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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)
