Ostectomy—Includes  removal  of  tooth supporting bone in the treatment of periodontal disease. Osseous reconstructive surgery—This involves procedures involving regeneration (regrowth) of lost  bone,  and  the  reestablishment  of  the periodontal  ligament,  cementum,  gingival fibers, and junctional epithelium. An   osseous  graft  is  a  procedure  that  involves implanting   living   tissue   or   inert   material   into periodontal   osseous   defects   to   regenerate   new periodontal  attachment  (bone,  periodontal  ligament, and  cementum).  Donor  bone  may  be  obtained  from adjacent cortical and cancellous bone, mixed with the patient's  blood.  Other  sources  for  bone  may  be  from edentulous   ridges,   extraction   sites,   or   maxillary tuberosity.   Bone   can   also   be   obtained   from   tissue banks or various crystalline synthetic substances, such as hydroxyapatite over a 4-6 month period. Grafts may also be placed in osseous defects. METALLIC  IMPLANTS A   method   of   tooth   replacement   involves   the surgical  implantation  of  coated  metal  implants  into the  bone  ridges  of  edentulous  areas  (fig.  6-15).  The root implant becomes firmly attached to the bone and a  new  crown  is  placed  upon  it  to  support  fixed  or removable  bridges.  The  procedures  involved  in  the use of metallic implants require a team approach from the   prosthodontics,   periodontic,   and   oral   surgery specialties. ROOT  AMPUTATION,  HEMISECTION, AND   BICUSPIDIZATION Sometimes the bone loss is so great around the root of a mutlirooted tooth that a root or section of the tooth Figure 6-15.—Implant placement. must be removed. The remaining portion of the tooth can  be  saved  if  sufficient  periodontal  support  is present.  Endodontic  treatment  is  required  before treatment of the remaining portion of the tooth. Root  amputation—The  complete  removal  of  one or more roots of a multirooted tooth, without removal of any portion of the crown. Hemisection—The   surgical   sectioning   of   a multirooted tooth through the furcation area so that the blocked,  defective,  or  periodontally  involved  root  or roots may be removed along with the associated portion of  the  crown.  An  artificial  crown  is  required  on  the remaining half of the crown. Bicuspidization—A  multirooted  tooth  is sectioned through the furcation and both halves of the tooth are retained. SURGICAL  DRESSINGS During  periodontal  surgery,  the  dentist  exposes soft  tissues  and  sometimes  bone,  leaving  open  wounds. Surgical dressing materials (packs) are usually applied to the wounds as a protective barrier. These packs not only protect the area by preventing food from injuring the surgical area, but also soothe and aid in the healing process.  Your  primary  duty  will  be  to  mix  the ingredients and form the dressing the dentist places in the   patient's   mouth.   Follow   the   manufacturer's instructions  for  mixing.  Most  dressing  will  stay  in place for 5-7 days. During the postoperative visit, the surgical dressing and any sutures will be removed. The dental officer may elect to place another dressing over the surgical area if the healing process is delayed. INSTRUMENT   SHARPENING Periodontal cutting instruments must be kept sharp by   a   correct   sharpening   technique.   To   be   able   to recognize   when   instruments   require   sharpening   is extremely important. To determine if an instrument is sharp,  you  must  be  familiar  with  each  instrument's cutting   edge(s).   Under   good   lighting,   examine   the cutting edge using a magnifying glass, or by looking directly  at  the  edge  while  slightly  turning  the instrument. A sharp cutting edge will not reflect light and appears as a line. A dull edge will reflect the light, creating a glare because the edge has been rounded off. SHARPENING  DEVICES The correct sharpening device is critical for a good cutting  edge.  Hard  felt  wheels  are  recommended  for 6-12