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osseous defect

a concavity or deformity in the alveolar bone involving one or more teeth

osseous surgery

the general term for all procedures designed to modify and re-shape defects and deformities in the bone surrounding the teeth

diagnosis

must determine the structure of the osseous defect, sound probe(perio probe), limitations do exist

classification of infrabony or intraboony defects

three-wall, two-wall, one-wall and combined defect

three-wall defect

occurs most frequently in the interdental region, usually the remaining bony walls are facial, lingual and proximal can be circumferential defects

two-wall defect

most prevalent osseous defect found interdentally with facial and lingual walls remaining, involves both the interproximal walls mainly crater defects or interdental crater defects.

one wall defect

usually only one interdental wall remains, hemi septum if remaining wall is proximal

combined defect

combination of one two or three wall defect

objectives of osseous surgery

create contours that permit better plaque control, create contours that will parallel the contours of the gingival tissue after healing, permit primary wound closure and crown lengthening (bone is actually removed for crown placement)

management of osseous defects

osteoplasty, ostectomy, induce or promote regrowth and regeneration of bone, amputate root or divide in half, non-surgical treatment and extraction of tooth

osteoplasty

remove or recontour non-supporting bone

ostectomy

remove tooth supporting bone

Bone grafts

induce or promote regrowth and regeneration of bone

antibiotics, SC/RP

non-surgical treatment

Biological width

in a healthy relationship, there is 1mm of CT attachment to the root and 1mm of JE along the tooth and there will be approximately a 1mm space between the gingiva and the tooth (sulcus)

1mm:1mm:1mm relationship

Biological width

Indications for osseous resection

shallow infrabony or intabony defects, class I and selected class II furcation, flat or reverse architecture, tori, exostosis, ledges, contouring of bone in conjunction with root resection and achieving primary closure of flaps in new attachment

contraindications

esthetics-max anterior, isolated deep defect, advance perio, local anatomic factors, high carries rate and systemic conditions

Indications for bone grafts

patient selection, defect selection(3wall & class 2 fur has a greater chance)

3 basic functions of osseous grafts

osseous conduction, osseous induction and osteogenesis

osseous conduction

grafts act as a template and assist in bone formation and depositing of bone

osseous induction

grafts stimulate or induces new formation

osteogenesis

cells of the graft actually produce new bone

types of bone grafts

autografts (2 types), allografts, xenografts, alloplastic grafts and composite grafts

auto grafts

free osseous autografts and contiguous autografts

free osseous autografts

contain cortical or cancellous bone or combination obtained intraoral (max tuberosities, edentualous ridges, retromolar ridges, healing sockets, during osteoplasty or ostectomy) or extraoral

contiguous autografts

bone swaging grafts (not used as much) green stick fracture

allografts

tissue transplant form person of same species; freeze dried cadaver (hydrochloric acid)

xenografts

obtained from a different species (bovine cow)

alloplastic grafts

synthetic substances

composite grafts

combination of autogenous bone with any other grafts

furcation

treatment of teeth with _________ involvement can complicate periodontal treatment, diagnosis is determined by use of nabers probe and evaluating radiographs

Grade I furcation

soft tissue lesion min osseous destruct

Grade II furcation

soft tissue lesion with bone loss

Grade III furcation

extensive bone destruction; covered by soft tissue

Grade IV furcation

exposed and open

Prognosis of furcations

extent of horizontal and vertical bone loss in the intraradicular space, number of roots, structure and furcal root structure, structure of intraradicular space, health status of PDL and access for surgical correction

prognosis of tooth with furcation

access of plaque control, pulpal status, ability to control occlusal forces and history of caries

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