Clinical
One wall defect Fig 1
Two wall defect Fig 2
Three wall defect Fig 3
Circumferential defect Fig 4
Continued »
by regenerative or additive bone surgery (or a combination of both).
Osteoplasty The term osteoplasty was intro- duced by Friedman in 1955. The aim of this technique is to reshape the bone to create a physiological form without removing the supporting bone (tissue connected to the tooth via periodontal fibres).
Surgical techniques After elevating a full thickness flap, osteoplasty is performed using medium grain diamonds mounted on a turbine or micromotor. The operation site must be abun- dantly irrigated with sterile saline solution. Initially, the diamond is moved in a coronal-apical direction to reduce the thickness of the bone. The surface is then
Diamonds for osteoplasty Fig 5
finished with the same diamond using a brush–type movement in a mesiodistal direction. During the operation, great care must be taken to avoid touching the root surfaces with the rotating diamond (Fig 5). Bone reabsorption caused by peri-
odontal disease has modified the bone architecture. After elevating a full thickness flap, it was decided to reshape the bone architecture by osteoplasty (Fig 6). After osteoplasty, the bone margin
is thinner and the ledge has been eliminated without removing the supporting bone (Fig 7).
Ostectomy Ostectomy describes the surgical procedure employed to remove the supporting tissue (bone connected to the tooth by means of peri- odontal fibres). This technique is used to re-establish the physiolog-
Before osteoplasty Fig 6
ABOUT THE AUTHOR:
Dr Alan Maxwell is a specialist in peri- odontics. He works at Care Dental Focus (Crieff), the Scottish Centre for Excellence in Dentistry (Glasgow) and Queen’s Cross Den- tal Practice (Aberdeen).
ical contour of bone tissue altered by periodontal disease. Fig 8 – The physiological architec-
ture of the bone has been completely altered by bone reabsorption caused by periodontal disease. Fig 9 – Ostectomy has been
performed. This operation has recreated the physiological archi- tecture of the Alveolar bone. The inter-proximal bone is now more tapered and located more coronally to the radicular bone.
Conclusion Resective bone surgery is by defi- nition destructive and does not in itself cure periodontitis as it is an infectious disease. This type of surgery is performed exclusively in the case of minor alterations in the bone architecture which, in asso- ciation with periodontal pockets, facilitate the progression of peri- odontal disease.
After osteoplasty Fig 7
Before ostectomy Fig 8
After ostectomy Fig 9
44 Scottish Dental magazine
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