Decay and periodontal disease are the two major causes of tooth loss. As the treatment of dental caries aims at restoring teeth in form and function for the long term, so it is that periodontal treatment is intended to reduce the risk of alveolar bone loss.
To that end, periodontal probing depths or pockets have been associated with not only the likely presence of periodontitis but also the poor maintainability of such sites may be associated with progressive deterioration and attachment loss.
Typically periodontitis affects the alveolar bone crest in a manner best described as reverse architecture where the interproximal alveolar crest is found to be more apical than its vestibular counterpart; this is because the plaque front and the ensuing periodontal breakdown occurs usually, where the lesion is primarily and initially initiated.
This osseous crestal loss resulting from periodontal disease does not in turn dictate the formation of soft tissue craters. In fact the soft tissue margin, under each and all circumstances, follows the radicular anatomy, not the bone.
Specifically, the soft tissue follows either the root surface down on the convex part of the vestibular portion of the roots or up on the concave and proximal radicular surfaces.
It is these discrepancies that result in the increased periodontal probing depths where the dynamics of the soft tissue cannot conform to osseous changes resulting from periodontal deterioration.
The rational for treatment is based on the fact that deep periodontal probing depths can be the result of periodontal deterioration but also provide an environment favorable to bacterial growth.
Then one treatment alternative in the form of osseous resective surgery is a way by which periodontal tissues may be repositioned usually, as positive architecture, more apically to where it had been prior. This results in an osseous topography in harmony with soft tissue contours leading to sustainable probing depths reductions.
In order to achieve an osseous crest to a positive architecture, it should be in harmony with the soft tissue thereby resulting in a reduction in periodontal probing depths (Schluger 1949).
Material and Methods up to including flap design and osseous recontouring, as well as suturing are similar to crown lengthening.