Osseous Surgery Flashcards Preview

Perio lectures > Osseous Surgery > Flashcards

Flashcards in Osseous Surgery Deck (32):
1

What are some indications for General Surgery?

  • Access for removal of calculus and subgingival microbiota
  • Treatment of periodontal abscess
  • Facilitate and enhance restorative, prosthetic and cosmetic dentistry

2

What are some contraindications for surgery?

  • Inadequate plaque
  • Non-compliance
  • Shallow PD
  • Medical conditions
  • Esthetic concerns
  • Psychosocial factors
  • Advacned lesions that may limit prognosis

3

What is the overall treatment goal?

Preserve the patient's dentition in health and comfort with adequate function and acceptable esthetics

4

What are some provider goals regarding therapeutic endpoints?

  • Stable or improved attachment levels
  • Minimal inflammation
  • Decreased and stable probe depths
  • Facilitate periodontal maintenance, restorative and esthetic needs

5

What are some patient goals regarding therapeutic endpoints?

  • Complete treatment in reasonable time
  • No undue discomfort or inconvenience

6

What is the definition of Osseous Resection?

Osseous resective surgery: periodontal surgery involving modification of the bony support of the teeth. 

 

Used in combination with apically positioned flap to maximize PD reduction in moderate intrabony pockets

7

Define Osteoplasty?

Reshaping of the alveolar process to acheive a more physiologic form WITHOUT removal of supporting bone

8

What is the definition of Ostectomy?

Ostectomy: The EXCISION OF BONE or a portion of bone

  • To correct or reduce bone deformities caused by periodontitis
  • Includes removal of supporting bone (alveolar bone proper)

9

What are some historical landmarks in Osseous Surgery?

  • Prior to 1935 - "necrotic bone"
  • Kronfeld (1935) - control of inflammation
  • Orban (1939) - gingibectomy introduced - interest in osseous surgery declined
  • Schluger (1949) - modern concepts of osseous resective surgery

10

What are some surgical prerequisites?

  • Adequate plauqe control
  • Maintenance compliance

- Wilson et al - 16% compliant; 49% erratic; 34% never returned

- Wilson et al - Changes instituted in practice

32% compliant; 48% erratic; 20% never returned

11

What are some Osseous Resection indications?

  • Shallow (mild-mod) crater defects
  • Osseous ledges or exostoses
  • Shallow Furcations (odontoplasty recommended)
  • Estehtic Crown Lengthening
  • Pre-prosthetic/restorative (Crown lenghening, Tori Reduction, Alveoplasty)

12

What are some contraindications to osseous resection?

  • Maxillary anterior
  • 3-walled defects (regenerate if possible)
  • Deep defects
  • Advacned bone loss
  • Anatomic Considerations
  • Sensitivity

13

What are the 3 dimensions of osseous defects?

1. Horizontal

2. Vertical

3. Combination (most common)

14

Waerhaug, in 1979 found that the plauqe "sphere of influence" measures...

0.5 - 2.7 mm

15

In thick bone, what type of vertical defects can you have?

  • Intrabony
  • One-Wall
  • Circumferenctial/moat
  • Vertical Components of furcation defects

16

What is the treatment for a one-wall defect (hemiseptal)?

  • Resective Therapy versus Curettage
  • May compromise

17

What is the most common type of defect? How do you treat?

Two-wall defect (crater) - 1/3 of all defects

Depends on depth of crater and root trunk length

18

What are the measurement parameters for a two-wall defect (crater)?

  • Shallow: 1 - 2 mm
  • Medium: 3 - 4 mm
  • Deep: > 5 mm

19

What are some root trunk measurments you should know for the maxilla and mandible?

Maxilla

  • Short - 3 mm
  • Average - 4 mm
  • Long - 5 mm

Mandible

  • Short - 2 mm
  • Average - 3 mm
  • Long - 4 mm

20

Describe a three wall defect and the treatment?

  • 3 osseous walls; tooth is 4th wall
  • Treatment: Reconstruction of periodontium: Open flap curettage, osseous or alloplastic grafting, guided tissue regeneration

21

How do you treat a circumferential defect?

  • Reconstruction of the periodontium

22

What are some anatomic considerations?

  • Positive architecture
  • Interdenal Space
  • Root prominence
  • Root proximity

23

What are some anatomic considerations?

  • External Oblique Ridge
  • Vestiblar Depth
  • Mylohyoid Ridge
  • Tori/Exostoses
  • Root Inclinations
  • Tooth Relationships (contacts, CEJs)

24

What are some goals of osseous resective surgery?

  • Defect elimination
  • Minimal removal of supporting bone
  • Tissue adaptation
  • Reduced probe depths

25

What are the 2 approaches to osseous resection?

Palatal & Lingual

26

What is the rationale for a palatal approach?

  • Avoids buccal furcation
  • Avoids dealing with shallow vestibule
  • All keratinized tissue
  • Wider interdental space
  • Greater access
  • Natural cleansing action of tongue

27

What is the rationale for the Lingual approach?

  • Avoids buccal furcation exposure
  • Avoids dealing with shallow vestibule
  • Base of defects are usually lingual
  • Thicker bone
  • Slightly wider embrasures
  • Natural cleansing action of tongue

28

What are the 5 steps in flap osseous?

  1. Bulk Reduction
  2. Interdental Fluting
  3. Elimination/Reduction of Defect Walls
  4. Resection to Acheive Positive Architecture
  5. Final Shaping

29

What did Lindhe & Nyman find in their study of 14 year F/O with APF?

  • Maintenance every 3-6 months
  • 93-99% of sites PD < 4 mm
  • < 1% developed PD > 6 mm
  • Some loss of attachment in shallow sites

30

Long term studies by Olsen & Ammons (5 years) where they conducted APF with and without osseous; split mouth found?

  • F/O with less probe depth at 3 and 5 years
  • More breakdown in sites without osseous, especially in deeper sites
  • "If minimal probe depth is goal, then osseous recontouring is the procedure of choice."

31

Long term studies by Kaldahl in 1997 over 7 years found what?

  • F/O with greater probe depth reduction in sites > 5 mm
  • F/O with greater LOA in sites 1-4 mm
  • More recession with F/O
  • F/O with less breakdown in sites > 7 mm versus RP and MWF

32