 Hello everyone, welcome back to another session in dentistry and more. Today, we have receptive osteosurgery in periodontology, it is a surgical methods which is used to correct the bone deformities. So, the damage resulting from periodontal disease manifests in variable destruction of tooth supporting bone. So, we know the periodontal disease is the cause for loss of supporting bone. So, as the disease progress or when it becomes severe, the ultimate result will be the supporting bone that is alveolar bone destruction. So, the most common pattern of destruction is it could be a horizontal one or vertical or most often a combination of these two horizontal and vertical. So, the horizontal bone loss which is the most common pattern and usually associated with supra-boni pockets. So, there are two types of pockets supra-boni pockets and intra-boni pockets. So, intra-boni pockets are pockets which is at an angulation, supra-boni pockets are which is present above the alveolar bone. And the attachment and bone loss which is proceeds at a uniform rate on majority of tooth surfaces. So, in the picture you can see there is a bone loss which is at a uniform rate, there is no unique or there is no oblique destruction or oblique pattern of bone destruction. In any of the teeth all are at a uniform rate of bone destruction or a uniform level. So, it is almost like a horizontal line. So, everywhere it is horizontal, so the horizontal bone loss it is the most common pattern the equal loss of bone happens at all levels or all sides of the tooth. Whereas, a vertical bone loss you can see a depression here. The bone loss is not at a horizontal level or not equally at both sides or all the sides. So, you can see a special trough like area here that is a depression which is caused by loss of bone. So, here it is horizontal and sudden depression is there. So, it is occur in a oblique direction leaving and hollow trough in the bone along side of the root. So, a trough like area is caused this is known as a intra-boni defect. This is within the bone not like a supra-boni defect. So, base of the defect located apical to the surrounding bone and accompany a intra-boni defect. So, the surrounding bone is this one. So, this is located apical to towards apex apical to the surrounding bone or the nearby bone. So, these intra-boni pockets or vertical bone loss classified on number of oscars walls present. So, how many walls it involves classifies the vertical bone loss or intra-boni pocket that is could be a 1-wall defect, could be a 2-wall defect or a 3-wall defect. So, the picture says the 1-wall defect can see the picture here. The only wall which is affected is a distal side of this tooth is affected and this is a tooth. Whereas, the 2-wall defect is a distal and lingual this is a distal and this is a lingual. So, distal and lingual is affected whereas, the 3-wall defect distal lingual and facial ok the distal lingual and this dotted facial. So, these 3 walls are affected and sometimes a combination type of oscars defect. So, the facial wall is half the height of distal and lingual wall. So, this is an oscars defect with 3 walls in apical half 3 walls in the apical half. So, apicaly it is 3-walled and the 2 walls in the ocrucial side ok. So, at the towards we are talking about the bone. So, the ocrucial or the coronal side of the bone the 2-wall defect is present whereas, the apical side this side. So, this side it is 3-wall defect ok. So, this is we are talking about intra-bonnie defects. So, these are the pictures of bonnie defects you can see the wall defect. The means sorry the facial distal and lingual walls are affected similarly here. So, oscars surgery can be defined as a procedure by which changes in the alveolar bone can be accomplished to rid it of deformities which is induced by the periodontal disease process or other related factors such as exostosis and tooth supereruption. So, it is nothing but a surgical procedure which helps the tooth to bring back its normal position or to correct the deformities the deformities which is caused by the exostosis or tooth supereruption or any other periodontal disease process. So, oscars surgery basically divided into additive or substractive types. So, additive or regenerative oscars surgery can see a picture over here before and after one year picture can see the bone loss and you can see the bone formation here. So, it includes procedure directed at restoring the alveolar bone to its original level. So, that is a regenerative oscars surgery or additive. So, you are bringing back the lost bone so bringing back the normal C. So, how it was before the periodontal disease? So, we are bringing back the or trying to bring back the bone level to the normal rate or the original level. So, it implies regeneration of lost bone and re-establishment of the periodontal ligament, gingival, fibres and junctional epithelium at a more coronal level. Can see it is towards more coronal side. Here the defect is almost at the apex. So, after one year there is deposition of bone, periodontal ligament and all other similar attachment, fibres, junctional epithelium at a more coronal level. So, bringing back to its perfect normal level is quite not possible but to a more coronal level than the diseased level is a practically possible way of managing the disease. So, that is additive or regenerative oscars surgery whereas the subtractive or receptive oscars surgery which is designed to restore the form of pre-existing alveolar bone to the level existing at the time of surgery or slightly more apical to this level. Okay. You can see the defect here but we are removing a portion of the bone towards more apically. Okay. So, it is to restore the form of pre-existing alveolar bone to the level existing at the time of surgery or slightly more apical to this level. We are bringing, well this is subtractive, we are removing the bone okay or receptive oscars surgery. So, what is the goal of oscars receptive therapy? It is