Glossary of Oral and Maxillofacial Implants Endorsing Organizations

Glossary of Oral and Maxillofacial Implants Endorsing Organizations:

American College of Prosthodontists

European Association for Osseointegration Editor-in-Chief: W. R. Laney Glossary of Oral and Maxillofacial Implants

Section Editors: N. Broggini D. Buser D. L. Cochran L. T.Garcia W. V.Giannobile E. Hjørting-Hansen T.D. Taylor

Co-Editors: J. A. Cirelli K. Dula R. E. Jung R. T.Yanase

Quintessence Publishing Co, Ltd Berlin, Chicago, Tokyo, Barcelona, Beijing, Istanbul, London, Milan, Moscow, New Delhi, Paris, Prague, São Paulo, Seoul, and Warsaw Imprint

German National Library CIP Data Acknowledgement The German National Library has listed this publication in the German National Bibliography. The authors thank Ms.Ute Drewes for her beau- tiful artwork and illustrations. We also thank Detailed bibliographical data are available on Ms. E.F.Davis for her excellent support and out- the Internet at http://dnb.ddb.de. standing commitment during the entire editing process. All rights reserved. In particular, the materials published in the Glossary of Oral and Maxillo- facial Implants are protected by copyright. Any Sources of figures reproduction, either in whole or in part, without the publisher’s prior written consent is prohibit- The majority of the figures in this book were ed. The information contained in the published computer-generated by Ms. U. Drewes. These il- materials can itself be protected by other intel- lustrations are not labeled with a source. The re- lectual property rights. Such information may maining figures were reproduced from previous not be used without the prior written consent of publications with permission from the respective the respective intellectual property right owner. authors or publishers. These figures are labeled with a source. Some of the manufacturer and product names referred to in this publication may be registered trademarks or proprietary names, even though specific reference to this fact is not made. Therefore, the appearance of a name without designation as proprietary is not to be construed as a representation by the publisher that it is in the public domain.

All rights reserved. This book or any part there- of may not be reproduced, stored in a retrieval system, or transmitted in any form or by any means,electronic, mechanical,photocopying,or otherwise, without prior written permission of the publisher.

Initiator: A. Ammann (QPC Berlin) Coordination: Ä. Klebba (QPC Berlin) Editing: L. Bywaters (QPC Chicago) Illustrations: U. Drewes (www.drewes.ch) Production: J. Richter (QPC Berlin) Printing: Bosch-Druck GmbH (www.bosch-druck.de)

Printed in Germany ISBN: 978-3-938947-00-5

IV Foreword

The preparation of the Glossary of Oral and Max- Implants is sure to become an indispensable illofacial Implants represents a crucial step to- tool for every professional fascinated by the vast wards harmonizing the terminology employed array of terminology in the field and who also worldwide by clinicians, researchers and aca- has the desire to employ it accurately and mean- demics who work in this field and establishing a ingfully. solid basis for mutual understanding. This volume does not aspire to the impossible The International Team for Implantology (ITI) task to cover all terms in this field. It has, how- has no hesitation in endorsing this valuable ever, selected around 2000 of the most com- work and congratulates its author, Prof. Dr. monly used terms from various areas of implant William R. Laney, his co-contributors and advi- dentistry. sors on producing such an extensive, accurate and considered work. The ITI is proud to have been involved in the development of this volume and is happy to recom- The aim of the ITI is to promote and disseminate mend it as a standard work from which every knowledge on all aspects of implant dentistry professional in the field can benefit. and related tissue regeneration. As it demon- strated with the ITI Treatment Guide series, the Congratulations on a job well done. ITI is keen to support the development of practical tools for professionals in this field. As a Dieter Weingart Daniel Buser work that lays the foundations for a shared vo- ITI President Chairman, cabulary, the Glossary of Oral and Maxillofacial ITI Education Committee

