ROS is a substractive method of having positive bone architecture. it includes osteotomy and ostectomy procedures. osteotomy is to remove non supporting bone and ostectomy is to remove supporting bone for having positive bony architecture. there is definitive osseous surgery and compromise osseous surgery. transgingival probing is a method of determining osseous topography. various hand and rotary instruments are use for this procedure.

1. APPROVED BY: PRESENTED BY
DR DIVYA JAGGI DR. ANKITA DADWAL
MDS 2ND YR
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RESECTIVE OSSEOUS SURGERY

2. CONTENTS
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 Introduction
 Bone destruction patterns
 Resective osseous surgery
 Objectives
 Osteoplasty and Ostectomy
 Techniques
 Contraindications
 Advantages And Disadvantages
 conclusion
 References

3. NORMALALVEOLAR BONE
MORPHOLOGY
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4. MORPHOLOGICALLY DESCRIPTIVE
TERMS
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5. BONE DESTRUCTION PATTERNS IN
PERIODONTAL DISEASE
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 Horizontal defects
 Vertical or angular defects
 Osseous craters
 Reversed architecture
 Bony ledges
 Furcation involvements
 Exostoses
 Bulbous bone contours

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Angular defect
Exostoses
Crater
Bulbous bony contours

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 Ledge
Reverse Architecture

8. RESECTIVE OSSEOUS SURGERY
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 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. CARRAZA 10TH EDITION
 Terms :
 DEFINITIVE OSSEOUS SURGERY : establishes a positive
or normal parabolic osseous form
 COMPROMISE OSSEOUS SURGERY: indicates an osseous
topography requiring extensive osseous removal that
would be detrimental to the long-term prognosis of the
tooth

9. OBJECTIVES
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 Elimination of periodontal pocket and creation of physiological
parabolic contour.
 This contour will maintain physiologic gingival architecture.
 Regeneration of periodontal apparatus destroyed by periodontal
disease.
 Create environment suitable to restorative and prosthodontic
treatment.

10. EXAMINATION AND TREATMENT
PLANNING
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 Transgingival probing /sounding (EASLEY, 1967)
1. Osseous topography
2. Intrabony defects (one, two, or three wall
defects)
3. Furcation involvement (Class I, II, or III)
4. Root shape or form
 Radiographs are important to locate the areas of bone loss

11. TERMINOLOGY OF OSSEOUS SURGERY
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 Tissue management
 Procedures used to correct osseous defects have been classified in
two groups:
 OSTEOPLASTY: defined as a plastic procedure by which
nonsupporting bone is reshaped to achieve a physiologic gingival
and osseous contour.
 OSTECTOMY: is the plastic removal of radicular and
interradicular supporting bone to eliminate osseous deformities.
FRIEDMAN 1955

12. ARMAMENTARIUM
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 A number of rotary and hand instruments have been used for osseous
resective surgery.

13. STEPS FOR RESECTIVE OSSEOUS
SURGERY
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 VERTICAL GROOVING
 RADICULAR BLENDING
 HORIZONTAL GROOVING
 SCRIBING
 GRADUALIZING INTERPROXIMAL BONE

14. OSTEOPLASTY:
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 It is a plastic procedure by which non supporting bone is reshaped
to achieve a physiological gingival and osseous contours.
INDICATIONS
 Pocket elimination
 Tori reduction
 Intra bony defects adjacent to edentulous ridges
 Incipient furcation involvement
 Thick heavy ledges and exostoses
 Shallow osseous craters
 Small intra bony defects

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 Osteoplasty includes the techniques of grooving or festooning
(ochsenbein, 1958) and radicular blending (carranza, 1984).
 These grooves are carried to the line angles of adjacent
teeth.
 Using a round no. 6, 8 or 10 bur in a high speed
handpiece with copious amounts of water, the grooves
are cut

16. 16/34

17. 17/34

18. 18/34

19. OSTECTOMY
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It is the plastic removal of radicular and interradicular supporting
bone to eliminate osseous deformities.
INDICATIONS
 Sufficient bone remaining for establishing physiologic contours
without attachment compromise
 No esthetic or anatomic limitations
 Interdental craters
 Intrabony defects not amenable to regeneration
 Horizontal bone loss with irregular marginal bone height
 Moderate to advanced furcation involvements and hemisepta.

