The document discusses principles of resective osseous surgery in periodontal therapy. It outlines the goals of reshaping alveolar bone to eliminate deformities caused by periodontal disease. This involves techniques like osteoplasty to reshape bone without removal and osteotomy to remove supporting bone. Specific procedures are described to correct issues like interdental craters, exostoses, and one-wall defects through techniques like vertical grooving, flattening interproximal bone, and gradualizing marginal bone. Factors in selecting patients and sites for resective surgery and postoperative care are also covered.
Resective osseous surgery involves reshaping the alveolar bone through additive or subtractive techniques to correct deformities caused by periodontal disease. The goal is to reshape the marginal bone to resemble healthy bone. Key steps include vertical grooving, radicular blending, flattening interproximal bone, and gradualizing marginal bone using instruments like chisels and curettes. This technique is best for early to moderate bone loss up to 3mm and can provide reduced pocket depths and stable tissue contours for long-term maintenance when performed with apically positioned flaps.
It restore alveolar bone to the level existing at the time of surgery or slightly more apical to this level. Aim is to achieve positive bony architecture.
STEPS INCLUDE:
1.VERTICAL GROOVING
2. RADICULAR BLENDING
3. FLATTENING INTERPROXIMAL BONE
4. GRADUALIZING MARGINAL BONE
PREFERRED TREATMENT FOR ONE WALLED PERIODONTAL BONE DEFECTS (HEMISEPTUM)
Resective osseous surgery involves removing tooth-supporting alveolar bone to reshape it and eliminate periodontal pockets. It is indicated for inconsistent bone margins, reverse bone architecture, one-wall defects, and other bone irregularities. The surgery involves using burs and chisels to perform vertical grooving of thick bone, blending any bone ledges on tooth roots, flattening interproximal bone in narrow areas, and gradualizing marginal bone. Flaps are closed to cover the new bony margins. Post-operative maintenance like cleaning and antibiotics is needed to allow healing over 2-3 weeks.
This document provides an overview of resective osseous surgery. It discusses the historical background, definitions, objectives, indications, and advantages/disadvantages of osseous surgery. It also covers normal alveolar bone morphology, bone destruction patterns in periodontal disease, and factors that determine bone morphology. Key aspects of the document include descriptions of osteoplasty, ostectomy, and the goals of resective osseous surgery to eliminate pockets and create a physiological bone contour.
This document discusses the theoretical background and techniques of the Hobo full mouth rehabilitation approach. It defines key terms like condylar guidance, incisal guidance, and disocclusion. It explains that the goal of reorganizing occlusion is to address issues like trauma, poor function, or lack of space. The optimal occlusion balances factors like condylar path, incisal guidance, and cuspal angles. The articulator aims to replicate these concepts to guide reconstruction of the full mouth.
Resective osseous surgery aims to eliminate periodontal pockets and create physiological bone contours and gingival architecture to facilitate plaque control. It involves osteoplasty to reshape bone and ostectomy to remove bone. Key principles are using a full-thickness flap, contouring bone to match healthy gingival form, and leaving a positive bone architecture. Techniques are used to modify defects like craters, ledges, and furcations. Studies found minimal bone loss with healing. The main objective is achieving periodontal architecture to enable self-oral hygiene.
Resective osseous surgery involves reshaping the alveolar bone through additive or subtractive techniques to correct deformities caused by periodontal disease. The goal is to reshape the marginal bone to resemble healthy bone. Key steps include vertical grooving, radicular blending, flattening interproximal bone, and gradualizing marginal bone using instruments like chisels and curettes. This technique is best for early to moderate bone loss up to 3mm and can provide reduced pocket depths and stable tissue contours for long-term maintenance when performed with apically positioned flaps.
It restore alveolar bone to the level existing at the time of surgery or slightly more apical to this level. Aim is to achieve positive bony architecture.
STEPS INCLUDE:
1.VERTICAL GROOVING
2. RADICULAR BLENDING
3. FLATTENING INTERPROXIMAL BONE
4. GRADUALIZING MARGINAL BONE
PREFERRED TREATMENT FOR ONE WALLED PERIODONTAL BONE DEFECTS (HEMISEPTUM)
Resective osseous surgery involves removing tooth-supporting alveolar bone to reshape it and eliminate periodontal pockets. It is indicated for inconsistent bone margins, reverse bone architecture, one-wall defects, and other bone irregularities. The surgery involves using burs and chisels to perform vertical grooving of thick bone, blending any bone ledges on tooth roots, flattening interproximal bone in narrow areas, and gradualizing marginal bone. Flaps are closed to cover the new bony margins. Post-operative maintenance like cleaning and antibiotics is needed to allow healing over 2-3 weeks.
This document provides an overview of resective osseous surgery. It discusses the historical background, definitions, objectives, indications, and advantages/disadvantages of osseous surgery. It also covers normal alveolar bone morphology, bone destruction patterns in periodontal disease, and factors that determine bone morphology. Key aspects of the document include descriptions of osteoplasty, ostectomy, and the goals of resective osseous surgery to eliminate pockets and create a physiological bone contour.
This document discusses the theoretical background and techniques of the Hobo full mouth rehabilitation approach. It defines key terms like condylar guidance, incisal guidance, and disocclusion. It explains that the goal of reorganizing occlusion is to address issues like trauma, poor function, or lack of space. The optimal occlusion balances factors like condylar path, incisal guidance, and cuspal angles. The articulator aims to replicate these concepts to guide reconstruction of the full mouth.
Resective osseous surgery aims to eliminate periodontal pockets and create physiological bone contours and gingival architecture to facilitate plaque control. It involves osteoplasty to reshape bone and ostectomy to remove bone. Key principles are using a full-thickness flap, contouring bone to match healthy gingival form, and leaving a positive bone architecture. Techniques are used to modify defects like craters, ledges, and furcations. Studies found minimal bone loss with healing. The main objective is achieving periodontal architecture to enable self-oral hygiene.
Orthodontic consideration of the old extraction siteAhmed Baattiah
This document discusses alveolar bone resorption after tooth extraction and socket healing. It notes that bone loss is most rapid in the first 3 years after extraction, with 40-60% loss, slowing to 0.25-0.5% annually thereafter. Within 24 hours of extraction, a blood clot forms in the socket, which is later replaced by granulation tissue and then bone deposition over 4-6 months as the socket heals. Methods to preserve sockets during healing include grafting, guided tissue regeneration, immediate implant placement, and platelet rich plasma. Orthodontic tooth movement can also be used to regenerate alveolar bone in areas of previous extractions.
