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Perio--Surgical (Spring) > 6. Ostectomy and Osteoplasty > Flashcards

6. Ostectomy and Osteoplasty Flashcards

1
Q

Why perform resective osseous surgery and what is it

A

What is it: Removal and recontouring of alveolar bone

Why?

  • Eliminate osseous defects contributing to pockets
  • Correct anatomic defects such as exostoses
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2
Q

Goals of Resective osseous surgery are

A
  • Soft tissue healing to a sulcus depth of 0-2 mm

- Reshape bone to physiologic contour

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3
Q

What are the two types of resective osseous surgery

A
  • Definitive

- Compromised

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4
Q

Indications for Osseous surgery

A
  • Generalized periodontitis with pronounced irregular bone loss (most common in LAP or chronic with open contacts and overhangs)
  • Defects exhibiting sharp bony margins or exostoses
  • Bony architecture preventing good plaque control
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5
Q

What is the most common osseous defect in chronic periodontitis

A

2 walled (interproximal craters) Where the BL walls are present and MD walls are missing

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6
Q

Why might you want to remove exostoses if you don’t need a denture and they are on the buccal

A
  • Food impaction
  • OH is difficult
  • *may lead to chronic periodontitis- esp interproximally *
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7
Q

What kind of flap is reflected to remove exostoses

A

full thickness MP flap (anytime there is osseous recontouring)

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8
Q

Contraindications for Osseous surgery

A

Patient (these are contraindications for every surgery)

  • Medical contrainditions
  • Poor OH

Anatomy… Proximity of

  • Maxillary sinus
  • Mandibular ramus (distals of lower 2nd and 3rd molars)

Severe alveolar bone loss
Extreme root sensitivity
Unacceptable post op esthetics (maxillary anteriors will lead to recession and black triangles and elongated crowns)

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9
Q

Compare and contrasts definitive and compromised osseous surgery

A

Definitive

  • Osseous defects corrected
  • Achieve positive or at least neutral architecture after surgery
  • Shallow to moderate bony defects (2-3 mm)
  • One or 2 walled defects

Compromised

  • Osseous defects can be improved but can’t be completely corrected without removing so much bone that teeth would be jeopardized
  • Treatment worse than disease
  • Advanced attachment loss and deep infrabony defects
  • Can’t achieve positive architecture.
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10
Q

Describe the appearance of physiologic alveolar bone

A
  • Alveolar crest parallels the CEJ
  • Scalloped parabolic shape (especially in anterior- posterior is more flat) –> interdental bone is coronal to radicular bone
  • Thin alveolar margin (not ledged to maintain thin gingival margin)
  • Interproximal sluiceways (important for the flow of food off the occlusal surfaces)
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11
Q

If there are diastemas between teeth than the scalloping of the alveolar crest is (more/less)

A

less

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12
Q

Scalloping in the posterior to anterior direction (increases/decreases)

A

increases

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13
Q

The interdental bone contours are a function of what two variables

A

tooth form and embrasure

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14
Q

Contours of interdental bone in the anterior is described how in terms of shape

A

pyramidal

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15
Q

What kind of flap is best near a dehiscence and fenestration- what teeth most commonly have these

A
  • Split thickness- Keeping the bone covered with CT rather than exposing will prevent bone loss post op
  • Maxillary 1st molars (esp MB root)
  • Canines
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16
Q

What is the most predictable method of reducing pockets in patients with osseous defects in patients with chronic periodontitis

A

Osseous surgery with pocket reduction

  • Ostectomy/osteoplasty
  • Apically position flap
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17
Q

Pocket reduction with osseous surgery results in a reduction of (alveolar bone/attachment)

A

both

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18
Q

What variables dictact the amount of bone that can be removed for osseous surgery

A

depends on the amount of bone the patient has remaining

  • The more bone that more than can be removed to attain optimal contours
  • Too little bone may be contraindication for surgery
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19
Q

Post op results of ostectomy with apically positioned flap are

A
  • Less BOP sites

- Favorable shift in subgingival microbes (gram negative anaerobes to gram positive cocci and rods)

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20
Q

Why is the classification of osseous defects important

A

dictates the treatment

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21
Q

Define the following terms for osseous architecture

  • Positive
  • Flat
  • Negative
A
  • Positive- interdental bone coronal to radicular bone
  • Flat- Interdental bone same level as radicular
  • Negative- interdental bone lower (more apical) than radicular bone
22
Q

