Bone Defect

Main Types• Horizontal Bone Loss• Vertical bone loss/angular defect • Osseous Craters

Horizontal Bone Loss• most common pattern of bone loss in

periodontal disease• Bone reduce in height, but bone margin

perpendicular to tooth surface• Affect interdental septa, facial and lingual

plate

Vertical Bone Loss• a sign of progressive periodontal breakdown• Occur in oblique direction• Leave hollowed-out trough in bone alongside the

root• Base of defect apical to surround bone• Interdental defect can appear on r/g• Facial, lingual or palatal defect may not seen on r/g

Angular Defect• Classified by number of osseous wall

Management

• Phase I: Periodontal Therapy (non-surgical)• Phase II: Periodontal Therapy (Surgical)

• Subtractive osseous surgery• Additive osseous surgery• Osteoplasty• osteotomy

Resective Osseous Surgery

• Non-bone graft associated new attachment• Bone graft associated new attachment

Reconstructive Periodontal Surgery

OHI for patient

• Toothbrushing– Dentifrices• Anti-plaque : eg. stannous fluoride (SnF(2))

– Techniques1. Bass2. Modified bass3. Charter4. Modified stillman5. Fones

• Provides gingival stimulation (vibratory motion)

• Suitable for gingival recession (Toothbrush bristle ends not directed into sulcus)

• Less traumatic to the gingiva• Who should use this? People with

continuous gingival recession

Stillman’s method

• Chemical plaque control

FIRST GENERATION • Antibiotic, phenol, quarternary ammonium

compounds & sanguinarine

SECOND GENERATION • Bisbiguanides,(chlorhexidine)

THIRD GENERATION• Eg: delmopinol

• Chewing Gums• Interdental Brush

Smoking Cessation – 5AsASK ~ Ask patient about smoking status

ADVICE ~ Provide clear, strong advice to quit with personalized messages about the impact of smoking

ASSESS ~ Assess the willingness of the patient to make a quit attempt within the next 30 days.

ASSIST ~ Suggest and encourage the use of problem-solving methods and skills for cessation. Provide social support as part of the treatment.

ARRANGE ~ Periodically assess smoking status and, if she is a continuing smoker, encourage cessation.

Smoking Cessation - 5RsRelevance• Encourage the patient to indicate why quitting is personally relevant

Risks• Ask the patient to identify potential negative consequences of tobacco use.

Rewards• Ask the patient to identify potential benefits of stopping tobacco use.

Roadblocks• Ask the patient to identify barriers or impediments to quitting.

Repetition • The motivational intervention should be repeated every time an unmotivated

patient has an interaction with a clinician. Tobacco users who have failed in previous quit attempts should be told that most people make repeated quit attempts before they are successful.

• http://imuoralhealth.blogspot.com/2010/07/importance-and-various-tooth-brushing.html