osseous resective therapy

lecture given 9/30/2026

what are definitive periodontal therapeutic techniques?

debridement- root planing

gingivectomy

free mucosal graft

pedicle graft

what are the goals of flap procedures?

apically position flap, contour irregular bone, ostectomy for bony defects, for regenerative procedures, debride osseous defects for repair

in sites with initial probing depths above the critical probing depths value (4.2mm) more gain of clinical attachment occurred following…

widman flap surgery than following scaling and root planing

false pocket (pseudopocket)

probe does not pass CEJ

suprabony true pocket

gingival or periodontal

infrabony true pocket

3, 2, 1 wall osseous defect

combination defects

gingiva tissues do not conform to…

abrupt architectural changes in bone produced by disease or resulting from surgical procedures

this means that some defects can go undetected without probing

in situations of gingival accumulation, subsequent plaque retention encourages…

recurrent inflammation and in pocket depth

which infrabony defect has the best prognosis?

3 wall defect

which infrabony defect has the worst prognosis?

circumferential defect

the configuration of the crest of the interdental alveolar septa are defined by the relative positions of…

adjacent cemento-enamel junctions in health

reverse architecture

a morphologic relationship in which the radicular bone on the facial or lingual aspects of the tooth is in a more coronal position than the adjacent interdental bone

considered to be an etiologic factor in periodontal disease progression as well as the result of the inflammatory disease process

what would make management of osseous defects easier?

if the alveolar bone resorbed in an apical direction uniformly and maintained a basic physiologic outline

but unfort it doesn’t which is why we have to take this class

what are classifications of bone contour in periodontal disease?

unaffected

resorbed but regular in contour

irregular bony contour

osseous defect formation

bone sounding

probing in the horizontal plane from the facial and lingual locating the crest of the proximal bony walls

probing in the vertical plane locates the based of the crater

how should you identify osseous defects?

probing and radiographic evaluation

what is the naber’s probe used for?

to determine furcation involvement

when probing maxillary molar furcations, where should you go from?

palate, not buccal

what does the pattern of bone resorption depend on?

thickness and quality of bone

pathway of inflammation

vascular network from gingival inflammatory lesion into the underlying alveolar process

the morphology of the investing root and its relationship to the ______, __________, and ______ are major factors in determining osseous lesion formation

volume, mineralization density, shape of bone surrounding it

since most periodontal defects offer a morphologic combination in apperance (being more contained at the base and less at the coronal part), treatment may include…

resective treatment of the uncontained portion of the defect (the coronal portion)

regeneration for the more predictable contained portion of the defect when resection will not jeopardize adjacent teeth

osseous surgery

encompasses varied forms of therapeutic procedures, each to manage the variety of bony lesions resulting from periodontal diseases, and with different goals of therapy in mind

fundamental to elimination of bony defects

creation of a physiologic form

controls and maintains a contiguous relationship with the overlying gingival tissues

results in minimal probing depths

what are the objectives of osseous resective therapy?

create contours that permit pts to accomplish effective plaque control

create bone contours which gingival tissue will parallel

permit primary wound closure

expose additional clinical crown for restorative treatment

what are the disadvantages of osseous resective therapy?

attachment loss caused by removal of supporting bone

un-esthetic root exposure

hypersensitive roots

ostectomy

removal of radicular and interradicular supporting bone to eliminate osseous defects

what are indications for osseous resective therapy?

adequate remaining attachment once physiologic morphology is established

no esthetic limitations

no anatomic limitations

no root hypersensitivity limitations

what are contraindications for osseous resective therapy?

inadequate remaining attachment

esthetic limitations

anatomic limitations

root hypersensitivity limitations

alternative, more effective therapy

osteoplasty

the surgical removal of non supporting bone for the purpose of reshaping it, to support a physiologic gingival and osseous contour

what are indications for osteoplasty?

pocket elimination

tori reduction

reductions of thick heavy bony ledges and/or exostosis

what are contraindications for osteoplasty?

shallow osseous craters

blunted interdental craters

small intrabony defects on buccal or lingual

enhanced flap placement with improved alveolar contours

how much bone support is usually removed to definitively correct osseous problems during periodontal sugery?

very little supporting bone is removed when resective techniques are properly applied

the need for splinting due to diminished attachment levels should be determined prior to the procedure

what does osseous surgery do?

creates contours that permit pt directed effective plaque control

permits primary wound closure

minimizes pocket depths

what do minimal probing depths allow for?

complete debridement with hand instrumentation during maintenance visits

effective daily home care procedures

predictible use of toothbrushing, flossing, and other adjunctive mesures

what are the objectives of pocket elimination?

minimal probing depths

restoration of physiologic gingival and osseous contours

prerequisite for adequate plaque control and preventive maintence

the relationship of the ________ to the ________, with the intervening connective tissue and epithelial attachment, is stable and predictable in the presence of optimal plaque control and effective recall therapy

alveolar crest, base of gingival sulcus

what does osseous management begin with?

elevation of buccal and lingual flaps

maintain appropriate dimension of keratinized gingiva

margins thinned and parabolic in shape, with an internal bevel incision

apically positioned flaps in conjunction with osseous resection…

predictable

achieve minimal probing depths

has the potential to increase the zone of attached gingiva

stable base for restorative dentistry

closed periodontal procedures have inherent limitations in…

effectively treating established periodontitis, as evidence by your findings upon flap reflection

most pockets are found…

interproximally, where craters and all variations of resorptive lesions occur, including thickened ledges and intrabony defects

the site of the intial osseous lesion of inflammatory disease is often…

the interdental area in the region of the septal vessels

interdental osseous crater

a two wall intrabony defect resulting from periodontal disease which has lost proximal bony walls adjacent to the approximating teeth and maintains intact facial and lingual bony walls

*root trunk dimension is often narrowest for the…

first molar

the depths of periodontal defects in terms of mm is not as significant for multi rooted teeth as is the relationship of the …

defect to the root trunk

shallow defect

1-3mm deep

within the dimensions of the root trunk when associated with multi-rooted teeth

deep defect

a depth greater than 3mm, and when adjacent to a multi-rooted tooth, it extends apical to the root trunk

how can you correct a shallow defect?

high speed carbide or diamond burs in the presence of generous supply of water, are used to remove bone, so that the base of a crater becomes the most coronal portion in the interdental septum

the bone of adjacent teeth may be removed during surgery, to avoid a precipitous change in the osseous morphology between teeth

how are widow’s peaks/bony spines removed?

from translational line angles by hand instruments like ochsenbein chisles, to establish a flat or horiontal MD crest

for proper physiologic contour, radicular bone should be ________ at the completion of resective osseous surgery

apical to the interdental septum

radicular bone on the facial and lingual surface is contoured by ostectomy/osteplasty to produce…

parabolic architecture similar to what had existed prior to disease

radicular bone thickness depends primarily on…

the tooth to bone relationship exisiting in the area

the degree of scalloping/parabolization is influenced by…

the tooth form and root anatomy and the relationship of tooth to bone

as the MD dimension increases (posteriorly), the bone and gingiva accept a flatter morphology

double parabolization

the development of a parabolic curve over each root toward the furcation, with the vertical groove in the interdental bone extending apically from the furca