Barrington: Prior to surgery, patients should be performing good oral hygiene and must have received and responded well to phase I. Full thickness flaps should be used because of minimized trauma to the tissues and because the flap will be fully vascularized for covering the area. Radiographs and probing will tell us about the morphology of the defect. Not only vertical bone but also horizontal bone loss require surgery, because it also induce reverse architecture. Ledging is another indication for osseous surgery. Intraoral grafts can be used in combo with osseous surgery in 3-wall defects, the latter being performed to create a better defect shape or to avoid a reentry. The goal of osseous surgery is to reestablish the bony physiologic contour. Very advanced bone loss is not an indication for osseous resection because all alveolar bone existent should be preserved. Ledges and bulges should be thinned and discrepancies between alveolar margin of two teeth corrected. Interproximal bone should be grooved because bulky ones work as food traps. Exostoses are reduced if they are part of the periodontal problem. Bone should cover the bone although sometimes apical reposition of the flap should be done to increase attached gingiva.
O'Bannon: Most of the osseous problems are not amenable to grafting and cannot be solved by subgingival curettage. They are corrected by osteoplasty or ostectomy. Oral hygiene and scaling and root planing are performed before the surgery. Depth can be accepted in areas the patient is able to remove plaque. Bone should be reshaped with the idea of enhancing oral hygiene. Principles of positive architecture include ostectomy on the palatal and buccal sides and on the line angles. Sometimes a split flap can preserve bone on the buccal side and osteoplasty can be done in some areas through the periosteum. Contouring following root amputations should be done visualizing what is desired after healing. Oral hygiene seems to be the key for long term success. -Point: sometimes we tend not to pay attention to oral hygiene very much because we are anxious to do surgery, which is a mistake. Patients unable to control plaque should not be candidates for surgery. Ochsenbein: heavy maxillary osseous plates, mandibular tori, and interdental creaters should be eliminated by osseous surgery. Osseous correction of craters is often necessary even to eliminate residual defects after grafting. Removal of widow-peaks are important after ramping the crater. The removal of marginal bone to get scalloped architecture should be based on the existing architecture; it is wrong to standardized scalloping for all patients because some tend to have a flatter contour. The opposite is also wrong; a flatter recontouring in a patient with scalloped contour will induce pocket recurrence. Osseous surgery should be done with minimal detailing in order to eliminate pocket.
Stallard: The periodontal ligament is vital for the maintenance of the alveolar bone; if it disappears by means of periodontal disease or extraction the alveolar bone also disappears (why don't we see this with ankylosed teeth then?!). Thick bone and ledges should be removed because they interfere with harmonious gingival contours and are not providing any support for the teeth. Osseous surgery should be limited to non-supportive bone areas.
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