20. CONTRAINDICATIONS
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 Areas of insufficient remaining attachment or where ostectomy
might unfavourably alter the prognosis of the adjacent teeth
 Anatomic limitations (prominent external oblique ridge , zygomatic
arch)
 Esthetic limitations (anteriorly , high smile line)
ADVANTAGES :
 Predictable pocket elimination
 Establishment of physiologic gingival and osseous architecture
 Establishment of a favorable prosthetic environment

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 Ostectomy is done by the technique of spheroiding or
parabolizing.
 Parabolizing is the removal of supporting bone to produce a
positive gingival and osseous architecture.
 This can be achieved by:
-Horizontal grooving
-Scribing
-Hand instrumentation

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24. MANAGEMENT OF DEEP CRATERS
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25. MANAGEMENT OF EDENTULOUS
RIDGE
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26. BASIC RULES OF OSSEOUS
SURGERY
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 Rule-1 A full-thickness mucoperiosteal flap should be raised.
 Rule- 2a. The scalloping of the flap should anticipate the final
underlying osseous contour, which is more prominent anteriorly
and decreases posteriorly.
 Rule -2b. The scalloping of the flap should reflect the patient’s
own healthy gingival architecture.
 Rule-2c. The degree of tissue and bone scalloping is reduced, as
the interproximal area becomes broader as a result of bone loss.

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 Rule-3. Osteoplasty generally precedes Ostectomy
 Rule-4. Osseous resective surgery whenever possible should
result in a positive osseous architecture.
 Rule-5. High-speed rotary instrumentation should never be used
adjacent to the teeth for fear of nicking and damaging the teeth
and should always be used with a generous spray.
 Rule-6. The final bony contours should approximate the
expected healthy postoperative gingival form with no attempt to
improve upon it.

28. CONTRAINDICATIONS
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 Position of the external oblique line in the mandibular molar area and
maxillary sinus, which is very close to the osseous defect and root
proximity.
 A periodontal pocket of more than 8mm exists after initial therapy.
 The bottom of osseous defect extends apically against multiple tooth–
root trunks.
 The deep intrabony defect is more than 3-4mm or the bottom of the
osseous defect is more than one half of the root length from the cemento
enamel junction.
 Extended tooth mobility.

29. ADVANTAGES
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 Reliable
 Short term (8-12 weeks)
 Obtain gingiva-alveolar bone morphology that facilitates easy
maintenance

30. DISADVANTAGES
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 Attachment loss
 Root exposure
 Compromising esthetics
 Strong possibility of hypersensitivity
 Strong possibility of root surface caries
 Possibility of phonetic impediment

31. FLAP PLACEMENT AND CLOSURE
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 Flap may be replaced to their original level to cover the new
bony margin or they may be apically positioned.
 Replacing the flap in the areas that previously had pockets may
result initially in greater post operative pocket depth, although
a selective recession may diminish the depth over time.
 Sutures should be placed with minimal tension to coadapt the
flaps, prevent their separation and maintain the position of the
flaps

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33. CONCLUSION
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 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 reduction should be
expected.

34. REFERENCES
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 Carranza 10th edition, resective osseous surgery, pg no 950-967.
 Cohen 4th edition
 Rose and mealey, Resective osseous surgery, pg no 502-552.
 Grant, periodontal osseous resection, pg no 838.
 Prichard, Periodontal osseous surgery, pg no-437.
 Soft tissue regrowth following Fiber Retention Osseous Resective
Surgery or Osseous Resective Surgery. A multilevel analysis,
Francesco Cairo, JCP 2015.

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