V Preface

As the field of implant dentistry has grown inter- Closely related to the expansion of implant clin- nationally, so has the need for a common im- ical practice has been the competitive technical plant language. With new developments and development and marketing activities by manu- technology has come an increasingly diverse facturers of implant system components, instru- and complex literature.For clinicians,educators, ments, and devices. While acknowledging that and researchers alike, it is time to bring univer- these products are essential to the expansion of sal consistency to the terminology of implant implant dentistry,it is important to note that the dentistry. intended aim of this glossary is to focus on col- laborative science and art as the basis for im- One component of the multimedia, multi-lan- plant therapy advancement and to minimize guage series by the Quintessence Publishing emphasis on commercial hardware technology Company, entitled Dynamics in Implant Den- and terminology. tistry, includes an illustrated glossary that provides a broadly based multidisciplinary introduc- The dedicated members of the Editorial Board tion to scientific terminology pertinent to the who have compiled and written this first-edition field. From a thorough review of implant text- represent the expertise of essential disciplines books and peer-reviewed periodical literature, comprising the broad spectrum of implant den- some 5000 terms were distilled for considera- tistry. To the following contributors, I extend my tion. Approximately 2000 of these were selected heartfelt thanks and appreciation for their par- for inclusion and defined by co-authors repre- ticipation,cooperation,and especially their well- senting an interdisciplinary variety of implant- recognized expertise: Prof. Dr. Daniel Buser, Dr. related interests, including surgery, radiology, Nina Broggini, Dr. Karl Dula, Prof. Dr. Erik Hjørt- hard and soft tissue biology, periodontics, ing-Hansen,Prof.Dr.William Giannobile,Dr.Joni prosthodontics, implant componentry, research Cirelli, Prof. Dr. Lily Garcia, Dr. Roy Yanase, Prof. methodology and statistics, biomechanics and Dr. David Cochran, Dr. Ronald Jung and Prof. Dr. ceramics. Thomas Taylor.In addition, Drs. Peter C. O’Brien

VI and Thomas G. Wilson, Jr.have contributed con- rector of Quintessence Berlin.Mr.Bernd Burkart, siderably to the glossary in support of the co-au- head of the Quintessence Berlin production de- thors. partment, coordinated and directed all production activities.The dedication,perseverance,and Without the profound interest and support of cooperation of the entire Quintessence Publish- the International Team for Implantology, this ing Company staff have been exemplary. glossary could not have progressed. It is anticipated that the Glossary of Oral and A work of this complexity and magnitude must Maxillofacial Implants will become a practical involve the collaboration of capable support per- education and communications tool for those sonnel.Ms.Ute Drewes has contributed her artis- students and practitioners who have or will have tic skills to the creation of illuminative illustra- an interest in implant dentistry. Nonetheless, tions. The daily tasks of compiling and editing this print resource should be considered a work database input have been timely and extraordi- in progress. New knowledge will continue to narily accomplished by Ms.Elizabeth Floyd Davis emerge and with it the need for additional (USA) and Ms. Änne Klebba, Quintessence Pub- terms, revision of those existing, and deletion of lishing, Berlin. Ms. Sandra Fielitz provided secre- those that are redundant or obsolete. tarial support in Quintessence Berlin and effi- ciently managed the laborious task of preparing William R. Laney, DMD, MS the initial database from which the included terms were selected. The final review, coordination and editing of terms was superbly accomplished by Ms. Lisa Bywaters, Senior Editor, and her staff at Quintessence Publishing, Chicago. This publication was conceived and very capably managed by Mr.Alexander Ammann, Project Di-

VII Editor and Authors

Oral and Maxillofacial Surgery/Diagnostics/ Biomedicine/Biomaterials Anatomy/X-Ray