Corticotomy facilitated orthodontics
Although the art and science of orthodontics have progressed significantly over the past 100 years, relatively little has been done to enhance the rate at which tooth movement occur. Many methods have been done to enhance the rate of tooth movement. These methods include the injection of biologically active peptides, the use of magnets and even the application of electric current and corticotomy.
Corticotomy: is slight penetration through the cortical bone and did not be confused with the osteotomy. Or defined as incision made into the cortical bone.
This penetration or incision leads to decrease the resistance of the alveolar and diminish physical alveolar bone contact that accelerates the rate of tooth movement.
Several authors have described rapid tooth in conjunction with corticotomy surgery as movement by bony (Block). Kole6 was the first describe the corticotomy as a surgical procedure in which one tooth or group of teeth with the adjacent bone is repositioned in one step. But others prefer to call this osteo-corticotomy or intra alveolar segmental osteotomy, reserving the term corticotomy for a technique in which cuts are made in the buccal cortical plate of bone. So that the segment to be moved orthodontically is held only by cancellous trabeculea and palatal cortical bone.
Kole in 19596 reported combining orthodontics with corticotomy surgery and complete the active tooth movement in adult orthodontic cases in 6 to 12 weeks.
The inter-proximal corticotomy cuts were extended through the entire thickness of the cortical layer, just barely penetrating the medullary bone.
The vertical cuts were connected beyond the apices of the teeth with horizontal osteotomy cut extending through the entire thickness of the alveolus, essentially creating blocks of bone in which one or more teeth were embedded, using the crowns of the teeth as a handles. Kole believed that he was able to move the blocks of bone some what independly of each other because they were only connected by less-dense medullary bone. He found no incidence of root resorption, no loss of tooth vitality and no pocket formation.
Kole used this surgical technique for correction of some of dento-alveolar problems as:
Protruding of lower incisors: this procedure is indicated in most of cases but should be determined whether a mandibular or dento-alveolar retrusion. Buccally the cortiocotomy is performed between the incisors and canine then horizontal cut is made 1cm. below the incisors, lingual two vertical and one horizontal cut is made fig(1).
Distal displacement of a single tooth or group of teeth: correction necessitates a long period of treatment in adult patients fig(2) .
The retrusion of all six lower anterior teeth: after buccal and ligual corticotomy is perefrmed.
Alignment of rotated teeth.
Correction of spaced teeth: in maxillary and mandibular protrusion with diastemas between the t
The document summarizes research on the healing process that occurs within the alveolar socket after a tooth extraction. It describes the three phases of socket healing: 1) inflammation and blood clot formation, 2) new bone formation through the deposition of woven bone, and 3) bone remodeling where woven bone is replaced with lamellar bone and bone marrow. It notes that socket healing results in dimensional changes to the alveolar ridge over time due to bone modeling and remodeling on the socket walls. Factors like surgical trauma from extraction and lack of a tooth's functional stimulus contribute to reductions in ridge width and height.
This study analyzed the position and angulation of 300 maxillary central incisors using cone beam imaging to provide data to help clinicians achieve good esthetic results for immediate dental implants. The thickness of buccal and palatal bone and apical bone height were measured. Incisors were classified according to their position (buccal, midline, palatal) and angulation (toward buccal, anterior to A point, parallel to alveolus). Most incisors were positioned buccally. Recommendations for implant placement based on tooth classification aim to maintain adequate buccal bone thickness and prevent complications.
Available Bone and Dental Implant Treatment Plans.pptxShreya Rastogi
The document discusses available bone and dental implant treatment plans. It defines available bone as the amount of bone in the edentulous area considered for implantation, measured in terms of width, height, length, angulation, and crown height space. It then describes the four divisions of available bone - Division A (abundant bone), Division B (barely sufficient bone), Division C (compromised bone), and Division D (deficient bone) - based on these measurements and the natural resorption process over time. Treatment options are outlined for each division of available bone.
alveolar ridge expansion and socket preservationMaherFouda1
Alveolar bone resorption occurs rapidly after tooth extraction or avulsion, especially in the first 3 years when 40-60% of bone can be lost. Extraction of anterior maxillary teeth is associated with progressive labial bone loss. The causes of alveolar bone resorption are thought to include disuse atrophy, decreased blood supply, localized inflammation, and prosthesis pressure. Immediate implant placement can help preserve the alveolar ridge after tooth extraction.
This document discusses bone considerations for dental implant therapy. It describes the different types of bone, including cortical, cancellous, woven bone and their properties. It also discusses factors like available bone height, width, density and their effect on implant treatment planning and surgical protocols. Insufficient bone requires augmentation procedures like bone grafts or sinus lifts to provide adequate support for dental implants. The success of implants placed in deficient bone depends on careful treatment planning and surgical skill.
This document discusses resective osseous surgery for treating periodontal bone defects. It covers normal bone anatomy, classification of bone defects, rationale for resective surgery, techniques, instruments and steps. Resective surgery aims to reshape marginal bone to resemble healthy bone and facilitate maintenance. It can reliably reduce pocket depth by 0.6-1.2mm but risks root exposure and recession. Success requires careful patient selection and surgical skill.
1. Resective bone therapy involves reshaping alveolar bone without removing tooth supporting bone, while osteoplasty involves reshaping bone with some removal of supporting bone and osteoectomy removes supporting bone.
2. Resective bone therapy is preferably used in patients with moderate to advanced periodontitis and early to moderate bone loss of 2-3mm with bony defects having 1-2 walls.
3. The procedure involves vertical grooving, radicular blending, flattening interproximal bone, and gradualizing marginal bone.
!Excellence in finishing current concepts goals and mechanics (1)Margarita Lopez
This document discusses concepts, goals, and mechanics for achieving clinical excellence in orthodontic finishing. It defines key finishing goals such as establishing normal static occlusal relationships including proper alignment, marginal ridge relationships, and transverse relationships of posterior teeth. It also discusses parameters for optimal anterior tooth inclination and positioning. The document emphasizes that finishing begins with treatment planning and focuses on static and dynamic occlusal relationships as well as periodontal and esthetic factors throughout treatment. The goals are to achieve excellent function, esthetics, and long-term stability.
