Osseous surgery

osseous resective surgery in periodontics by Dr.Suhani Goel

1. DR.SUHANI GOEL

2. 1.INTRODUCTION- NORMAL BONE
2.BONE LOSS IN PERIODONTAL DISEASE
3.PATHWAYS OF SPREAD OF INFLAMMATION
4. CLASSIFICATION OF OSSEOUS DEFECTS
5.TYPES OF RESECTIVE OSSEOUS SURGERIES
6.RATIONALE OF RESECTIVE OSSEOUS SURGERIES.
7.ADVANTAGES & DISADVANTAGES
8.INSTRUMENTS
9.STEPS OF RESECTIVE OSSEOUS SURGERY.
10.CONCLUSION
CONTENTS

3. The interproximal bone is more coronal in position than the labial or
lingual/palatal bone and pyramidal in form.
The form of the interdental bone is a function of the tooth form and the
embrasure width.
The position of the bony margin mimics the contours of the CEJ.this
scalloping is related to tooth and root form, as well as tooth position, within
the alveolus.
CHARACTERISTICS OF NORMAL BONE

4. BONY ARCHITECTURE
www.wikipedia.com

5. Alveolar bone is most dynamic and most unstable tissue of
the periodontium,which is constantly undergoing
remodelling..
Physiologic liability is maintained by a balance between
bone formation & resorption.

6. Chronic inflammation is the most common cause of bone
destruction in periodontal disease, as it results in extension of
inflammatory process to bone.
Extension of inflammatory process from marginal gingiva
into supporting periodontal tissue marks the transition from
gingivitis to periodontitis .
Extension of inflammation to supporting structures may be
modified by pathogenic potential of plaque or by resistance
of the host.
BONE LOSS IN PERIODONTAL DISEASE

7. Pathways of spread of inflammation to bone
Carranza’s clinical perodontology 10
th
edition

8. Periods of destruction:
Periodontal disease occurs in an episodic pattern with periods of
activity and periods of in activity.
Periods of destruction are characterized by loss of collagen of
alveolar bone with deepening of pocket.
Bone destruction caused by trauma from occlusion:
This may occur in the presence or absence of inflammation.
Periodontal disease alters the morphologic features of bone in
addition to reducing the bone height. An understanding of nature and
pathogenesis of these alterations is essential for effective diagnosis
and treatment.

9. Pathological
Non-pathological – Exostosis
Fenestrations
Dehiscence
Excessive tuberosity

CLASSIFICATION OF OSSEOUS DEFECTS

10. Fenestrations and dehiscence's :
Isolated areas in which the root is denuded of
bone and root surface is covered by periosteum
and overlying gingiva are termed fenestration where
the marginal bone intact .
When the denuded areas extend through marginal
bone the defect is called dehiscence's.

11. Goldman and Cohen classification (1958)
Osseous defects
Suprabony defects
Infrabony defects
a)intrabony defects
1 wall
2 wall
3 wall
combinations
b)craters,ledges,butressing bone formation
Interradicular defects

12. Horizontal classification (based on furcation
involvement) (Glickman1953)
Grade 1
Grade 2
Grade 3
Grade 4
Vertical classification
(Tarnow & Fletcher)
subclass A
subclass B
subclass C

13. Types of osseous defects

16. Circumferential defect ( moat)

17. Combined defect

18. Horizontal classification (Hamp’s 1975)
Class I Class II Class III

19. Vertical classification
Subclass A
Subclass B Subclass C

20. OSSEOUS SURGERY : may be defined as the procedure by
which changes in the alveolar bone can be accomplished
to rid of deformities induced by the periodontal disease
process or other related factors, such as exostosis & tooth
supraeruption.