Authors Author Daniel Buser, DMD, Prof., Dr. med. dent. Erik Hjørting-Hansen, Prof., Dr. odont. Professor/Chair, Department of Oral Surgery Department of Oral and Maxillofacial Surgery and Stomatology School of Dentistry and University Hospital School of Dental Medicine (Rigshospitalet) University of Bern University of Copenhagen Freiburgstrasse 7 Norre Alle 20 3010 Bern, SWITZERLAND 2200 Copenhagen N, DENMARK [email protected] [email protected]

Nina Broggini, DMD, MS, Dr. med. dent. Department of Oral Surgery and Stomatology Periodontics School of Dental Medicine University of Bern Author Freiburgstrasse 7 William V.Giannobile DDS, D. Med. Sc. 3010 Bern, SWITZERLAND Najjar Professor of Dentistry [email protected] Director Michigan Center for Oral Health Research Private Practice: University of Michigan Studio Borsa Broggini Lanfranchini 24 Frank Lloyd Wright Drive Via Stazione 1 Lobby M, Box 422 6828 Balerna, SWITZERLAND Ann Arbor, MI 48106, USA [email protected] [email protected]

Co-Author Co-Author Karl Dula, PD, Dr. med. dent. Joni Augusto Cirelli, DDS, PhD Chair, Section of Dental Radiology Research Fellow, Department of Periodontics Department of Oral Surgery and Stomatology and Oral Medicine School of Dental Medicine School of Dentistry University of Bern University of Michigan Freiburgstrasse 7 1011 N. University Avenue 3010 Bern, SWITZERLAND Ann Arbor, MI 48109, USA [email protected] [email protected]

VIII Prosthodontics Biometry/Statistics/Research/Methodology

Author/Editor-in-Chief Author William R. Laney, DMD, MS David L. Cochran, DDS, MS, PhD, MMSci Professor Emeritus Professor, Department of Periodontics Division of Prosthodontics MSC 7894 Department of Dental Specialties University of Texas Health Science Mayo Clinic College of Medicine Center at San Antonio Rochester, MN 55905, USA 7703 Floyd Curl Drive [email protected] San Antonio, TX 78229-3900, USA [email protected] Contributors Peter C. O’Brien, PhD Co-Author Professor of Biostatistics Ronald E. Jung, Dr. med. dent. Division of Biostatistics Assistant Professor, Clinic for Fixed Department of Health Sciences Research and Removable Prosthodontics Mayo Clinic College of Medicine Center for Dental and Oral Medicine Rochester, MN 55905, USA and Cranio-Maxillofacial Surgery [email protected] University of Zurich Plattenstrasse 11 Thomas G. Wilson, Jr., DDS 8032 Zurich, SWITZERLAND Private Practice of Periodontics [email protected] 5465 Blair Road, Suite 200 Dallas, TX 75231, USA [email protected] Biomechanics/Ceramics

Author Implant Componentry Thomas D. Taylor, DDS, MSD Professor/Chair, Author Department of Reconstructive Sciences Lily T.Garcia, DDS, MS University of Connecticut School Professor/Chair, Department of Prosthodontics of Dental Medicine University of Texas Health Science Center at 263 Farmington Avenue San Antonio Farmington, CT 06030-1615, USA 7703 Floyd Curl Drive, MSC 7912 [email protected] San Antonio, TX 78229-3900, USA [email protected]

Co-Author Roy T.Yanase, DDS Clinical Professor, Continuing Education and Advanced Education in Prosthodontics University of Southern California School of Dentistry 22330 Hawthorne Boulevard, Suite 316 Torrance, CA 90505-2590, USA [email protected]

X Y

Abutment connection

A A

Abscess Pathologic process that is an en- Abutment clamp Instrument used to handle closed collection of purulent exudates (pus) or hold the implant abutment. The concave in tissues, organs, or confined spaces in the design is such that when engaged, the clamp body. Signs of infection, swelling, and inflam- fits circumferentially around the component. mation are typical. See also: Acute abscess; Chronic abscess; Gingival abscess; Periodontal abscess; Residual abscess.

Absorbable See: Bioabsorbable material.