This document discusses factors that affect the stability of complete dentures. It defines stability as the ability of a denture to resist horizontal or rotational forces. The key factors discussed are:
1) The relationship of the denture base to the underlying tissues, including accurate impressions, border extension, ridge anatomy and orientation.
2) The relationship of the denture's external surface and periphery to surrounding muscles, including allowing for muscle function and using muscles to enhance stability.
3) The relationship of opposing occlusal surfaces, including occlusal schemes, tooth position, and ridge relationships.
This document discusses residual ridge resorption after tooth extraction. It covers the etiology, classification, prevention and treatment. Residual ridge resorption is caused by anatomical, metabolic, mechanical and prosthodontic factors and results in reduced alveolar bone size over time. The residual ridge can be classified based on its shape and height. Prevention focuses on maintaining oral health and correcting systemic factors. Treatment involves improving denture fit through specialized impression techniques to maximize support and retention of dentures on resorbed ridges.
1. Corticotomy facilitates faster orthodontic tooth movement by reducing resistance in the cortical bone layer.
2. Selective alveolar decortication (SAD) is shown to create a transient demineralization-remineralization effect on the alveolar bone through the regional acceleratory phenomenon (RAP), allowing teeth to move 2-3 times faster.
3. The periodontally accelerated osteogenic orthodontics (PAOO) technique combines SAD with alveolar bone grafting to generate new bone, reducing relapse risk and extending treatment limits.
The document discusses pre-prosthetic surgery, which aims to modify the oral environment to better support prosthetic appliances. The goals are to provide a broad, flat ridge with height and a firm mucosal covering. Objectives include eliminating disease, conserving structures, and providing support to withstand forces. The document describes various basic surgical procedures like alveoloplasty, tori removal, and soft tissue procedures to reshape ridges and remove excess tissue in preparation for dentures.
This document summarizes a study on using bone grafts and immediate implant placement in areas of high aesthetic value. It describes using block bone grafts taken from the mandible to augment alveolar ridge deficiencies in the maxilla before placing implants. The goals were to assess success rates of implants placed in grafted bone and determine if this technique is suitable for aesthetic areas. The methodology involved using SPI implants and placing immediate provisional restorations on the implants after grafting and implantation to condition the soft tissues during healing. Success was based on radiographic and clinical assessments during outpatient follow-ups.
This document summarizes a study on using bone grafts and immediate implant placement in areas of high aesthetic value. It describes using block bone grafts taken from the mandible to augment alveolar ridge deficiencies in the maxilla before placing implants. The goals were to assess success rates of implants placed in grafted bone and determine if this technique is suitable for aesthetic areas. The protocol involved using SPI implants and placing immediate provisional restorations on the implants after graft integration to condition the soft tissues during healing. The study aims to evaluate if this technique can provide rigid fixation and osseointegration of implants in grafted bone for functional loading.
The document discusses surgical and prosthodontic considerations for patients who have undergone a radical maxillectomy. It provides details on:
1) Closing the surgical defect with a radial forearm free flap and addressing distortions to palatal contours and secretions in the nasal cavity.
2) Retaining key abutment teeth by making bony cuts between teeth rather than through them.
3) Covering the palatal margin of defects with palatal mucosa when possible.
4) Designing obturators to be lightweight, inexpensive, and perforated to wire to residual dentition.
This document discusses alveolar bone osteoplasty, which is a periodontal surgical procedure used to reshape alveolar bone. It can be used to eliminate deformities caused by periodontal disease. There are two main types - additive, which restores bone to its original level, and subtractive, which restores bone form to the pre-existing level. Selection of technique depends on the type of bone defect, with one-wall defects treated by recontouring, three-wall defects by regeneration, and two-wall defects either way. The goal is to shape the bone to resemble undamaged alveolar process. Various osteoplastic techniques are described to achieve positive bone architecture.
This document provides an overview of preprosthetic surgery procedures. It begins with definitions and history of preprosthetic surgery. It describes common patterns of alveolar ridge resorption over time. The main goals and classification of preprosthetic surgeries are outlined, including ridge correction, extension, and augmentation procedures. Specific techniques are explained for alveoloplasty/alveolectomy, vestibuloplasty, tuberosity reduction, and mylohyoid ridge reduction. The document provides context and details on surgical methods for modifying hard and soft tissues to improve denture support and retention.
This document provides information on epithelial tissue and cell junctions. It discusses the general features of epithelial tissue, including that epithelial cells are closely packed with many cell junctions. It also describes the different types of epithelial tissue (simple vs stratified), the cell shapes (squamous, cuboidal, columnar), and locations in the body. The document further explains the structure and functions of the basement membrane and cell junctions, including occluding junctions, anchoring junctions, and communicating junctions. Key cellular adhesion molecules and proteins involved in different junction types are also outlined.
This document provides information about lymph nodes and the lymphatic system. It discusses the anatomy, embryology, histology, and physiology of lymph nodes and lymphatic drainage. Key points include:
- Lymph nodes act as filters for the lymphatic system and help fight infection. They are located along lymphatic vessels.
- The primary lymphoid organs are the bone marrow and thymus, where lymphocytes develop. Secondary lymphoid organs include the spleen, lymph nodes, tonsils, and skin.
- Lymph nodes have an outer cortex and inner medulla. Lymph enters through afferent vessels and exits through efferent vessels. High endothelial venules are found
More Related Content
Similar to 7. Remodeling Resective Osseous Surgery.pptx
Orthodontic consideration of the old extraction siteAhmed Baattiah
This document discusses alveolar bone resorption after tooth extraction and socket healing. It notes that bone loss is most rapid in the first 3 years after extraction, with 40-60% loss, slowing to 0.25-0.5% annually thereafter. Within 24 hours of extraction, a blood clot forms in the socket, which is later replaced by granulation tissue and then bone deposition over 4-6 months as the socket heals. Methods to preserve sockets during healing include grafting, guided tissue regeneration, immediate implant placement, and platelet rich plasma. Orthodontic tooth movement can also be used to regenerate alveolar bone in areas of previous extractions.
