Horizontal bone loss
Bone is lost equally on adjacent teeth.
Vertical (angular) bone loss
bone is lost more rapidly on one tooth than the adjacent tooth creating a defect. The defect can have one, two or three walls or a combination.
Radiographic examination
Reveals the existance of angular bone losses in the interdental spaces. The radiograph will not show the number of bony walls of the defect.
Clinical examination
determines the presence and depth of periodontal pockets on any surface of any tooth and can also give a general sense of the bony topography.
Transgingival probling
Can predict the many features of the underlying bony topography
Osseous surgery
May be defined as the procedure by which changes in the alveolar bone can be accomplished to rid it of deformities induced by the periodontal disease process or other related factors such as exostosis and tooth supraeruption.
Subtractive osseous surgery
designed to restore the form of pre-existing alveolar bone to the level existing at the time of surgery or slightly more apical to this level-bone resection.
Additive osseous surgery
includes procedures directed at restoring the alveolar bone to its original level- bone grafting/ regeneration
The shape
What feature of the osseous defect determines the surgery or technique used to treat the defect?
one wall angular defect treatment
usually have to be recontoured using surgical resection
Three wall defects
if they are narrow and deep, they can be treated with techniques that aim at new attachment and bone such as bone graft and regeneration
Two walled defects
Can be treated with either surgical recontouring or new attachment and bone regeneration. Interdental craters are two walled defects best dealt with by surgical recontouring
Goal of Resective surgery
Reshaping the marginal bone to resemble physiologic architecture. Performed in combination with apically displaced flaps. Thsi will eliminate periodontial pocket depth and improve tissue contour.
Osteoplasty
refers to shaping the bone without removing tooth-supporting bone.
ostectomy
includes the removal of tooth-supporting bone
Interdental bone to radicular bone
Positive and negative architecture refer to the relative position of which two types of bone?
Positive
Architecture is _______ when the radicular bone is apical to the interdental bone.
Negative
Bone has ________ archtecture if the interdental bone is more apical than the radicular.
flat
when the interdental bone and the radicular bone are reduced to the same height it is called ____ architecture.
Definitive osseous reshaping
Implies that further osseous reshaping would not improve the overall result
Compromise osseous reshaping
Indicates a bone pattern that cannot be improved without significant osseous removal that would be detrimental to the overall result.
Which technique is preferable when dealing with interproximal craters?
The technique that reduces the least amount of supporting bone.
Widow's peak
small bony discrepancies on the gingival line angles
higher
Failure to remove widow's peaks allow the tissue to rise to a _____ level than the base of the bone loss in the interdental area.
Osseous resection technique
1.Vertical grooving
2. Radicular blending
3. flattening interproximal bone
4. gradulalizing marginal bone