Osseous Surgery

Question 1

Osseous Surgery

Answer 1

• Procedures to modify bone
  
  • reshape alveolar process to physiologic form
    
    • do not remove supporting bone
  • remove supporting bone
    
    • change position of crestal bone compared to the tooth root

Question 2

Osseous (resective) Surgery: Rationale

Answer 2

• Level and shape of bone and gingiva
  
  • put at risk for recurrent Pocket Depth post surgery
• not universally accepted
  
  • lose radicular bone during healing

Question 3

What is the goal of osseous surgery?

Answer 3

• Reshape the marginal bone
  
  • look like an undamaged alveolar process

Question 4

What type of flaps are used in osseous surgery?

Answer 4

apical positioned

Question 5

What doe Osseous surgery try to eliminate?

Answer 5

pocket depth

Question 6

What does osseous surgery try to improve?

Answer 6

• tissue contour→easy maintenance

Question 7

Ostectomy

Answer 7

• aka Osteotomy
• remove supporting bone
  
  • bone attached to tooth
• change the position of crestal bone relative to root
• correct/reduce deformities in
  
  • marginal and interalveolar bone

Question 8

Osteoplasty

Answer 8

• Reshape alveolar process to achieve physiologic form
• does not remove supporting bone

Question 9

Physiological architecture

Answer 9

• Soft tissue or bone
• includes:
  
  • positive architecture in a vertical dimension
  • buccal-lingual contours
    
    • NO ledges and exostoses
  • interradicular grooves

Question 10

Positive Architecture

Answer 10

• crest of interdental gingiva or bone is coronal to mid facial/Lingual margin

Question 11

Reverse Architecture

Answer 11

• AKA Negative architecture
• Crest of the interdental gingiva or bone is apical to its mid facial and mid lingual margins
• craters in embrasure
  
  • crater=pockets w/bacteria

Question 12

What is the ideal Osseous Form

Answer 12

• Bone more coronal interproximal vs facial/lingual surfaces
• Marginal Bone
  
  • similar interdental height
  • Scalloped:
    
    • curved slopes b/w interdental peaks
  • Follows CEJ:
    
    • Health=2mm below CEJ
• Molars (Vs Bicuspids/incisors=Scalloped)
  
  • less scalloped;
  • more flat

Question 13

Osseous Surgery: Indications

Answer 13

• Generalized Perio
  
  • w/pronounced & irregular bone loss
  • shallow or moderate craters
• intrabony defects
  
  • that can’t be regenerated OR
  • Shallow (1, 2-wall)
• Perio Pockets
  
  • is preventing adequate plaque control
• Incipient furcation
• Thick bony ridges or exotoses/tori
• Crown Lengthening

Question 14

Osseous Surgery: Contraindications

Answer 14

• Anatomy limitations
  
  • root proximity
  • external oblique ridge
• Poor Crown: Root Ratio
• unacceptable esthetic result
• Sacrificing too much bone on adjacent teeth
• inadequate perio attachment
• Intrabony defects
  
  • that can be regenerated OR
  • Deep (3 wall)
• Surgical related
  
  • poor OH
  • caries
  • medical
    
    • past hx of bisphosphonates
    • Bleeding disorder
    • uncontrolled diabetes
    • Organ transplant

Question 15

Classification of Bony Lesions:

Answer 15

• based on:
  
  • Configuration
    
    • # of bony walls*

Question 16

Who initially came up with the principle of osseous resection?

Answer 16

Schluger

Question 17

Who came up with osteoplasty and ostectomy

Answer 17

Frieman

Question 18

Who came up with the infra bony technique?

Answer 18

Pritchard

Question 19

Who came up with how to classify and treat infra bony pockets?

Answer 19

Goldman

Question 20

Osseous Surgery: Armamentarium

Answer 20

• High speed burs
• High speed handpick w/irrigation
• Chisels
• Bone files

Question 21

What is the objective of the Flap Design in osseous surgery?

Answer 21

• Create thin flaps
  
  • w/ even thickness
• at the level of the osseous crest

Question 22

During Flap Design, what does the incision depend on?

Answer 22

• amount of keratinized gingiva

Question 23

During flap design, what are some esthetic concerns to consider?

Answer 23

• recession in anterior sextant
  
  • black triangles
  • exposes darker colored CEJ and cementum

Question 24

What is another word for defect in intrabony defects?

Answer 24

Crater

Question 25

What is the most common intrabony defect?

Answer 25

2-wall defect/crater

Question 26

Periodontal Craters

Answer 26

• occur at the expense of interseptal bone
• Buccal-Lingual inter proximal contour that results
  
  • opposite to the contour of the CEJ
• IF facial and lingual plates are resected
  
  • interproximal contour would be flattened or ovate

Question 27

What determines the extent of bone attachment that is removed during osseous recection?

Answer 27

• Relationship b/w the:
  
  • depth & configuration of the bony lesion
    
    • TO
  • root morphology and adjacent teeth

Question 28

In what clinical scenario is best for ostectomy vs osteotomy?

Answer 28

• Ostectomy
  
  • early to moderate bone loss
  • moderate-length root trunks
  • 1 or 2 wall bone defects
• Osteotomy & Ostectomy:
  
  • shallow to moderate defects

Question 29

Furcation: Clinical Considerations

Answer 29

• Furcation entrances:
  
  • use radiograph to eval root trunk
  • avg distance from CEJ to furcation on Max molars:
    
    • buccal: 4.2mm
    • Mesial: 3.6mm
    • Distal: 4.8 mm
• Furcation involvement
  
  • avoid
  • treat each root as its own tooth

Question 30

Interradicular area: Clinical consideration

Answer 30

• treat like interproximals
• create double scalloped appearance