Osseous Surgery Flashcards
Osseous Surgery
- Procedures to modify bone
- reshape alveolar process to physiologic form
- do not remove supporting bone
- remove supporting bone
- change position of crestal bone compared to the tooth root
- reshape alveolar process to physiologic form
Osseous (resective) Surgery: Rationale
- Level and shape of bone and gingiva
- put at risk for recurrent Pocket Depth post surgery
- not universally accepted
- lose radicular bone during healing
What is the goal of osseous surgery?
- Reshape the marginal bone
- look like an undamaged alveolar process
What type of flaps are used in osseous surgery?
apical positioned
What doe Osseous surgery try to eliminate?
pocket depth
What does osseous surgery try to improve?
- tissue contour→easy maintenance
Ostectomy
- aka Osteotomy
- remove supporting bone
- bone attached to tooth
- change the position of crestal bone relative to root
- correct/reduce deformities in
- marginal and interalveolar bone
Osteoplasty
- Reshape alveolar process to achieve physiologic form
- does not remove supporting bone
Physiological architecture
- Soft tissue or bone
- includes:
- positive architecture in a vertical dimension
- buccal-lingual contours
- NO ledges and exostoses
- interradicular grooves
Positive Architecture
- crest of interdental gingiva or bone is coronal to mid facial/Lingual margin
Reverse Architecture
- AKA Negative architecture
- Crest of the interdental gingiva or bone is apical to its mid facial and mid lingual margins
- craters in embrasure
- crater=pockets w/bacteria
What is the ideal Osseous Form
- Bone more coronal interproximal vs facial/lingual surfaces
- Marginal Bone
- similar interdental height
- Scalloped:
- curved slopes b/w interdental peaks
- Follows CEJ:
- Health=2mm below CEJ
- Molars (Vs Bicuspids/incisors=Scalloped)
- less scalloped;
- more flat
Osseous Surgery: Indications
- Generalized Perio
- w/pronounced & irregular bone loss
- shallow or moderate craters
- intrabony defects
- that can’t be regenerated OR
- Shallow (1, 2-wall)
- Perio Pockets
- is preventing adequate plaque control
- Incipient furcation
- Thick bony ridges or exotoses/tori
- Crown Lengthening
Osseous Surgery: Contraindications
- Anatomy limitations
- root proximity
- external oblique ridge
- Poor Crown: Root Ratio
- unacceptable esthetic result
- Sacrificing too much bone on adjacent teeth
- inadequate perio attachment
- Intrabony defects
- that can be regenerated OR
- Deep (3 wall)
- Surgical related
- poor OH
- caries
- medical
- past hx of bisphosphonates
- Bleeding disorder
- uncontrolled diabetes
- Organ transplant
Classification of Bony Lesions:
- based on:
- Configuration
- # of bony walls*
- Configuration
Who initially came up with the principle of osseous resection?
Schluger
Who came up with osteoplasty and ostectomy
Frieman
Who came up with the infra bony technique?
Pritchard
Who came up with how to classify and treat infra bony pockets?
Goldman
Osseous Surgery: Armamentarium
- High speed burs
- High speed handpick w/irrigation
- Chisels
- Bone files
What is the objective of the Flap Design in osseous surgery?
- Create thin flaps
- w/ even thickness
- at the level of the osseous crest
During Flap Design, what does the incision depend on?
- amount of keratinized gingiva
During flap design, what are some esthetic concerns to consider?
- recession in anterior sextant
- black triangles
- exposes darker colored CEJ and cementum
What is another word for defect in intrabony defects?
Crater
