Friedman, N. Periodontal osseous surgery: osteoplasty and ostectomy. J Periodontol, 26:257, 1955

As described by Schluger, the gingival soft tissues do not have the ability to follow the bony resorption pattern observed in periodontal disease. Pocket elimination is the goal of periodontal treatment. It can be achieved by subgingival curettage, reattachment, gingivectomy, and osseous resection. Pockets should be carefully clinical and radiographically examined to determine the morphology of the defect and the technique for elimination chosen.

Osteoplasty: bone removal to get physiologic contour of the bone itself and gingiva overlying it. The bone removal is not part of the attachment apparatus.

Ostectomy: the bone removed to get phydiologic contour is part of the attachment apparatus of one or more teeth. The amount of bone to be removed is an important criterion for its use.

Osteoplasty indications:

1. Deep interproximal pockets on posterior teeth involving the buccal interdental bone: the cone-shaped interdental bone should be reinstituted by means of grooving.
2. Pockets on the buccal, lingual, and palatal surfaces where resorption of bone results in thick ledges.
3. Tilted lower second molar adjacent to non-replaced extracted first molar.

Ostectomy indications:

1. Interproximal craters in bone: shallow and wide craters are not favorable for reattachment while deep and narrow are. When ostectomy is the procedure of choice one of the spines is removed and the bone is ramped to the other side.
2. Extremely deep interproximal pockets where the neighbor areas are intact or minimally affected.
3. Shallow infrabony defects (interproximal), and where reattachment has failed.

Methods:

1. Modified flap: a gingivectomy is performed first and flap is elevated later and bone gouges, chisels, files and burs are used to reshape the bone.
2. Full flap: used when the operator did not decide between reattachment procedure or resective procedure. A full flap is indicated when a visualization of the field is desired before therapy.
3. Use of diamond stones without a flap.

Postoperative care:

Infection is rare; saliva is an important defense. Antibiotics can be used if healing is poor.

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