Osseous surgery: Surgical procedure performed on bone with the purpose of reshaping or restoring it.
Osseous resection: correcting osseous defects produced by periodontal disease or anatomic architectural abnormalities or a combination of both.
Osteoplasty: reshaping of bone without removal of alveolar bone.
Ostectomy: same thing but involves the removal of alveolar bone.
Healthy peridontium: gingiva follows the bone; when there are bone deformities the gingiva does not follow and plaque accumulates and pockets reoccur. Osteoplasty and ostectomy are employed to eliminate these defects (horizontal and vertical bone loss).
Full thickness flaps are used for osseous surgery. The basic technique for flap management is then described. Osteoplasty is recommended for buccal, lingual, and interproximal correction of thick bone ledges seen in horizontal bone loss as well as other osseous deformities. Ostectomy should be used for correction of bony deformities affecting the alveolar supporting bone, specially reverse architecture.
Biological basis of osseous surgery: new cementum formation after surgery is found at 1 month. Only 3/4 of the surgically exposed root will be covered by cementum. The epithelial attachment after surgery forms between 3 weeks to 2 months. Connective tissue proliferation in the area of the periodontal ligament reaches its peak at 2-3 days after surgery. New bone formation occurs 4 weeks to 4 months after surgery. There is difference between pocket reduction with different methods using osseous surgery or not.
Indications for osteoplasty: thick marginal ledges, exostoses, tori.
Indications for ostectomy: interproximal craters, inconsistent margins, hemisepta, furcation involvement, combinations of deformities, combinations of deformities and anatomical aberrations Contra-indications for osseous surgery: three walled intrabony defect, bony effects situated on the buccal aspect of the terminal mandibular molars and associated with external oblique ridge, moderate to deep circumferential defects, advanced periodontal lesions or isolated deep creaters, wide orifice three wall bony defects and other severe deformities.
In any periodontal treatment, the most important phase is the maintenance visits and good oral hygiene.
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