L6 - Osteotomy and Osteoplasty

indications for osseous surgery

generalized periodontitis with pronounced irregular bone loss defects exhibiting sharp bony margins or exostoses bony architecture preventing good plaque control

LAP osseous defects

circumferential defects

interdental scalloping

decreases ant to post pyramidal form anterior

bacteria in pocket reduction with osseous surg

favorable shift in subging g- anaerobes to G+ cocci and rods

pocket reduction with osseous surgery post op

fewer sited with bleeding on probing

osteotomy and osteoplasty for 1 wall defect

full thickness flap remove granulation tissue instrument root surfaces sharp and protuberant bone is recontoured under contact cooling interdental craters are opened tooth supporting bone not removed apically positions flap

definitive osseous surgery

osseous defecs corrected achieve positive or neutral architecture shallow to mon bony defects (2-3mm) one or two wall defects

Compromised osseous surgery

osseous defect can be improved but can't be completely corrected w/o removing so much bone that teeth would be jeopardized "treatment worse than disease' advanced attachment loss and deep intra bony defects cant achieve positive architecture

most predictable method for pockets with osseous defects

pocket reduction with osseous surgery

pt related osseous surgery failures

poor plaque control - root caries faile to follow post op instructions

pocket reduction with osseous surgery

reduced both alveolar bone and attachment -limited by amount of bone and attachment loss that is acceptable - compromised osseous surgery

respective osseous surgery procedures

remontoir alveolar bone to eliminate osseous defects from periodontitis correct anatomic defects such as exotoses

ostectomy

removing tooth supporting bone

Goals of respective osseous surgery

reshape bone to a physiologic contour soft tissue healing with sulcus depth of 0-2mm

osteoplasty

reshaping bone w/o removing tooth supporting bone

surgical tech leading to osseous failure

short term - post op infection, poor flap management (necrosis) long term - incomplete pocket elimination, deviations from ideal form, poor suturing, expose thin bone, dishecences, or fenestrations

contraindications for osseous surgery

Pt meds, poor oral health anatomy - prog of maxillary sinus, mandibular rams severe alveolar bone loss, extreme root sensitivity, unacceptable post op esthetics

physiologic alveolar bone

alveolar crest parallels CEJ scalloped, parabolic shape interdental bone coronal to radicular bone thin alveolar margin interproximla sluiceways

chronic periodontitis osseous defects

inter proximal osseous crater

negative osseous architecture

interdental bone apical to radicular bone leads to progressing attachment and bone loss

Flat osseous architecture

interdental bone at same level as radicular bone

Positive osseous architecture

interdental bone coronal to radicular bone

what dictates tx

morphology of defect