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Dr Sharma > Week 7- Perio Surgery Furcations, Bone Grafts, GTR > Flashcards

Week 7- Perio Surgery Furcations, Bone Grafts, GTR Flashcards

1
Q

What is the issue with furcation involved teeth?

A

Tend to respond less favourable to non-surgical perio therapy and have reduced prognosis.

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2
Q

What are surgical tx options for furcation involved teeth?

A
  • Resective surgery
    • Furcation plasty
    • Hemi-section, root resection, bicuspidization
  • Regenerative surgery
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3
Q

What is the classification for furcation involvement?

A
  • Grade I: incipient, catch in furcation
  • Grade II: bone loss, not through and through ‘cul-de-sac’
  • Grade III: bone loss through and through
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4
Q

What is the perio pocket in a furcation lesion influenced by?

A
  • Anatomy of soft tissue (thick, thin)
  • Bone (horizontal and angular loss)
  • Inter-radicular anatomy of tooth
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5
Q

What does furcation plasty involve?

A
  • Odontoplasty (reshaping tooth)
  • Osteoplasty (reshaping bone)
  • Gingivoplasty (reshaping gingiva) to enhance pocket and furcation access following open debridement.
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6
Q

What are the steps of furcation plasty?

A
  1. Flap to access inter-radicular area
  2. Odontoplasty to widen furcation entrance
  3. Osteoplasty to reduce or eliminate the intra-bony defect and decrease thickness of bone.
  4. Positioning flap at level of alveolar bone crest.
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7
Q

What is the goal for furcation plasty?

A

Improved access for self-care and professional supportive care should result

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8
Q

What teeth should aggressive odontoplasty be avoided on and why?

A

Aggressive odontoplasty should be avoided on vital teeth due to risk of hypersensitivity

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9
Q

What furcation involved teeth can receive tunnel preparation?

A

Md molars with deep grade II and III furcation defects

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10
Q

What is the rationale for hemi-section, root resection and bicuspidization?

A

Complete elimination of furcation defect. Involves a multidisciplinary approach and aims to preserve tooth or part of it

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11
Q

When is endo tx completed when hemi-section, root resection and bucuspidization are undertaken?

A
  • Endo done before surgery
  • Occasionally, decision to resect root is made during surgery, in which case endo tx is done along with surgery.
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12
Q

What is hemisection?

A

Sectioning tooth in 2 and removing one half of it (can do cantilever off remaining segment)

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13
Q

What teeth is hemi-section vs root resection done in?

A
  • Hemi-section: lower molar
  • Root resection: upper molar
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14
Q

What is this procedure?

A

Hemi-section

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15
Q

When is hemi-section indicated?

A
  • Severe bone loss around one root
  • Perforations during endo
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16
Q

What is root resection?

A

Removal of one or two roots (with poorest prognosis)

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17
Q

What is this procedure?

A

Root resection

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18
Q

What is bicuspidization?

A

Splitting tooth in 2 and retaining both sections

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19
Q

What is this procedure?

A

Bicuspidization

20
Q

What are the steps of hemi-section, root resection and bicuspidization?

A
  • Mucoperiosteal flap to expose furcation area
  • Sectioning root or tooth with straight line cut
  • Careful removal of root (root resection), tooth section (hemisection). Non for bicuspidization.
  • Re-positioning of flaps at level of bone crest.
21
Q

What are failures for hemi-section, root resection and bicuspidization often associated with?

A
  • Usually due to non-periodontal complications so care should be taken to ensure sound endo therapy and a balanced occlusion
  • Remaining roots should have adequate bone support
22
Q

What is regenerative surgery?

A

Regeneration of periodontal defects involves formation of new cementum, new attachment periodontal fibers and new bone that was destroyed by perio disease.

23
Q

How can true regeneration be verified?

A

Only via histologic evaluation by removing tooth and bone. No way to confirm clinically.

24
Q

What can you confirm by doing re-entry surgery after regenerative surgery?

