Switch to Dark theme

References

White DA, Tsakos G, Pitts NB, Fuller E, Douglas GV, Murray JJ Adult Dental Health Survey 2009: common oral health conditions and their impact on the population. Br Dent J. 2012; 213:567-572
Larato DC. Intrabony defects in the dry human skull. J Periodontol. 1970; 41:496-498
Tal H. The prevalence and distribution of intrabony defects in dry mandibles. J Periodontol. 1984; 55:149-154
Wouters FR, Salonen LE, Hellden LB, Frithiof L. Prevalence of interproximal periodontal intrabony defects in an adult population in Sweden. A radiographic study. J Clin Periodontol. 1989; 16:144-149
Tomasi C, Koutouzis T, Wennstrom JL. Locally delivered doxycycline as an adjunct to mechanical debridement at retreatment of periodontal pockets. J Periodontol. 2008; 79:431-439
Matuliene G, Pjetursson BE, Salvi GE, Schmidlin K, Bragger U, Zwahlen M Influence of residual pockets on progression of periodontitis and tooth loss: results after 11 years of maintenance. J Clin Periodontol. 2008; 35:685-695
Ower P. BPE Guidelines: British Society of Periodontology Revision 2016. Dent Update. 2016; 43:406-408
Davies KJ, Drage NA. Adherence to NICE guidelines on recall intervals and the FGDP(UK) Selection Criteria for Dental Radiography. Prim Dent J. 2013; 2:50-56
Tsitoura E, Tucker R, Suvan J, Laurell L, Cortellini P, Tonetti M. Baseline radiographic defect angle of the intrabony defect as a prognostic indicator in regenerative periodontal surgery with enamel matrix derivative. J Clin Periodontol. 2004; 31:643-647
Cortellini P, Carnevale G, Sanz M, Tonetti MS. Treatment of deep and shallow intrabony defects. A multicenter randomized controlled clinical trial. J Clin Periodontol. 1998; 25:981-987
Matthews DC. Prevention and treatment of periodontal diseases in primary care. Evid Based Dent. 2014; 15:68-69
Cobb CM. Non-surgical pocket therapy: mechanical. Ann Periodontol. 1996; 1:443-490
Renvert S, Nilveus R, Egelberg J. Healing after treatment of periodontal intraosseous defects. V. Effect of root planing versus flap surgery. J Clin Periodontol. 1985; 12:619-629
Nibali L, Pometti D, Chen TT, Tu YK. Minimally invasive non-surgical approach for the treatment of periodontal intrabony defects: a retrospective analysis. J Clin Periodontol. 2015; 42:853-859
Polson AM, Heijl LC. Osseous repair in infrabony periodontal defects. J Clin Periodontol. 1978; 5:13-23
Froum SJ, Coran M, Thaller B, Kushner L, Scopp IW, Stahl SS. Periodontal healing following open debridement flap procedures. I. Clinical assessment of soft tissue and osseous repair. J Periodontol. 1982; 53:8-14
Nyman S, Lindhe J, Rosling B. Periodontal surgery in plaque-infected dentitions. J Clin Periodontol. 1977; 4:240-249
Nyman S, Gottlow J, Karring T, Lindhe J. The regenerative potential of the periodontal ligament. An experimental study in the monkey. J Clin Periodontol. 1982; 9:257-265
Karring T, Nyman S, Lindhe J. Healing following implantation of periodontitis affected roots into bone tissue. J Clin Periodontol. 1980; 7:96-105
Nyman S, Karring T, Lindhe J, Planten S. Healing following implantation of periodontitis-affected roots into gingival connective tissue. J Clin Periodontol. 1980; 7:394-401
Polson AM, Proye MP. Fibrin linkage: a precursor for new attachment. J Periodontol. 1983; 54:141-147
Haney JM, Nilveus RE, McMillan PJ, Wikesjo UM. Periodontal repair in dogs: expanded polytetrafluoroethylene barrier membranes support wound stabilization and enhance bone regeneration. J Periodontol. 1993; 64:883-890
Wikesjo UM, Nilveus R. Periodontal repair in dogs: effect of wound stabilization on healing. J Periodontol. 1990; 61:719-724
Wikesjo UM, Lim WH, Thomson RC, Hardwick WR. Periodontal repair in dogs: gingival tissue occlusion, a critical requirement for GTR?. J Clin Periodontol. 2003; 30:655-664
Kao RT, Nares S, Reynolds MA. Periodontal regeneration – intrabony defects: a systematic review from the AAP Regeneration Workshop. J Periodontol. 2015; 86:(2 Suppl)S77-104
Needleman IG, Worthington HV, Giedrys-Leeper E, Tucker RJ. Guided tissue regeneration for periodontal infra-bony defects. Cochrane Database Syst Rev. 2006; (2)
Esposito M, Grusovin MG, Papanikolaou N, Coulthard P, Worthington HV. Enamel matrix derivative (Emdogain(R)) for periodontal tissue regeneration in intrabony defects. Cochrane Database Syst Rev. 2009; (4)
Farina R, Simonelli A, Minenna L, Rasperini G, Trombelli L. Single-flap approach in combination with enamel matrix derivative in the treatment of periodontal intraosseous defects. Int J Periodontics Restorative Dent. 2014; 34:497-506
Troiano G, Laino L, Zhurakivska K, Cicciu M, Lo Muzio L, Lo Russo L. Addition of enamel matrix derivatives to bone substitutes for the treatment of intrabony defects: a systematic review, meta-analysis and trial sequential analysis. J Clin Periodontol. 2017; 44:729-738
Castro AB, Meschi N, Temmerman A, Pinto N, Lambrechts P, Teughels W Regenerative potential of leucocyte- and platelet-rich fibrin. Part A: intra-bony defects, furcation defects and periodontal plastic surgery. A systematic review and meta-analysis. J Clin Periodontol. 2017; 44:67-82
Sculean A, Nikolidakis D, Nikou G, Ivanovic A, Chapple IL, Stavropoulos A. Biomaterials for promoting periodontal regeneration in human intrabony defects: a systematic review. Periodontol 2000. 2015; 68:182-216
Takei HH, Han TJ, Carranza FA, Kenney EB, Lekovic V. Flap technique for periodontal bone implants. Papilla preservation technique. J Periodontol. 1985; 56:204-210
Cortellini P, Tonetti MS. Improved wound stability with a modified minimally invasive surgical technique in the regenerative treatment of isolated interdental intrabony defects. J Clin Periodontol. 2009; 36:157-163
Trombelli L, Farina R, Franceschetti G, Calura G. Single-flap approach with buccal access in periodontal reconstructive procedures. J Periodontol. 2009; 80:353-360
Liu S, Hu B, Zhang Y, Li W, Song J. Minimally invasive surgery combined with regenerative biomaterials in treating intra-bony defects: a meta-analysis. PLoS One. 2016; 11
Graziani F, Gennai S, Cei S, Cairo F, Baggiani A, Miccoli M Clinical performance of access flap surgery in the treatment of the intrabony defect. A systematic review and meta-analysis of randomized clinical trials. J Clin Periodontol. 2012; 39:145-156
Cortellini P, Stalpers G, Mollo A, Tonetti MS. Periodontal regeneration versus extraction and prosthetic replacement of teeth severely compromised by attachment loss to the apex: 5-year results of an ongoing randomized clinical trial. J Clin Periodontol. 2011; 38:915-924

