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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)
(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.
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
http://books.google.com/books?id=EAx7TrNa45cC&printsec=frontcover&dq=review+of+clinic
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
se

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
http://books.google.com/books?id=WM67jyzXrAUC&printsec=frontcover#v=onepage&q&f=fal
se

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

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Perio Project Osseous Resective Surgery

  • 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 http://books.google.com/books?id=EAx7TrNa45cC&printsec=frontcover&dq=review+of+clinic 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 se 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 http://books.google.com/books?id=WM67jyzXrAUC&printsec=frontcover#v=onepage&q&f=fal se 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