Osseous resective surgery involves recontouring bone through ostectomy or osteoplasty to establish a healthier periodontal pocket depth. The goal is to create a shallower pocket that is easier to maintain. Indications for osseous resection include shallow infrabony defects, one-walled angular defects, and furcation involvement. Contraindications are deep isolated defects and advanced periodontitis. The surgery involves raising a mucoperiosteal flap and reshaping the bone using burs and chisels, then suturing the flap.
1. Osseous Resective Surgeries: Ostectomy and Osteoplasty
Chapter 13:
Osseous resective surgery is one method of treatment that may be implemented to repair
an osseous defect. The goal of this surgery is to reestablish a healthy periodontal pocket depth
through recontouring of the bone. An ideal periodontal pocket after this surgery is one that has a
shallower depth, allowing the patient and clinician to maintain the pocket depth more effectively.
The surgeon must take into account, however, the extent of the defect. (Vernino, Gray &
Hughes, 2008) According to Vernino, Gray, and Hughes, “the indications for definitive osseous
resective surgery are limited to incipient or moderate osseous defects...”. A conservative
approach must be taken in order to leave enough bone to support the teeth. There are two
categories of osseous resective surgery: ostectomy and osteoplasty. Osteoplasty is the removal
of non-tooth supporting bone. Ostectomy is the removal of bone that supports the tooth (it
contains periodontal ligament fibers). (Perry & Beemsterboer, 2007)
There are two types of pocket destruction. A suprabony pocket is one that the base of the
pocket is coronal to the alveolar crest. This is seen in horizontal bone destruction. An infrabony
pocket is one that is apical to the alveolar crest– it results in vertical or angular destruction of the
bone. Infrabony (angular) pockets are categorized by the number of bone supporting walls
present: one-walled (hemiseptal), two-walled, and three-walled (intrabony). (Reddy, 2008) A
three-walled (intrabony) defect has the most bone support and the one-walled has the least.
Indications for osseous resection include: shallow infrabony defects (1-2mm), one-walled
angular defects, furcation involvement, thick bony margins, flat or reverse architecture, tori,
exostoses and ledges, and use in conjunction with root resection surgery. (Reddy, 2008)
(Vernino, Gray, & Hughes, 2008)
Contraindications of osseous resection include: isolated deep defects where too much
tooth-supporting bone will be lost, such as a three-walled osseous defect, advanced periodontitis,
patients at a high risk for caries or those with extreme root sensitivity (osseous resection exposes
the root surface), patients with improper oral hygiene, systemic conditions, and unacceptable
esthetic results (i.e. anterior region). ( Reddy, 2008) (Vernino, Gray & Hughes, 2008)
The mucoperiosteal tissue is flapped using a para-marginal or sub-marginal incision.
Additional releasing incisions may be used to add visibility. Interdental defects or crests may be
completely flattened or recontoured using a palatal/lingual approach. The bone is reshaped using
a round bur and finished with bone files. Residual bone left at the line angles of the teeth, called
widow’s peaks, are removed with hand chisels. Next the flap is repositioned and sutured using a
vertical or horizontal periosteal mattress suture. An interrupted or continuous technique may be
used. A periodontal dressing may or may not be placed. (Dibart & Dietrich, 2010)
2. (Reddy, 2008) A one-wall defect; this wall has (Reddy, 2008) A two-walled defect
the least amount of tooth-supporting
bone remaining
(Reddy, 2008) A three-walled defect has (Narayanaswamy, 2007)
the most bone support remaining
(Kenney, 1998)
Osteoplasty: Removal of non-supportive bone; one example seen above is removal of exostoses
(Levine &
Filippelli, 1999) Osteoplasty in conjunction with ostectomy– removal of tooth-supporting bone.
Note that the recontouring of the bone follows the outline of the CEJ, creating a scalloped shape.
3. Dibart, S., & Dietrich, T. (2010). Periodontal osseous resective surgery. Practical periodontal
diagnosis and treatment planning (pp. 77-87). Iowa: Blackwell Publishing. Retrieved from
http://books.google.com.gt/books?id=h6akidbw7h8C&printsec=frontcover#v=onepage&q&f=fal
se
Kenney, B. E. (1998). UCLA periodontics information center: Flap surgery. Retrieved from
http://www.dent.ucla.edu/pic/index-3.html
Levine, D. F., & Filippelli, G. (1999). A review of osseous resective surgery. Retrieved from
Journal of the California Dental Association website:
http://www.cda.org/library/cda_member/pubs/journal/jour299/osseous.html
Narayanaswamy, K. K. (2007). Review of clinical periodontology (pp. 68). New Dehli: Jaypee
Brothers Medical Publishers. Retrieved from
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al+periodontology&hl=en&ei=BtW6TuLPAeLv0gHGpeTeCQ&sa=X&oi=book_result&ct=resu
lt&resnum=1&ved=0CDYQ6AEwAA#v=onepage&q&f=false
Perry, D. A., & Beemsterboer, P. L. (2007). Chapter 13: Periodontal surgery. Periodontology for
the dental hygienist (p. 301). Missouri: Saunders.
Reddy, S. (2008). Osseous surgery. Essentials of clinical periodontology and periodontics
(pp.330-333). Missouri: Jaypee Brothers Medical Publishers. Retrieved from
http://books.google.com/books?id=WM67jyzXrAUC&printsec=frontcover#v=onepage&q&f=fal
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Reddy, S. (2008). Bone loss and patterns of bone destruction. Essentials of clinical
periodontology and periodontics (pp. 200, 205-206). Missouri: Jaypee Brothers Medical
Publishers. Retrieved from
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Vernino, A. R., Gray, J., & Hughes, E. (2008). The periodontic syllabus (pp. 189-193).
Maryland: Lippincott, Williams & Wilkins. Retrieved from
http://books.google.com/books?id=WDGZTitJoqYC&printsec=frontcover