Osseous surgery: Resection- Review Flashcards
Osseous surgery may be ____ or ____
Resective or regenerative
Osseous surgery in which we are subtracting or taking away bone:
Resective procedure
Osseous surgery in which we are adding bone:
Regenerative procedure
What is the rationale behind osseous surgeries?
A reduced probing depth will both increase the effectiveness of oral hygiene by the patient and facilitate the ease of maintenance by the therapist
Indications of osseous surgery include:
- shallow infrabony defects
- osseous ledges & tori
- furcation invasions (class I or shallow class II)
- cutting multirooted teeth to be single rooted
- inconsistent margins
Contraindications of osseous surgery include:
- maxillary anteriors (esthetics)
- three-wall defects (want to regenerate these areas if possible)
- isolated deep defects
- generalized advanced bone loss
- high caries rate
- dentinal sensitivity
- local anatomic factors
- poor plaque control
Advantages of osseous surgery:
- predictable
- one-step
- single site
- minimal healing time
- ease of post-op maintenance
- improved contours for better flap adaptation
Disadvantages of osseous surgery:
- root sensitivity
- esthetics
- defect dependent
- loss of attachment (by ostectomy but usually limited)
Alternative treatments to osseous surgery:
- regenerative procedures
- root amputation or hemisection
- non-surgical therapy
- extraction
Resective surgery technique depends on:
- anatomic factors
- gingival contours
- bone thickness & contour
- dentition
Steps of resective surgery:
- bone sounding
- intrasulcular incisons
- mucoperiosteal flap resection
- root & defect debridement
What are some differinf techniques involved in resection:
- vertical interproximal grooving
- reduction of marginal radicular bone
- elimination of lips of craters
- removal of “widows peaks”
- removal of marginal radicular bone
With closure during resection, the tissue placement can be done at the ____ or ____
AT THE alveolar crest or CORONAL to the alveolar crest
If the soft tissue is placed AT the alveolar crest during closure:
pocket elimination
If the soft tissue is placed CORONAL to the alveolar crest during closure:
pocket reduction
Between the palatal and lingual approach of osseous surgery, the ____ approach is more common
Palatal
The palatal approach of osseous surgery is used for:
maxillary surgery
The palatal approach of osseous surgery is used for maxillary surgery due to:
- furcations more apical
- wider embrasures
- defects commonly seen on palatal
- more cancellous bone
- all keratized tissue
- one root in palatal (vs two on buccal)
The lingual approach of osseous surgery is used for:
mandibular surgery
The lingual approach of osseous surgery is used for mandibular surgery due to:
- furcations more apical
- wider embrasures
- defects commonly seen on lingual
- axial inclination of molars
- avoids external oblique ridge
The re-shaping of bone to achieve a more physiologic form without removal of alveolar bone proper:
OsteoPLASTY
The removal of alveolar bone proper (supporting bone):
OstECTOMY
Osseous defect classifications include:
- infrabony
- suprabony
- inconsistent margins
- other
Osseous defect that is apical to the alveolar crest, within the bone, and considered more severe- classified into one, two or three-walled:
INFRAbony
Osseous defect that is coronal to the alveolar crest- may be vertical or horizontal:
SUPRAbony
Infrabony osseous defects are classified as:
Suprabony osseous defects are classified as:
Infra= one, two or three-walled
Supra= horizontal or vertical
In a suprabony defect, if the distance between the roots of the teeth is GREATER than or EQUAL to 2.5mm, the defect will be a _____ defect
Vertical
In a suprabony defect, if the distance between the roots of the teeth is less than 2.5mm, then the defect will be a ___ defect
Horizontal
Defect in which the interdental crestal bone is located apical to the level of the radicular bone resulting in a NEGATIVE architecture:
Inconsistent margins
Other osseous defects not categorized as infrabony, suprabony or inconsistent margins include:
- interradicular defects (furcations)
- dehiscence (missing bone, most common MB root of maxillary first molar)
- Fenestrations (windowing of bone)
Dehiscences are ____ and most commonly occur ____
Missing bone; MB root of maxillary first molar
Windowing bone:
Fenestrations
Interradicular defects=
Furcations
Defect classified by the number od walls remaining:
infrabony osseous defect
Infrabony osseous defects are categorized by:
The number of walls remaining
One wall defect:
hemiseptum
Defect in which there is only one wall remaining:
one wall defect (hemiseptum)
Disease starts interproximally underneath the contact point (leads to this defect):
Two wall
What is the most common type of infrabony defect?
Two wall
A “true” infrabony defect, “hole” that osseous graft materials does into:
Three wall
A two wall defect is also called:
crater defect
Type of defect in which we have the best chance of success for regeneration/graft:
Three wall defect
What type of defect is a contraindication for resection:
Three wall
Considered both a INFRAbony and INTRAbony defect:
Three wall
A ____ is considered a four wall defect
Implant (circumferential defect)
Physiologic architecture of bone=
positive architecture
Reverse architecture or inconsistent margins of bone (interdental crestal bone located apical to the level of radicular bone):
Negative architecture
Interdental crestal bone located APICAL to the level of radicular bone:
Negative architecture
Type of architecture that tends to be done by dental providers to help maintain various factors:
Flat architecture
List the determinants of gingival contour:
- interdental space
- position of tooth in arch
- root shape
- crown shape
T/F: The determinant of gingival contour is NOT necessarily underlying bone
True