Absorption Uptake of substances into or across tissues (eg, skin, mucosa, intestine, or renal tubules).

Abutment Tooth, tooth root, or implant com- Contoured to fit ponent that serves as support and/or reten- specific component tion for a dental prosthesis.1 See also: Abutment clamp. Anatomic healing abutment; Angled/angulated abutment; CAD/CAM abutment; Castable abut- Abutment connection Act of connecting an ment; Ceramic abutment; Healing abutment; abutment to an endosseous implant.2,3 See Nonangled abutment; Nonrotating abutment; also: External abutment connection; Internal Prefabricated abutment; Preparable abutment; abutment connection; Morse taper connection. Standard abutment; Temporary abutment; Transmucosal abutment; UCLA abutment.

Screw design of a. Prosthetic implant component manufactured with threads at the apical portion of the element. This term refers to the manufacture of a specific thread pattern unique to a particular implant company.

Tightness of a. Amount of clamping force present within the body of an abutment Internal External Internal connection connection connection screw following placement. See also: Preload. Abutment connection. (Redrawn from Yanase and Preston2 with perission.)

1 Abutment-implant interface

A Abutment-implant interface Common contact surface area between an implant abutment and the supporting implant.3

Abutment screw Single-piece implant component with a threaded apical portion that can be connected directly to the implant. No additional screw is required to connect and secure the abutment component.

Threaded apical Access hole. element of (Reprinted from Watzek4 with permission.) screw abutment

Acellular Limited in or devoid of cells.

Acellular dermal allograft Skin graft made of a thin split-thickness of dermis that has un- dergone a tissue-preparation process to remove cellular material.

Acid-etched implant External surface of an Abutment screw. implant body that has been modified by the chemical action of an acidic medium. The Access hole Opening in a replacement tooth’s subtractive surface is intended to enhance occlusal or lingual surface of an implant-re- osseointegration. tained prosthesis that provides entrance for abutment or prosthesis screw placement or Acid etching Act of modifying an implant sur- removal.3 face by exposure to an acidic medium with the intention of enhancing osseointegration. See also: Etching.

Acquired immunity Specialized form of immunity involving antibodies and lymphocytes. Active immunity develops after exposure to a suitable agent (eg,by an attack of a disease or by injection of antigens), and passive immunity occurs with transfer of antibodies or lymphocytes from an immune donor.

Access hole. Acquired immunodeficiency syndrome (Reprinted from Watzek4 with permission.) See: AIDS.

2 AIDS

Acrylic crown See: Acrylic restoration. Adjustable attachment system Stud-shaped A attachment in which the stud (easily re- Acrylic resin Thermoplastic resin produced by placed) serves as the patrix, and the matrix polymerizing esters of acrylic or methyl- consists of a metal housing. The base of the methacrylate acids. patrix can be cast-to or soldered as part of a coping, and the matrix can be incorporated Acrylic restoration Tooth or other prosthetic into the dental prosthesis. The patrix is ad- restoration fabricated from acrylic resin, justable using a special tool to modify the such as an acrylic crown. spread of the patrix width.8,9

Actinobacillus actinomycetemcomitans Gram- negative, fermentative, nonmotile, coccoid or Matrix rod-shaped bacterium of the family Pasteurel- laceae, part of the normal mammalian mi- croflora. This bacterium has been associated with periodontal infections and, in particular, Patrix early-onset, aggressive forms of periodontal disease.

