Osseous Resective Surgery Research Articles

Effect of post-surgical flap position on soft tissue regrowth and keratinized tissue increase following fibre retention osseous resective surgery: a 6-month randomized study with multilevel analysis

BackgroundThe aim of this randomized split-mouth study was to assess the influence of primary flap position on the amount of coronal soft tissue regrowth and keratinized tissue (KT) 6 months after osseous resective surgery with fiber retention technique (FibReORS).Materials and methodsTwo contralateral posterior sextants in 16 patients were treated with FibReORS and randomly assigned to flap positioning either 2 mm below the bone crest (apical group) or at the level of bone crest (crestal group). Clinical parameters were recorded at 1, 3 and 6 months and patient-related outcomes during the first two post-operative weeks.ResultsHealing period was uneventful. Patient’s discomfort was similar in both groups. The overall soft tissue rebound was higher in the apical than in the crestal group (2.0 ± 1.3 mm versus 1.3 ± 0.7 mm), but the difference was statistically significant only interproximally (2.2 ± 1.3 mm versus 1.6 ± 0.8 mm). Multilevel analyses showed higher soft tissue rebound in sites with normal compared to thin phenotype (1.5 mm, p < 0.0001) and treated with flap positioned 2 mm apically to the bone crest (0.7 mm, p < 0.001). An additional 0.5 mm KT increase was observed at interdental sites in the apical group.ConclusionsApical flap positioning increases soft tissue rebound and KT width, mainly at the interdental sites, with reduced patient discomfort.Trial registrationThe trial was registered at ClinicalTrials.gov (ID: NCT05140681, Registration date: 1/12/2021, retrospectively registered).

Enhanced Anterior Esthetic using Crown Lengthening and Depigmentation at Single Visit

Gingival hyper-pigmentation becomes more obvious when it is associated with excessive gingival display. The treatment of excessive gingival display and depigmentation collectively are the key to patient satisfaction. The objective of the present article was to evaluate 6 months' result of surgical protocol that integrated surgical depigmentation, gingivectomy, and an apically positioned flap with osseous resective surgery to correct hyper-pigmentation and excessive gingival display in maxillary anterior teeth among different patients. The author has discussed in detail the selection of surgical techniques in different clinical conditions to achieve pleasant and long-term results. The selected techniques for depigmentation and crown lengthening resulted in excellent color and contour of the gingiva at the 6-month follow-up.

Osseous surgery: Traditional vs fiber retention resective surgery

Periodontitis is a disease originating from bacteria in a susceptible host, in which a nonprotective, chronic inflammatory process results in the destruction of supporting soft and hard tissues surrounding the teeth, eventually causing the loss of dentition over time. The ultimate goal of periodontal treatment is to control the progression of periodontal disease. This is achieved by removing the causative factors and stopping progression of clinical attachment loss and ultimately preventing loss of teeth. Osseous resective surgery (ORS) is one of the treatment modalities used to gain access to the root surfaces and boney defects, visualize removal of plaque and calculus from the root surfaces, and reestablish proper bone and soft tissue contours in order to facilitate removal of plaque by the patient as well as dental professionals. Osseous resective surgery fiber retention (FibReORS) is another less commonly used variation of this resective approach. Although it has shown promising results, little research exists comparing the two approaches. The aim of this review is to revisit the dogma of traditional ORS and highlight the differences between the two surgical approaches in regard to clinical procedures, clinical outcomes, and patient's reported outcomes.

Understanding the role of resective osseous surgical procedure in chronic periodontitis patients

Variety of treatment approaches have been developed and used to treat periodontal diseases associated with attachment loss. While the goal of periodontal surgical treatments is to access the root surfaces for proper debridement, the decision to remove or reshape the supporting bone has been controversial. Osseous resective surgery necessitates following the use of strict guidelines for proper recontouring of the alveolar bone and proper management and positioning of the gingival tissues so that the results from osseous resective surgery are highly predictable.

