The aim of the narrative review pre-sented in this Module is to illustrate the indications and the operative steps of modern non regenerative periodontal surgical techniques with particular focus on osseous resective surgery. The authors made a selection of the available scientific literature from classic articles to the most current trends, in order to provide the scientific basis and to guide the clinician in choosing the correct surgical approach. The clinical practice guidelines (S3 lev-el) for treatment of stage I-III periodontitis published by the European Federation of Periodontology (EFP), in 2020, give an indication for osseous resective surgery in cases with deep residual pockets (PD ≥6 mm) in patients with stage III periodontitis after an adequate non-surgical therapy has been com-pleted, keeping in mind the potential risk of increase in gingival recession af-ter this type of procedure. In fact, osseous resective surgery modifies the bony support altered by periodontal disease through reshaping of the alveolar process without removing supporting bone or through the removal of part of the alveolar bone. The aim of this surgical technique is to obtain minimal probing depths and positive osseous and gingival architecture, that will allow and ease the patient in performing correct oral hygiene maneuvers. The present review describes the operative steps of the technique, starting from an accurate presurgical evalua-tion that will consider quality and quantity of the keratinized tissue, probing depth and anatomy. The incision and flap decision are carefully described, flap elevation is made, and through os-teoplasty and ostectomy maneuvers the profile of the hard tissues is re-shaped to obtain positive osseous ar-chitecture in a more apical position compared to the presurgical condition. Finally, the soft tissues are repositioned apically or at the bone crest. A modification to traditional osseous resective surgery is that of osseous surgery with fibre retention. This technique allows for a more conservative approach and can reduce post-surgi-cal recession and discomfort for the patient. It is based on the notion that supra crestal connective tissue fibres embedded into radicular cement are always present (even in diseased peri-odontium) on average about 1 to 2 mm coronally to the base of the defect. For this reason, through this ap-proach, the base of the defect is no longer made of mineralized tissue but it’s moved coronally at the level of the connective tissue attachment. The coronal shift of the most apical portion of the defect allows for a more conservative osseous resection. In conclusion, osseous resective surgery is a very effective surgical procedure in the elimination of periodontal pockets. Today it is used mostly to treat shallow intraosseous defects in non esthetic areas and in perio-prosthetic cases (such as clinical crown lengthening procedures). Having a good understanding of the rationale and of the operative steps of this surgical technique constitute the basis of every periodontal surgery.
Access flap and osseous resective surgery: indications and operative procedures|Chirurgia conservativa e ossea resettiva: indicazioni e step operativi
Nastri L.
Writing – Original Draft Preparation
;
2022
Abstract
The aim of the narrative review pre-sented in this Module is to illustrate the indications and the operative steps of modern non regenerative periodontal surgical techniques with particular focus on osseous resective surgery. The authors made a selection of the available scientific literature from classic articles to the most current trends, in order to provide the scientific basis and to guide the clinician in choosing the correct surgical approach. The clinical practice guidelines (S3 lev-el) for treatment of stage I-III periodontitis published by the European Federation of Periodontology (EFP), in 2020, give an indication for osseous resective surgery in cases with deep residual pockets (PD ≥6 mm) in patients with stage III periodontitis after an adequate non-surgical therapy has been com-pleted, keeping in mind the potential risk of increase in gingival recession af-ter this type of procedure. In fact, osseous resective surgery modifies the bony support altered by periodontal disease through reshaping of the alveolar process without removing supporting bone or through the removal of part of the alveolar bone. The aim of this surgical technique is to obtain minimal probing depths and positive osseous and gingival architecture, that will allow and ease the patient in performing correct oral hygiene maneuvers. The present review describes the operative steps of the technique, starting from an accurate presurgical evalua-tion that will consider quality and quantity of the keratinized tissue, probing depth and anatomy. The incision and flap decision are carefully described, flap elevation is made, and through os-teoplasty and ostectomy maneuvers the profile of the hard tissues is re-shaped to obtain positive osseous ar-chitecture in a more apical position compared to the presurgical condition. Finally, the soft tissues are repositioned apically or at the bone crest. A modification to traditional osseous resective surgery is that of osseous surgery with fibre retention. This technique allows for a more conservative approach and can reduce post-surgi-cal recession and discomfort for the patient. It is based on the notion that supra crestal connective tissue fibres embedded into radicular cement are always present (even in diseased peri-odontium) on average about 1 to 2 mm coronally to the base of the defect. For this reason, through this ap-proach, the base of the defect is no longer made of mineralized tissue but it’s moved coronally at the level of the connective tissue attachment. The coronal shift of the most apical portion of the defect allows for a more conservative osseous resection. In conclusion, osseous resective surgery is a very effective surgical procedure in the elimination of periodontal pockets. Today it is used mostly to treat shallow intraosseous defects in non esthetic areas and in perio-prosthetic cases (such as clinical crown lengthening procedures). Having a good understanding of the rationale and of the operative steps of this surgical technique constitute the basis of every periodontal surgery.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