Patrix base Acute abscess Abscess of relatively short du- ration, typically producing local swelling, inflammation, and pain. Adjustable attachment system. (Redrawn from Staubli and Bagley9 with permission.) Acute infection Infection with a rapid onset and usually a severe course.5 See also: Infection. Adjustment Modification of a tooth or prosthetic restoration to improve its appearance, Additive surface treatment Implant surface fit, or function.10 modification created by the addition of material. Surface modification may also be ac- AIDS Acronym for acquired immunodeficiency complished by subtractive surface treat- syndrome, caused by HIV (human immunode- ment. Compare: Substracted implant sur- ficiency virus), that leaves the body vulnerable face. to a host of life-threatening illnesses. There is no cure for AIDS, but treatment with antiviral Adhesive Intervening substance used to unite medication can suppress symptoms. The virus adjoining surfaces. In maxillofacial prosthet- attacks selected cells of the immune, nervous, ics, adhesives have been used for border and other systems,impairing their proper func- adaptation, marginal seal, and the retention tion and rendering the subject highly vulnera- of facial, auricular, nasal, or orbital prosthe- ble to life-threatening conditions (eg, Pneumo- ses. Systems commonly used include biphase cystis carinii pneumonia) and those that can be- adhesive tape and medical-grade adhesives.6,7 come life threatening (eg, Kaposi sarcoma). Oral lesions may include necrotizing ulcerative Adhesive retention See: Cementation. gingivitis (NUG), necrotized ulcerative periodontitis (NUP), linear gingival erythema Adjunctive treatment Supplementary thera- (LGE), candidiasis, hairy leukoplakia, herpes peutic procedure to augment a main thera- simplex, and rapidly progressive periodontitis. peutic procedure in an additive,usually incre- mental, manner.

3 Alendronate sodium

A Alendronate sodium Oral bisphosphonate methacrylate (HEMA) polymer, or bioactive used in the treatment of different types of os- glass that is derived either synthetically or from teoporosis with a reasonably high degree of a foreign, inert source. See also: Alloplast. treatment success in prevention of fractures of the vertebral column. Aluminum oxide Oxide ceramic (Al2O3) used in single-crystal form as implant material. Algae See: Calcified algae. Because it is biocompatible and has a hard- ness similar to that of the gem sapphire, it Algipore See: Calcified algae; Porous marine- has been called single-crystal sapphire. Alu- derived coralline hydroxyapatite. minum oxide has been replaced by titanium as the material of choice for implants. Alkaline phosphatase Enzyme found in high concentrations in osteoblasts; commonly lo- Alveolar Related to the alveolar process, the cated on cytoplasmic processes extending in- maxillary or mandibular ridge of bone that to the osteoid. The level of alkaline phos- supports the roots of teeth. phatase in serum is a systemic indicator for bone formation. Alveolar atrophy Decrease in the volume of the alveolar process occurring after tooth Allodynia Pain resulting from a nonnoxious loss, decreased function, and/or localized stimulus that does not normally provoke pain. overloading from an improperly fitting removable partial or complete denture.13 Allogeneic bone graft Graft between genetically dissimilar members of the same species. Alveolar bone That part of the maxilla or Iliac cancellous bone and marrow, freeze- mandible comprising the tooth-bearing dried bone allograft (FDBA), and demineral- and/or supporting part of the jawbones. It ized freeze-dried bone allograft (DFDBA) are consists of cortical plates,the vestibular plate available commercially from tissue banks. being the thinnest, and trabecular bone. Called also allograft. See also: Atrophic alveolar bone; Cancellous bone. Allograft Graft between genetically dissimilar members of the same species.11,12 See also: Quality of a. b. Of major importance to the Acellular dermal allograft; Allogeneic bone outcome of implant placement,bone qual- graft; Soft tissue augmentation. ity has been categorized in a number of classification systems,illustrating the vari- Integration with a. Independent of allo- ance in relative volume of compact corti- graft or bone substitute use for osseous re- cal bone and trabecular bone. Although it construction, implants will always have is often used, the term bone quality is a newly formed host bone in juxtaposition to misnomer; a more correct term would be the implants as part of the process of os- bone density. A popular and often-quoted seointegration. classification was originally proposed by Lekholm and Zarb (1985). Type 1 refers to Alloplast Inorganic, synthetic, or inert foreign homogenous compact bone of high densi- material implanted into tissue.11,12 ty but low vascularity; hence not an ideal clinical situation. Types 2 and 3 describe Alloplastic graft Graft material such as hydroxya- bone that still has a dense cortical plate patite (HA), tricalcium phosphate (TCP), poly- but also has a cancellous portion with methylmethacrylate (PMMA) and hydroxyethyl- good vascularity for ideal implant place-

