Bone loss has been classified as either horizontal or vertical. Horizontal bone loss generally results as a relative thickening of the marginal alveolar bone. The effect of this thickening and the develpoment of vertical defects leave the alveolar bone with countless combinations of bony shapes. In order to alter these bony changes, a method of recontouring must be followed.
Osseous surgery may be defined as the procedure by which changes in the avular bone can be accomplished to rid it off deformities induced by gum disease or other relative factors such as bony exostosis and tooth supraeruption.
Osseous surgery can be either Additive or Subtractive in nature.
Additive osseous surgery- It implies regeneration of lost bone and reestablishment of the periodontal ligament, gengival fibres and junctional epithelium at a more functional level.
Subtractive osseous surgery- It is designed to restore the form of pre existing avular bone to the level present at the time of surgery or slightly appical.
Procedures used to correct osseous defects are classified in two groups,
Osteoplasty- It refers to reshaping the bone without removing tooth supporting bone.
Ostectomy- This includes removal of tooth supporting bone.
Osseous form is said to be ideal when the bone is consistently more coronal on the interproximal surfaces than the facial and lingual surfaces.
Osseous resective surgery follows a series of guidelines for proper contouring of avular bone and subsequent management of the over-lined gengival soft tissues.
More than any other surgical technique, osseous resective surgery is performed at the bony tissue and attachment level. Hence its value as a surgical technique is limited.
The goal of the osseous resective therapy is to reshape the marginal bone to resemble that of the unbalanced alvular process.
The technique is performed in combination with apically positioned flaps and the procedure eliminates periodontal pocket deaths and the tissue contour, so as to make patients oral hygiene maintenance easier.
A number of hand and rotary instruments have been commonly used for resective osseous surgery.
Rotary instruments are useful for osteoplasty whereas hand instruments provide more safety with ostectomy procedures.
Following are the sequential steps that need to be followe to perform resective osseous surgery.
Vertical grooving- this is designed to reduce the thickness of alveolar housing and provide more prominence to thye radicular aspects of the teeth.
It is the first step of the process, because it can define the general thicknes and subsequent form of the alveolar bone. It is performed using rotary instruments such as round carbide or diamond burs.
It should be avoided in areas with closed roots or thin alveolar housing.
Radicular blending- this is the second step of the process, and an extention to vertical groovig. It is an attempt to gardulise the bone over the entire root surface.
This step is not necessary if vertical grooving is very minor or if the radical bone is thin.
Both these procedures compose the bulb of resective osseous surgery.
Flattening interproximal bone- It requires the removal of very small amount of supporting bones. It is indicated when the interproximal bone levels vary horizontally.
It is best used in defects that have a coronally placed 1 walled edge of a predominantly 3 walled angular defect, and it can be helpful in obtaining good flap closure and improved healing.
Gradualizing marginal bone- this is the final step in the resective procedure. Bone removal is minimal but necessary to provide a sound regular base for the gingival tissue to follow.
FLAP PLACEMENT AND CLOSURE
After performing the osseous resection ,the tissue flap edges are replaced to their original position to cover the new bony margin or they may be positioned apically.
Positioning the bone apically to expose the marginal bone is one method of altering the width of gingiva. However it results in more post surgical bone resorption and patient discomfort.
Suturing may be accomplished using various suture materials and sutured knots.
Care should be taken, to place the sutures such that ther is minimal tension on the flaps wich could lead for their separation.
POST OPERATIVE MAINTENANCE
After suture removal, the surgical site is examined.
The patient is provided with post surgical maintenance instructions to maintain the surcal site plaque free.
Healing should proceed uneventfully in 14 to 21 days.
Maturation and remodelling can continue for upto 6 months. It is usually advisable to wait for atleast 6 weeks post healing of the surgical areas before beginning with dental restorations.
Although osseous surgical technique cannot be applied to every bony defect, but when properly performed it helps in achieving a physiologic architecture of marginal alveolar bone conducive to gingival flap adaptation with minimal pocket probing depth.
Hence resective osseous surgery is an important technique to provide a maintenable periodontial for periodontal patients.