The document discusses resective osseous surgery, its historical background, various techniques, terminology, indications, and contraindications. It emphasizes the importance of reshaping alveolar bone to alleviate periodontal deformities and achieve physiological gingival contours. The conclusion highlights that while not applicable to all bony abnormalities, effective osseous surgery can significantly modify dental defects and improve long-term oral hygiene maintenance.

1. Resective
Osseous
Surgery
Presented by:
Dr Divjot
Guided by: Dr
Kumar Saurav
Singh

2. CONTENTS:
 INTRODUCTION
 HISTORY
 TERMINOLOGY
 FACTORS IN SELECTION OF TYPE OF ROS
 EXAMINATION
 METHODS
 TECHNIQUES
 CONCLUSION
 REFERENCES

3. HISTORY:
 Schluger(1949)- “osseous resection”- A Basic Principle in
periodontal surgery.
 Goldman(1950)- “the development of physiologic gingival
contour by gingivoplasty”
 Friedman(1955)- “ Periodontal osseous surgery”:
osteoplasty and ostectomy.

4. Introduced the importance
of bony contour during soft
tissue gingivectomies.
Surgical removal of the
gingiva and reshaping of
the bone to eliminate the
pocket and correct
unphysiological bone
architecture.

5. INTRODUCTIO
N:
 Periodontal destruction often leads to alveolar bone
destruction.
 This bone loss has been classified as “vertical” or
“horizontal”
 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.

6. TERMINOLOGI
ES
Subtractive osseous
surgery:
Designed to restore
the form of
preexisting alveolar
bone to the level at
the time of surgery or
slightly more apical
Additive osseous
surgery :
Includes procedure
directing at restoring
alveolar bone to its
original level

7. ARCHITECTUR
E
INTERDENTAL BONE
RADICULAR BONE
RADICULAR BONE
INTERDENTAL BONE
RADICULAR BONE
INTERDENTAL BONE
POSITIVE
FLAT NEGATIVE

8.  Osseous form is considered to be “ideal”
when the bone is consistently more
coronal on the interproximal surfaces
than on the facial and lingual surfaces.
 The ideal form of the marginal bone has
similar interdental height, with gradual,
curved slopes between interdental peaks

9. OSSEOUS
DEFECTS
 Is periodontal regeneration effective in a long-term maintenance of teeth with advanced
periodontitis? A case report:2007

12. HORIZONTA
L BONE
LOSS:
CLASSIFICATION BY GLICKMAN(1958)
1. GRADE I-incipient bone loss
2. GRADE II-partial bone loss(cul-de-sac)
3. GRADE III-through and through
opening
4. GRADE IV- involvement of soft tissue-
gingival recession exposing the
furcation view

13. VERTICAL
BONE
DEFECTS:
CLASSIFICATION BY TARNOW AND
FLETCHER (1984)
1. SUB-CLASS A= 0-3mm
2. SUB-CLASS B = 4-6mm
3. SUB-CLASS C = >7mm

14. 1) BONE
GRAFTS
2)GTR
OSSEOUS
SURGERY
ADDITIVE RESECTIVE
1)OSTEOPLAST
Y
2)OSTECTOMY

15. INDICATION
S:
1. pocket elimination
2. Tori reduction
3. Intrabony defects adjacent to
edentulous ridge
4. Incipient furcation involvement
5. Thick heavy ledges and exostoses
6. Shallow osseous craters
7. Small intra bony defects

16. CONTRA-
INDICATION
S:
1. Areas of insufficient remaining
attachment
2. Anatomic limitations(prominent ridge)
3. Aesthetic limitations(anteriorly, high
smile line)

17. OSTEOPLASTY:
1. It is a plastic
procedure by
which non
supporting bone
is reshaped to
achieve a
physiologic
gingival and
osseous contours.
2. Osteoplasty
includes the
techniques of
radicular blending
OSTETECTOMY:
1. It is the plastic
removal of
radicular and
interradicular
supporting bone
to eliminate
osseous
deformities
2. Done by the
technique of
spheroidng or
parabolizing

18. RATIONALE:
1) PERIOODNTAL DISEASE
2) DISCREPENCIES IN LEVEL AND
SHAPE OF BONE
3)POCKET RECURRENCE

19. EXAMINATION:
Periodontal probing and exploration
• pocket depth greater than that of a normal
gingival sulcus,
• the location of the base of the pocket
relative to the mucogingival junction and
attachment level on adjacent teeth, the
number of bony walls
• the presence of furcation defects.
• Transgingival probing, or sounding, under
local anesthesia confirms the extent and
configuration of the intrabony component
of the pocket and of furcation defects

20. Instrument
s:
Rongeurs
Interproximal
files
Ochsenbein
chisels
Friction grip
Burs

21. Sequential
steps :
Vertical grooving
Radicular blending
Flattening interproximal
bone
Gradualizing marginal bone

22. Vertical
Grooving:
1)reduce the thickness of the
alveolar housing
2)relative prominence to the
radicular aspects of the teeth
3)provides continuity from the
interproximal surface onto the
radicular surface.

