Osseous Resective Surgery Flashcards
What are the main goals of Osseous Resective surgery?
MAIN GOAL: Reestablish positive architecture
Eliminate pockets, develop architectural form to enable patient and dentists to maintain teeth
What are the 4 indications for Resective surgery?
- Access
- Remove Calculus
- Reduce or eliminate persistent diseased sites
- Alter periodontium for esthetics, restorative, or prosthetic
What are the contraindications of osseous resective surgery? (7)
- Ineffective plaque control
- Non compliant patient
- Shallow probing depths
- Soft or hard tissue defects amenable to repair or regeneration
- Severely advanced diseased
- Unesthetic result
- Uncontrolled systemic illness
- What is the main GOAL of a gingivectomy?
2. What is the most common approach?
- Elimination of soft tissue pockets
2. External bevel is most common approach
What are the INDICATIONS of Gingivectomy? (4)
- MAIN INDICATION: Remove SUPRABONY pockets or gingival enlargement/overgrowth
- Eliminate soft tissue craters
- Esthetics from delayed passive eruption
- Create clinical crown length for restorative or endodontic purposes when ostectomy is not required
What are the ContraIndications of gingivectomy? (8)
- Acutely inflamed gingiva
- Poor OH
- Pocket depth that is apical MGJ
- Inadequate keratinized gingiva
- Presence of interdental osseous craters and infrabony defects, osseous ledges and exostoses
- Inadequate depth of the vestibule
- High Caries
- Unacceptable cosmetic compromise
What are the types of gingivectomy?
External Bevel: Incision at base of pocket, painful, cannot suture. Needs perio dressing
Internal Bevel: Less painful. Can suture. Heal by primary intention. Does not expose root surface.
What are the advantages of Modified Widman Flap (MWF)? (6)
- Exaggerated palatal scallops to ensure interproximal flap adaptation
- Formation New Cementum/ Bone Conservation
- Minimal flap reflection
- Retention of any residual CT attachment coronal to the bone
- Close interproximal flap adaptation to maximize healing – more regeneration potential
- Optimal Root Coverage
How does Modified Widman Flap (MWF) heal and what are the long term results?
Heals by Long Junctional Epithelium
You will see CAL gain and PD decrease but there is NO TRUE NEW ATTACHMENT
Discuss using a Palatal approach osseous technique? (5)
- Refine interdental craters
- Avoid exposure buccal furcation
- Wider palatal embrasure space
- Palate is all keratinized tissue
- Poor posterior access from buccal approach
Discuss the lingual approach osseous technique?
- Lingual crown incliniation of posterior teeth
- Most mandibular posterior craters/defects are located lingually due to the inclination
- Thicker lingual plate
- Avoids presence of shallow vestibular depth from prominent external oblique ridge on buccal
What is the wound healing after osseous surgery:
Discuss the variables (7) and
Flap Reflection + Debridement
Osteoplasty with Full Thickness Flap
Ostectomy
Variables:
- Management of soft tissues during incision
- Flap thinning
- Flap elevation
- Flap closure
- Extent of attachment loss
- Configuration of osseous defects
- Amount of trauma during surgery
A. Flap Reflection + Debridement: 0.2 mm mean loss of bone
B. Osteoplasty with Full Thickness Flap: 0.6 mm mean crestal bone loss
C. Ostectomy: Immediate CAL, with further loss during remodeling
What are the 4 indications for Clinical Crown Lengthening?
- Tooth decay at or below the gingival margin
- Tooth fracture below the gingival margin, with adequate remaining periodontal support and attachment
- Teeth with excessive occlusal or incisal wear
- Teeth with insufficient interocclusal space for restorative
What distance is needed from the alveolar crest to restoration margin in Clinical Crown Lengthening?
3-5.5 mm (Maynard, Becker)
**need a minimum 4mm of tooth to accommodate biologic width and enough tooth structure for a ferrule.
