OstectomyIncludes removal of tooth
supporting bone in the treatment of periodontal
Osseous reconstructive surgeryThis involves
procedures involving regeneration (regrowth) of
lost bone, and the reestablishment of the
periodontal ligament, cementum, gingival
fibers, and junctional epithelium.
An osseous graft is a procedure that involves
implanting living tissue or inert material into
periodontal osseous defects to regenerate new
periodontal attachment (bone, periodontal ligament,
and cementum). Donor bone may be obtained from
adjacent cortical and cancellous bone, mixed with the
patient's blood. Other sources for bone may be from
edentulous ridges, extraction sites, or maxillary
tuberosity. Bone can also be obtained from tissue
banks or various crystalline synthetic substances, such
as hydroxyapatite over a 4-6 month period. Grafts may
also be placed in osseous defects.
A method of tooth replacement involves the
surgical implantation of coated metal implants into
the bone ridges of edentulous areas (fig. 6-15). The
root implant becomes firmly attached to the bone and
a new crown is placed upon it to support fixed or
removable bridges. The procedures involved in the
use of metallic implants require a team approach from
the prosthodontics, periodontic, and oral surgery
ROOT AMPUTATION, HEMISECTION,
Sometimes the bone loss is so great around the root
of a mutlirooted tooth that a root or section of the tooth
Figure 6-15.Implant placement.
must be removed. The remaining portion of the tooth
can be saved if sufficient periodontal support is
present. Endodontic treatment is required before
treatment of the remaining portion of the tooth.
Root amputationThe complete removal of one
or more roots of a multirooted tooth, without removal of
any portion of the crown.
HemisectionThe surgical sectioning of a
multirooted tooth through the furcation area so that the
blocked, defective, or periodontally involved root or
roots may be removed along with the associated portion
of the crown. An artificial crown is required on the
remaining half of the crown.
BicuspidizationA multirooted tooth is
sectioned through the furcation and both halves of the
tooth are retained.
During periodontal surgery, the dentist exposes
soft tissues and sometimes bone, leaving open wounds.
Surgical dressing materials (packs) are usually applied
to the wounds as a protective barrier. These packs not
only protect the area by preventing food from injuring
the surgical area, but also soothe and aid in the healing
process. Your primary duty will be to mix the
ingredients and form the dressing the dentist places in
the patient's mouth. Follow the manufacturer's
instructions for mixing. Most dressing will stay in
place for 5-7 days. During the postoperative visit, the
surgical dressing and any sutures will be removed. The
dental officer may elect to place another dressing over
the surgical area if the healing process is delayed.
Periodontal cutting instruments must be kept sharp
by a correct sharpening technique. To be able to
recognize when instruments require sharpening is
extremely important. To determine if an instrument is
sharp, you must be familiar with each instrument's
cutting edge(s). Under good lighting, examine the
cutting edge using a magnifying glass, or by looking
directly at the edge while slightly turning the
instrument. A sharp cutting edge will not reflect light
and appears as a line. A dull edge will reflect the light,
creating a glare because the edge has been rounded off.
The correct sharpening device is critical for a good
cutting edge. Hard felt wheels are recommended for