21. ADDITIVE OSSEOUS SURGERY: includes procedures
directed at restoring the alveolar bone to its original level.
SUBTRACTIVE OSSEOUS SURGERY: is 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.
TYPES OF OSSEOUS SURGERY

22. •Most predictable pocket reduction technique.
•The major rationale for osseous resective surgery is
centered to the view that discrepancies in level and
shapes of the bone and gingiva predispose patients to
the recurrence of pocket postsurgically.
•Reshape the marginal bone to resemble that of the
alveolar process undamaged by periodontal disease.
•Promote periodontal maintenance.
RATIONALE FOR OSSEOUS SURGERY

23. Indications:
1. Shallow intrabony defect around a tooth with sufficient
periodontal support
2. Existence of nonsupporting bone that could affect a
periodontal pocket or that hinders close adaptation of flap
like shelflke bone, bony protuberance,exostosis,crater &
thick alveolar bone around the intrabony defect.
RESECTIVE OSSEOUS SURGERY

24. 3.Class I & II furcation involvement
4. Residual osseous defect remaining after regenerative
procedures.
5. Clinical crown requires lengthening before
restorative/prosthetic treatment.
6. Deep caries or crown fracture extending subgingivally or to
the alveolar bone.

25. ESTHETIC AREA
Hall’s Critical decision making in periodontology 2ndedition

26. Contraindications for osseous resection
1.A periodontal pocket of more than 8mm exists after
initial therapy.
2.The bottom of the osseous defect extends apically
against multiple-tooth root trunks.
3.The osseous defect is more than one half of the root
length from CEJ.
4.Advanced tooth mobility.
5.Position of the external oblique line is very close to the
osseous defect or root proximity.

27. •Reliable
•Short-term (8-12 weeks)
•Obtain gingival-alveolar bone morphology that
facilitates easy maintenance.
ADVANTAGES OF RESECTIVE
PROCEDURES

28. •Attachment loss
•Root exposure, compromising esthetics
•Hypersensitivity
•Root surface caries
•Possibility of phonetic impediment.
DISADVANTAGES OF RESECTIVE
PROCEDURES

29. OSTEOPLASTY: reshaping of the alveolar process to achieve
a more physiologic form without the removal of supporting bone.
OSTECTOMY: the removal of some alveolar bone, thus
changing the position of crestal bone on the root. It is done to
reshape deformities caused by periodontitis in the marginal &
interalveolar bone.

30. INSTRUMENTS
Burs
Chisels
Wikipedia.com

31. Steps:
1.Vertical grooving
2.Radicular blending
3.Flattening
interproximal bone
4.Gradualizing
marginal bone.
TECHNIQUE
www.periobasics.com last assessed on 5 sept,2018

32. VERTICAL GROOVING
Cohen’s Atlas of cosmetic and reconstructive periodontal surgery 2
nd
edition

34. Steps in Resective osseous surgery
Schluger,Yuodelis,Page and Johnsons’ PERIODONTAL DISEASES 2
nd
edition

35. Osteoplasty

36. Osteoplasty

38. Osteoplasty

39. Ostectomy
Removal of radicular bone

40. Osteoplasty

41. Thickened bony contours

42. Osteoplasty

44. RAMPING
Carranza’s clinical perodontology 10
th
edition

45. MANAGEMENT OF CRATERS
Carranza’s clinical perodontology 10
th
edition

46. HEALING AFTER OSSEOUS
SURGERY
Caffese et al 1968

47. Recession
-Becker et al; 1988: 0.95-2.77mm after 1 yr
-Kaldahl et al 1988: 1.72 mm /yr
Probing Depth
- Bragger et al – 1.23 mm
SOFT TISSUE RESPONSE

48. •Selipsky 1976- o.6 mm
•Aeschlimann 1979 – 0.22 mm
•Moghadas & Stahl 1980- Avg. 0.06-0.22
mm
•Carnevale et al 1994 - 0.62-1.04 mm
AMOUNT OF BONE LOSS DURING
RESECTIVE OSSEOUS SURGERY

49. CONCLUSION
The results from osseous resective surgery are technique sensitive .
It has limited use in treating cases with very deep intrabony or
hemiseptal defects, which should be treated with a different surgical
approach.
If osseous resective surgery is used in advanced lesions, a
compromise in the amount of probing depth reduvction should be
expected.