A Rare Case Report Along With Surgical Management of Bilateral Maxillary Buccal Exostosis in a Patient of Polydactyly and Distomolars

Buccal exostosis is bony prominence located on buccal side of alveolar ridge of maxilla or mandible. It is commonly seen in maxilla than mandible, whereas the etiology remains unclear. This article presents a rare case of bilateral maxillary buccal exostosis, distomolars and polydactyly along with surgical management of exostosis. A 39-year-old male patient came to the dental OPD with a chief complain of swelling in the right and left back region of upper jaw from 12 years, which was a cosmetic concern to the patient. Patient was medically healthy with no familial history of gingival overgrowth. On examination, patient had polydactyly and bilateral mandibular distomolars. These isolated findings couldn’t be related to any syndrome after thorough examination and medical consultation. Finally, the treatment plan consisted of, oral hygiene instructions, mechanical debridement and periodontal resective osseous surgery, so as to reduce gingival inflammation and improve esthetic by removing the exostosis. Nonsurgical periodontal therapy alone did not reduce the gingival enlargement because of the bony nature of enlargement, thus necessitating surgical intervention. Post-operative evaluation at 1, 3 and 12 months reveled an uneventful healing and no sign of recurrence at surgical sites.

REGENERATIVE/RESECTIVE APPROACH FOR GRADE III FURCATION INVOLVEMENT- A CASE REPORT WITH QUESTIONABLE CLINICAL SCENARIO

Introduction: Teeth with furcation involvement can be maintained in a state of function for a longer period of time if appropriately treated and if the patient is motivated adequately. This report highlights the effect of regenerative and resective therapy in the management of grade III furcation involvement. Observation: A 48 years old male patient was evaluated for furcation involvement with respect to the root canal treated lower right first molar tooth. Grade III furcation involvement was noted for which regenerative therapy was attempted with platelet rich fibrin (PRF) and bone grafts. After 2 years of follow up, the furcation involvement still persisted and patient had a complaint of food lodgement. Hence, resective osseous surgery (tunnel preparation) was done to make the furcation ease for maintaining oral hygiene. Commentary: In cases of periodontal loss, periodontal regenerative therapy must be the first treatment of choice. However, regeneration of grade III furcation involvement is more challenging and very few reports are available in the literature. Conclusion: The selection of cases for regenerative or resective therapy depends on the clinicians’ knowledge and practice. The ultimate goal of periodontal therapy is to provide a dentition that will function in health and comfort for life.

Analysis of Resective Osseous Surgical Procedures - A Retrospective Hospital Based Study

Resective osseous surgery is a procedure to modify osseous support either by reshaping the alveolar bone to achieve physiologic form without removal of supporting bone (osteoplasty) and by the removal of some alveolar bone (ostectomy). The aim of this study is to analyse the prevalence of resective osseous surgical procedures performed in the outpatient department of Saveetha dental college and hospitals. Overall, 100 case sheets were reviewed which were dated between June 2019 to March 2020. The data was collected by the patient records of a dental college hospital. From this study, we observed that resective osseous surgical techniques were done in 60% of male patients and in 40% of female patients and the most frequent technique performed was osteoplasty which was 68% Within the limits of this study, the most common techniques used were osteoplasty and frequent anatomical site was upper first molar and male patients underwent more resective osseous surgery than that of females.

Surgical Management of Bilateral Maxillary Buccal Exostosis in a Patient with Polydactyly and Distomolars - A Rare Case Report

Introduction: Buccal exostosis is bony prominence located on the buccal side of the alveolar ridge of the maxilla or mandible. It is commonly seen in the maxilla than mandible, whereas the etiology remains unclear. This article presents a rare case of bilateral maxillary buccal exostosis, distomolars, and polydactyly along with surgical management of exostosis.Case Report: A 39-year-old Yemeni male patient came to the dental OPD with a chief complaint of swelling in the right and left-back region of the upper jaw from 12 years, which was a cosmetic concern to the patient. The patient was medically healthy with no familial history of gingival overgrowth. On examination, patient had polydactyly and bilateral mandibular distomolars. These isolated findings couldn’t be related to any syndrome after a thorough examination and medical consultation. Finally, the treatment plan consisted of, oral hygiene instructions, mechanical debridement, and periodontal resective osseous surgery, so as to reduce gingival inflammation and improve esthetic by removing the exostosis. Nonsurgical periodontal therapy alone did not reduce the gingival enlargement because of the bony nature of enlargement, thus necessitating surgical intervention.Conclusion: Postoperative evaluation at 1, 3, and 12 months revealed uneventful healing and no sign of recurrence at surgical sites.

