2. • Procedure that alter the shape of alveolar bone to remove deformities due
to periodontal disease or other related factors like exostosis
• It is also known as subtractive osseous surgery
Definition
• Reshaping alveolar bone without removal of tooth supporting bone
Osteoplasty
• Reshaping alveolar bone which includes removal of tooth supporting
bone
Osteoectomy
• Reduce pockets with bony discrepancies
• Preferably in patients moderate to advanced periodontitis, with early to moderate bone loss (2 to
3mm), with moderate length root trunk and have bony defect with 1 or 2 walls
• However, keep in mind that this surgical technique is done at the cost of bony tissue and attachment
level
Indications
• Deep infrabony or hemiseptal defects
• Advanced attachment loss
Contraindications
3. EXAMINATION:
Probing can know about :
• Increased pocket depth
• Location of base of pocket
in relation to
mucogingival junction and
original attachment level
• Number of bony walls
• Furcation defects
4. Transgingival probing (transgingival sounding)
• Confirm extent and configuration of intrabony
component of pocket and furcation defect
• Require local anesthesia to perform Transgingival probing is done vertically until
resistance is felt
Transgingival probing is done horizontally
and bleeding point is marked.
5. Radiograph can know about :
• Extent of interproximal bone
loss
• Presence of angular bone loss
and caries
• Root trunk length
• Root morphology
Radiograph is done using radiovisiograph
6. Clinical significance
Moderate to advanced
periodontitis with
persistence bleeding
on probing
Indicates presence of
residual plaque and
calculus
Due to difficulty
obtaining access for
instrumentation or
lack of oral hygiene
If due to difficulty
obtaining access –
indicate for resective
osseous surgery
If due to poor oral
hygiene, not advised
to undergo surgery
Able to facilitate other
procedures
Dental caries – can
expose for
restoration
Fractured root of
abutment tooth – can
be removed
Bony irregularities –
alter contour for
better performance
of prosthesis
Short anatomic
crown – improve
esthetics
Using resective
osseous surgery to :
• Remove exostoses
• Obtain access to
the caries under
stainless steel
crown
7. Picture A shows
preoperative
condition of the site,
showing exostoses
and caries under the
stainless steel crown
Picture B shows
the flap being
reflected apically,
revealing the
exostoses and the
caries.
Picture C shows the
alveolar bone being
reshaped with resective
osseous surgery,
removing the bony
exostoses and exposing
the caries which
facilitates in gaining
access for
instrumentation of
restorative procedures
Picture D shows
the postoperative
condition, 6 weeks
after the resective
osseous surgery.
* Using resective osseous surgery to :
• Remove exostoses
• Obtain access to the caries under stainless steel crown
9. Vertical Grooving
• Goal:
• reduce thickness of alveolar bone
• Provide continuity from interproximal surface to
radicular surface
• Useroundcarbideor diamondburs
• Indications:
• Thick bony margin
• Shallow crater formation
• Areas that need maximal osteoplasty but minimal
ostectomy
• Contraindications:
• Close roots
• Thin alveolar bone
Vertical grooving is done at
the interdental region as
well as the furcation region.
10. Radicular blending
• This step is done in continuation of vertical
grooving
• Goal – gradualize bone until smooth
blended surface for the flap to adapt better
Radicular blending is done
after vertical grooving.
11. Flattening
Interproximal bone
• Willremovea verysmallamountofsupporting
bone
• Goal–allowgoodflapclosureandimproved
healing
• Resultinincreasedpocketdepth
• Indication:
• Hemiseptal defects
• Contraindications:
• Advanced lesion
• Large hemiseptal defects
• They will be too costly in terms of bony support
Flattening of interdental
bone is done.
12. Gradualizing Marginal
Bone
• Goal – remove small bony discrepancies on
gingival line angles
• Precautions :
• Avoid creating nicks or grooves on the root
• Avoid overdoing as the radicular bone is thin
Gradualizing the marginal
bone is done, making the
surface smooth and regular.
13. Flap Placement
and Suture
Place flap at
their original
position
Suture with
minimal tension,
just right to
coapt the flaps
and prevent
separation or
displacement of
them
Suture with
excessive
tension will
tear the flaps
Buccal and lingual flaps are approximated
with continuous sling sutures.
14. Post operative
Maintenance
Non resorbable
sutures – remove
after 1 week
Resorbable
sutures can
maintain from 1 to
3 weeks
Gently cleanse the
area from debris
using cotton pellet
soaked with saline
Excessive
granulation tissue
can be removed
with sharp curette
If tooth
restorations were
to be done, wait at
least 6 weeks after
complete healing
of the surgical
area
16. Aspects Regenerative bone therapy Resective bone therapy
Objectives • Pocket reduction
• Clinical attachment gain
• Bone fill of osseous defect
• Regeneration of new cementum, pdl
and bone,
• Establishment of healthy
environment.
• Elimination of periodontal pocket
• Creation of physiological parabolic
contour
• Create environment suitable for
restoration and prosthesis.
Indications • Two or three wall intrabony defect
• Class II furcation
• Recession defects
• One wall angular defects
• Thick, bony margins
• Shallow crater formations
Contraindications • Poor oral hygiene
• Generalised horizontal bone loss
• Multiple adjacent defects
• Close proximity of roots to antrum
• Age
• Systemic health
17. Aspects Regenerative bone therapy Resective bone therapy
Techniques • Non graft associated new
attachment technique.
• Graft associated new
attachment technique.
• Combination of both
• Vertical grooving
• Radicular blending
• Flattening of
interproximal bone
• Gradualizing marginal
bone
Diagnosis • Histological method
• Radiograph method
• Clinical method
• Surgical re-entry method
• Clinical probing
• Radiographs
• Transgingival probing
18. Conclusions
1. The focus of
periodontal surgery
has shifted over time
from a philosophy
based on resection to
one based on
regeneration.
2. This shift has
particular significance
in cases of advanced
periodontitis in the
anterior maxilla, which
may be associated with
an unaesthetic smile.
3. When severe attachment
loss is present,
comprehensive cosmetic
reconstruction cannot take
place until the periodontitis
has been treated and the
ongoing loss of attachment
has been arrested.
4. In the past, resective
surgical techniques did not
adequately address aesthetic
concerns, whereas surgical
periodontal techniques
directed toward regeneration
have as their ideal outcome the
restoration of lost periodontal
tissues.
5. Currently, the
focus of treatment
of severe
periodontitis is
regenerative in
nature.
19. Conclusions
5. Currently, the focus
of treatment of severe
periodontitis is
regenerative in
nature.
6. As regenerative
therapy for periodontal
disease has evolved,
various treatment
modalities have been
developed.
7. Bone grafts, root surface
demineralization, and
guided tissue regeneration
have all been used with
varying degrees of success
to regenerate lost attachment
in deep intrabony defects.
8. Histologic observations and
controlled clinical trials have
demonstrated that some of the
available regenerative
procedures may result in
healing that can be termed
“periodontal regeneration.”
9. Accompanying this shift
in philosophy has been a
change in scientific
emphasis from clinical
observation to histologic
understanding of tissue
formation
20. Conclusions
9. Although
regenerative surgery
is more preferable
nowadays, it still has
to be improved more
in terms of behavioral
risk factors
10. Accompanying this
shift in philosophy has
been a change in
scientific emphasis
from clinical
observation to
histologic
understanding of tissue
formation