Why is negative osseous architecture bad

A

Because it leads to progressing attachment and bone lose

23
Q

When doing Osteoplasty the osseous architecture we wish to achieve is _ but sometimes settle for _

A

positive… Flat (NEVER negative)

24
Q

What osseous defect is most common in…

  • Chronic perio
  • Localized aggressive perio
A
  • Chronic perio= interproximal osseous crater (2 walled)

- Localized aggressive perio = Circumferential defects (one wall)

25
Q

LAP affects what teeth

A

1st molars and incisors

26
Q

What is the standard of care for osseous grafts

A

decalcified freeze dried bone allograft

27
Q

How to treat a one walled osseous defect

A

Ostectomy and osteoplasty (poor graft site- nothing to pack the graft into)

28
Q

How to treat a 2 walled osseous defect

A
  • Ostectomy/osteoplasty and/or
  • Graft and/or
  • CTR (Guided tissue regeneration)
29
Q

How to treat a 3 walled osseous defect

A
  • *Favorable results with debridment and graft
  • Grafts work best on 3 walled defects
  • GTR
  • NOT osteotomy/osteoplasty
30
Q

Other names for a circumferential osseous defect

A
  • Circumferential One-walled defect

- Circumferential gutter

31
Q

What osseous defect can achieve new CT attachment and bone fill

A

3 walled

32
Q

Etiologies of circumferential osseous defects are

A
  • LAP

- Occlusal trauma (wiggling of the tooth in the socket)

33
Q

Can occlusal trauma cause perio pockets

A

no- (exacerbates pockets in the presence of plaque)

34
Q

What is a combined osseous defect

A
  • Apically a 3 walled defect

- Coronally a 2 walled defect

35
Q

How to treat a combined osseous defect

A
  • Graft apical section

- Osetectomy the 2 walled

36
Q

Define ostectomy and osteoplasty

A

Osteoplasty= reshaping bone without removing tooth supporting bone (like removing tori)

Ostectomy- removing tooth supporting bone

**These procedures go hand in hand

37
Q

Armamentarium for osseous surgery includes

A
  • High speed burs
  • Bone files
  • Chisels
  • Rongeurs
38
Q

Surgical burs are useful for

A

-Gross removal of bone (i. eliminating the BL walls when repairing a 2 wall defect)

39
Q

Why is water necessary for surgical burs

A

bone necrosis will occur when the termperature is over the critical point)

40
Q

Name an interproximal file

A

sugarman file

41
Q

Describe the design of a sugarman file

A

-flat end that goes against the tooth so it doesn’t get scored

42
Q

Interproximal files are useful in the removal of

A

granulation tissue

43
Q

Chisels are useful in the removal of

A

thin bone (especially when near the roots of the teeth)– don’t want bur there

44
Q

Rongeurs are used for

A

Exostoses (esp when they are round and pedunculated)

45
Q

What flap is indicated for osseous surgery

A

full thickness mucoperiosteal

46
Q

What flap is not indicated for osseous surgery and why

A

partial (split) thickness)

  • Obscures defect
  • Necessitates tearing of periosteum and CT
47
Q

Run through the steps of osseous surgery

A
  • Flap
  • Remove granulation tissue and tissue tags
  • Instrument root surfaces
  • Sharp bony prominances are recontoured
  • Interdental craters are opened
  • Tooth supporting bone not removed
  • Apically positioned flap
48
Q

1-walled defects can commonly be seen one what teeth

A

tipped

49
Q

Correction of interdental osseous craters is done by

A

ramping (Ramp to the buccal and ramp to the lingual)

50
Q

Surgical failures can either be due to the patient of the surgical technique, describe the actions a patient can do to result in failure

A
  • Poor plaque control
  • Root caries
  • Fail to follow post-op instructions
51
Q

What are the short and long term failures of osseous surgery that result due to surgical technique

A

Short-term

  • Post-op infection
  • Poor flap management (flap necrosis)

Long term

  • Incomplete pocket elimination
  • Deviations from ideal form (osseous contour)
  • Poor suturing
  • Expose thin bone, dehiscences, or fenestrations.

Perio--Surgical (Spring) (8 decks)

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