Resective osseous surgery

It restore alveolar bone to the level existing at the time of surgery or slightly more apical to this level. Aim is to achieve positive bony architecture.
STEPS INCLUDE:
1.VERTICAL GROOVING
2. RADICULAR BLENDING
3. FLATTENING INTERPROXIMAL BONE
4. GRADUALIZING MARGINAL BONE
PREFERRED TREATMENT FOR ONE WALLED PERIODONTAL BONE DEFECTS (HEMISEPTUM)
�

1. Resective Osseous S urgery

2. Perio Files

3. C ontents Definition Historical prospective Osteoplasty, Ostectomy Rationale Indications Contra- Indications Factors affecting selection of cases Presurgical evaluation Steps of Resective Surgery Postsurgical maintainance Advantages Causes of Failure

4. What both definitions have in common ? T he goal of osseous surgery is to produce osseous contours that are consistent with the shape and form of the healthy gingival tissues as gingival contours always follow the bony contours

5. Historical prospective

6. Osteoplasty & Ostectomy (Friedman 1955) OSTEOPLASTY Refers to reshaping the bone without removing tooth supporting bone. OSTECTOMY OR OSTEOECTOMY Includes reshaping with removal of tooth supporting bone. H eight of supporting bone decreases .

7. Rationale of osseous resective surgery When there is discrepancy in level & shape of bone and gingiva that predispose to recurrence of pocket post-surgically. To create tissue contour that is easily maintainable ( i.e. create positive bony architecture and favorable post-operative gingival morphology). These surgeries are usually combined with apically positioned flap to eliminate periodontal pockets.

8. BONY MORPHOLOGY A , Positive Bony Architecture: means interdental bone is more coronal than the radicular bone. B , Flat Bony Architecture: means radicular bone is at same height as interdental bone C , Reversed Or Negative Bony Form: means radicular bone is more coronal to interdental bone Aim is to achieve positive architecture

9. Terms relating to thoroughness of osseous reshaping-

10. Indications for Resective Osseous Surgery

11. Indications for Resective Osseous Surgery

12. Indications for Resective Osseous Surgery

13. Contra-Indications for Resective Osseous Surgery

14. Contra-Indications for Resective Osseous Surgery

15. FACTORS IN SELECTION OF RESECTIVE OSSEOUS SURGERY 1. Early to moderate bone loss (2-3mm) with moderate root trunk length, and one or two walls bone defect . During ostectomy , there is approximately 0.6mm of attachment loss ( Selipsky HS; 1976). So resective surgery is not indicated in patients with advanced attachment loss. Regenerative therapy is preferred in such patients or osteoplasty can be done along with regenerative procedures to reduce bony ledges and to facilitate flap closure and to achieve proper gingival contours

16. 2. Two wall defects or craters should be treated with resection of ledges and ostectomy in facial, lingual, palatal surface and interproximal areas to obtain positive architecture. Otherwise, presence of window’s peak causes recurrence of interproximal pockets.

17. WIDOW’S PEAK- These are residual peaks of cortical bone that remain left over facial & lingual /palatal line angle (as in craters). Gingiva will heal over these peaks, but with time these bony peaks resorbs leading to pocket formation on interproximal areas. So ostectomy should be done to remove these widow peaks

18. 3. In maxillary arch, the palatal approach may be indicated as opposed to a more accessible buccal surface for esthetic reasons & for being a more conservative approach.

19. 4. If one-walled defect is present next to edentulous ridge, the ridge is reduced to the level of bone defect

20. Selection Based on Morphology of Defects One wall Angular - Osseous resection 3 Wall, Narrow & Deep - Bone Regeneration 2 Wall Angular - Depending on depth, width & c onfiguration (Osseous resection or regeneration)

21. PRE-SURGICAL EXAMINATION RADIOGRAHS – to see bone loss ( amount & pattern of bone loss). Periodontal probing- to check pocket depth & furcation involvement. TRANSGINGIVAL PROBING/ BONE SOUNDING- to check bone topography and type of bony defect But best evaluation of type of defect is done by raising the flap during surgery

22. Instruments used for resective osseous surgery Hand, Rotary, Piezoelectric surgical techniques Hand instruments - bone rongeurs , bone files and bone chisels Rotary instruments - burs & micromotor . Hand instruments are best for ostectomy procedures. Rotary instruments are good for osteoplasy .

23. STEPS IN RESECTIVE OSSEOUS SURGERY VERTICAL GROOVING RADICULAR BLENDING FLATTENING INTERPROXIMAL BONE GRADUALIZING MARGINAL BONE Not all steps are necessary in every case First 2 steps involve osteoplasty Last 2 steps involve ostectomy .

24. 1. Vertical grooving ( osteoplasty ) : “first step” Done by instruments as carbide or diamond burs. It is designed to: Reduce thickness of alveolar housing. Provide relative prominence to radicular part of the teeth. Provide smooth continuity from interproximal area onto the radicular area

25. 1. Vertical grooving ( osteoplasty ) : “first step” Indications: Thick margins of bone, shallow craters Areas that require minimal amount of osteoctomy and maximal osteoplasty   Contraindication: Areas with close root proximity or thin alveolar housing.

26. 2. Radicular blending ( osteoplasty ) : Continuity of vertical grooving Gradualize the entire bone over the radicular surface to give the best results from vertical grooving. Provides smooth surface for good flap adaptation and the best post-operative gingival contours  

27. 2. Radicular blending ( osteoplasty ) :   Indications: Presence of thick ledges of bone on radicular surface. Contraindication: T hin, fenestrated radicular bone

28. 2. Radicular blending ( osteoplasty ) :   Both vertical grooving and radicular blending may be used for treatment of: Shallow crater formation. Thick bony ledges in radicular surface. Class I and early class II furcation.

29. 3. Flattening Interproximal bone ( osteoctomy ) : V ery small amount of supporting bone is removed Indications: Coronally placed one wall edge of 3 wall angular defect One-walled interproximal defect (preferably shallow as deep defect lead to compromised osseous architecture)

30. 4. Gradualizing marginal bone ( osteoctomy ) : Minimal bone removal to provide a smooth, regular base for gingival tissue to follow. Failure to remove the widow peak’s led to recurrence of pockets Hand instruments as chisel and curette are preferred over rotary instruments to prevent excess bone loss.

31. Post Surgery maintainance

32. Advantages * Produces immediate reduction in probing depth; * Improves access for daily oral hygiene; * Preserves gingival width via apically positioned flaps; * Permits recontouring of bone anomalies (e.g., tori, ledges);

33. * Allows access for root resection and hemisection; * Permits access for correction of radicular anomalies (e.g., cervical enamel projections, enamel pearls etc.); * Facilitates recontouring of restorative overhangs

34. CAUSES OF FAILURE OF RESECTIVE OSSEOUS SURGERY   Poor post-operative plaque control. Failure to create ideal bone form.

35. Other causes can be : » Improper Flap management » Sequestration and resorption of bone following surgery. » Improper suturing » Exposure of thin bone during or after surgery. » Flap necrosis. » Post-surgical infection » Root caries or pulpal problems.

36. Thank you