牙周病手术治疗03

Resective osseous surgery
Osteoplasty Reshaping the bone without removing tooth-supporting bone. Ostectomy (or osteoectomy) Reshaping the bone includes the removal of tooth-supporting bone.
Materials
Non-Bioabsorbable Cellulose acetate (Millipore® ) e-PTFE (Gore Tex® )
Materials
Bioabsorbable Cross-linked collagen
Polylactic acid/polymers
Polyglycolic acid
Root resection, hemisection and “tunneling” procedure are usually used to treat such problems and to facilitate oral hygiene.
Indications for root resection and hemisection
Osteolrlasty
reduce and reshape thick bony ledges
Ostectomy
Resection of supporting bone Bone contouring
Regenerative osseous surgery
Ideally periodontal therapy is designed to regenerate new tissues. Regenerative osseous surgery is designed to stimulate new bone formation to fill the osseous defects and recreate physiologic bone morphology. In this technique, full-thickness flaps are reflected, the areas are thoroughly debrided, and a serious of grafts is placed over the bony defect.
Procedures
Placement of a physical barrier to cover the bone and periodontal ligament, temporarily separating them form the gingival epithelium. Ensure that the detached root surface becomes repopulated with cells from the periodontal ligament.
1. Furcation involvement (Degree Ⅲ,Ⅳ)
2. Fracture of a tooth or root.
3. Failure of endodontic therapy in one canal
and correction or retreatment of this canal
Root Resection
Suture
Root Resection
Hemisection
In a hemisection the tooth is cut in half. The technique is used mainly on mandibular molars to treat Class II or III furcation invasions. The tooth is sectioned from buccal to lingual. In contrast to root resection, extraction of one of the sections does not necessarily need to be performed.
Hemisection The second mandibular molar has a Class II furcation involvement and each root still has adequate bone support
The tooth was divided in half and each half treated as a separate“premolar”
is not possible. 4. Recession exposing the entire length of a root and correction with mucogingival procedures is not possible.
Contraindications
1. RCT cannot be done on the remaining roots, e.g. partly calcified canal or fused roots.
Root Resection
Advanced bone loss on the distobuccal root of the maxillary first molar, with degree Ⅲbuccal to distal furcation. The major attachment has been lost on the distal surface of this maxillary first molar. So the best treatment option is resecting the distobuccal root.
Root Resection
A bur is used to cut the root. This cut is apical to the opening of the furcation. Once resected, the root is extracted. The remaining stump is contoured to smooth out any sharp angles and to remove any undercuts.
Grafts
Autografts/Autogenous - from the same individual - intraoral or extraoral Allografts/Homografts - from genetically dissimilar members of same species Heterografts/Xenografts - from a donor of another species, such as cattle (bovine bone) Synthetic Grafts - from man-made material
Osseous Surgery
Periodontal Department Deng yuquan
OUTLINE
Resective osseous surgery
-osteolrlasty
-ostectomy (or osteoectomy)
Regenerative osseous surgery
According to biological principles 4 tissue types compete for the space adjacent to the tooth root after surgery. Without interference epithelium usually wins the race, forming a long junctional epithelium.
graft is a piece of living tissue or synthetic material placed in contact with injured tissue to repair a defect or correct a deficiency.
Guided Tissue Regeneration
Applications
Intrabony defects
-1,2 or 3 walls
Furcation involvement
-Degree I -Degree II
Buccal gingival Recession
Possible outcomes of therapy
New attachment with periodontal regeneration is the ideal outcome of therapy because it results in obliteration of the pocket and reconstruction of the marginal periodontium.
Hemisection
A hemisection often will be followed by the extraction of one of the sectioned halves. This is done primarily when the severe attachment loss is restricted to one root, the other root can be treated, and there is no other stable distal abutment.
Oxidized cellulose
Surgical therapy for furcation involvement
Furcation involvement is a pathological situation, which develops when bone loss exposes the furcation between the roots of multirooted teeth. The gingival margin usually is coronal to the furcation.