Osseous Surgery Flashcards
Osseous Surgery definition
Procedures by which changes in the alveolar bone can be accomplished to remove deformities induced by the periodontal disease process or other related factors
Ostectomy Definition
Removal of bone that is attached to the tooth
Remove mid-facial bone until it is apical to the interdental bone (this fixes the reverse architecture)
What are the indications of Ostectomy
Sufficient remaining bone for establishing physiologic contours without attachment compromise
No esthetic or anatomic limitations
Intrabony defects not amenable to regeneration
Moderate to advanced furcation involvement
Hemisepta (1-walled defect)
Advantages of Ostectomy
Predictable pocket elimination
Physiologic gingival and osseous architecture
Favorable prosthetic environment
Contraindications of Ostectomy
Insufficient remaining attachment Unfavorablely affect adjacent teeth (too close root proximity) Anatomic limitations Esthetic limitations Effective alternative treatment
Disadvantages of Ostetomy
Loss of attachment (losing bone that supports tooth)
Esthetic compromise
Increased root sensitivity
Osteoplasty definition
Reshaping of alveolar process to achieve a more physiologic form without removing the alveolar bone proper - we remove non-tooth supporting bone
Osteoplasty indications
Tori reduciton
Intrabony defects adjacent to the edentulous space
Incipient furcations
Reduction in thick heavy ledges or exostoses
Shallow osseous craters
Physiologic architecture
When the crest of the interdental gingiva or bone is located coronal to its midfacial and midlingual margins
This is ‘normal’
Reverse architecture
When the crest of the interdental gingival or bone is located apical to its midfacial and midlingual margins
Steps in Osseous Resective Surgery
1) Flap
2) Decide how much bone you want to remove (by making vertical grooves)
3) Radicular blending (grind the bone so it blends with the grooves)
4) Gradualizing marginal bone (grind the bone to get positive architecture)
Steps in Osseous Surgery
1) Reflect full thickness flap
2) Smooth the bone until we get back the scalloped look
3) Put the flap back
Why is the palatal approach the preferred method?
More keratinized gingiva on the palate
Larger palate embrasure for better surgical access
Less post surgical bone resorption due to increased cancellous bone on the palate
What determines how many walls we remove?
Dimensions of the crater
How many walls are removed if we have thick walls and shallow (2-3mm) defects
Remove 1 wall