Corticotomy facilitated orthodontics
Although the art and science of orthodontics have progressed significantly over the past 100 years, relatively little has been done to enhance the rate at which tooth movement occur. Many methods have been done to enhance the rate of tooth movement. These methods include the injection of biologically active peptides, the use of magnets and even the application of electric current and corticotomy.
Corticotomy: is slight penetration through the cortical bone and did not be confused with the osteotomy. Or defined as incision made into the cortical bone.
This penetration or incision leads to decrease the resistance of the alveolar and diminish physical alveolar bone contact that accelerates the rate of tooth movement.
Several authors have described rapid tooth in conjunction with corticotomy surgery as movement by bony (Block). Kole6 was the first describe the corticotomy as a surgical procedure in which one tooth or group of teeth with the adjacent bone is repositioned in one step. But others prefer to call this osteo-corticotomy or intra alveolar segmental osteotomy, reserving the term corticotomy for a technique in which cuts are made in the buccal cortical plate of bone. So that the segment to be moved orthodontically is held only by cancellous trabeculea and palatal cortical bone.
Kole in 19596 reported combining orthodontics with corticotomy surgery and complete the active tooth movement in adult orthodontic cases in 6 to 12 weeks.
The inter-proximal corticotomy cuts were extended through the entire thickness of the cortical layer, just barely penetrating the medullary bone.
The vertical cuts were connected beyond the apices of the teeth with horizontal osteotomy cut extending through the entire thickness of the alveolus, essentially creating blocks of bone in which one or more teeth were embedded, using the crowns of the teeth as a handles. Kole believed that he was able to move the blocks of bone some what independly of each other because they were only connected by less-dense medullary bone. He found no incidence of root resorption, no loss of tooth vitality and no pocket formation.
Kole used this surgical technique for correction of some of dento-alveolar problems as:
Protruding of lower incisors: this procedure is indicated in most of cases but should be determined whether a mandibular or dento-alveolar retrusion. Buccally the cortiocotomy is performed between the incisors and canine then horizontal cut is made 1cm. below the incisors, lingual two vertical and one horizontal cut is made fig(1).
Distal displacement of a single tooth or group of teeth: correction necessitates a long period of treatment in adult patients fig(2) .
The retrusion of all six lower anterior teeth: after buccal and ligual corticotomy is perefrmed.
Alignment of rotated teeth.
Correction of spaced teeth: in maxillary and mandibular protrusion with diastemas between the t
The document summarizes research on the healing process that occurs within the alveolar socket after a tooth extraction. It describes the three phases of socket healing: 1) inflammation and blood clot formation, 2) new bone formation through the deposition of woven bone, and 3) bone remodeling where woven bone is replaced with lamellar bone and bone marrow. It notes that socket healing results in dimensional changes to the alveolar ridge over time due to bone modeling and remodeling on the socket walls. Factors like surgical trauma from extraction and lack of a tooth's functional stimulus contribute to reductions in ridge width and height.
This study analyzed the position and angulation of 300 maxillary central incisors using cone beam imaging to provide data to help clinicians achieve good esthetic results for immediate dental implants. The thickness of buccal and palatal bone and apical bone height were measured. Incisors were classified according to their position (buccal, midline, palatal) and angulation (toward buccal, anterior to A point, parallel to alveolus). Most incisors were positioned buccally. Recommendations for implant placement based on tooth classification aim to maintain adequate buccal bone thickness and prevent complications.
Available Bone and Dental Implant Treatment Plans.pptxShreya Rastogi
The document discusses available bone and dental implant treatment plans. It defines available bone as the amount of bone in the edentulous area considered for implantation, measured in terms of width, height, length, angulation, and crown height space. It then describes the four divisions of available bone - Division A (abundant bone), Division B (barely sufficient bone), Division C (compromised bone), and Division D (deficient bone) - based on these measurements and the natural resorption process over time. Treatment options are outlined for each division of available bone.
alveolar ridge expansion and socket preservationMaherFouda1
Alveolar bone resorption occurs rapidly after tooth extraction or avulsion, especially in the first 3 years when 40-60% of bone can be lost. Extraction of anterior maxillary teeth is associated with progressive labial bone loss. The causes of alveolar bone resorption are thought to include disuse atrophy, decreased blood supply, localized inflammation, and prosthesis pressure. Immediate implant placement can help preserve the alveolar ridge after tooth extraction.
This document discusses bone considerations for dental implant therapy. It describes the different types of bone, including cortical, cancellous, woven bone and their properties. It also discusses factors like available bone height, width, density and their effect on implant treatment planning and surgical protocols. Insufficient bone requires augmentation procedures like bone grafts or sinus lifts to provide adequate support for dental implants. The success of implants placed in deficient bone depends on careful treatment planning and surgical skill.
This document discusses resective osseous surgery for treating periodontal bone defects. It covers normal bone anatomy, classification of bone defects, rationale for resective surgery, techniques, instruments and steps. Resective surgery aims to reshape marginal bone to resemble healthy bone and facilitate maintenance. It can reliably reduce pocket depth by 0.6-1.2mm but risks root exposure and recession. Success requires careful patient selection and surgical skill.
1. Resective bone therapy involves reshaping alveolar bone without removing tooth supporting bone, while osteoplasty involves reshaping bone with some removal of supporting bone and osteoectomy removes supporting bone.
2. Resective bone therapy is preferably used in patients with moderate to advanced periodontitis and early to moderate bone loss of 2-3mm with bony defects having 1-2 walls.
3. The procedure involves vertical grooving, radicular blending, flattening interproximal bone, and gradualizing marginal bone.
!Excellence in finishing current concepts goals and mechanics (1)Margarita Lopez
This document discusses concepts, goals, and mechanics for achieving clinical excellence in orthodontic finishing. It defines key finishing goals such as establishing normal static occlusal relationships including proper alignment, marginal ridge relationships, and transverse relationships of posterior teeth. It also discusses parameters for optimal anterior tooth inclination and positioning. The document emphasizes that finishing begins with treatment planning and focuses on static and dynamic occlusal relationships as well as periodontal and esthetic factors throughout treatment. The goals are to achieve excellent function, esthetics, and long-term stability.
This document discusses factors that affect the stability of complete dentures. It defines stability as the ability of a denture to resist horizontal or rotational forces. The key factors discussed are:
1) The relationship of the denture base to the underlying tissues, including accurate impressions, border extension, ridge anatomy and orientation.
