OSSEOUS SURGERY Flashcards
Advantages of osseous surgery?
- Predictable procedure, if principles are followed.
- Immediate results.
- Normal sulcus depths can be achieved.
- Probing depth reduction
- Facilitates periodontal maintenance
** over the long term, osseous resection offers better PD reduction and less potential for significant attachment loss**
Disadvantages of osseous surgery?
- Removes supporting bone
- Exposes more root structure
-increases sensitivity
-may compromise aesthetics - Open interdental spaces
-results in food retention
-requires additional time and additional aids for oral hygiene
Indications for osseous surgery?
- Elimination of shallow (1-2mm) 1 wall defects
- Elimination of 1-2mm intrabony defects (classic crater defect)
- Reduction of 3-4mm intrabony defects
- Defects >5mm: attempt regeneration or combination of resection- regeneration
- Correcting reverse architecture with minimal discrepancy between proximal and radicular crestal height
- Improve access for existing class 1 or shallow class 2 furcation invasions not amenable to regeneration (consider tooth shaping/barrelling-in of furcation entrance)
- Reduction of thick ledges and exostoses
- Avoid maxillary anterior with exception of esthetic crown lengthening procedures.
Rationale for palatal approach?
- Avoids buccal furcation exposure
- Avoids shallow buccal vestibule
- More cancellous bone on palate
- All keratinized tissue
- Wider interdental space
- Greater access
- Natural cleansing action of tongue
Steps for palatal approach
- Extent of submarginal scallop is influences by probing or sounding depth, anticipated amount of osseous resection, root anatomy, depth of palatal vault. (interdental bottom of the osseous defect will become the peak)
- Distal wedge ( H or pie shape)
- Bleeding points, join with scallop, thinning incision, cut back incision, crevicular incision to release the collar.
How does the palatal vault effect your submarginal incisions on palate?
- High palatal vault= redundant tissue if you do a crevicular incision, you have excess tissue.
- Shallow palatal vault= crevicular or 1-2mm is better
How many mm of KT should you have on buccal after resection?
2-3mm; if not then aim for crevicular incisions
Lingual approach
- Avoids buccal furcation exposure
- Avoid dealing with shallow vestibule
- Base of defects are usually lingual
- Thicker bone
- Slightly wider embrasures
- Natural cleansing action of tongue
** thick lingual bone allows for greater osseous reduction with less permenant post operative resorption
** defect is located closer to the lingual should logically be treated from the lingual
** more apically located lingual furcation relative to the buccal, reduce probability of significant furcation exposure
** thicker post resective marginal bone contrasted to thinner buccal bone permits a flatter gingival architecture patter post surgically.
Mandibular distal wedge considerations
- Incision must stay on bone
- follow ramus distally and laterally - Retain as much KT as possible
*lingual nerve can be coronal to bone crest of 3rd molars 15-20% of time.
Lingual flap management
- where broad band of KT, submarginal incisions are recommended.
- thinning involves thicker embrasures
- osseous resection primarily from lingual depending on buccal root trunk length
- facilitates flap positioning at or close to the alveolar crest
Buccal flap and shallow vestibule on mandibular
- if broad band of KT, allows for submarginal incisions
- maintain 2-3mm of KT - if KT is lacking, make crevicular incisions
- minimal osseous resection accomplished on the buccal
- facilitates flap positioning at or close to alveolar crest.
Is it important to place the flap at the alveolar crest post osseous surgery?
Penner 2019- J Perio
Surgical flap margins placed within 3mm of the alveolar crest are more likely to result in PDs 3mm of less at 6months.
Mandibular and maxillary root trunk lengths?
Mandibular:
short-2mm
medium-3mm
long> than or =4mm
Maxillary:
short: 3mm
medium: 4mm
long: > than or =5mm
Resective approach in mandible, according to crater depth and root trunk height:
Shallow craters: Lingual approach for all lengths of trunk (short, average, long)
Medium craters: Lingual approach (shallow root trunk), Lingual + some buccal (average root trunk) some compromise, Lingual approach (long root trunk)
Deep craters: compromised, consider other therapy for any root trunk length
Resective approach in maxilla, according to crater depth and root trunk height:
Shallow craters: Palatal approach for all lengths of trunk (short, average, long)
Medium craters: Palatal approach (shallow root trunk) with some compromise, Most palatal some buccal (average root trunk), Palatal and buccal approach (long root trunk)
Deep craters: compromised, consider other therapy for any root trunk length