to reshape the marginal bone to resemble that of alveolar process undamaged by periodontal lysis. It is not exactly bringing back to its original shape and form. It is to resemble that of alveolar process. Okay. So, you can see the damage here bone here. So, we are bringing back to or resembles to its normal alveolar process. So, this conversion of a periodontal pocket to a shallow gingival sulcus. So, there will be deep pockets. So, we are creating a shallow gingival sulcus which enhances the patient's ability to remove plague and oral debris from this condition. Okay. So, if it is a very deep pocket, there will be deposition, there will be accumulation and there will be inflammation leading to periodontal lysis. If the pocket, if the deep pocket is made shallow, then it will be a more of a self-cleansable area or the patient can easily do cleansing using the brushing techniques or any other adjunctive techniques like mouth washes and other techniques. So, the normal alveolar morphology. So, basically normally the position of bone margin which mimics the contours of the cemento enamel junction. So, it is almost in a similar pattern of CJ, then distance from the facial bone margin of the tooth to the intraproximal bone crest is more flat in the posterior region than the anterior and the scalloping of the bone on the facial surface. Okay. There will be a scalloping on the facial surface which is due to the tooth and root form and also the position of the alveolus. So, anterior tooth and the posterior tooth, its different scalloping of the bone will be there because of its positional change. So, the intraproximal bone is more coronal in position than the labial or lingual bone and it is pyramidal in form. So, teeth with prominent roots or those displaced to the facial or lingual side may also have fenestrations or daisins. Daisins you can see the complete denudation of bone. This is a focal denudation of bone. So, loss of a focal area. This is complete loss of facial bones. It is due to the prominence of this root or the displacement to the facial or lingual side. Okay. It is due to the positional change. Now, let us see what is the positive architecture, negative architecture and flat architecture. Positive architectureal were the radical bone is apical to the inter-radicular.. or sorry the inter dental bone. This is the inter dental bone. Okay. So, the radical bone is more apical to the interdental bone. Negative architecture is a inter-dental bone. Okay. This is inter-dental bone. It is apical to the radical bone. bone. Here the radicular bone is apical to the interdental bone. Here the interdental bone is apical to radicular bone. Flat is reduction of interdental bone to the same height as radicular bone. So, procedure used to correct Osceus defects have been classified into two groups, osteoplasty and ostectomy. So, methods of Osceus receptive surgery is fundamentally an attempt to gradualize the bone sufficiently to allow soft tissue structures to follow the contour of the bone. So, osteoplasty is a reshaping of bone without removal of the tooth-supporting bone to achieve a physiologic, interdental and Osceus contour, whereas the ostectomy or osteoctomy is a removal of tooth-supporting bone. Here we are reshaping the bone without removal of the bone, but in ostectomy we are removing the tooth-supporting bone. So, Osceus reshaping is basically definitive or compromising. So, in definitive the Osceus reshaping would not improve the overall result, whereas a compromised, which indicates the bone pattern that cannot be removed without significant Osceus removal that would be detrimental to the overall result. And what are the indications? So, the indications, there should be 1 volt angular defects, inconsistent bone emergence, shallow crater formations, reverse architecture, buttressing bone formation, ledges and plate 2, vocation defects, crown lengthening for restorative dentistry and it is contraindicated in anatomic factors such as proximity of the roots to the maxillary, sinus, age, systemic health problems, improper oral hygiene, there is high caries index, extreme root sensitivity, severe bone loss, unacceptable aesthetic results or existing mobility. So, all these are disadvantages or contraindications. In advantages, the predictability, complete elimination of perontal pockets and obtaining an ideal bone form. And loss of valuable supporting bone and post surgical mobility, gingival recession and its sequelae and lengthy unpleasant post surgical recovery. So, these are the disadvantages and the factors, which is involved in selection of receptiose surgery are the depth and configuration of bone elation to root morphology and adjacent teeth and amount of bone, which requires removal, extent of the loss of attachment, the number of remaining walls of bone defect and amount of soft tissues, which is present interproximately. These are the instrument used to various bows and chisels, files and the steps. There are four steps, vertical grooving, radical ablanting, flattening of interproximal bone and gradualizing the marginal bone. So, the step one and two will come under osteoplasty and three and four is oestectomy. This is shaping of the bone, this is oestectomy is removal of the bone. So, vertical grooving is the first step in osteoplasty. So, these four are continuum or continuous or one by one steps, the first two is like shaping of bone. So, it is known as osteoplastic procedure, this is oestectomy procedures. So, vertical grooving is designed to reduce the thickness of alveolar housing. So, this is how we do vertical grooving, we create grooves. So, provides continuity of the interproximal surface onto the radical surface. It is the first step, which is performed with rotary instruments, carbide and diamond bars, which indicates when indicated when there is thick bone emergence and shallow crater formation and areas that require minimal oestectomy. So, minimal oestectomy we mainly do vertical grooving. So, we