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Perio II > EXAM 2 Principles of Osseous Resective Surgery > Flashcards

EXAM 2 Principles of Osseous Resective Surgery Flashcards

1
Q

what is described by the following definition:

bony deformities are not uniform: often a combination of horizontal and vertical loss

concavity or deformity in alveolar bone involving one or more teeth

A

osseous defect

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2
Q

T or F

the presence of osseous defect is a sign of active disease

A

false

it is not a sign of active disease

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3
Q

an osseous defect is an osseous deformity resulting from ___

A

periodontal disease

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4
Q

what two things can be used in the diagnosis and evaluation of an osseous defect?

A

radiographs and probing

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5
Q

radiographs can reveal the existence of ___ in the interproximal space, but only provides ___ information

A
  • angular bone loss
  • 2-dimensional
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6
Q

probing supplies only ___ measurements of the soft tissue pocket

A

linear

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7
Q

what is transgingival probing?

A
  • “bone sounding”
  • indicates the topography of the bony defect in two directions
    • vertical and horizontal
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8
Q

what are the three classifications of osseous defects?

A
  • 3-wall infrabony defects
  • 2-wall infrabony defects
  • 1-wall infrabony defects
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9
Q

___-wall infrabony defects are usually located in the interdental region

A

3-wall

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10
Q

3-wall defects consist of which 3 walls?

A

facial, proximal, and lingual

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11
Q

what is the name for 3-wall defects that wrap around the tooth involving two or more contiguous root surfaces?

A

circumferential defects (a type of 3-wall infrabony defect)

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12
Q

what are the 4 additional designations for 3-wall infrabony defects?

A

narrow, wide-mouth, shallow, and deep

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13
Q

what is another word for infrabony?

A

intrabony

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14
Q

what are the two types of two-wall infrabony defects?

A

interdental craters and two-wall hemiseptum

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15
Q

what are the most common bony defects?

A

interdental craters (2-wall)

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16
Q

interdental craters are located ___

A

interdentally

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17
Q

interdental craters consist of what 3 things?

A

facial bony wall, lingual bony wall, two adjacent roots

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18
Q

what infrabony defect is described as 1/2 of an interdental septum, and a lingual and proximal wall or a facial and proximal wall?

A

2-wall hemiseptum (2-wall infrabony defect)

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19
Q

what infrabony defect is described by the following:

remaining one wall usually located interdentally (hemiseptum); may also be located on facial or lingual aspect

A

1-wall infrabony defect

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20
Q

what is described by the following:

the general term for procedures which modify and shape bone defects and deformities

may be defined as a procedure which aims to eliminate deformities induced by periodontal disease process or other related factors, such as exostosis and tooth supraeruption

A

osseous surgery

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21
Q

what are the 2 types of osseous surgery

A
  • additive osseous surgery (regenerative)
  • subtractive osseous surgery (resective)
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22
Q

what are the 5 therapeutic choices for osseous defects

A
  • osseous recontouring (osteoplasty vs. ostectomy)
  • induce regeneration of bone
  • root resection with osseous resection
  • maintenance of the pockets associated with osseous defects
  • tooth extraction
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23
Q

what procedure is described by the reshaping of bone without removing tooth supporting bone?

A

osteoplasty

24
Q

what procedure is described by the reshaping of the bone, including the removal of tooth structure?

A

ostectomy

25
Q

what are the 5 therapeutic determinants for osseous surgery?

A
  • depth of the defect
  • width of the defect mouth
  • defect topography
  • number of remaining bony walls
  • number and configuration of the adjacent root surfaces
26
Q

an objective of osseous resection is to reshape the ___ bone to resemble the alveolar process undamaged by ___

A
  • marginal
  • periodontal disease
  • *positive architecture vs. negative architecture
27
Q

an objective of osseous resection is to create ___ contours that will be parallel to ___ contours with shallow crevice depths after healing

A
  • bony
  • gingival
28
Q

an objective of osseous resection is to create ___ gingival contours

A

cleansable

29
Q

an objective of osseous resection is to permit easier primary wound closure by ___ bone and allowing better ___

A
  • thinning
  • flap approximation
30
Q

an objective of osseous resection is to expose additional ___ for proper restoration

A

clinical crown (for crown lengthening)

31
Q

what are 4 considerations of gingival behavior?

A
  • the biologic width
  • normal gingival contours
  • bone - hard tissues
  • gingival tissues - tend to follow more fluid form
32
Q

in normal gingival contours, there are ___ and ___ scalloping of marginal gingiva to the tips of the interdental papilla

A

facial and lingual

33
Q

the degree of scalloping is determined by what 3 things?