Management of intrabony defects in periodontal disease

From Volume 46, Issue 3, March 2019 | Pages 257-265

Authors

William Anderson

BSc, BDS, MFDS, MPerio RCS (Ed), FDS (Rest Dent) RCS Ed

Consultant, Restorative Dentistry, University Hospitals Morecambe Bay NHS Trust

Articles by William Anderson

Andrew Pye

Consultant in Restorative Dentistry, Dundee Dental Hospital and School, Park Place, Dundee DD1 4HR, UK

Articles by Andrew Pye

Abstract

Intrabony periodontal defects present a clinical challenge in the treatment of periodontal disease and maintenance of compromised teeth. The management of such defects ranges from non-surgical mechanical debridement to modern minimally invasive regenerative surgery. The incidence of intrabony defects is discussed along with prognosis and likely outcomes of various treatment options.

CPD/Clinical Relevance: Vertical or intrabony (IB) defects are a common occurrence in patients suffering from advanced periodontal disease. Primary care practitioners must be aware of possible treatment options in order to make suitable referrals when initial phases of treatment prove unsuccessful.

Article

Periodontal disease management is taking ever greater importance in dental professionals' daily lives, as caries prevalence reduces from 48% of teeth in 1998 to 26% in 2009.1 The number of adults retaining teeth into old age is increasing and, as such, a significant proportion of these patients will present with periodontal pathology: in 2009, 19% of 55–64 year-olds presented with pockets of 6 mm or more;1 35% of all 55–64 year-olds in 1988 were registered as edentate; whereas the figure for this age group had reduced to just 5% in 2009.

Patterns of destruction of tissue, and particularly bone, due to periodontitis are well established, and are classified dependant on the location of the base of the pocket relative to the alveolar bone crest. Generally, periodontal bone loss follows the pattern of horizontal bone loss, but a significant proportion of sites will present with a vertical defect, also known as an intrabony defect. A bacteria-induced ‘dysbiosis’ affecting the inflammatory pathways within the periodontal tissues can lead to osteoclastic activation and destruction of bone. If this pattern occurs to leave a ‘trough’ around the tooth, with the base of the defect apical to the surrounding bone crest, it is termed an ‘intrabony’ or ‘angular’ defect.

Register now to continue reading

Thank you for visiting Dental Update and reading some of our resources. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Up to 2 free articles per month
  • New content available

Already have an account? Sign in here