23. Vertical grooves
Instruments: Round carbide or
diamond burs
Indications: bony margins,
shallow crater formations with
thick bony margins.
Contraindications : close roots
or thin alveolar housing

24. RADICULAR
BLENDING:
To gradualize 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

25. Radicular
blending
Indications:
1) same as vertical grooving
Contraindications:
1)vertical grooving is very minor
2) radicular bone is thin or
fenestrated

26. Flattening
interproxim
al bone:
Removal of very small
amounts of vertical bones
Used in defects that have a
coronally placed, one-walled
edge of a three-walled
angular defect
Improves flap closure and
healing in three-walled
defects

27. Flattening
interproximal
bone:
Indications:
1)one-walled interproximal defects
or hemiseptal defects.
Contraindications:
1) inter-proximal crater formations
2) flat interproximal defects

29. Gradualizin
g marginal
bone:
•Ostectomy step
•No bony discrepancies should be
left in the interdental or marginal
or interradicular area otherwise the
pocket reduction process remains
incomplete
•A widows peak should be left and
blend on the radicular root surface
area

31. The reduction should be made to remove the least
amount of alveolar bone required to
(1) produce a satisfactory form,
(2) prevent the therapeutic invasion of furcations
(3) blend the contours with the adjacent teeth.
The selective reduction of bony defects by “ramping” the
bone to the palatal or lingual to avoid involvement of the
furcations has been advocated by Ochsenbein and
Bohannan18 Tibbetts et al.

32. SPECIFIC
OSSEOUS
RESHAPING
SITUATIONS
:
Correction of one wall hemi
septal defects is by reducing the
bone level as apical as possible.
 If one-walled defects occur next
to an edentulous space, the
edentulous ridge is reduced to
the level of the osseous defect:
RAMPING
The walls of the crater may be
reduced at the expense of the
buccal, lingual, or both walls.

33. CRATERS:

36. FLAP
PLACEMENT
AND
CLOSURE:
 Repositioned to the original position or
apically

37. POST
OPERATIVE
MAINTENECE:
Nonresorbable sutures such as silk are
usually removed after 1 week of healing
Resorbable sutures maintain wound
approximation for varying periods of 1 to
3 weeks or more
After suture removal the surgical site is
examined carefully, and any excessive
granulation tissue is removed with a
sharp curette.
the surgical site is gently cleansed of
debris with a cotton pellet dampened
with saline

38. BASIC
RULES OF
OSSEOUS
SURGERY:
When properly performed, resective
osseous surgery achieves a
physiologic architecture of marginal
alveolar bone for to gingival flap
adaptation with minimal probing
depth.

39. RULE 1:
A full thickness mucoperiosteal
flap should be raised whenever
osseous resective surgery is
planned.

40. RULE 2:
1) The scalloping of the flap should
anticipate the final underlying osseous
contour, which is most prominent
anteriorly and decreases posteriorly.
2) The scalloping of the flap should reflect
the patients own healthy gingival
architecture.
3) The degree of the tissue and bone
scalloping is reduced as the
interproximal area becomes broader as
a result of bone loss.

41. RULE 3:
Osteoplasty generally
precedes ostectomy

42. RULE 4:
Osseous resective surgery
should result in a positive
architecture

43. RULE 5:
1) High speed rotatry
instruments should never be
used adjacent to the teeth.
2) Copious irrigation should be
maintained

44. RULE 6:
The final bony contours should
approximate the expected healthy
postoperative gingival form, with no
attempt to improve on it.

46.  FibReORS aims to shift the base of the intrabony defect to
a more coronal position, thus making it shallower and
more easily eliminated with minimal resection of
supporting bone.
 In addition, the apical migration of the gingival margin is
reported to be less pronounced with FibReORS as
compared with traditional ORS

47. CONCLUSIO
N
 Although osseous surgical techniques
cannot be applied to every bony
abnormality or topographic modification,
it has been clearly demonstrated that
properly used osseous surgery can
eliminate and modify defects, as well as
gradualize excessive bony ledges,
irregular alveolar bone, early furcation
involvement, excessive bony exostosis,
and circumferential defects.

48. TAKE HOME
MESSAGE:
 The goal is to establish contours that
existed naturally (physiologically), with
the assumption that this will facilitate
hygiene and long-term maintenance.

49. REFERENCES:
 Carranza 10th
edition
 Cohen 4th
edition
 Schluger S: Osseous resection: a basic
principle in periodontal surgery, Oral
Surg Oral Med Oral Pathol 2:316, 1949.
 David F. Levine & Greg Filippelli (1999) A
Review of Osseous Resective Surgery,
Journal of the California Dental
Association, 27:2, 125-132, DOI:
10.1080/19424396.2016.12221105

50. THANK
YOU!