A
  • cemento-enamel junctions
  • the convexity of the teeth
  • tooth position in alveolar bone
34
Q

gingival behavior after surgery:

gingiva will heal according to what?

A

the same anatomic concepts as in health (follow contours of tooth or contours of CEJ)

35
Q

gingival behavior after surgery:

the gingiva will attempt to re-establish the ___ with shallow sulci

A

biologic width

36
Q

what are the 5 indications for osseous resection?

A
  • shallow infrabony defects (1-2mm deep)
  • incipient and shallow definites furcation invasions
  • flat or reverse architecture, tori, exostoses and ledges
  • bone contouring in conjunction with root resection
  • to achieve primary closure of flaps by thinning bone (osteoplasty), not removing attached bone (ostectomy)
37
Q

what are the 6 contraindications for osseous resection?

A
  • esthetic areas
  • isolated deep pockets
  • advanced periodontitis
  • the presence of certain local anatomic factors
  • a patient with a high caries index
  • a patient with a serious systemic condition
38
Q

one contraindication for osseous resection is the presence of certain local anatomic factors. what are the 4 factors?

A
  • near the ascending ramus
  • near the external oblique ridge
  • in close proximity to the maxillary sinus
  • adjacent to a flat palate
39
Q

what are two types of instruments used for osseous resective surgery?

A

hand instruments and rotary instruments

40
Q

for osseous resective surgery, a basic flap approach should be used, with what 3 things?

A
  • local anesthesia
  • full thickness, apically positioned flaps
  • thorough tissue debridement
41
Q

what are the 4 steps of the osseous resection phase?

A
  1. vertical grooving
  2. radicular blending
  3. flattening interproximal bone
  4. gradualizing marginal bone
42
Q

describe the vertical grooving step of the osseous resection phase

A
  • reduces the thickness of the alveolar housing and provides relative prominence to the radicular aspect of the teeth
  • also provides continuity from the interproximal surface onto the radicular surface
43
Q

describe the radicular blending step of the osseous resective phase

A
  • it attempts to gradualize the bone over the entire radicular surface
  • provides a smooth surface for good flap adaption
44
Q

describe the flattening interproximal bone step of the osseous resection phase

A
  • requires removal of very small amounts of supporting bone
  • indicated when interproximal bone levels vary horizontally
45
Q

describe the gradualizing marginal bone step of the osseous resection phase

A
  • minimal bone removal
  • necessary to provide a sound, regular base for gingival tissue to follow
46
Q

in osseous resection, failure to remove small bone discrepancies on the gingival line angles (“widow’s peaks”) can cause what?

A

allows the tissue to rise to a higher level than the base of the bone loss in the interdental area

47
Q

what are the advantages for the lingual approach for osseous resection?

A
  • maxilla: defects are ramped towards the palate
  • mandible: defects are ramped towards the lingual
48
Q

describe how it is advantageous for maxilla defects to be ramped towards the palate in the lingual approach to osseous resection

A
  • avoids removing bone from facial, exposing molar furcations
  • the palatal aspect has wider interdental embrasures for access during surgery and for post surgical maintenance
  • a better esthetic result is achieved
49
Q

describe how it is advantageous for mandibular defects to be ramped towards the lingual in the lingual approach to osseous resection

A
  • less removal of supporting bone due to a lingual inclination (approx. 20*) in posterior teeth
  • the deepest point of most interdental osseous defects is usually positioned lingually
  • less chance to expose lingual furcation (positioned more apically)
50
Q

what are the disadvantages of the lingual approach to osseous resection from the mandibular aspect?

A
  • the lingual bone is often thick
  • a considerable amount of osteoplasty is required to achieve proper architecture
51
Q

in osseous resection, the flap is positioned ___ to cover the marginal bone crests with flap-tooth contact ___ mm supracrestally and sutured

A
  • apically
  • 1-2mm
52
Q

what are the 3 advantages of osseous resection?

A
  • more predictable than osseous regeneration
  • a minimal waiting period for healing
  • plaque control is easier with shallower probing depths than deeper probing depth
53
Q

what are the disadvantages of osseous resection?

A
  • greater loss of attachment than other surgeries
  • esthetics compromised, especially in the maxillary anterior region
  • root hypersensitivity
  • root caries
54
Q

what is positive architecture?

A

the radicular bone is apical to the interdental bone

55
Q

what is negative architecture?

A

the interdental bone is more apical than the radicular bone

56
Q

what is flat architecture?

A

interdental and radicular bone are at the same height

57
Q

what is ideal osseous form?

A

when the bone is consistently more coronal on the interproximal surfaces than on the facial and lingual surfaces

Perio II (5 decks)

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