Role of Local Flaps to Achieve Primary Wound Closure in Medication-Related Osteonecrosis of the Jaws Osseous-Resective Surgery.

The aim of the present work is to evaluate the most suitable surgical technique in relation to location and extent of medication-related osteonecrosis of the jaws (MRONJ) through comparison of success rate between the routinely used mucoperiostal flaps and different local flaps designs and propose a standardization of surgical procedures according to MRONJ stage and localization with 2 objectives: to provide the surgeon with an algorithm of treatment according to MRONJ localization and extension; to maximize the success of surgical treatment.Thirteen consecutive patients affected by focal MRONJ were surgically treated with radical osteotomy at the Center for Treatment of the Osteonecrosis of the Jaws (University of Messina, Italy).Initial defects were classified according to the classification of the Italian Societies of Oral Medicine and Maxillofacial Surgery (the SICMF-SIPMO staging system) which consider not only bone exposure but also radiological bone involvement. Treatment outcome was retrospectively assessed according to the different adopted surgical procedure: mucoperiostal flaps (GROUP A) advanced mucoperiostal flaps or rotation flaps (GROUP B) local flaps (GROUP C).Outcome after surgical treatment of focal MRONJ was positive in every group irrespective of MRONJ localization and extension. This may be due to the appropriate selection of surgical procedure.The results obtained demonstrated that focal MRONJ surgical treatment is a reliable procedure irrespective of the initial clinical situation. Radical osteotomy combined with appropriate selection of soft tissue management is crucial.

Pocket elimination after osseous resective surgery: A systematic review and meta-analysis.

To systemically review the available evidence on the clinical performance of osseous resective surgery (ORS) in the treatment of residual periodontal defects in terms of pocket elimination and biological costs in patients with chronic periodontitis. Three databases (PubMed, EMBASE and Cochrane) were searched up to January 2019. Clinical trials with a follow-up duration of at least 12months after ORS with or without fibre retention technique were included. Quantitative synthesis was conducted with random-effect meta-analysis. Overall, 1,765 studies were retrieved, of which 53 full-text articles were screened by two reviewers. Finally, a total of three RCTs were included in the meta-analysis. Random-effect meta-analysis showed a weighted mean percentage of pocket elimination (final PD≤4mm) at 12months of 98.3% (95% CI: 96.8; 99.7) with I2 of 26%. The weighted mean amount of resected bone was 0.87mm (95% CI: 0.49; 1.25), and the weighted mean increase in gingival recession was 2.13mm (95% CI: 1.49; 2.78) at 12months. ORS represents an effective surgical approach for the elimination of residual periodontal pockets in the short to medium term. Additional randomized controlled clinical trials with data on pocket elimination are warranted.

Resident memory T cells: Possible players in periodontal disease recurrence.

Tissue-resident memory T cells (Trm) represent a new subset of long-lived memory T cells that remain in barrier tissues after previous bacterial or viral infection to support early/immediate defense mechanisms, providing site-specific protection from pathogen challenge. As data on Trm cells in human gingiva are just emerging, the aim of the present study was to explore their presence and distribution in epithelial and connective periodontal tissues in relation to microbial exposure and periodontal damage. Periodontitis tissue specimens were collected from 20 generalized chronic periodontitis patients at the time of osseous resective surgery. As a control, 18 healthy tissue specimens were harvested each from both the primary flap and the palatal graft in 18 periodontally healthy patients during mucogingival surgeries. As CD69 and CD103 are phenotypic markers associated with tissue residence, intraepithelial and stromal CD103+ and CD69+ cells per high-power field were counted in areas with highest expression. Double immunohistochemistry for CD3 and CD69 was performed to identify T cells. CD69 +and CD103+ cells showed a lymphocytic morphology, and double CD69 and CD3 staining confirmed the T cell phenotype of these cells. CD103 and CD69 expression was significantly enhanced in epithelial and connective tissues from patients with periodontitis compared with healthy controls (P<.001). Significant positive correlation between PD and both CD103 and CD69 epithelial expression was observed in tissue specimens from periodontitis patients (P<.001). Within the limits of the present study, these results indicate that Trm cells are higher in periodontitis lesions. They could orchestrate the host response to microbial challenge, leading to a faster reactivation of periodontal disease.