4 Alveolar nerve

ment and stability. Type 4 describes inad- Alveolar mucosa Mucosa covering the basal A equate density, and caution in its use for part of the alveolar process and continuing implant placement is warranted.14 into the vestibulum and floor of the mouth without demarcation. In contrast to attached gingiva, alveolar mucosa is nonkeratinized, mobile,and has a thin lamina propria,numerous elastic fibers, and a distinct submucosa. It is a dark red tissue,movable,and loosely attached to the periosteum. The alveolar mucosa is coronally separated from the gingiva by a line called the mucogingival junction. 1234

Bone quality Alveolar nerve Either of the superior alveolar nerve branches of the maxillary nerve of the second division of the trigeminal nerve (rami Quality of alveolar bone. alveolares superiores posteriores, ramus alve- 14 (Redrawn from Lekholm and Zarb with permission.) olaris superior medius, and ramus alveolaris superior anteriores).Supplies sensory innerva- Quantity of a. b. Of major importance to tion to the maxillary molars,the premolars,or the outcome of implant placement, bone the canine and incisors, respectively. The in- volume at a given implant site ideally ferior alveolar nerve (nervus alveolaris inferi- should be at least 10 mm in vertical dimen- or) is the largest branch of the mandibular sion and 6 mm in horizontal dimension.15 nerve of the third division of the trigeminal nerve or cranial nerve V, which supplies sen- Alveolar distraction osteogenesis Augmen- sory innervation to the mandibular teeth, tation procedure involving the surgical mobi- lower lip, and chin. Descending between the lization, transport, and fixation of an alveolar sphenomandibular ligament and mandibular bone segment. A mechanical distraction de- ramus, the inferior alveolar nerve enters the vice allows a gradual, controlled displacement medial aspect of the mandible by way of the of the mobile bone segment at an ideal rate mandibular foramen and continues anterior- of 0.4 mm a day. Following the desired aug- ly through the mandibular canal,first forming mentation, the device is left in place for 3 to the inferior dental plexus that supplies senso- 4 weeks for consolidation of the newly formed ry innervation to the molars and premolars. bone.16 See also: Distraction osteogenesis Continuing anteriorly to the mental foramen, (DO). it then divides into two terminal branches: the mental nerve (nervus mentalis) which branches off at the level of the premolars and exits the mental foramen, supplying the sensory branches of the lower lip and chin; and the incisive branch, which supplies the canines and incisors. Other branches of the mandibular nerve include the mylohyoid nerve (nervus mylohyoideus), which supplies the mylohyoideus muscle and the anterior belly of the digastricus.17

Alveolar distraction osteogenesis. (Redrawn from Chin16 with permission.)

5 Alveolar process

mm A Alveolar process Ridge of maxillary or mandibu- Anterior mandible lar bone supporting the roots of erupted teeth 35 25 and unerupted, developing tooth buds. 15 Labial

5 Alveolar reconstruction Surgical reconstruc- 5 15 II III IV V VI mm tion of an atrophic alveolar ridge that does not mm Posterior mandible 25 allow for simultaneous implant placement because of the extent of bone deficiency. Ridge 15 Buccal defects are present following long-standing 5 edentulism,trauma,tumor resection,or infec- 5 15 II III IV V VI mm tion. Localized defects are treated with auto- mm Anterior maxilla genous block grafts from intraoral donor sites 0 and often combined with particulate autoge- 10 nous bone, bone substitutes, and/or barrier 20 10 0 II III IV V VI mm membranes. More extensive defects require mm Posterior maxilla extraoral autogenous block grafts,which offer 0

the greatest amount of augmentation volume 10 Palatal Labial and stability. In vertical reconstruction, dis- 10 0 II III IV V VI mm traction osteogenesis could be an alternative Classification of alveolar ridge morphology. 18 to onlay grafting. (Redrawn from Cawood and Howell with permission.)

