exam 2 (L8) - osseous surgery

Question 1

define osseous surgery.

Answer 1

procedure to cause changes in alveolar bone by removing deformities induced by periodontal disease or other related factors

Question 2

how does osseous surgery compare with coronal scaling, modified Widman flap surgery, and SRP in terms of effectiveness?

Answer 2

after several years:

• OS had least number of furcation sites w/ breakdown
• OS had greatest decrease in PPD areas > 5 mm

Question 3

define ostectomy

Answer 3

removal of bone that is attached to the tooth (by PDL)

Question 4

what are the indications for ostectomy (7)?

Answer 4

• enough bone left to make physiologic contours w/out compromising attachment
• no esthetic or anatomic limitations
• elimination of interdental creaters (2-wall defects)
• intrabony defects that aren’t amenable to regeneration
• horizontal BL w/ irregular marginal bone height
• moderate to advanced furcation involvement
• hemisepta (1-wall)

Question 5

what are the contraindications for ostectomy (5)?

Answer 5

• insufficient remaining attachment
• unfavorable effects on adjacent teeth
• anatomic limitations
• esthetic limitations
• better alternative treatments

Question 6

what are advantages of ostectomy?

Answer 6

• predictable pocket elimination
• regain physiologic gingival and osseous contours
• provides favorable environment for prosthetics

Question 7

what are disadvantages of ostectomy?

Answer 7

• AL
• esthetic compromise
• increased root sensitivity

Question 8

define osteoplasty

Answer 8

reshaping of the alveolar process to achieve physiologic form without removing alveolar bone proper

• AKA, only remove bone that doesn’t act as main support for teeth
• also used to remove tori, exostoses, and buttressing bone

Question 9

what are indications for osteoplasty (5)?

Answer 9

• tori reduction
• intrabony defects adjacent to edentulous ridge
• incipient furcations
• reduction of thick heavy ledges or exostoses
• shallow osseous craters

Question 10

define physiologic architecture

Answer 10

crest of interdental gingiva or bone is located coronally to midfacial or midlingual margins

Question 11

define reverse architecture

Answer 11

crest of interdental gingiva or bone is located apical to midfacial or midlingual margins

Question 12

what 3 types of instruments are used for osseous surgery?

Answer 12

• chisels
• files
• rotary instruments

Question 13

what are the steps in osseous resective surgery?

Answer 13

• decide how much bone to remove
• create vertical grooves interdentally
• radicular (F/L) blending and flattening of interproximal bone
• gradualizing marginal bone

Question 14

to what procedure is osseous surgery analogous?

Answer 14

• clinical crown lengthening (CCL)

- OS is for tx, while CCL is for prevention

Question 15

what approach is used for OS on the maxillary arch?

Answer 15

• palatal approach, effective b/c:
  + have keratinized gingiva on palate
  + palatal embrasures larger
  + more cancellous bone present limits BL

Question 16

what approach is used for OS on the mandibular arch?

Answer 16

- lingual approach, effective b/c:
\+ avoids thick buccal shelves of bone
\+ avoid shorter buccal root trunks
\+ mandibular teeth are lingually inclined (9, 20 degrees)
\+ craters are more lingual
\+ lingual embrasures wider

Question 17

what are the 4 crater (2-wall) classes, and how are they approached?

Answer 17

• class I (2 - 3 mm deep) = palatal ramping
• class II (4 - 5 mm) = facial & palatal ramping
• class III (6 - 7 mm) = facial & palatal ramping
• class IV (deep, very thin walls) = remove both walls

Question 18

what is a hemisection?

Answer 18

molar is cut in half when severe furcation involvement or deep pockets