Effect of two post-surgical cleansing protocols on early periodontal wound healing and cytokine levels following osseous resective surgery: A randomized controlled study.

The aim of this RCT study was to compare early wound healing and gingival crevicular fluid cytokine levels of patients treated with two different post-surgical cleansing protocols. A total of 30 chronic periodontitis patients scheduled for osseous resective surgery with fibre retention technique were randomly assigned to follow one of two post-surgical protocols. Patients assigned to the test protocol (n=15) were instructed to brush the surgical area with a sonic toothbrush starting the day after surgery in addition to 0.12% chlorhexidine (CHX) rinsing, while patients following the control protocol (n=15) rinsed only with 0.12% CHX solution and resumed mechanical cleansing with a manual toothbrush on day 14 after surgery. Interleukin (IL)-1β and IL-8 levels were assessed before and 14days post-operatively in gingival crevicular fluid. Patients were recalled on day 7, 14, 21 and 28 after surgery for clinical assessment. Pain was self-reported by a visual analogue scale. Lower early wound healing scores, higher bacterial plaque reduction and milder inflammatory response were observed at the surgical sites in the test group on day 7, 14 and 28 when compared to the control group (P<0.01). The faster wound healing process was modulated by a statistically significant decrease in IL-1β and IL-8 levels on day 14 in the sonic group. The intensity of pain was similar between groups. The introduction of sonic toothbrush on the first post-operative day as an adjunct of daily CHX rinsing would seem to accelerate early wound healing.

Multiple Massive Maxillary Exostoses-A Case Report with Complete Denture Rehabilitation

Exostoses are benign, asymptomatic bony outgrowth arising from cortical bone and occasionally from spongy bone along the maxillary or mandibular arches. They tend to appear in early adolescence and may very slowly increase in size with age. Theyare not usually a concernto a patient with complete dentition. However, in an edentulous patient they may pose a major concern for denture placement over these areas, leading to pressure and ulceration, which demands their complete surgical excision. The following article presence a rare case ofbilateral massive buccal exostoses, which was incompatible with the patient ability of prosthetic rehabilitation and hence a resective osseous surgery was carried outfollowed by a complete denture rehabilitation.

Interdisciplinary management of a patient with a gummy smile

This article describes the novel use of cone-beam computed tomography (CBCT) to predictably plan a crown-lengthening procedure without osseous contouring. The method aimed to achieve maximum incisal tooth reduction while avoiding endodontic treatment as a method for conservative management of a patient with excessive gingival display. Managing the case involved performing gingivoplasty without osseous recontouring. Prosthetic reconstruction was also performed to replace the missing canines and adjust the incorrect position of the maxillary incisors. A CBCT was used to precisely locate the alveolar bone level and pulp chamber level to avoid the risk of pulp exposure during tooth preparation. Laser was used to perform gingivoplasty. Computer-aided design/Computer-aided manufacturing technology was used to construct all-ceramic restorations making the use of smile design and virtual articulator features in the software. The patient's excessive gingival display was conservatively treated without osseous surgery or root canal treatment. Six monthly checks were performed for 5 years to check pulp vitality, and all teeth responded normally to vitality tests. The patient expressed great satisfaction with the result with minimal postoperative pain. With careful preoperative planning and novel use of CBCT, esthetic, and conservative treatment of excessive gingival display was made possible, while avoiding osseous resective surgery and root canal treatment. This made the treatment prompt with little need for a recovery period, more appealing to the patient, and longevity of treatment was ensured.