A

Can measure bone fill but cannot ascertain if new cementum or periodontal fibers have formed.

25
Q

What are the possible healing outcomes after flap surgery?

A
  • Long junctional epithelium
  • Connective tissue adhesion & root resorption
  • Root resorption & ankylosis
  • New connective tissue attachment
26
Q

What are indications for bone grafts?

A
  • Infra/intra bony defects (3 and 2 walled defects
  • Grade II furcation involvement
  • Preparation of site for implant (GBR)
  • In combo with GTR procedures
27
Q

What are contraindications for bone grafts?

A
  • Horizontal bony defects associated with teeth
  • Lack of soft tissue coverage
  • Pt with poor plaque control
  • Systemic issues suck as smoking and poor general health
28
Q

What are the 4 types of bone grafts in order of best to worst for healing?

A
  1. Autogenous graft ( tissue from self)
  2. Allograft (tissue from another human)
  3. Xenograft (tissue derived from animal)
  4. Alloplast (synthetic)
29
Q

Properties of osteogenic bone grafts

A

Formation of new bone from living cells transplanted within the graft e.g. autographs

30
Q

What is osteoinductive bone graft?

A

Graft sends signals to attract, proliferate and differentiate early-lineage cells cable of forming bone e.g. allografts

31
Q

What is osteoconductive bone graft?

A

Graft serves as scaffold onto which bone cell can attach, migrate, grow and/or divide e.g. allografts and some xenografts

32
Q

What are characteristics of autographs?

A
  • Gold standard (most compatible & best quality)
  • Blocks or chips can be scraped off bone surface (can control how much bone is harvested)
  • Intra-oral or extra-oral sites can be harvested
33
Q

What are the reasons for extra-oral autograph bone graft, what are the cons and where are the common sites?

A
  • If larger quantity of bone is required (e.g. jaw reconstruction)
  • Increased morbidity (GA)
  • Theatre cost

Common sites: hip bone, ribs, fibula, tibia

34
Q

What are the reasons for intra-oral autograph bone graft, what are the pros/cons and where are the common sites?

A
  • When you need limited quantity of bone
  • Lesser morbidity (under LA)
  • Surgical expertise

Possible sites: exo sites, retromolar area, md ramus, md symphysis. mx tuberosity, tori

35
Q

What is DFDB?

A

Decalcified Freeze-Dried Bone

  • Type of allograft
  • Very compatible
36
Q

What is xenograft?

A

Protein extraction of bovine bone to produce porous bone mineral hydroxyapatite (Bio-Oss is common product)

37
Q

What is selective repopulation GTR?

A

Selective repopulation blocks epithelial and connective tissue, to allow only PDL and bone to fill space.

38
Q

What are the steps of GTR?

A
39
Q

What are examples of non-resorbable membranes?

A
  • PTFE Membranes (Gore-Tex)
  • Titanium reinforced dense PTFE (Cytoplast)
40
Q

What are characteristics of non-resorbable membranes?

A
  • Needs 2nd surgery to remove
  • Exposure can lead to infection
  • Used mainly in GBR
41
Q

What is this procedure?

A

Placement of non-resorbable membrane for GBR (socket preservation)

42
Q

What are the 3 types of resorbable membranes?

A
  • Collagen
  • Polylactic acid
  • Polyglycolic acid
43
Q

What are advantages of resorbable membranes?

A
  • Eliminates need for 2nd surgery
  • More tissue friendly
  • Enhances tissue coverage
  • Resist microbial colonisation
44
Q

What are disadvantages of resorbable membranes?

A
  • May elicit immune or inflammatory response
  • Time of resorption cannot be controlled
45
Q

What is this?

A

Bio-Glide (Resorbable collagen membrane)

46
Q

Give an example of each type of bone graft

A
  • Autograph: hip, retromolar area
  • Allograft: DFDB
  • Xenograft: BioOss
  • Alloplast: Perioglas

Dr Sharma (4 decks)

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