Resective bone surgery with fibers retention

The updated approach to resective bone surgery is the fibers retention technique, proposed many years ago and widely used today in the everyday practice to treat bone irregularities and intra-bony defects up to 2-3 mm. It is also essential to perform crown lengthening procedures.

A young 35 years old, healthy, female with no history of diabetes, or smoking presented with deep probing depth, bleeding on probing and sligth mobility of the molars. It was decided to approach the case with osseous surgery with fiber retention.

style italiano styleitaliano dentistry

Fig.1
Resective bone surgery with fiber retention. Buccal probing.

style italiano styleitaliano dentistry

Fig.2
Lingual probing.

style italiano styleitaliano dentistry

Fig.3
Initial radiographs.

style italiano styleitaliano dentistry

Fig.4
Design of the buccal flap with a double parabola on 46. Than Vertical incision distal to 43.

style italiano styleitaliano dentistry

Fig.5
Lingual sub-marginal incision.

style italiano styleitaliano dentistry

Fig.6
Buccal bone defects before bone re-contouring.

style italiano styleitaliano dentistry

Fig.7
Buccal bone re-contouring with elimination of the defect between 46 and 47 and correction of the reverse bone morphology on premolars.

style italiano styleitaliano dentistry

Fig.8
Lingual bone defects before bone re-contouring.

style italiano styleitaliano dentistry

Fig.9
Lingual re-contouring with osteoplasty of lingual tori, creation of lingual buccal ramps, and retention of fibers at the inter-proximal level and in the furcation area.

style italiano styleitaliano dentistry

Fig.10

style italiano styleitaliano dentistry

Fig.11
Sutures with apical repositioning of flaps at the bone crest.

style italiano styleitaliano dentistry

Fig.12

style italiano styleitaliano dentistry

Fig.13
Radiographic comparison between before surgery (upper) and after 2 years.

style italiano styleitaliano dentistry

Fig.14

style italiano styleitaliano dentistry

Fig.15
Buccal comparison between before surgery (Img. 14) and after 2 years.

style italiano styleitaliano dentistry

Fig.16

style italiano styleitaliano dentistry

Fig.17
Lingual comparison between before surgery (Img. 16) and after 2 years.

Conclusions

The resective bone surgery approach allowed elimination of probing depths, of minor intrabony defects, and obtaining of adequate soft tissue architecture and better possibility for the patient to maintain proper oral hygiene.

Bibliography

Rosling B, Nyman S, Lindhe J, Jern B. The healing potential of the periodontal tissues following different techniques of periodontal surgery in plaque-free dentitions. A 2-year clinical study. J Clin Periodontol. 1976;3(4):233-50.
Olsen CT, Ammons WF, Van Belle G. A longitudinal study comparing apically repositioned ?aps, with and without osseous surgery. Int J Periodontics Restorative Dent. 1985;5(4):10-33.
Ochsenbein C. Osseous resection in periodontal surgery. J Periodontol. 1958;29:15-26.
Ochsenbein C. Current status of osseous surgery. J Periodontol. 1977;48(9):577-86.
Rosling B, Nyman S, Lindhe J, Jern B. The healing potential of the periodontal tissues following different techniques of periodontal surgery in plaque-free dentitions. A 2-year clinical study. J Clin Periodontol. 1976;3(4):233-50.
Carnevale G, Kaldahl WB. Osseous resective surgery. Periodontol 2000. 2000;22:59-87.
Levine HL. Periodontal ?ap surgery with gingival ?ber retention. J Periodontol. 1972 Feb; 43(2): 91-8.
Carnevale G, Cordioli G, Mazzocco C, Brugnolo E. Technics for gingival ?ber conservation. Dent Cadmos. 1985;15. 53(19):15- 32, 35-40.
Carnevale G. Fibre retention osseous resective surgery: a novel conservative approach for pocket elimination. J Clin Periodontol. 2007;34(2):182-7.

RELATED CASES

Simultaneous white and pink approach

The aim of this article is to present contemporary approach where the pink part is performed simultaneously with the prosthetic procedure in order to improve the final outcome and use the final prosthetic design as a healing references for the connective tissue graft.