Osseous Defects Flashcards
By definition, what is an osseous defect?
A concavity or deformity in alveolar bone involving one or more teeth
What do you use to diagnose/evaluate an osseous defect?
Radiographs and probing the area in both horizontal and vertical aspects
What are three classifications for infrabony defects?
three-wall, two-wall, one-wall
What bone has resorbed in a three-wall infrabony defect?
Either the mesial or distal bone (adjacent to a tooth’s root)
Which wall is most common to be missing in a two-wall infrabony defect?
The facial wall because there is less bone on that side of the alveolar ridge
What are the likely sides to see comprising a one-wall defect?
Mesial/distal wall, and rarely you’ll see just a lingual wall
What is the most important step in trying to regenerate bone in an infrabony defect?
Getting all surfaces of the defect cleaned of bacteria/disease
What is a circumferential 3-wall defect?
A three wall defect that wraps around half of a tooth
Does a narrow or wide defect have a better prognosis?
Narrow - blood clot stays better
Is prognosis better with a deep or shallow osseous defect?
Deep - better supports blood clot
What is the most common bony defect?
interdental craters
What kind of infrabony defect is an interdental crater?
A two-wall because it only has the facial and lingual walls made of bone (other walls are adjacent roots)
Give some examples for two-wall defects.
Interdental crater, two-wall hemiseptum
What is the most commonly seen one-wall defect, and why?
Hemiseptum (interdental bone is the one wall), and it can be caused by people flossing too aggressively
Define osseous surgery.
A procedure which aims to eliminate deformities caused by periodontal disease or other related factors, such as exostosis and tooth supraeruption.
What are the two basic types of osseous surgery?
Subtractive (resective) and Additive (regenerative)
List five options for osseous surgery.
osseous recontouring, induce regeneration of bone, root resection via osseous resection, maintenance of pockets caused by bony defects, and tooth extraction
What is the number one reason preventing a patient from having osseous surgery?
Socioeconomic factors
What’s the difference between osteoplasty and ostectomy?
osteoplasty = reshaping the bone without removing tooth-supporting bone ostectomy = removal of tooth-supporting bone
Name five therapeutic determinants for osseous surgery.
depth of defect, width of defect’s mouth, topography, number of walls, and configuration of adjacent tooth surfaces
What’re some objectives of osseous resection?
Reshaping marginal bone to resemble natural, healthy bone; smooth bone to induce gingival regeneration; create easier cleanable areas; allow for better flap approximation; crown lengthening
What three things determine the degree of scalloping of gingiva?
CEJ, convexity of teeth, and tooth position in the alveolar bone
If the osseous crest is ≤5mm from the contact point between adjacent teeth, what is the likelihood that the papilla will fully regenerate?
%
Gingiva will heal according to… ?
same anatomic concepts as in healthy gingiva
Give some indications for osseous resection?
Shallow infrabony defects (1-2mm deep); incipient and shallow furcation invasions; unnatural bony architecture (like tori, etc); contouring of bone
What are some contraindications for osseous resection?
if its an esthetic area, an isolated deep pocket, have advanced periodontitis, or near certain anatomic factors, high caries risk, or serious systemic condition
What kinds of anatomic factors should you avoid with osseous resection?
Ascending ramus, external oblique ridge, maxillary sinus, adjacent to flat palate
What are the four general steps to osseous recontouring?
vertical grooving, radicular blending, flattening interproximal bone, gradualize marginal bone
Why would you do radicular blending?
to provide a smooth surface for good flap adaption
When should you flatten interproximal bone when recontouring?
When the interproximal bone levels vary horizontally
What happens if you fail to remove discrepancies on the gingival line angles (widow’s peak)?
The tissue rises to a higher level than the bone you recontoured in the interdental area
