OSS RES SURGERY1

8/3/2019 OSS RES SURGERY1

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WISHING YOU ALL A VERY GOOD

MORNING


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Vertical bore loss

Horizontal bone loss results

in a relative thickening ofmarginal alveolar bone

Combination


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RESECTIVEOSSEOUSSURGERY

BY-ANISHA MANDAVIA

BDS IV YR


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DEFINITION-

Osseous surgery may be defined as theprocedure 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


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TYPES-

Resective (subtractive):

Procedure directed to restore the form of

preexisting alveolar bone to the level

existing at the time of surgery or slightly

more apical to this level.

Reconstructive (additive):Procedures directed at restoring the

alveolar bone to its original level.


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SELECTION OF TREATMENT TECHNIQUES

-

Morphology of osseous defects will

determine the treatment technique:

Three-walldefect

boneregeneration

Two-walldefect

bothregeneration

andresection

One-walldefect

resection

Interdentalcrater

resection


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RATIONALE-

The goal of osseous resective surgery is reshaping of themarginal bone to resemble the alveolar process undamaged byperiodontal disease.

The technique is performed in combination with apicalydisplaced flap, and the procedure eliminates periodontalpocket depth and improve the tissue contour to provide amore easily maintainable environment.

It is proposed that the conversion of the periodontal pocket toa shallow gingival sulcus enhances the patients ability toremove plaque and oral debris from the dentition.


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NORMAL ALVEOLAR BONE MORPHOLOGY-

The interproximal bone is more coronal inposition than labial or lingual/ palatal bone and

pyramidal in form.

The form of interdental bone is a function ofthe tooth form and the embrasure width.

More tapered toothmore pyramidal bony form.

Wider embrasuremore flattened interdental bone

mesiodistally and buccolingually.

The position of the bony margin mimics the

contours of the cementoenamel junction.


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Terminology-

Morphologic Bone Forms :

Ideal osseous form:

The bone consistently more coronal on the interproximal surfaces

than on the facial and lingual surfaces. Similar interdental height,

with gradual, curved slops between interdental peaks.

Flat architecture:

The interdental bone at the same level with radicular bone.

Positive architecture:

The interdental bone at the level coronal to radicular bone.

Negative architecture:

The interdental bone at the level apical to radicular bone.


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Osteoplasty: bone removal to get physiologiccontour of the bone itself and gingiva overlyingit. The bone removal is not part of the attachment

apparatus.OR

Reshaping of bone without removing the supportingbone.

Ostectomy: the bone removed to getphysiologic contour is part of the attachment

apparatus of one or more teeth. The amount ofbone to be removed is an important criterion forits use.OR

Reshaping of bone with removal of supporting bone.


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PROCEDURE-

Soft tissue palpation.Radiographic examination.

Provide information about the interproximal bone loss,the presence of angular bone loss.

It does not identify the presence of periodontitis, notaccurately document the extent of bony defect or thenumber of bony walls remains.

It can indicate the presence of intrabony pocket when:

Angular bone loss.

Irregular bone loss.

Pocket of irregular depth in adjacent areas of the same toothor adjacent teeth are found.


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ProbingIt reveals the presence of:

Pocket depth greater than that of normal gingival sulcus.

The location of the base of pocket relative to the mucogingival

junction and attachment level on adjacent teeth.

The number of bony walls.

The presence of furcation defects.

Trans-gingival probing (sounding):Under local anesthesia confirms the extent and configuration

of the intrabony component of the pocket or furcation

defects.

The probe walks along the tissue-tooth interface to feel thebony topography.

The probe may pass horizontally through the tissue to provide

three-dimensional information regarding bony contours.


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Apically displaced flap.

Osseous resection.


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Osseous resection technique-


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INSTRUMENTS-

Rongeurs

Carbide burs

Diamonds burs

Interproximal files (Schlugar and Sugarman)

Back action chisel

Ochsenbein chisel


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Bone - Rongeurs


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Carbide burs


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Diamonds burs


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TECHNIQUE-


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Resective Osseous Surgery-Steps

Vertical Grooving

Radicular Blending &Flattening

Gradualizing MarginalBone


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1. Vertical grooving (osteoplasty):

It is the first step because it can define the general thickness andsubsequent form of alveolar housing.

It is usually done by rotatory instruments as carbide or diamond burs.

it is designed to:Reduce the thickness of the alveolar housing.

Provide relative prominence to the radicular aspect of the teeth.

Provide continuity from interproximal surface onto the radicular surface.

Indications:

Thick, bony margins, shallow crater formations.

Areas require maximal osteoplasty and minimal osteoctomy.

Contraindication:

Areas with close root proximity or thin alveolar housing.


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2. Radicular blending (osteoplasty):

It is an attempt to gradualize the bone over the entire radicular surfaceto provide the best results from vertical grooving.

It provides smooth, blended surface for good flap adaptation.

Indications:

Thick ledges of bone on the radicular surface.

Contraindication:

Minor vertical grooving or thin, fenestrated radicular bone.

Both vertical grooving and radicular blending may be used fortreatment of:

Shallow crater formation.

Thick osseous ledges of bone in radicular surface.

Class I and early class II furcation involvement.


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3. Flattening Interproximal bone (osteoctomy):

Removal of very small amount of supportingbone.

Indications:

Interproximal bone varies horizontally.

One-walled interproximal defect.


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4. Gradualizing marginal bone (osteoctomy):

Minimal bone removal to provide a sound,regular base for gingival tissue to follow.

Failure to remove the widow peak (Peaks of

bone remain at the facial, lingual/ palatal lineangles of the teeth) allows the tissue to rise to

higher level than the base of the bone loss in

the interdental area.Hand instruments as chisel and curette are

favorable over rotatory instruments.


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Specific osseous reshaping situation


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Correction of one walled hemiseptal defect:

The bone should reduce to the level of the most apicalportion of the defect.

It required removal of some bone on the side withgreatest coronal bony height. This result in significantreduction in attachment on relatively unaffected adjacent

teeth to eliminate the defect.If the tooth has one wall defect on both its mesial anddistal surfaces, the severely affected tooth may beextruded by orthodontics during disease control tominimize the need for resection of bone from theadjacent teeth.

If one walled defect occurs next to edentulous area, theedentulous ridge is reduced to the level of the osseousdefect.


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Exostoses, Malpositioned or Supraerupted tooth-

Osteoplasty to eliminate the exostoses orreduce the buccal/ lingual bulk of bone.

It is common to incorporate adegree of vertical

grooving during reduction of the bony ledges,since it facilitate the process of blending the

redicular bone into interproximal areas.

Previous 4 steps.


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Exostoses Surgical Planning


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In the absence of ledges or exostoses-

Reduction of interdental walls of craters and theone-walled component of angular defects andwells, and grooving into sites of early involvement.

The walls of the crater may be reduced at the

expense of the buccal, lingual or both walls.The reduction should be made to remove the leastamount of alveolar bone required to produce asatisfactory form, prevent furcation and blend thecontour with adjacent tooth.

The selective reduction of bony defects by rampingthe bone to the palatal or lingual to avoidinvolvement of the furcations.


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Preoperative view of themaxillary left buccal.

Post-operative view ofthemaxillary left buccal.


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Preoperative view of themaxillary left palatal.

Post-operative view ofthemaxillary left palatal.


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Preoperative view of themandibular right buccal

Post-operative view of themandibular right buccal


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Preoperative view of themandibular right lingual

Post-operative view of themandibular right lingual


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THANK YOU AND HAVE A NICE DAY !!!

OSS RES SURGERY1

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