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38 terms

Osseous defects

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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