RESECTIVE OSSEOUS SURGERY

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 exostoses and tooth supra
eruption
 Additive Or Subtractive ???
• Additive Osseous Surgery includes
procedures directed at estoring the
alveolar bone to it’s original level; where
as Subtractive Osseous Surgery is
designed to restore the form of pre-
existing alveolar bone to the level existing
at the time of surgery or slightly more
apical to this level.
 Additive Osseous Surgery brings about the
ideal result of periodontal therapy –
regeneration of lost bone and
reestablishment of the periodontal
ligament, gingival fibers, and the junctional
epithelium at a more coronal level.
Subtractive Osseous Surgeries are done
when the other method is not feasible
Selection Based on Morphology of Defects:
• One wall Angular > Surgical recontouring
• 3 Wall, Narrow & Deep > New Attachment &
Bone Regeneration
• 2 Wall Angular > Depending on depth,width
& Configuration
Terminology
• Osteoplasty & Ostectomy
Osteoplasty refers to reshaping the bone without removing
tooth supporting bone
Ostectomy or Osteoectomy includes the removal of tooth
supporting bone
Morphologic Bone Forms :
• Positive – If Radicular Bone Is Apical To The Interdental
Bone
• Or Negative Architecture – If ViceVersa
• Flat Architecture – Same Height
• TransGingival Probing Or
Sounding
Osseous resective surgery is the combined use
of both osteoplasty and ostectomy to re-
establish the marginal bone morphology
around the teeth to resemble ‘‘normal bone
with a positive architecture’’, albeit at a more
apical position.
By definition, ‘‘normal bone with a positive
architecture’’ means that the surface of
interdental bone is coronal to that of the facial
and lingual radicular bone. The endpoints of
osseous resective surgery are minimal
probing depths and a gingival tissue
morphology that enhances good self-
performed oral hygiene and periodontal health
 STEPS IN RESECTIVE OSSEOUS
SURGERY

• VERTICAL GROOVING
• RADICULAR BLENDING
• FLATTENING INTERPROXIMAL
BONE
• GRADUALIZING MARGINAL
BONE
Resective Osseous Surgery-Steps

Vertical Grooving

Gradualizing Marginal
Radicular Blending & Bone
Flattening
Exostoses – Surgical Planning
Osseous Contouring In Interdental Craters - I
Osseous Contouring In Interdental Craters - II
Osseous Contouring In Exostoses -
I
Osseous Contouring In Exostoses -
II
Osseous Contouring In One Wall Vertical Defect - I
Osseous Contouring In One Wall Vertical Defect – I I
Rationale, Advantages, Limitations
Resective Osseous Surgery is the most predictable pocket
reduction technique
But it is performed at the expense of bony tissue and
attachment level
So limited by the presence, quantity and shape of bony
tissues and by the amount of attachment loss that is
acceptable
The Goal of Osseous Resective Therapy is reshaping the
marginal bone to resemble the alveolar process
undamaged by periodontal disease
Done in combination with apically displaced flaps, and the
procedure eliminates pocket depth and improves tissue
contour to provide a more easily maintainable
environment.
Osteoplasty: bone removal to get
physiologic contour of the bone itself and
gingiva overlying it. The bone removal is
not part of the attachment apparatus.

Ostectomy: the bone removed to get

physiologic contour is part of the
attachment apparatus of one or more teeth.
The amount of bone to be removed is an
important criterion for its use.
Osteoplasty indications:
Osteoplasty is used to treat buccal and lingual bony
ledges or tori, shallow lingual or buccal intrabony
defects, thick interproximal areas and incipient
furcation
involvements that do not necessitate removing
supporting bone
Deep interproximal pockets on posterior teeth involving
the buccal interdental bone: the cone-shaped
interdental bone should be reinstituted by means of
grooving.
Pockets on the buccal, lingual, and palatal surfaces
where resorption of bone results in thick ledges.
Tilted lower second molar adjacent to non-replaced
extracted first molar.
Ostectomy indications:
Ostectomy isutilized to treat shallow (1–2 mm deep) to
medium (3–4 mm deep) intrabony and hemiseptal
osseous defects and correct reversals in the osseous
topography
Interproximal craters in bone: shallow and wide craters
are not favorable for reattachment while deep and
narrow are. When ostectomy is the procedure of choice
one of the spines is removed and the bone is ramped to
the other side.
Extremely deep interproximal pockets where the
neighbor areas are intact or minimally affected.
Shallow infrabony defects (interproximal), and where
reattachment has failed
Interproximal osseous ramping. A. Presurgical view with 6 mm probing depth on
mesial of first molar. B. Deep two-wall intrabony defect between the second
premolar And first molar, hemiseptal defect between the two premolars and lingual
exostosis. C. Osseous resective surgery eliminated the interproximal osseous
defects by ramping to the lingual, corrected the reversed osseous topography and
removed the osseous ledges. D. Normal scalloped gingival morphology and good
health 6 months after osseous resective surgery
Resective Periodontal Surgery Used To Correct
Gummy Smile

Pre-Surgical Photograph
Resective Periodontal Surgery Used To Correct
Gummy Smile

Pre-Surgical Photograph – IntraOral –Maxillary Anteriors with short

clinical crowns
Resective Periodontal Surgery Used To Correct
Gummy Smile

Immediate Post Surgical

Apically positioned flap sutured after osseous resective surgery
Resective Periodontal Surgery Used To Correct
Gummy Smile

Post Surgical Photograph – 1 Year

Resective Periodontal Surgery Used To Correct
Gummy Smile

Pre-Surgical Photograph Post Surgical – 1Year

 Points To Remember !!!
• Definition:

• Positive, Negative, Flat Architectures

• Transgingival Probing Or Bone Sounding
• Steps :