Step 3 surgery & bony defects

Question 1

What types of surgery are there?

Answer 1

Access surgery
Regenerative surgery

Question 2

What are the aims of access surgery?

Answer 2

Access to areas of continued inflammation
To allow for surgical debridement

Question 3

When might ACCESS surgery be considered?

Answer 3

When deep residual pockets of = or >6mm (after repeated sub-gingival instrumentation)
Patients must have controlled their modifiable risk factors
Patients with stage 3/4 perio
Pt. likely to comply with post-surgery maintenance
OH - plaque <20%, marginal bleeding <10%

Question 4

What are indications for REGENERATIVE surgery?

Answer 4

Intra-bony defect 3mm or deeper as assessed radiographically (diff. to probing depth)
Grade 2 or 3 furcation defect
2 or 3 walled vertical defects

Question 5

What is a vertical bony defect and how is it caused?

Answer 5

When there is bone loss but bone is still present on the other side.
Plaque’s zone of destruction is approximately 2mm so if bone width between teeth is less than 2mm then HORIZONTAL bone loss occurs.
If greater then 2mm width = VERTICAL/ ANGULAR DEFECT

Question 6

How are vertical bony defects classified?

Answer 6

Classified by number of walls
1, 2, or 3-walled defects

2 and 3-walled defects have better prognosis

Question 7

What is an example of regenerative surgery that can be used for vertical bony defects?

Answer 7

Guided tissue regeneration - GTR
Use of bone-derived grafts e.g. bio-oss

Question 8

How else can vertical bony defects be managed if GTR fails?

Answer 8

Palliative care - pmpr and plan for loss
Hemi-section - cutting a multi-rooted tooth in half to remove periodontally involved half
Extraction