This paper discusses the status of osseous surgery in periodontics in 1977.
Gingival form is independent of bone architecture. If their contour is different, it will be reflected in pocket depth. Bone is not a scaffold for gingiva to rest upon.
Osteoplasty: heavy bony ledges and tori on buccal and palatal of maxillary teeth; thick bone on the lingual of lower mandibular molars, lower tori interfering associated with pocketing, thick bone on buccal of lower molars, specially the second. Early furcation invasions.
Ostectomy: management of the shallow creater, that is accomplished by removal of either the buccal or the palatal wall. The degree of sloping is important because it will determine the amount of ostectomy on the palate.
Three-walled intraosseous defect that can be treated successfully by the denudation technique. Bony defects situated on the terminal buccal aspect of mandibular molars and associated with the external oblique ridge. Moderate to deep circumferential defects are better treated by grafting techniques. Advanced periodontal lesions or isolated deep craters that should be treated by grafts, root amps, extractions, or simple curettage. Wide-orifice three wall defects should be treated by grafting. Osseous surgery should be done meticulously in order to achieve pocket elimination.
Bone remodeling: thin bone does a certain amount of reshaping and rounding. However, cases such as shallow craters do not resolve alone. It seems that when cancellous bone is present, the bone is not able to reshape by itself.
Although the simple exposure of some bony areas may be risky and detrimental it may be necessary and beneficial in other areas. (Widow's peaks)
Shallow crater: its buccal and lingual walls are not thin; they are thick and have slopes toward the bottom of the crater. If the clinician thinks that the wall of the crater are at right angle with the tooth and its manipulation is casual, there will be little effect on pocket depth. Bone conservation: conservation of supporting bone should be a major concern in osseous surgery. This and some other anatomic considerations were the reasons to develop the palatal approach and the lingual approach.
"Osseous surgery is a very useful procedure in the practice of periodontics but should be performed properly and applied where it is indicated."
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