest is more flat
in the posterior areas than the anterior
Teeth with prominent roots that are displaced to
the facial or lingual may also have fenestrations or
dehiscences
The molar teeth have less scalloping and a
more flat profile than bicuspids and incisors

12. FENESTRATION / DEHISCENCE

13. TERMINOLOGY
OSTEOPLASTY
Reshaping the bone
without removing tooth-supporting bone
OSTECTOMY
Removal of tooth-supporting bone

14. POSITIVE ARCHITECTURE
Radicular bone is apical to interdental bone
NEGATIVE ARCHITECTURE
The interdental bone is more apical than
the radicular bone
FLAT ARCHITECTURE
Reduction of the interdental bone to the
same height as the radicular bone

15. FACTORS DETERMINING
Depth and configuration of bony lesions
to root morphology
Early-to-moderate bone loss [2-3mm]

16. EXAMINATION AND TREATMENT PLANNING
PROBING REVEALS
Pocket depth
Location of the base of the pocket
Number of bony walls
Presence of furcation defects
Configuration of the bone – Trangingival

17. RADIOGRAPHS PROVIDE
Extent of interproximal bone loss
Presence of angular bone loss
Caries
Root length
Root morphology

18. METHODS
It is important for the clinician to know the
underlying bone tissue before flap reflection by :
Soft tissue palpation
Radiographic assessment and
Transgingival probing or “sounding”

19. Trans gingival probing is extremely useful
just before flap reflection
It is necessary to anesthetize the tissue locally
before inserting the probe
The probe should be “walked” along the
tissue-tooth interface so that the operator can
feel the bony
topography
The probe may also be passed horizontally
through the tissue to provide three-dimensional
information regarding bony contours [thickness,

20. THE OSSEOUS RESECTION TECHNIQUE
INSTRUMENTS
Hand and rotary instruments are useful for
osteoplastic
steps
Hand instruments provide the most precise
and safe results
Care and precision are required to prevent
excessive bone removal or root damage

21. RONGERS CARBIDE BURS DIAMOND
I.P FILES B. ACTION CHISELS OCHSENBEIN

22. TECHNIQUE
VERTICAL GROOVING
RADICULAR BLENDING
FLATTENING INTERPROXIMAL BONE
GRADUALIZING MARGINAL BONE

23. VERTICAL GROOVING
Reduce the thickness of the housing
Provide relative prominence to the radicular
aspects of the teeth
Continuity from the interproximal surface
onto the radicular surface
Performed with rotary instruments such as
round carbide burs or diamonds
Contraindicated in area with close root
proximity or thin alveolar housing

24. RADICULAR BLENDING
Is an extension of vertical grooving
Provides smooth,blended surface for good
flap
adaptation
Both vertical grooving and radicular blending
are purely osteoplastic techniques that do not
remove supporting bone
Shallow crater formations, thick osseous ledges
of bone on the radicular surfaces,class I & classII
furcation involvements are treated with these two steps

25. FLATTENING INTERPROXIMAL BONE
Requires the removal of very small amounts of
supporting bone
Indicated : one-walled defects
Best used in :coronally angular defect
Helpful in obtaining good flap closure and
Improved healing in three-walled defect

26. GRADULIZING MARGINAL BONE
Bone removal is minimal
Provide a sound, regular base for the
gingival tissue to follow
Performed with great care not to produce
nicks or grooves on the roots
Chisels and curettes are preferable

27. 1 2 & 3 4
1 VERTICAL GROOVING
2 RADICULAR BLENDING
3 FLATTENING INTERPROXIMAL BONE
4 GRADUALIZING MARGINAL BONE

28. INTERDENTAL CRATERS
EXOSTOSES
ONE-WALL DEFECT

29. OSTEOPLASTY -- BONY LEDGES / EXOSTOSES

30. OSTEOECTOMY AND OSTEOPLASTY
BUCCAL LINGUAL

31. RAMPING : ONE – WALL DEFECT

32. EXOSTOSES

33. FLAP PLACEMENT AND CLOSURE
Replaced to their original position to cover the new
margin resulting in minimum post-operative complications
and optimal post-surgical pocket depths

34. POST-OPERATIVE MAINTENANCE
Sutures removed
Excessive granulation tissue is removed
with a sharp curette
Maintenance instructions given

35. SUMMARY
ELIMINATES
Defects
Gradualize bony ledges
Irregular alveolar bone
Furcation involvement
Bony exostosis
Circumferential defects

36. ADVANTAGES
Achieves physiological architecture of marginal al.bone
Enhance oral hygiene and periodic maintenance
Preserves the width of the attached gingiva
Provide access for debridement of radicular surfaces