create grooves, so that there will be a continuity at interproximal area towards the radical surface. Contrary indicated when there is closed roots or thin alveolar housing, we cannot do vertical grooving. And radical uplanting is the second step, which is continuation of first step. So, to gradualize the bone on radical surface to provide the best results from vertical grooving, because we already done vertical grooving here. So, we just do the blending, so that it becomes a smooth surface. So, it indicates when there is shallow crater formation or thick oscish ledges of bone on radical surfaces or class 1 and early class 2 vocation enrolment and contraindicated in when radical bone is thin and if there is a fenestration and if vertical grooving is very minor. Now, we are into the oestectomy, which is the plastic removal of radical and interradicular supporting bone to eliminate oscish deformities, which is indicated when there is sufficient bone remaining for establishing physiologic condor without attachment compromise, no aesthetic or anatomic locations and elimination of interdental craters are indicated, intra-bonate effects not amenable to regeneration, horizontal bone loss with irregular bone height and moderate to advanced vocation involvement. So, contraindicated in advanced relations and large hemicepital effect might require removal of inordinate amounts of bone to provide flattened architecture and when there is effective alternative treatment, this is contraindicated. So, the third step or the first step of oestectomy or the third step is a flattening of inter proximal bone that is requires removal of very small amount of supporting bone. So, we are making or we are doing oestectomy or we are removing small amount of supporting bone that is indicated when inter proximal bone levels very horizontally when there is changes in the inter proximal bone in a horizontal direction. Indicated mostly for hemicepital defects that is one wall defect and next step is whether a second step in oestectomy or the fourth step in surgery that is a gradualizing the marginal bone. This is the final step that is a bone removal is a minimal, but necessary to get sound regular base for gingeral tissues to follow. So, if failure to remove small bone discrepancies on the gingeral line angle such as I have just known as widow's peak which allows tissues to rise to a higher level than the base of the bone loss in inter tendal area. So, if you are not removing the bone discrepancy on the gingeral line angle. So, this is a gingeral line angle. So, you know the gingeral line angle when there is two surface meets there will be a line angle. So, this gingeral line angle if we are not removing the bone ed effect at the gingeral line angle what happens is this is known as widow's peak these line angles the bone ed discrepancy which is seen on the line angles. So, if we are not removing then what happens the tissues to rise to a higher level than the base of the bone. So, these tissues will go to a higher level than the base of the bone loss in inter tendal area. So, this inter tendal area bone loss is there. So, these tissues which is going at a higher level because it has a small bony area in the line angles. So, it will create problems at the inter tendal area that is gradualizing marginal bone concept. So, reduction of one wall angular defect. So, angular defect means to the tilted molar. So, how do we correct it we can reduce the defect by ramping the angular bone we can just make the bone as a ramp. So, that it makes easy for cleaning or the accumulation or deposition of bacteria and debris can be easily removed making a ramp of bone. So, reflection of the flap reveals a bulbous contour of bone and after this Ushu's receptive surgery it is removed. Similarly, a palatal excess toss is removed and the flap placement and closure. So, flap position and suture to cover the new bony margin or they may be positioned apically. So, we need to position using suture. So, this is apically positioned with the margins at Ushu's crest and this is periosteal suture's flap placement at margin at the level of Ushu's crest. So, postoperative maintenance is very critical in prognosis. So, non-resorbable sutures removed after one week of healing and resorbable sutures maintained won't approximation for varying periods of one to three weeks or more. At the suture removal appointment dressing is removed and surgical site is gently cleaned of debris with cotton pellet and dampened words saline. Sutures are then cut removed if any excess granulation tissue present should be removed with a sharp curate and post surgical maintenance instructions should be given. So, it takes attachment of flap to underlying bone usually 14 to 21 days and maturation and remodelling up to six months. So, we need to wait six weeks after completion of healing the last surgical area before beginning the dental restorations. So, finally to conclude this Ushu's receptive surgery is a specific approach to recondouring the bone used in conjunction with apical flap positioning that requires precise surgical technique and it is limited to the treatment of moderate bone loss in teeth with adequate residual root in relation to bone volume. So, it results in formation of a healthy periodontal attachment apparatus. So, that is all about Ushu's surgery. Basically, we need to learn this four steps that is osteoplasty and ostectomy. Vertical grooving, radical blending, flattening of inter proximal bone and gradualizing marginal bone. It is indication, contraindication, advantages, disadvantages. So, osteoplasty and ostectomy is commonly asked question or Ushu's receptive surgery could be a question and fenestration and descents due to the positional change of the root. So, these are the basic two types additive and subtractive. So, that is all about the Ushu's receptive surgery and also the horizontal and vertical bone loss. So, I will come up with a new topic in the industry and more. Thank you.