what is the evidence supporting osseous resective surgery
Becker
-although there were no differences in CAL loss, the osseous group overall had less CAL breakdown compared to SRP or MWF
Kaldahl:
-initially more PD reduction for moderate pockets
what are the objectives of osseous surgery
to eliminate osseous defects and create a positive bony architecture where the gingival tissue will adapt and remain following healing
what factors determine how to shape the bone architecture for ossoeus
-phenotype
-root shape
-tooth position
-interdental space
-furcations
what are disadvantages to osseous sx
-removes supporting bone
-exposes more root structure which compromises esthetics and increases sensitivity
-wider embrassures open which causes food trap and additional time for OH
how much bone is actually removed during osseous sx
0.6mm (Selipsky)
steps for osseous surgery
-create bleeding points on the palate based on PD and bone sounding
-follow bleeding points to create a submarginal internal bevel incision
-flap should be thinned out while making incisions
-distal wedge done on the 2nd molar
-crevicular incision to remove collar of tissue
-for the buccal, allow 2-3mm of KT remaining
what is the rationale for lingual/palatal approach - flap design
-overall lingual inclination of teeth, so it avoids a buccal furcation exposure and also the defect tends to be more lingual
-longer root trunk on the lingual
-avoids buccal furcation exposure
-there is a shallow vestibule on the buccal due to external oblique ridge
-thicker bone on lingual
-lingual has wider embrasures which allows for better access
-more KT on palatal
-can easily create a ramping effect from buccal to palatal with minimal ostectomy
-cleansing effect from the lingual
steps for osseous reduction
-interdental fluting and vertical grooving
-remove buccal and lingual defect walls such that the base of the crater becomes the peak of interdental septum
-thinning of radicular bone (more osteoplasty) to create scallop
-ostectomy and remove widow’s peaks at line angles
-final shaping and smoothing
where should the flap be sutured
Machtei - after MWF the flap sutured 3mm or less from crest will have minimum PD after healing
