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 or the oral hygiene by the patient and facilitate the ease of maintenance by the therapist
Indications of osseous surgery include:
- shallow infra bony defects
- osseous ledges and tori
- furcation invasions (class I or shallow class II)
- cutting multi-rooted teeth to be single rooted
- inconsistent margins
Contraindications of osseous surgery:
- maxillary anteriors (esthetics)
- three walled 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 osteotomy but usually limited)
Alternative treatments to osseous surgery include:
- 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
- instrsulcular incisions
- mucoperiosteal flap reflection
- root and defect debridement
What are some differing techniques with 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 soft tissue is place 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 palatial 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 keratinized tissue
- one root on 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 reshaping 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
- supra bony
- inconsistent margins
- other
Osseous defect that is apical to the, within the bone, and considered more severe. Characterized by 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 supra bony defect, if the distance between the roots of the teeth is GREATER or EQUAL TO 2.5mm, then the defect will be a ____ defect
vertical
In as supra bony 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 defect not categorized as infra bony, supra bony, or inconsistent margins include:
- interradibular defects (furcations)
- dehiscence (missing bone, most commonly MB root of max 1st molar)
- fenestrations (windowing of bone)
Dehiscence are _____ and they most commonly occur ____.
missing bone, MB root of maxillary 1st molar
Windowing of bone=
fenestrations
Interradicular defects =
furcations
Defects classified by the number of walls remaining:
infra bony osseous defect
Infrabony osseous defects are categorized by the number of walls:
remianing
One wall defect:
hemiseptum
Defect in which there is only one wall remaining:
one wall defect (aka hemiseptum)
Disease starts inter proximally underneath the contact point (leads to this type of defect):
two wall defect
What is the most common type of infra bony defect?
two wall defect
A “true” infra bony defect, “hole” that osseous graft material goes into:
Three wall defect
A two wall defect is also called a:
crater
Type of defect In which we have the best chance of success for regeneration/graft:
three wall
What type of defect is a contraindication for resection?
3 wall
Considrered both an INFRAbony and INTRAbony defect:
three wall
A _____ is considered a four-walled defect
implant (circumferential defect)
Physiologic architecture of bone:
positive architecture
Reversed architecture or inconsistent margins (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 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