2) The relationship of the denture's external surface and periphery to surrounding muscles, including allowing for muscle function and using muscles to enhance stability.
3) The relationship of opposing occlusal surfaces, including occlusal schemes, tooth position, and ridge relationships.
This document discusses residual ridge resorption after tooth extraction. It covers the etiology, classification, prevention and treatment. Residual ridge resorption is caused by anatomical, metabolic, mechanical and prosthodontic factors and results in reduced alveolar bone size over time. The residual ridge can be classified based on its shape and height. Prevention focuses on maintaining oral health and correcting systemic factors. Treatment involves improving denture fit through specialized impression techniques to maximize support and retention of dentures on resorbed ridges.
1. Corticotomy facilitates faster orthodontic tooth movement by reducing resistance in the cortical bone layer.
2. Selective alveolar decortication (SAD) is shown to create a transient demineralization-remineralization effect on the alveolar bone through the regional acceleratory phenomenon (RAP), allowing teeth to move 2-3 times faster.
3. The periodontally accelerated osteogenic orthodontics (PAOO) technique combines SAD with alveolar bone grafting to generate new bone, reducing relapse risk and extending treatment limits.
The document discusses pre-prosthetic surgery, which aims to modify the oral environment to better support prosthetic appliances. The goals are to provide a broad, flat ridge with height and a firm mucosal covering. Objectives include eliminating disease, conserving structures, and providing support to withstand forces. The document describes various basic surgical procedures like alveoloplasty, tori removal, and soft tissue procedures to reshape ridges and remove excess tissue in preparation for dentures.
This document summarizes a study on using bone grafts and immediate implant placement in areas of high aesthetic value. It describes using block bone grafts taken from the mandible to augment alveolar ridge deficiencies in the maxilla before placing implants. The goals were to assess success rates of implants placed in grafted bone and determine if this technique is suitable for aesthetic areas. The methodology involved using SPI implants and placing immediate provisional restorations on the implants after grafting and implantation to condition the soft tissues during healing. Success was based on radiographic and clinical assessments during outpatient follow-ups.
This document summarizes a study on using bone grafts and immediate implant placement in areas of high aesthetic value. It describes using block bone grafts taken from the mandible to augment alveolar ridge deficiencies in the maxilla before placing implants. The goals were to assess success rates of implants placed in grafted bone and determine if this technique is suitable for aesthetic areas. The protocol involved using SPI implants and placing immediate provisional restorations on the implants after graft integration to condition the soft tissues during healing. The study aims to evaluate if this technique can provide rigid fixation and osseointegration of implants in grafted bone for functional loading.
The document discusses surgical and prosthodontic considerations for patients who have undergone a radical maxillectomy. It provides details on:
1) Closing the surgical defect with a radial forearm free flap and addressing distortions to palatal contours and secretions in the nasal cavity.
2) Retaining key abutment teeth by making bony cuts between teeth rather than through them.
3) Covering the palatal margin of defects with palatal mucosa when possible.
4) Designing obturators to be lightweight, inexpensive, and perforated to wire to residual dentition.
This document discusses alveolar bone osteoplasty, which is a periodontal surgical procedure used to reshape alveolar bone. It can be used to eliminate deformities caused by periodontal disease. There are two main types - additive, which restores bone to its original level, and subtractive, which restores bone form to the pre-existing level. Selection of technique depends on the type of bone defect, with one-wall defects treated by recontouring, three-wall defects by regeneration, and two-wall defects either way. The goal is to shape the bone to resemble undamaged alveolar process. Various osteoplastic techniques are described to achieve positive bone architecture.
This document provides an overview of preprosthetic surgery procedures. It begins with definitions and history of preprosthetic surgery. It describes common patterns of alveolar ridge resorption over time. The main goals and classification of preprosthetic surgeries are outlined, including ridge correction, extension, and augmentation procedures. Specific techniques are explained for alveoloplasty/alveolectomy, vestibuloplasty, tuberosity reduction, and mylohyoid ridge reduction. The document provides context and details on surgical methods for modifying hard and soft tissues to improve denture support and retention.
Similar to 7. Remodeling Resective Osseous Surgery.pptx (20)
This document provides information on epithelial tissue and cell junctions. It discusses the general features of epithelial tissue, including that epithelial cells are closely packed with many cell junctions. It also describes the different types of epithelial tissue (simple vs stratified), the cell shapes (squamous, cuboidal, columnar), and locations in the body. The document further explains the structure and functions of the basement membrane and cell junctions, including occluding junctions, anchoring junctions, and communicating junctions. Key cellular adhesion molecules and proteins involved in different junction types are also outlined.
This document provides information about lymph nodes and the lymphatic system. It discusses the anatomy, embryology, histology, and physiology of lymph nodes and lymphatic drainage. Key points include:
- Lymph nodes act as filters for the lymphatic system and help fight infection. They are located along lymphatic vessels.
- The primary lymphoid organs are the bone marrow and thymus, where lymphocytes develop. Secondary lymphoid organs include the spleen, lymph nodes, tonsils, and skin.
- Lymph nodes have an outer cortex and inner medulla. Lymph enters through afferent vessels and exits through efferent vessels. High endothelial venules are found
Dr. Sonam Rani presented on the topic of cementum to several professors and colleagues. Cementum is a calcified tissue that covers tooth roots and provides attachment for periodontal ligaments. It comes in several types classified based on cellularity, presence of fibers, and origin. Cementum is formed by cementoblasts and cementocytes and plays an important role in tooth adaptation and repair. Systemic conditions like Paget's disease and cleidocranial dysplasia can affect cementum formation and structure.
This document provides an overview of pain, including its definition, classification, theories, transmission and modulation pathways, assessment, and management approaches. It begins with definitions of pain from Dorland's Medical Dictionary and Monheim. It then classifies pain according to intensity, temporal relationship, qualities, onset, and localization. Theories of pain discussed include specificity, pattern, and gate control theories. It describes the dual nature of pain and the transduction, transmission, modulation, and perception of pain. It discusses referred pain and neuropathic pain. The document concludes by covering pain assessment tools and pharmacological and non-pharmacological management strategies.
