Osseous Resective Surgery I
T/F: Its okay to expose the furcation when crown lengthening
False, FAKE news.
T/F: Resective Osseous Surgery has a less predictable pocket reduction technique. It is performed at the expense of bone and attachment levels, and limited by the presence/quantity/shape of bone loss and amount of attachment loss deemed acceptable.
False, It is more predictable. True
T/F: The distance from the facial bony margin to the interproximal bony crest is more pointed in posterior teeth. "Scalloping" of bone on the facial surfaces and lingual/palatal surfaces is related to tooth and root form, as well as tooth position in the alveolus
False, more flat True
The procedure of reshaping bone without removing tooth-supporting bone : ___________ The procedure of removing tooth-supporting bone: _________ One or both procedures may be necessary to produce desired result
Osteoplasty Ostectomy
_______ architecture: - Radicular bone is apical to interdental bone
Positive Architecture
List the terms used to describe bone form after reshaping
Positive architecture Negative architecture Flat Ideal
Mean reduction in attachment circumuferentially around the tooth = ____ mm at six probing sites ( Maximum ___ mm) Technique is best applied to _________ lesions that are 1-3 mm deep in patients with ______ to ______ root trunks Defects are often managed by a combination of ostectomy and osteoplasty
0.6mm, 3 mm interproximal, moderate to long
Bone Remodeling and Healing still present _____ following surgery Healing by repair is by __________ in most cases
1 year long junctional epithelial attachment
In selection of osseous resective surgery, Ostectomy is best when: - early to moderate bone loss (__-__ mm) - _______ length root trunks - ____ or ____ wall bony defects that are shallow to moderate
2-3 moderate one or two
________ Osseous Surgery = restoring the alveolar bone to its original level _______ Osseous Surgery = re-create the original form or shape of normal alveolar bone upon bone modified by disease
Additive Osseous Surgery Subtractive Osseous Surgery
T/F: "Ideal" bone form is when bone is consistently more coronal in the interproximal surfaces than on the facial and lingual surfaces. There is similar interdental height with gradual, curved slopes between interdental peaks
T T
T/F: Relationship Between Depth & Configuration of Bony Lesion(s) to Root Morphology and the Adjacent Teeth Determines Extent that Bone & Attachment is Removed During Resection
True who writes sentences like this? i just wanna talk??
One Wall Defect Near Edentulous Ridge - bone reduced to level of most ______ portion of defect - defect is reduced by "______" angular bone
apical "ramping"
Ostectomy requires too much bone removal for teeth with advanced _____ loss and deep bony defects. It is not recommended for ________, deep bony defects.
attachment isolated
Additive (regenerative) Osseous Surgery is the ideal result of periodontal therapy - regeneration of lost bone & re-establishment of the PDL, gingival fibers, and junctional epithelium at a more ______ level
coronal
Terms to describe the thoroughness of Osseous reshaping: _________: further osseous reshaping WOULD NOT improve overall result _______: Bone pattern cannot be improved without significant osseous removal - detrimental to overall result
definitive compromised
Subtractive (Resective) Osseous Surgery - alternative to regenerative methods - used when regenerative procedures are not ______
feasible
Goal of Osseous Resective Surgery: - Reshape _______ bone to resemble alveolar process undamaged by periodontal disease - performed in combination with _________ flaps. - eliminates ______ and improves tissue contour to provide a more easily maintainable environment for the patient and the dentist.
marginal apically positioned flaps pocket
Other techniques: Flattening the interproximal bone Gradualizing marginal bone (_______)
ostectomy
Osseous surgery involves procedures to address Alveolar bone from deformities induced by - ________ disease(s) - other related factors like exostoses or tooth supraeruption Osseous surgery can be either _______ or _______
periodontal diseases additive or subtractive
Crown lengthening is when you expose more tooth structure to facilitate ______ therapy It often requires _____ and _____ Likely location of the crown margin is estimated Need at least _____ mm between the gingival margin and bone crest to allow for biologic width
restorative osteoplasty and ostectomy 3
The reshaping process is fundamentally an attempt to gradualize the bone sufficiently to allow _______ structures to follow the contour of bone
soft-tissue
Vertical grooving is a technique that reduces the _______ of the alveolar housing and provides relative _______ to the radicular aspects of teeth.
thickness, prominence
T/F: Morphology of the osseous defect largely determines the treatment technique What kind of defects would need resective osseous surgery?
true Interdental craters One-Wall Defects Wide, Shallow Two Wall defects
Reduction of Walls of Craters: Reduced at the expense of the ______, ______, or both walls Reduction made to remove the least amount of alveolar bone required to - produce a satisfactory form (_______) - prevent therapeutic invasion of ________ - blend contours with adjacent teeth
Buccal, lingual ramping furcations
________ : - reduction of interdental bone to the same height as radicular bone
Flat
Describe Normal Alveolar Bone Morphology
Interproximal bone is more coronal than labial or lingual/palatal bone Shape of the Interndental bone is a function of tooth form and embrasure width - more tapered tooth, more pyramidal bony form - wider embrasure, more flattened interdental bone MD and BL Position of the bony margin mimics contours of CEJ
_______ architecture: - Interdental bone is more apical than radicular bone
Negative Architecture
What should be included in the Pre-Surgical Evaluation of Bony Defects?
Perio charting Radiographs Transgingival probing or bone sounding - useful just before flap reflection - local anesthesia - probe is "walked" along the tissue-tooth interface to feel the bony topography
_________ (osteoplasty) is an attempt to gradualize bone over an entire radicular surface it provides a smooth, blended surface for ______ adaptation
Radicular blending flap
Complication during Radicular blending: Osteoplasty creates ________ architecture Peaks of bone remain at the facial and lingual/palatal line angles, called ___________ - these need to be removed w/ ostectomy - can contribute to pocket recurrence
Reverse Widow's Peaks
In the molars, there is less/ more scalloping and a more flat / pointed profile than the premolars and incisors. Teeth with prominent roots or those displaced facially or lingually may have ________ or ________
less, flat dehiscences or fenestrations
Flaps placed to cover new bony margin - minimizes post-operative complications - optimal physiologic probing depths Sutures Placed with ________ tension - flap adaptation - prevents separation - maintains flap _______
minimal position
Osseous Surgery should be performed with great care. - Avoid Nicks or grooves on the _______. - It is easy to overdo, causing ________ Osteoplasty is often performed with ______ instruments _____ instruments such as _____ are preferred for Ostectomy
roots sensitivity rotary hand, chisels