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