COMMON SEMINAR STERILISATION, INFECTION CONTROL AND HOSPITAL MANAGEMENT.pptxmalti19
This document discusses sterilization, infection control, and hospital management in dentistry. It defines key terms like sterilization, disinfection, and asepsis. It then describes various methods of sterilization including physical methods like heat and radiation, and chemical methods like alcohols, phenols, aldehydes, halogens, and gases. The document provides details on specific sterilization techniques and protocols for sterilizing dental instruments used in different specialties. It emphasizes the importance of proper sterilization to prevent disease transmission between patients.
This document summarizes key concepts in immunology as they relate to periodontal disease. It discusses the epithelial barrier and pattern recognition receptors that detect pathogens. Inflammatory mediators recruit immune cells through chemotaxis. T lymphocytes develop and differentiate into subsets like Th1, Th2, Th17 that activate different immune responses. B cells produce antibodies through somatic hypermutation. Regulatory T cells control self-tolerance. The adaptive response becomes antigen-specific and develops memory. Dendritic cells present antigens to activate T cells. An imbalance in T cell subsets can lead to tissue destruction in periodontal disease.
Thrombosis, embolism, and infarction are related pathological processes involving blood clots. Thrombosis is the formation of a blood clot within a blood vessel, while embolism occurs when a piece of a clot breaks off and travels to another location. Infarction results from obstruction of blood flow by a clot, causing tissue death. The document discusses the mechanisms, types, features, and progression of thrombosis, embolism, and infarction. It also covers related topics like Virchow's triad, hypercoagulable states, fat embolism, and amniotic fluid embolism.
Thrombosis, embolism, and infarction are related pathological processes involving blood clots. Thrombosis is the formation of a blood clot within a blood vessel, while embolism occurs when a piece of a clot breaks off and travels to another location. Infarction results from obstruction of blood flow by a clot, causing tissue death. The document discusses the mechanisms, classifications, and morphological features of thrombosis, embolism, and infarction. It also covers related topics like Virchow's triad, hypercoagulable states, and the development and types of infarcts over time.
Immune responses in periodontal disease final.pptxmalti19
This document discusses the immune responses involved in periodontal disease. It begins by defining periodontitis as an infectious disease caused by anaerobic bacteria. Both bacteria and a susceptible host are required to cause disease. It then describes the pathogenesis which involves environmental and genetic risk factors interacting with the microbial challenge to activate the host immune response, resulting in inflammation and bone/tissue destruction. The document discusses the types of immunity, including innate and adaptive immunity. It covers topics such as dendritic cells, T-cell and B-cell roles, the roles of cytokines and RANKL in linking the immune response to bone loss, and hypotheses about the roles of the Th1 and Th2 responses in periodontitis.
This document provides an overview of antibiotics used in periodontics. It begins with an introduction to antibiotics and their historical background. It then covers classification of antimicrobial agents based on chemical structure, mechanism of action, organisms targeted, and spectrum of activity. Guidelines for antibiotic use in periodontal diseases are presented, along with the diseases where antibiotics can be used. Commonly used antibiotics like tetracycline, doxycycline, metronidazole, penicillin, and amoxicillin-clavulanate are described in detail. The document concludes with a reference to research on systemic antibiotic use in periodontics.
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Calcium and Phosphorous metabolism 23-03-23.pptxmalti19
Calcium and phosphorus metabolism is tightly regulated by vitamin D, parathyroid hormone, and calcitonin. Calcium is crucial for bone development, nerve function, and other processes. The recommended daily intake is 800 mg for adults. Dietary sources include dairy products, leafy greens, and fish. Absorption occurs in the small intestine and is influenced by vitamin D, PTH, and other factors. Hormonal signals work to maintain calcium levels within a narrow range. Disorders like rickets and osteomalacia can result from vitamin D deficiency. Precise regulation is needed to prevent hypercalcemia or hypocalcemia.
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The facial nerve emerges from the brainstem between the pons and medulla. It has motor, sensory, and parasympathetic secretomotor components. During embryonic development, it arises from the second branchial arch. The nerve passes through the internal acoustic meatus and facial canal within the temporal bone. It gives off several branches within the facial canal before exiting at the stylomastoid foramen. Its main branches in the face include the temporal, zygomatic, buccal, marginal mandibular, and cervical branches which innervate the muscles of facial expression.
1) PRP and PRF are platelet concentrates that provide growth factors that may enhance tissue regeneration.
2) Studies have shown PRP and PRF can increase the release of growth factors like PDGF, TGF-β1, and VEGF compared to control groups.
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Reducing fracture risk with Calcium and Vitamin D
Osteoporotic fractures are a major health problem that most commonly affect the spine and hip. Low calcium intake and vitamin D deficiency increase fracture risk by reducing bone mineral density and strength. Clinical trials show that calcium and vitamin D supplementation can reduce fracture risk, especially when vitamin D doses reach 800 IU daily and calcium intake reaches 1000-1200 mg. For older individuals, supplementation is most effective for those at high risk of deficiency living in nursing homes or with low dairy intake.
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This document summarizes evidence on the use of adjunctive antibiotics for chronic periodontitis. A systematic review of 25 studies found some additional benefits of antibiotics in deep pockets, including 0.2-0.6 mm more attachment gain and 0.2-0.8 mm more probing depth reduction. However, the clinical relevance is uncertain given limitations in defining chronic periodontitis and its microbiota. Overall, current studies have not conclusively established benefits of adjunctive antibiotics, so they cannot be routinely indicated as adjuncts for chronic periodontitis.
The document discusses immediate dentures, which are complete or partial dentures fabricated immediately after tooth extraction. It describes the differences between conventional (classic) immediate dentures and interim (transitional) immediate dentures. Conventional immediate dentures are intended as the long-term prosthesis and are made when only anterior teeth remain. Interim immediate dentures are short-term and are made when posterior teeth remain, requiring only one surgical visit. The document outlines the procedures, indications, contraindications, advantages and disadvantages of both types of immediate dentures.
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
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LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
How to Manage Your Lost Opportunities in Odoo 17 CRMCeline George
Odoo 17 CRM allows us to track why we lose sales opportunities with "Lost Reasons." This helps analyze our sales process and identify areas for improvement. Here's how to configure lost reasons in Odoo 17 CRM
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
How to Fix the Import Error in the Odoo 17Celine George
An import error occurs when a program fails to import a module or library, disrupting its execution. In languages like Python, this issue arises when the specified module cannot be found or accessed, hindering the program's functionality. Resolving import errors is crucial for maintaining smooth software operation and uninterrupted development processes.
