1. Management of Osseous Defects
Osseous Surgery

2. Definitions
OSSEOUS DEFECT is a concavity or deformity in the alveolar bone involving one or more teeth
OSSEOUS SURGERY is defined as recontouring and eradication of angular boney defect and crater
It is all the procedures designed to modify and reshape defects and deformities in the bone surrounding the teeth

3. Morphology of Bone Defect
It is important, before any Osseous Surgery to determine the morphologic classification of any osseous defect as accurately as possible by:
Topography in single plane
Routine probing – linear measurement
Radiographic materials
Visualization of the defect at the time of surgery

4. Classification of Boney Pockets
Periodontal pockets with their base apical to the crest of alveolar bone are called infraboney pockets
Three-wall defect
Two-wall defect
One-wall defect

6. The Biologic width Normal relation of the gingiva to the tooth
Gingival behavior upon healing following Periodontal Surgery
Osseous Resective Surgery, Osteoplasty and/or Ostectomy, are techniques to achieve physiologic contours in the bone during surgery that parallel the anticipated post surgical gingival form

9. Osteoplasty – Friedman 1955
The purpose of Osteoplasty is to create a physiological form of the alveolar bone without removing any supporting bone. It is therefore a technique ANALOGOUS to gingivoplasty
Thinning of thick Osseous ledges and
The establishment of a scalloped contour of the buccal, lingual and palatal bone crest
E.g. flat or reverse architecture “tori, exostoses”
Contouring of bone in conjunction with root resection

10. Ostectomy
Is the removal of bone that is supporting the tooth “bone containing the fibers of the periodontal ligament”
It is considered to be an important part of surgical technique aimed at pocket elimination, e.g.
Shallow infraboney defects (1-2 mm in depth)
Grade 1 and selected grade 2 furcation involvement

11. Contraindications of Osseous Surgery
Esthetic. Unacceptable esthetic appearance for most patients if bone in the maxillary anterior areas is removed
Isolated deep defects
Advanced periodontitis
Systemic conditions

12. Technique of Osseous Resection
Adequate local anesthesia
Full thickness flap
Buccal and/or lingual crater walls are reduced to the base of the Osseous Defect by round or diamond bur, under continuous saline irrigation
If bone resection carried out in interdental area, the buccal and lingual/palatal bone margins may subsequently have to be recontoured
Suturing. Interrupted, suspensory, continuous suture
Dressing materials