Goldman, HM, Cohen, DW The infrabony pocket. Classification and treatment. J Periodontol, 29:272, 1958

The morphology of the intraosseous defect is important for the decision about its regeneration or eradication. The classification is therefore based on the number of osseous walls surrounding the defect.

1. Four osseous walls: (a) buccal, lingual, mesial, and distal walls
2. Three osseous walls: (a) proximal, buccal, and lingual walls; (b) buccal, mesial, and distal walls; (c) lingual mesial and distal walls
3. Two osseous walls: (a) buccal and lingual (crater walls); (b) buccal and proximal walls; (c) lingual and proximal walls
4. One osseous wall: (a) proximal wall; (b) buccal wall; (c) lingual wall
5. Combination: (a) 3+2 walls; (b) 3+2+1 wall; (c) 3+1 wall; (d) 2+1 wall

The recording of the size and general topography of the defect by clinical and radiographical means is very important.

Etiology: Calculus and food impaction are the primary etiology. Tooth anatomy as well as tooth position are important. Occlusal traumatic lesion, although not an attachment loss factor per se, may work as a secondary factor. Infrabony defects are also commonly observed in cases of periodontosis.

Therapy: elimination of signs and symptoms. Tooth anatomy conductive to food impaction, uneven marginal ridges, tilting of teeth and occlusal trauma should be corrected before surgery is performed. Splinting of mobile teeth is often necessary.

Selection of therapeutic procedure: The objective of the treatment is pocket elimination. Two basic ways are described: (a) curettage of the part of the defect below the bone crest to enhance formation of new cementum, bone and PDL; (b) osseous resection to level of the base of the defect. The higher the number of osseous walls present the better is the chance of having success with curettage.

Treatment of 3-wall osseous defects: curettage-gingivectomy procedure for new attachment. A gingivectomy is performed and the contents of the pockets are removed. Roots should be carefully debrided.

Treatment of the infrabony defect with one or two osseous walls by ostectomy-osteoplasty: contraindications to this procedure may be weakening of support of an adjacent tooth or creation of gingival form not conductive to self-cleansing or areas difficult to be cleaned. When the pocket is shallow and not much support is lost, the procedure is indicated. In this modality of treatment, a flap is raised and bone is trimmed. A gingivectomy can be performed before the flap is raised. To treat the interdental creater, it is often advisable to remove the buccal wall (as opposed to what we do today) for oral hygiene access. (This article is prior to #5 Oschenbein- palatal approach).

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