2. The principles of osseous surgery in
periodontal therapy were outlined by
Schluger (1949) and Goldman (1950).
They pointed out that alveolar bone loss
caused by inflammatory periodontal
disease often results in an uneven outline
of the bone crest.
the elimination of soft tissue pockets
often has to be combined with osseous
reshaping and the elimination of osseous
craters and angular bony
Osseous Surgery
3. The discrepancies of bone and gingiva
to recurrences of pocket
That is why we reshape the marginal bone to
resemble alveolar process undamaged by
periodontitis
Usually we use apically displaced flap to
eliminate pocket and improves tissue contour.
The end result is improve tissue contour to
provide easy maintainable environment
Rationale
4. the more effective the periodontal maintenance
therapy,
the greater is the longitudinal stability of the surgical
result.
The efficacy of osseous surgery therefore depends
on its ability to
affect pocket depth and to
promote periodontal maintenance for both patent and
the Periodontist.
Rationale ….cont…
5. {
1) The interproximal bone is
more coronal in position
than the labial or
lingual/palatal bone and
pyramidal in form
Normal Alveolar Bone
Morphology
6. {
2. The form of the interdental
bone is depend on the tooth
form and the embrasure width.
tapered tooth
more pyramidal the bony
the wider the embrasure
more flattened is the
interdental bone mesiodistally
and buccolingually.
Normal Alveolar Bone
Morphology…cont..
7. {
3.The position of the bony
margin mimics the contours of
the cementoenamel junction.
‘scalloping’ depend on root
form,
tooth and position within the
alveolus “dehiscense &
fenestration’
Normal Alveolar Bone
Morphology…cont..
8.
9. Osseous Surgery: defied as the
procedure by which changes in the
alveolar bone can be accomplished
to rid it of deformities induced by
the periodontal disease process or
other related factors such as
exostosis and tooth supraeruption.
can be either additive or subtractive
in nature
Definitions……
10. Additive Osseous Surgery eg bone graft
includes procedures directed at restoring the
alveolar bone to it’s original level.
Subtractive Osseous Surgery
is designed to restore the form of pre-existing
alveolar bone to the level existing at the time of
surgery or slightly more apical to this level.
Additive Or Subtractive
11. Bone loss has been classified as either:
Vertical bone loss.
Horizontal bone loss results in a relative
thickening of marginal alveolar bone.
Combination.
12. brings about the ideal result of periodontal
therapy
regeneration we reestablishment of the
periodontal ligament, gingival fibers, and the
junctional epithelium at a more coronal level.
Additive Osseous
Surgery
13.
14. Osseous surgery defined as :the procedure by
which changes in the alveolar bone can be
accomplished to rid it of deformities induced
by the periodontal disease process or other
related factors, such as exostoses and tooth
supra eruption
RESECTIVE OSSEOUS
SURGERY
15. Osteoplasty: Reshaping of the alveolar process to
achieve a more physiologic form without removal of
supporting bone.
Ostectomy: The excision of a bone or portion of bone.
In periodontics, ostectomy is done to correct or reduce
deformities caused by periodontitis in the marginal
and interalveolar bone and includes the removal of
supporting bone
(other terms for supporting bone are: alveolar bone
proper, cribriform plate, and bundle bone)
17. {
are done when the other
method is not feasible
Subtractive Osseous Surgeries
18.
19.
20.
21. {
One wall Angular > Surgical
recontouring e.g.
one-wall defects and wide,
3 Wall, Narrow & Deep >
New Attachment & Bone
Regeneration
Selection Based on
Morphology of Defects
22. {
2 Wall Angular >
Depending on depth, width &
Configuration
Eg:
shallow two-wall defects
interdental craters
Selection Based on
Morphology of Defects
26. Terms that describe bone after reshaping:
• Ideal osseous form:
– The bone consistently more coronal on the interproximal surfaces
than on the facial and lingual surfaces. Similar interdental height,
with gradual, curved slops between interdental peaks.
• Flat architecture:
• Positive architecture:
• Negative architecture:
27. {
The bone consistently
more coronal on the
interproximal surfaces
than on the facial and
lingual surfaces.
Similar interdental
height, with gradual,
curved slops between
interdental peaks.
Ideal osseous form
31. Terms that
describe bone
after reshaping:
Ideal osseous
form
Flat architecture:
Positive
architecture:
Negative
architecture
32.
33. Terms that relate to the thoroughness of the osseous
reshaping techniques include “definitive” and
“compromise.”
Definitive osseous reshaping implies that further
osseous reshaping would not improve the overall result.
Compromise osseous reshaping indicates a bone pattern
that cannot be improved without significant osseous
removal that would be detrimental to the overall result.
References to compromise and definitive osseous
architecture can be useful to the clinician as terms that
express the expected therapeutic result.
thoroughness of the
osseous reshaping techniques
34. • Procedure use to correct osseous defect have been classified
into two group:
– Osteoplasty: it is reshaping of bone without removing the
supporting bone.
– Osteoectomy: it is reshaping of bone with removal of supporting
bone.
Terminology
35. • The technique ostectomy is best applied to patient
with early to moderate bone loss(2-3mm)with
moderate –length root trunks that have bony defect
with one or two wall defect.
• Patient with advanced attachment loss and deep
intrabony defect are not candidate for the
procedure
• Two wall defects, or craters, occur at the expense of
the interseptal bone. As a result they have lingual
and buccal wall that extend from one tooth to the
adjacent tooth, the bacco-lingual contour that result
is opposite to contour of the CEJ of the teeth.
Factor in selection of
resective surgery
36.
37.
38.
39.
40.
41.
42. {
A and B, Diagram of facial
and interproximal bony
contours after flap
reflection.
Note the loss of some
interproximal bone and
cratering. C and D, Line
angles; this is only
Osteoplasty and has
resulted in a reversed
architecture.
