This article was written in order to describe a new procedure designed to overcome some of the problems presented by the gingivectomy technique.
When gingivectomies are performed, unsupported soft tissue is removed, but no attention is paid to the bony outline of the pockets. As a consequence, it is common to observe soft tissue growth creating some area areas of depth after these operations specially in interdental areas. According to the author, it is due to the irregular bony resorption caused by periodontal disease; soft tissue does not have the ability to follow these irregularities.
When the angle formed by the bone line between teeth and the soft tissue pocket outline exceeds 30°, in general, we can expect increased depth after gingivectomy. A gradual rise and fall in the bony architecture with the greatest curvature of the arch being the deepest point of the pocket should be promoted by bony recontouring. The best way to perform the procedure is to perform a gingivectomy first and then reflect a flap for access. This way the exposed bone will be covered at the end.
Indications: (a) localized narrow and deep bone loss on the buccal and lingual surfaces; (b) mesial aspect of tilted second molars where the lowest first molar has been lost and replaced; (c) isolated areas of deep interproximal pocket on a single tooth when the adjoining teeth have normal bone support; (d) some deep lingual and buccal pockets where there is ledging of the bone and a thinning of the bone margin is indicated; (e) interdental craters.
Technique: flap should be designed to cover the remaining bone. Bone resection should be done with burs, bone files, and bone gouges and chisels. The interseptal bone should be removed first and then the buccal and lingual bone. A lingual approach can be used in a great number of cases leaving the buccal bone intact. Surgical dressing and penicillin should be used.
An important consideration before performing osseous recontouring is to avoid furcation exposure or removal of a lot of supporting bone from areas adjacent to the defect, when recurrent deep areas or even tooth extraction may be more appropriate.
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