In brief: Osseous contouring (also called osseous recontouring or bone reshaping) is minor gum surgery in which the dentist reshapes the bone around teeth or implant sites. It is used to remove bone defects left by gum disease, to make room for a healthy gum margin before a crown, and to smooth or level the jaw before implants. It is done under local anaesthetic and the gums usually settle over a few weeks to a few months.
What osseous contouring is
The gum sits on a layer of jawbone (the alveolar bone) that holds the teeth. When that bone has an uneven shape, the gum over it follows the same shape, and problems such as deep pockets, an uneven gum line or a lack of space for a crown can result.
Osseous contouring corrects the bone so the gum can heal in a stable, cleanable position. There are two parts to it:
- Osteoplasty: reshaping bone that does not support a tooth, for example thinning a thick ledge or smoothing a sharp edge.
- Ostectomy: removing a small amount of supporting bone, for example to level a crater between two teeth or to move the bone crest further from a crown margin.
Both are usually done in the same procedure, and the amount of bone removed is kept to what is needed.
When it is used around natural teeth
Gum disease with bone defects
Periodontitis can leave ledges, craters and uneven bone between teeth. Plaque collects in these areas and pockets stay deep even after cleaning. Reshaping shallow defects lets the gum lie flatter and shallower so daily brushing and professional cleaning can reach. Deeper, narrow defects are often better treated with regeneration (grafting) than by removing bone.
Crown lengthening
A tooth broken or decayed at or below the gum line needs some healthy tooth above the bone before a crown can be fitted. The gum and its attachment need roughly 2 to 3 mm of space between the crown edge and the bone. If a crown is placed too close to the bone, the gum stays inflamed. Crown lengthening removes a little bone to recreate that space. See our crown lengthening page.
Gummy smile
Some people have short-looking front teeth because the gum and bone never moved back fully as the teeth erupted (altered passive eruption). Trimming the gum alone often lets it grow back. Reshaping the bone underneath keeps the new gum line stable. Our gummy smile guide explains the options.
When it is used around implants
Implants need a smooth, even ridge of bone. After teeth are extracted, the ridge can be sharp, uneven or knife-edged. Smoothing it (alveoloplasty) gives a flatter platform for the implants and for the gum over them.
For full-arch treatment such as All-on-4, the dentist often levels and reduces the ridge on the day of surgery. This creates vertical space for the bridge, hides the join between bridge and gum below the lip line, and leaves a flat bone platform for the implants.
Reshaping can also remove thin, sharp bone edges that would otherwise press through the gum or leave a ridge that is hard to clean. Where bone is missing rather than excess, grafting is used instead.
How the procedure is done
- Planning: X-rays or a CBCT scan show the bone height and shape and the position of roots, nerves and the sinus.
- Anaesthetic: the area is numbed with local anaesthetic. Sedation can be offered to anxious patients.
- Access: the gum is gently lifted (a flap) to expose the bone.
- Reshaping: the bone is shaped with hand instruments, fine burs or ultrasonic (piezo) tips, under water cooling. In selected cases an Er:YAG hard-tissue laser such as the Fotona LightWalker may be used.
- Closure: the gum is placed back at the planned level and stitched.
A few teeth usually take about an hour. When the work is part of implant surgery, it is done in the same session.
Healing and aftercare
Mild swelling and soreness for two to four days are common and are managed with prescribed medicines. Stitches are usually removed after 7 to 14 days.
- Eat soft, cool foods for the first few days and chew on the other side.
- Do not brush the surgical area until advised. Use the prescribed mouthwash instead.
- Avoid smoking, which slows gum and bone healing.
- Teeth may feel more sensitive to cold for a few weeks as more root surface is exposed.
The gum looks healed within a few weeks, but it keeps settling for about three months. For front teeth, the final crown is often made after this so the gum line has stopped moving. More on gum procedures is on our gum surgery page.
Told you need crown lengthening or bone reshaping before an implant? Book a Consult at our Bandra West or Kemps Corner clinic.
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