E and F, Ostectomy on the
facial and lingual bone
and the removal of the
residual widow's peaks to
produce a positive bony
architecture
Effect of correction of craters
43. {
In crater if the facial
and lingual plate of
this bone is resected ,
the resultant
interproximal
contour would
become more
flattened
44. If confining resection to ledges and the
interproximal lesion result in facial and lingual
bone form in which the interproximal bone is
located more apically than the bone on the facial or
lingual aspects of the tooth. The result would be
reversed or negative architecture
45.
46.
47. • Although the reversed architecture minimizes
the amount of ostectomy that is preformed , it
is not without consequences ( widow’s peaks)
facial and lingual line angel (attachment loss)
resorb the peak = pocket
• For the positive architecture ostectomy is
required to remove the widow’s peak as well
as some of the facial , lingual and palatal and
interproximal bone. and this will gives the
topography that resembles normal bone form
before disease .
48.
49. Probing and exploration are key aspects of the
examination
Probing reveals the presence of :
Pocket depth
Base of pocket relative to mucogingival
junction and attachment level on the adjecent
teeth.
Number of bony wall defects.
The presence of furcation defect.
Examination and treatment
planning
50. Trans-gingival probing (sounding):
Under local anesthesia confirms the extent and
configuration of the intrabony component of the pocket
or furcation defects.
The probe walks along the tissue-tooth interface to feel
the bony topography.
The probe may pass horizontally through the tissue to
provide three-dimensional information regarding
bony contours
51. Radiograph ( two dimension) cannot accurately
document the number of bony walls and the
presence or extend of bony lesion on the facial
/buccal or lingual/palatal walls.
Well made radiograph provide useful
information about the extend of interproximal
bone loss, angular bone loss, caries, root trunk
length, and the root morphology.
52. • After oral hygiene instruction and
debridement , the response of the patient to
these treatment procedures is evaluated by
reexamination and recording the changes in
the periodontium.
• Because the extend of periodontal involvement
may vary from tooth to tooth in the same
patient.
• After resolution of edema and swelling, will
result in return to normal pocket depth and
configuration.
53. In patient with moderate to advanced
periodontitis and bony defects, although the
overt sign of periodontitis may be reduced,
may display a persistence of pocket depth
bleeding on probing and suppuration. These
sign may indicate the presence of residual
plaque and calculus inability to instrument
deep pocket or patient unwillingness to
preform adequate oral hygiene
54.
55. Osseous resective surgery is also used to
facilitate certain restorative and prosthetic
dental procedure.
Caries
Fracture root of abutment teeth can be exposed
for removal.
Bony exostoses
Short anatomic crown can be lengthened
60. Technique:
• VERTICAL GROOVING
• RADICULAR BLENDING
• FLATTENING INTERPROXIMAL BONE
• GRADUALIZING MARGINAL BONE
STEPS IN RESECTIVE OSSEOUS SURGERY continued
61. • It is the first step because it can define the general thickness
and subsequent form of alveolar housing.
• It is usually done by rotatory instruments as carbide or
diamond burs.
• it is designed to:
– Reduce the thickness of the alveolar housing.
– Provide relative prominence to the radicular aspect of the teeth.
– Provide continuity from interproximal surface onto the radicular
surface.
• Indications:
– Thick, bony margins, shallow crater formations.
– Areas require maximal osteoplasty and minimal osteoctomy.
• Contraindication:
– Areas with close root proximity or thin alveolar housing.
Vertical grooving (osteoplasty):
62.
63. - It is an attempt to gradualize the bone over the entire radicular
surface to provide the best results from vertical grooving.
- It provides smooth, blended surface for good flap adaptation.
• Indications:
– Thick ledges of bone on the radicular surface.
• Contraindication:
– Minor vertical grooving or thin, fenestrated radicular bone.
• Both vertical grooving and radicular blending may be used for
treatment of:
– Shallow crater formation.
– Thick osseous ledges of bone in radicular surface.
– Class I and early class II furcation involvement.
Radicular blending (osteoplasty):
64.
65. – Removal of very small amount of supporting bone.
• Indications:
Interproximal bone varies horizontally.
One-walled interproximal defect.
Flattening Interproximal bone
(osteoctomy)
66. • Minimal bone removal to provide a sound,
regular base for gingival tissue to follow.
• Failure to remove the widow peak (Peaks of
bone remain at the facial, lingual/ palatal line
angles of the teeth) allows the tissue to rise to
higher level than the base of the bone loss in
the interdental area.
• Hand instruments as chisel and curette are
favorable over rotatory instruments.
Gradualizing marginal bone
(osteoctomy):
80. Correction of one walled hemiseptal defect:
The bone should reduce to the level of the most apical
portion of the defect.
If one walled defect occurs next to edentulous
area, the edentulous ridge is reduced to the
level of the osseous defect.
Specific osseous reshaping situation
81. Osteoplasty to eliminate the exostoses or reduce the buccal/ lingual
bulk of bone.
It is common to incorporate a degree of vertical grooving during
reduction of the bony ledges, since it facilitate the process of
blending the redicular bone into interproximal areas.
Previous 4 steps.
In case of exostoses, malpositioned or supraerupted tooth:
84. Reduction of interdental walls of craters and
the one-walled component of angular defects
and walls, and grooving into sites of early
involvement.
The walls of the crater may reduced at the
expense of the buccal, lingual or both walls.
The reduction should be made to remove the
least amount of alveolar bone required to
produce a satisfactory form, prevent
furcation and blend the contour with
adjacent tooth.
The selective reduction of bony defects by
ramping the bone to the palatal or lingual to
avoid involvement of the furcations.
In the absence of ledges or exostoses:
85. Interproximal osseous ramping. A. Presurgical view with 6 mm probing depth on
mesial of first molar. B. Deep two-wall intrabony defect between the second premolar
And first molar, hemiseptal defect between the two premolars and lingual exostosis.
C. Osseous resective surgery eliminated the interproximal osseous defects by ramping
to the lingual, corrected the reversed osseous topography and removed the osseous
ledges. D. Normal scalloped gingival morphology and good health 6 months after
osseous resective surgery
86. Replacing the flap in areas that previously had
deep pockets may result initially in greater
postoperative pocket depth, although a
selective recession may diminish the depth
over time. minimizes postoperative
complications
Positioning the flap apically to expose marginal
bone is results in more postsurgical resorption
of bone and patient discomfort
Flap Placement and Closure
87. Suturing may be accomplished using a variety
of different suture materials and suture knots