Resective osseous surgery involves removing tooth-supporting alveolar bone to reshape it and eliminate periodontal pockets. It is indicated for inconsistent bone margins, reverse bone architecture, one-wall defects, and other bone irregularities. The surgery involves using burs and chisels to perform vertical grooving of thick bone, blending any bone ledges on tooth roots, flattening interproximal bone in narrow areas, and gradualizing marginal bone. Flaps are closed to cover the new bony margins. Post-operative maintenance like cleaning and antibiotics is needed to allow healing over 2-3 weeks.

1. RESECTIVE OSSEOUS
SURGERY

2. Definition
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 exostosis and tooth
supraeruption.

3. Additive or regenerative osseous surgery includes procedures directed at
restoring the alveolar bone to its original level.
Resective or 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

4. Normal Alveolar Bone morphology
1. The interproximal bone is more coronal in
position than the labial or lingual/palatal
bone.
2. The form of the interdental bone is a
function of the tooth form and the
embrasure width and pyramidal in form.
3. The position of the bony margin mimics
the contours of the cementoenamel
junction.

5. Terminologies
 Osteoplasty refers to reshaping the bone without removing tooth-supporting
bone.
 Ostectomy, or osteoectomy, includes the removal of tooth-supporting bone.
 Positive architecture - if the radicular bone is apical to the interdental bone
 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.

6. Positive architecture
Negative architecture
Flat architecture

7. Resective Osseous Surgery - Indications
1. Inconsistent bone margins
2. Reverse architecture
3. One wall defects
4. Buttressing bone formation
5. Ledges and plateau
6. Shallow craters
7. Furcation defects
8. Crown lengthening for restorative dentistry

8. Contra-indications
1. Extensive bone loss
2. High caries activity
3. Existing mobility
4. Esthetic zones

9. Advantages
1. Predictability
2. Complete elimination of periodontal pockets
3. Obtaining ideal bone form

10. Disadvantages
1. Loss of valuable supporting bone
2. Gingival recession and its sequelae
3. Often lengthy unpleasant post surgical recovery
4. Postsurgical mobility

11. Factors in selection of Resective Osseous
surgery
1. Depth and configuration of bony lesion to root morphology and the adjacent teeth.
2. Amount of bone that requires removal
3. The extent of attachment loss
4. The number of remaining walls of bony defect
5. The amount of soft tissue present interproximally.

12. Examination and treatment planning
The following factors should be assessed.
1. The type of bone loss and its configuration by sounding or transgingival
probing under local anesthesia.
2. Evaluation of the esthetics
3. Restorative/prosthodontic considerations
4. Prognosis of the overall dentition
5. The type of periodontitis
6. Response to phase 1 therapy.

13. Instrumentation
BURS
RONGEURS/ NIPPERS
CHISELS

14. Steps in Resective Osseous Surgery
1. Vertical grooving
2. Radicular blending
3. Flattening interproximal bone
4. Gradualizing marginal bone.

15. 1. Vertical grooving
 It is indicated to reduce the thickness of alveolar bone
housing and it provides continuity from the interproximal
surface into the radicular surface.
 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.

16. It is designed to:
1)Reduce the thickness of the alveolar housing.
2)Provide relative prominence to the radicular aspect of the teeth.
3)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.

17. 2. Radicular blending
 The second step of the osseous reshaping technique, is an
extension of vertical grooving.
 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.

18. Indications:
Thick ledges of bone on the radicular surface.
Contraindications:
Minor vertical grooving or thin, fenestrated radicular bone
Both vertical grooving and radicular blending may be used for treatment of:
1)Shallow crater formation.
2)Thick osseous ledges of bone in radicular surface.
3)Class I and early class II furcation involvement.

19. 3. Flattening interproximal bone
It requires removal of very small amounts of supporting
bone
Indications:
One-wall defect or hemiseptal defects,
Combined defects.
Limitations :
Cannot be utilized in advanced defects where removal of
inordinate amounts of bone may be required.

20. 4. Gradualizing marginal bone
Final step in osseous resective surgery, is also an Ostectomy
procedure
Bone removal is minimal but necessary to provide a sound
regular base for the gingival tissue to follow.
Failure to do so may result in ‘window’s peaks’ , allows the
tissues to rise to a higher level than the base of the bone loss
in the interdental areas.
This may result in selective recession and incomplete
pocket reduction

21. Flap placement and closure
Flaps may be replaced to their original position, to cover the new bony margin, or
they may be apically positioned.
Positioning the flap to cover the new margin minimizes postoperative
complications and results in optimal postsurgical pocket depths
The sutures should be placed with minimal tension to coapt the flaps, prevent their
separation, and maintain the position of the flaps.

22. Post-operative maintainace
After suture removal the surgical site is examined carefully, and any
excessive granulation tissue is removed with a sharp curette.
Post-operative instructions to maintain oral hygiene.
Prescribe Supersoft tooth brushes with chlorhexidine mouthrinse .

23. Healing
Healing should proceed uneventfully, with the attachment of the flap to the
underlying bone completed in 14 to 21 days.
Maturation and remodeling can continue for up to 6 months.
It is usually advisable to wait at least 6 weeks after completion of healing of the
last surgical area before beginning dental restorations.

24. Thank you