Treatment of bilateral maxillary buccal exostoses on gummy smile

Backgrounds: Buccal exostoses is benign, broad-based surface masses of the outer or facial aspect of the maxilla and less commonly at the mandible, found usually in the premolar and molar region. A definitive female sex predictions is characteristic of this condition. They are painless, self limiting and may increase patient concern about poor esthetics. Gummy smile is an excessive gingival display during smiling which can occur in response to certain medications--e.g., phenitoin -- or smaller than normal teeth due to developmental events, tooth eruption abnormalities, orthodontic treatments and even congenital defects. Objectives: The objective of this treatment are eliminate buccal exostoses and gingival overexposure with osseus resective surgery and crown lengthening for improve the esthetics of the gingiva, especially on anterior teeth. Case Presentation: A 30 years old female presented buccal exostoses with gummy smile on the buccal aspect from molar to caninus region of the bilateral maxillary arch. This case managed by a combination of osseous resective surgery to treat exostosis and crown lenghtening for removing alveolar bone and excessive gingival. Discussion: Selection treatment for this case is osseus resective surgery and crown lengthening that aims to removal of bone and achieving a physiological bone architecturebilateral exostoses, functional of gingiva and aesthetic. The surgical procedure is aimed at re-establishing the biological width, apically, while exposing more tooth structure. Conclusion: The exostoses and gummy smile increase poor esthetics. Osseus resective surgery andcrown lengthening are the option treatment to makes patient smile more proportional and achieving optimal aesthetics.

Surgical Alternatives for Treating Peri-implantitis.

The objective of this case series was to describe surgical approaches that can be used to efficiently and effectively treat peri-implantitis as measured by positive changes in clinical parameters. A total of 32 patients with 45 implants were treated surgically to eliminate peri-implantitis. Baseline clinical parameters measured prior to surgery were compared to those made 6 months postsurgery to evaluate the efficacy of each procedure. Implants demonstrating signs of peri-implantitis were treated by one of three approaches: (1) regenerative surgery, (2) osseous resective surgery, or (3) apically repositioned flap surgery. In all instances, the exposed implant surfaces were debrided and decontaminated. Relative to baseline values, regenerative surgery yielded statistically significant changes in probing depth (PD) (7.21 ± 0.27 mm to 4.09 ± 0.14 mm) and percentage of sites exhibiting bleeding on probing (BoP) (100.0% ± 0.0% to 10.6% ± 3.3%) as measured at the 6-month recall visit (P ≤ .05). The decrease in probing depth was not dependent on the type of graft material used (P ≤ .05). Resective surgery yielded statistically significant changes in PD (5.86 ± 0.23 mm to 3.63 ± 0.14 mm) and the percentage of sites exhibiting BoP (100.0% ± 0.0% to none) (P ≤ .05). Finally, the implants treated via apically repositioned flap surgery demonstrated statistically significant decreases (P ≤ .05) in both PD (6.79 ± 0.27 mm to 4.32 ± 0.16 mm) and BOP (100.0% ± 0.0% to 14.3% ± 6.7%) (P ≤ .05). Regenerative, resective, and apically positioned flap surgery can be utilized to successfully treat peri-implantitis.

Oral-Health-Related Quality of Life After Surgical Treatment of Osteonecrosis of the Jaws.

The aim of this study is to analyze the clinical outcome and the change in oral-health-related quality of life (QoL) of osteoporotic patients affected by medication-related osteonecrosis of the jaws (MRONJ). Forty-one patients, consecutively treated for a 10-year period, were retrospectively analyzed. All the patients underwent a marginal osseous resective jaw surgery. A clinical 12 months postoperative evaluation has been performed and the complete mucosal healing, the absence of swelling and suppuration, and no signs of disease recurrence were defined like success parameters. Quality-of-life surveys tests like EORTC QQ-C30 and QLQ-HN35 appendices in conjunction with a perceived oral health visual analog scale (VAS) were administered before (time of diagnosis of MRONJ) and after surgery (at least 6 months) in order to record the different oral health status of the treated patients. The majority of MRONJ-diagnosed patients complained symptoms like pain, eating discomfort, and sense problems, with occasional involvement of the social dimension. There was a prevalence of troubles with social eating and social contact.The complete mucosal healing was achieved in 100% of the patients and the administered survey tests reported a significant improvement in all the investigated spheres. Similarly, an increased mean score of perceived oral health VAS was reported.Marginal-resective surgery of the necrotic jaw bone can be an effective treatment of osteoporotic patients affected by localized MRONJ. Quality-of-life parameters are demonstrated to be useful for recording the patient-centered outcome of MRONJ treatment.

