Indications, contraindications, steps in resectvie osseous surgery, terminologies, osteotomy, osteotomy....what is ideal, positive and negative architecture, what is additive and what is resectvie osseous surgery

1. Resective Osseous Surgery
By
Dr. A.J.Ashmi
Department of Periodontology
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DEPARTMENT OF PERIODONTOLGY

2. Additive osseous surgery
Includes procedures directed
at restoring the alveolar
bone to its original level.
Osseous Surgery
Subtractive osseous surgery
Designed to restore the form of
preexisting alveolar bone to the
level existing at the time of
surgery or slightly more apical
to this level.
Ideal results of Periodontal
Therapy
When not Feasible
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DEPARTMENT OF PERIODONTOLGY

3. Osseous Surgery
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DEPARTMENT OF PERIODONTOLGY
Ostectomy or Osteoectomy Osteoplasty
Includes the removal of tooth-
supporting bone
Refers to reshaping the bone without
removing tooth-supporting bone.
Although reducing the volume of bone ,
does not involve removal of any bony
attachment from the tooth

4. Surgical elimination of the pocket with resultant minimal probing depths
allows the patient access for proper plaque control and facilitates
maintenance by the therapist..
Basis of Osseous Resective Surgery
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DEPARTMENT OF PERIODONTOLGY

5. World Workshop in Periodontics
 Buccal or lingual bony ledges,
tori, etc.;
 Intrabony defects associated with
tilted molars;
 Shallow buccal or lingual
intrabony defects;
 The elimination of deep
interproximal defects to achieve
physiological contour;
 Incipient furcation involvements;
and
 For improvement of alveolar
contours for flap adaptation
Indications
Carranza and Carranza
• To recontour bone that
forms part of the outer wall
of the pocket,
• To prevent recurrence of
the pocket, and
• To reshape the alveolar
crest, establishing a normal
fiber arrangement.
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DEPARTMENT OF PERIODONTOLGY

6.  Shallow intrabony defects around a tooth with sufficient
periodontal support
 Existence of non supporting bone that could affect a
periodontal pocket or hinders flap adaptation
- Thick alveolar bone margin
- Shelf like bone
- Bony protruberance
- Exostosis
- Interdental craters
-Thick alveolar bones around the intrabony defect
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DEPARTMENT OF PERIODONTOLGY

7.  Class I and Class II furcation involvement
• Residual osseous defect after regenerative therapy
• Irregularity of bone morphology related to hemisection or root amputation
• Clinical crown lengthening for restorative/ prosthetic treatment
• Deep caries or crown fracture extending subgingivally
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DEPARTMENT OF PERIODONTOLGY

8. Deep osseous craters,
Three-wall osseous defects,
Moderate to deep circumferential defects,
Bony defects situated on the buccal aspect of terminal mandibular molars
associated with the external oblique ridge.
Remember that osseous surgery is best-suited to treating early and moderate
periodontal defects
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DEPARTMENT OF PERIODONTOLGY

9.  The more walls that compose the defect the more likely the defect is contraindicated for osseous
surgery.
 Operating in the aesthetic zone.
 Removal of supporting bone during ostectomy will unduly compromise the attachment of teeth at
the edge of the operative field.
 Where a risk of root caries is considered high.
 Cases where patients have experienced problems controlling root hypersensitivity.
 General contraindications for surgery.
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DEPARTMENT OF PERIODONTOLGY

10. Supporting Alveolar Bone
Bone that is directly involved in tooth support where the principal fibers of the
periodontal ligament attach.
Non Supporting Bone
Bone not directly related to tooth support
Bony exostoses,
Edentulous ridges,
Tori,
Flattened interdental contours
Ledges
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DEPARTMENT OF PERIODONTOLGY

11. Positive Architecture
Flat Architecture
Negative Architecture
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DEPARTMENT OF PERIODONTOLGY
https://quizlet.com/525895401/5a-resective-
osseous-surgery-crown-lengthening-flash-cards/

12. Vertical Grooving
Radicular Blending
Flattening Interproximal Bone
Gradualising marginal bone
Not all steps necessary…
Sequencing
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DEPARTMENT OF PERIODONTOLGY

13.  Reducing Thickness of Alveolar Housing
 Defines general thickness and subsequent form of the
alveolar bone.
Vertical Grooving
•Advantages
–More apparent with thick, bony margins,
shallow craters
–An Osteoplastic procedure
•Contrandications: Close root proximity, thin bony
plates
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DEPARTMENT OF PERIODONTOLGY

14.  Extension of VG………for good flap
adaptation
 Similar indications as that of VG
 Not necessary if VG is minor or alveolar
housing is thin
 VG and RB are purely osteoplastic
 Shallow craters
 Thick osseous ledges on radicular surfaces
 Class I & Easy class II furcation invasion
Radicular Blending
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DEPARTMENT OF PERIODONTOLGY

15.  Indicated when interproximal bone levels vary
horizontally
 One walled interproximal or hemiseptal
 Best suited for defects that have coronally placed one
walled edge of a three walled angular defect.
 Also advantageous in
 Obtaning good flap closure & Improved healing in
3 walled defect.
 Limitation :Advanced lesions
Flattening Interproximal Bone
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DEPARTMENT OF PERIODONTOLGY

16.  Ostectomy procedure
 Necessary bone removal for sound
regular bony base for the gingival tissue
to follow.
 Careful not to produce gooves or nicks
on the root surface
 Especially when radicular bone is thin –
chances of overdoing
 Hand Instruments – Chisels, Curettes
Gradualising Marginal Bone
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DEPARTMENT OF PERIODONTOLGY

17.  Using strict guidelines and protocols it demonstrated that when properly used; osseous
surgery can eliminate and modify defects. Osseous resective surgery has been and remains
one of the principal periodontal treatment modalities because of its proven clinical success.
Conclusion
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18.  Carranza’s clinical periodontology 13th edition
 Carnevale G, Kaldahl WB. Osseous resective surgery. Periodontol 2000. 2000 Feb;22:59-
87.
 Meghil MM, Timothius CJ, Miller EC, Ghaly M. Osseous surgery: Traditional vs fiber
retention resective surgery. Dentistry Review. 2022 May 21:100050.
Reference
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19. Thank you
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