Rationale for the lingual approach to mandibular osseous surgery.

Area of Science:

• Periodontology
• Oral Surgery
• Anatomy

Background:

• Achieving definitive periodontitis treatment with pocket elimination and maintainable periodontal architecture is challenging.
• Osseous reduction is a key surgical technique in managing periodontal defects.
• Understanding mandibular anatomical variations is critical for successful periodontal surgery.

Purpose of the Study:

• To evaluate the effectiveness of osseous reduction techniques in treating periodontitis, focusing on the posterior mandible.
• To highlight the importance of anatomical considerations in planning and executing osseous correction.
• To explore strategies for improving access and efficacy of surgical interventions.

Main Methods:

• Analysis of anatomical patterns of the posterior mandible, including buccal and lingual bone housing.
• Evaluation of tooth-to-bone relationships and common periodontal defect locations (interdental craters, infrabony defects).
• Discussion of osteoplasty and osteoectomy techniques, emphasizing lingual vs. buccal approaches.

Main Results:

• The lingual aspect of the posterior mandible presents unique anatomical features influencing osseous reduction.
• Shallow interdental craters, common in periodontitis, are suitable for osseous reduction rather than grafting.
• Lingual access for osseous reduction can be challenging, necessitating careful surgical planning to avoid over-treatment of the buccal aspect.

Conclusions:

• Osseous reduction, especially from the lingual aspect, is vital for periodontal pocket elimination and architecture restoration.
• Awareness of mandibular anatomy, including bone thickness and tooth inclination, is essential for optimal surgical outcomes.
• Strategic reduction of the mylohyoid ridge can enhance lingual access, improving oral hygiene and surgical results.