Tooth preservation by forced extrusion using magnets. A case report

Teeth with extensive loss of coronal tooth structure due to caries or trauma require restorative or prosthetic rehabilitation. However, deep subgingival preparation jeopardizing the biological width or the loss of ferrule effect compromise a succesful longterm restoration. Therefore, crown lengthening is indicated instead. This can be achieved by resective osseous surgery or by forced extrusion of the tooth. An advantage of crown lengthening by extrusion is the preservation of the adjacent periodontium and alveolar bone. Particularly in the esthetically challenging maxillary front region the level of the marginal gingiva can be positively corrected by forced extrusion using orthodontic appliances or magnets. Magnets for forced extrusion due to their small size can be invisibly integrated into temporary devices providing further advantages in the esthetic zone. However, forced extrusion requires a longer treatment time. This case report presents a forced extrusion procedure using magnets on a severely destroyed canine with optimization of the marginal gingiva.

Periodontal surgery improves oral health-related quality of life in chronic periodontitis patients in Asian population

The effect of periodontal surgery on patients' quality of life was investigated. Sixty patients received regenerative surgery or resective osseous surgery. Oral health-related quality of life and health-related quality of life instruments were used to assess the participants' quality of life before surgery and 4 weeks after surgery. Periodontal surgery can improve patients' quality of life by alleviating the physical pain and psychological discomfort. The scores were lower (more favorable) in the regenerative surgery group, and the functional limitations of the regenerative surgery group improved substantially compared with those of the resective osseous surgery group (P = 0.0421). The patients' oral health-related quality of life scores improved significantly after periodontal surgery. Clinicians can take advantage of the positive functional oral health-related quality of life impacts of regenerative surgery.

Increased early inflammatory response and osteoclastic activity in gingival tissues following conventional osseous resective surgery compared with the fibre retention technique: a pilot study

The retention of suprabony connective fibres attached into the root cementum during fibre retention osseous resective surgery (FibReORS) results in a more conservative intrasurgical removal of bone, and limits further bone loss and patient morbidity during healing, compared with conventional osseous resective surgery (ORS). This may be a result of the protective effect of preserved connective tissue over the interproximal sites and the lower activation of the inflammatory mechanisms. Thus, the aim of this pilot study was to compare the expression of inflammatory and osteoclastic activity markers in gingival tissues following FibReORS and ORS in the early postsurgical phase. Twenty-six posterior sextants requiring osseous resective surgery were selected in 13 patients with chronic periodontitis: 13 sextants were randomly assigned to ORS and 13 to FibReORS in a split-mouth design. Gingival biospies were collected during the surgical sessions and at suture removal. Tissue samples were analysed to evaluate the expression of proinflammatory and immunity regulatory mediators (interleukin-1α, C-X-C motif chemokine ligand 5, interferon-γ and tumour necrosis factor-α), cluster of differentiation 14 (CD14; a monocyte/macrophage marker) and TRAP (an osteoclast marker) using immunohistochemical, immunofluorescence and cytofluorimetric analyses, respectively. Postsurgery, a higher number of inflammatory cells and stronger expression of proinflammatory cytokines were observed in the epithelium and connective tissue of ORS gingival samples compared with FibReORS gingival samples (p < 0.001). This was accompanied by increased numbers of CD14-positive and TRAP-positive cells. Retention of the supracrestal connective fibres appears to reduce the postsurgical intensity of the host-mediated inflammatory response.