Periodontal Osseous Surgery

Fill in with negative or flat: _____ bone architecture is compatible with health ____ bone architecture will promote pocket formation

--flat (positive but flat bone = posterior regions) --negative *note: image = positive, flat, negative (top to bottom)

A ____-wall bony defect is a good candidate for bone grafting which is a ____ (regenerative/resective?) procedure

3; regenerative

how much supporting bone should be removed during osseous surgery with proper technique? (measured in terms of circumferential mean reduction in attachment)

< 1mm

1 vs 2 vs 3 wall bony defect?

A = 3 wall defect B = 2 wall defect C = 1 wall (hemi-septal) bony defect *note: 3 wall defect means 3 walls are remaining. 4th "wall" = tooth surface

best prognosis is seen with a _____-walled defect worst prognosis is seen with a ____-walled defect

best = 3 worst = 1-walled (aka hemi-septal defect)

Fill in with coronal/apical: Positive bone architecture is when bone is more _____ in interproximal regions and more ____ in facial/lingual regions

coronal apical (good thing)

Your pt has a broad three-wall infrabony defect on the mesial of #19 with furcation bone still intact. why is resective osseous surgery a better option than debridement of the defect and root surface?

debridement is not enough b/c junctional epithelium/gingiva will still heal to the bony defect and thus there will still be a deep pocket. surgery must eliminate the infrabony defect or else the probing depth will return

T/F: For obtaining a positive bone architecture via resective surgery, you must remove a greater amount of supporting bone when interproximal craters are ____ (deep/wide?)

deep

Which are more predictable and why?: deeper defects vs shallow defects

deeper (more surrounding bone surface = more blood supply for regenerating tissue)

T/F: Radiographs are a reliable method for visualization of bony defects

false -- not reliable method for determining bony configuration

T/F: Increased long-term tooth mobility is a disadvantage of osseous surgery for most patients

false -- not true in most instances where there was negligible mobility PRIOR TO surgery *note: will see inc mobility post-op but mobility will return to pre-op levels unless there are excessive occlusal factors

T/F: A narrow one-walled defect could heal following debridement alone

false--a narrow THREE walled defect could

T/F: Results of resective osseous surgery are difficult to predict due to the lack of documented long-term success

false. predictable results w/ well-documented long-term success

periodontal surgery can produce more ideal results and will be easier when you are dealing with ____ instead of _____ (fill in with infrabony defects or horizontal bone loss)

horizontal bone loss > infrabony defects

most common bony defect

osseous crater two-walled (buccal and lingual) defect

difference between osteoplasty and ostectomy

osteoplasty = re-shaping bone without removing supportive bone ostectomy = includes removal of supportive bone note: supportive bone = tooth-supporting bone

Ideally, there should be ____ bone architecture in anterior regions with ____ mm between CEJ and bone margin

positive 1-2 mm *note: posterior regions = positive but flat bone architecture

an important consideration when it comes to resective osseous surgery candidates?

pt must be motivated and willing to conform to a strict perio maintenance schedule (it is a very predictable pocket reduction technique but pt must keep pockets reduced post-surgery)

why might resective osseous surgery be contraindicated on molars with short root trunks?

to avoid furcation exposure

T/F: Exostoses must be removed as part of resective osseous therapy and will increase the amount of time required for the surgical procedure

true

T/F: Resective osseous surgery provides improved access for pt to debride root surfaces of calculus/plaque

true

T/F: Reduced pocket depths can be expected after healing from a resective osseous surgery

true (soft tissue usually follows the bone contours)

T/F: A lingual ledge of bone with deep interproximal craters would benefit from osseous recontouring T/F: Heavy buccal bone with a one-walled infrabony defect would benefit from osseous recontouring

true; true

treatment of ____-wall bony defects depends on depth, width, and general configuration

two

First step in osseous recontouring procedure for pt with buccal ledge of bone (buttressing bone)

vertical grooving

What step of resective osseous surgery is necessary with thick marginal bone? (to reduce overall thickness of alveolar housing) *note: not performed with thin alveolar housing

vertical grooving (type of osteoplasty) *note: creates continuity from interdental bone to radicular bone

what is a combined osseous defect

when the coronal part of bone has one type of defect but the apical part of bone has a different type of defect

Which are more predictable and why?: narrow defects vs wide defects

narrow (a wide defect means a longer distance for the regenerate)

Most of the bone removed in osseous surgery is _____ (supporting/non-supporting?)

non-supporting

___-wall bony defects require osseous recontouring (aka resection)

one

Considerations for osseous surgery: 1) In anterior regions, caution must be used due to ____ 2) Root ______ is a common side effect of osseous surgery but can be predictably addressed post-surgery 3) A patient with ____ caries may not be a good candidate for perio surgery

1) esthetics 2) sensitivity 3) root

1) Resective osseous surgery allows for visualization of bony changes 2) T/F: Resective osseous surgery allows for development of negative osseous architecture

1) true 2) false -- positive osseous architecture

List the 4 goals of resective osseous surgery: 1. reshape ____ to a more physiologic architecture 2. debride ______ 3. improve ____ contours for easier long-term perio maintenance 4. form a healthy a periodontal attachment apparatus in a more ____ position

1. diseased marginal bone 2. root surfaces 3. soft tissue contours (pocket depths) for easier long-term perio maintenance 4. apical

name the 3 types of flaps that internal beveled incisions are used for

1. modified widman flap 2. undisplaced/replaced/repositioned flap 3. apically positioned flap

Which of the 4 steps of osseous surgery are considered osteoplasty? Which are ostectomy? 1. vertical grooving 2. radicular blending 3. flattening of interproximal bone 4. gradualizing marginal bone

1. osteoplasty 2. osteoplasty 3. ostectomy 4. ostectomy *note: the bulk of resective osseous surgery is attained through steps 1 and 2

Resective osseous surgery should be considered: 1. to eliminate soft tissue ____ 2. when pt requires adequate ____ support, or restorative splinting,f or a stable _____ 3. when pt has ____ concerns, especially in max anterior region 4. to eliminate gingival _____ due to apical positioning of soft tissue 5. for pts who are experiencing ____ sensitivity

1. pockets 2. root; occlusion 3. esthetic 4. recession 5. root (thermal)

What 2 things can be used to help determine the configuration of underlying bone?

1. probing depths 2. bone sounding (note: there may be unusual bone features/root anomalies/fractures that arent seen on 2D radiograph)

4 steps in bone reshaping for resective osseous surgery

1. vertical grooving 2. radicular blending 3. flattening of interproximal bone 4. gradualizing marginal bone *note: image = vertical grooving. step 2 = smoothing these lines out

resective osseous surgery is indicated for patients with _____ to ____ periodontitis. but note: it is less effective with ____ (deep/shallow?) infrabony pockets

moderate to severe deep *note: some root exposure is anticipated with resective surgery so esthetics should be discussed w pt