A review of osseous resective surgery.

The treatment of periodontal diseases associated with attachment loss has involved a variety of approaches. 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. This paper will address the controversy as well as discuss surgical pocket therapy directed toward pocket reduction through recontouring the underlying bone.     

牙周骨切除术和骨成形术教学训练模型的设计制作及初步应用

牙周基础性手术训练是牙周专业教学重点内容之一.本研究设计一种模拟临床病损拟实施牙周骨切除术和骨成形术的教学训练石膏模型,并制定相关的手术训练流程.该训练模型直观地模拟了临床中常见的典型牙槽骨缺损类型,研究生和进修医生在手术训练过程中可以深刻理解牙周炎导致牙槽骨骨破坏的特点,熟练掌握牙槽骨修整的过程,并学会如何通过修整形...     

Assessment of morbidity after periodontal resective surgery

Background: The goal of this study is to evaluate morbidity after periodontal surgery and to compare postoperative morbidity of male and female patients treated by experienced periodontists to patients treated by postgraduate (PG) periodontal students. Methods: A total of 271 patients underwent resective periodontal surgery. Of them, 122 patients were treated by PG periodontal students and 149 patients were treated by experienced periodontists. One week after surgery a questionnaire was given to the patients to rate postoperative pain, swelling, thermal sensitivity, and bleeding. Tactile sensitivity was evaluated in terms of presence or absence. Data were analyzed statistically by applying the analysis of variance test for comparison of the values of bleeding and the Student t test for comparing pain, swelling, tenderness to percussion, and thermal sensitivity. Results: Postoperative bleeding did not show statistically significant differences between surgeries performed by PG periodontal students and experienced periodontists. There were statistically significant differences in contact sensitivity, thermal sensitivity, edema, and pain between surgeries performed by PG periodontal students and experienced periodontists. There were no statistically significant differences in postoperative morbidity between male and female patients. Conclusions: Morbidity after resective periodontal surgery is low. Patients treated by experienced periodontists had lower postoperative morbidity than patients treated by PG periodontal students. There were no differences in morbidity between male and female patients.     

Osseous resective surgery: long-term case report

This case report evaluated the long-term effects of osseous resective therapy in the treatment of a patient with moderately advanced periodontal disease. In 1984, the patient underwent initial therapy followed by a periodontal surgical phase consisting of osseous recontouring with an apically positioned flap. After 20 years, in 2003, the patient presented with a traumatic complication. An exploratory surgery revealed a fracture on the roof of the pulp chamber on the maxillary left first molar. The buccal roots were resected, preserving the palatal root, and a reevaluation of the long-term outcome of osseous resective surgery was performed. It is suggested that the positive treatment result is the consequence of the reestablishment of tissue morphology favorable for oral hygiene and plaque control by the patient.     

���ܹ����ؽ�����

牙周炎可导致临床上出现各种骨形态异常，影响病情程度、牙齿稳固和组织修复，易使病损迁延难愈。牙周骨性手术从最基本的翻瓣术和骨成形术开始修整因病损改变的骨壁外形，用骨移植术和引导性组织再生术来弥补自身组织修复不足和选择性促进不同组织再生，到联合应用不同技术提高综合疗效，均有各自特点和适应条件。本文主要从牙周骨性手术的类型、应用材料、基本技术要点、影响因素、疗效评价和发展等方面进行简要对比阐述；为更好的临床选择和应用提供管窥之见。     

Long-term effects of supportive therapy in periodontal patients treated with fibre retention osseous resective surgery. II: tooth extractions during active and supportive therapy

BACKGROUND: Long-term tooth retention is the main objective of periodontal treatment. The aim of this retrospective study was to describe the prevalence and reasons of tooth extraction during active periodontal therapy (APT) and supportive periodontal care (SPC) in periodontal patients. MATERIAL AND METHODS: Three hundred and four periodontal patients were examined. APT consisted of non-surgical periodontal treatment and fibre retention osseous resective surgery, where needed, to obtain no sites with PD>3 mm. All patients participated in an SPC programme for 3-17 years (mean time 7.8 years). RESULTS: At the initial examination, 45% of the patients had moderate periodontitis and 41% severe periodontitis. During APT, 576 teeth were extracted (7.5%). The main reason for tooth extraction during APT was the presence of advanced periodontal lesions (44%). The number of tooth extractions was higher in cases with severe periodontitis. Extracted teeth showed a mean bone loss of 76% of the total root length. During SPT, a total of 67 teeth were removed (0.9%) in a subgroup of 50 patients. The clinical problems were primarily related to the incidence of root fracture (48%) and secondarily to the progression of periodontal disease (30%). CONCLUSION: Prevalence of tooth extraction during APT is associated with the severity of periodontal disease. Tooth loss during supportive periodontal care may be negligible when a meticulous SPC programme is performed in patients where minimal probing depth is consequential to APT.     

���ܹ���������ٴ�Ӧ��

牙周炎造成的骨缺损以及骨形态的改变在很大程度上影响牙周治疗效果.牙周基础治疗对骨组织再生的影响有限,而牙周骨外科手术因其备受肯定的疗效已被广泛应用于临床,通过牙周骨外科手术达到牙周组织缺损的修复重建成为牙周临床治疗领域的关注热点.     

An abbreviated history of osseous surgery

Various forms of periodontal therapy, including surgery, have been advocated and documented in the dental literature during the last three centuries. This variety of treatment modalities has been developed to address the anatomical consequences (pocket formation and bone loss) sustained from chronic periodontal disease. The marked differences in techniques have created significant controversies between the greatest leaders in dentistry and their equally influential disciples. Nevertheless, these leaders have always shared a common goal: the preservation of the natural dentition in a harmonious environment of health, comfort, and proper function. This article discusses the history of periodontal osseous surgery, including not only the technical issues, but also the conceptual underpinnings of this form of therapeutic intervention. In the process of examining this subject closely, three main controversies in the field of periodontics are brought into sharper focus: non-surgical versus surgical periodontal therapy; gingivectomy versus osseous resective periodontal therapy; and the nature of clinical decision-making: scientific and evidenced-based versus subjective clinical judgement.