week 8 Flashcards
(11 cards)
Osseous surgery
procedure which changes are made to the alveolar bone to rid it of deformities induced by periodontal disease or other related factors (exostosis, tooth supraeruption)
Additive osseous surgery
procedures that attempt to restore alveolar bone
to its original level
• Implies regeneration of lost bone and reestablishment of periodontal attachment
apparatus
Subtractive osseous surgery
procedures that restore preexisting alveolar bone to the level present at the time of surgery or slightly more apical
• Used when additive surgery is not possible
wall defect morpholgy and txt
- One-wall angular: recontoured surgically (subtractive)
• Three-wall: can be treated to obtained new attachment and bone (additive)
• Two-wall angular: additive or subtractive depending on depth, width and
configuration
RATIONALE/GOAL OF OSSEOUS SX
• Most predictable pocket reduction technique, performed at expense of bony tissue and attachment level.
• Rationale: discrepancies in level and shape of bone/gingiva predispose the patient to a recurrence of pocket depths post-SRP
• Goal: to reshape the marginal bone to resemble that of the alveolar process
undamaged by periodontal disease
NORMAL ALVEOLAR MORPHOLOGY
• Interproximal bone is more coronal in position than the labial or lingual/palatal
bone
• IP bone is pyramidal in form
• Form of IP bone is a function of tooth form and embrasure width
•– The more tapered the tooth, the more pyramidal the bony form
•– The wider the embrasure, the more flattened the IP bone is mesiodistally and buccolingually
• Position of bony margin mimics the contours of the CEJ
–molar teeth have less scalloping
Osteoplasty vs Ostectomy
Osteoplasty: reshaping the bone without removing tooth-supporting bone
Ostectomy: includes the removal of tooth-supporting bone
positive vs negative vs flat vs ideal architecture
Positive Architecture: radicular bone is apical to the interdental bone
Negative Architecture: interdental bone is apical to the radicular bone
Flat Architecture: the reduction of the interdental bone to the same height as the radicular bone
Ideal: bone is consistently more coronal on the IP surfaces than on the facial and lingual surfaces
Definitive osseous reshaping vs Compromised osseous reshaping
Definitive osseous reshaping: further osseous reshaping would not improve the overall result
Compromised osseous reshaping: a bone pattern that cannot be improved without significant osseous removal that would be detrimental to the overall result
correction of craters
Therapeutic result is less pocket depth and increased ease of maintenance
• Results in attachment loss at proximal line angles and facial/lingual aspects
• Mean attachment loss is 0.6 mm, therefore technique is best indicated for
interproximal craters of 1-3 mm
• Consider regeneration for craters with 4+ mm bone loss
how do you do osseous sx
1) vertical grooving
2) radicular blending
3) gradualizing and preserving bone at furcation