Alveolar ridge Osseous part of the mandible Radiographic assessment of a. r. Radio- and maxilla remaining after removal of graphic analysis of existing alveolar ridge teeth; ie, alveolar process. This entity usual- dimensions using individual periapical ra- ly becomes atrophic when not loaded or diographs, orthopantomogram, comput- when loaded in an unphysiologic way (eg, re- er tomography, and/or digital volume to- movable partial or complete dentures). The mography prior to implant placement to transfer of forces through implants can determine local bone anatomy, local maintain ridge volume and thereby avoid pathology, and vital anatomic structures atrophy. in close proximity.

Classification of a. r. Several alveolar bone Alveolar ridge augmentation Surgical aug- morphologic classification systems exist. mentation of the alveolar ridge in a hori- The most classic and frequently-used sys- zontal and/or vertical direction using one of tem – proposed by Cawood and Howell – several approaches based on the size and/or describes potential denture-bearing bone location of the defect. as Class I: dentate; Class II: immediately postextraction; Class III: well-rounded Bone grafting for a. r.a. Surgical procedure ridge form that has adequate height and by which the residual alveolar ridge is en- width; Class IV: knife-edge ridge form, ad- hanced in height and/or width with an au- equate in height but inadequate in width; togenous graft,allograft,synthetic graft,or Class V: flat ridge form with inadequate any combination of these materials. height and width; Class VI: depressed ridge form with evident basal bone Calvarial bone grafting for a. r. a. Outer loss.18 See also: Cawood and Howell clas- cortex of the calvarium is harvested for on- sification. lay alveolar ridge augmentation in patients with severe maxillary or mandibular atro-

6 Alveolar ridge defect, Implant placement

phy; multiple blocks may be harvested.The Disadvantages of iliac crest harvesting in- A bone is cortical in structure and tends to re- clude the need for general anesthesia, in- sorb less than iliac crest bone.19 creased donor site morbidity, and potential for greater postoperative resorption A. r.a. in esthetic zone site Requires not on- rate as compared to intraoral sources of ly the generation of sufficient volume for bone.21-24 See also: Iliac crest. implant placement but also labial volume to mimic the natural contour of the alveo- Le Fort I downfracture for a. r. a. Surgical lar process and support of the soft tissues. augmentation in a severely resorbed max- Attention also needs to be given to the illa by a combination of a Le Fort I osteoto- coronal-apical level of the augmented bone my and interposition of a bone graft har- and subsequently to the gingival margins vested from a separate donor site within so that an esthetic harmony among all the patient (eg, iliac crest).25 maxillary anterior teeth is achieved and/or preserved.20 Osteotome technique for a. r. a. See: Osteotome technique. Guided bone regeneration for a. r. a. Prin- ciple of guided bone regeneration (GBR) Ramus bone grafting for a. r. a. using barrier membranes, either re- See: Bone mill; Mandibular block graft, sorbable or nonresorbable, to exclude cer- from the ramus. tain cell types such as rapidly proliferating epithelium and connective tissue, thus Split-ridge technique for a. r.a. Augmenta- promoting the growth of slower-growing tion procedure to increase the width of a cells capable of forming bone.GBR is often narrow residual alveolar ridge by surgical- combined with bone grafting procedures. ly splitting it or by expanding it with a series of osteotomes of increasing diameter. Iliac bone grafting for a. r. a. Common ex- The procedure can be combined with si- traoral corticocancellous source of autoge- multaneous implant placement. nous bone graft in cases where large block volumes are required for alveolar ridge Titanium mesh–autogenous bone grafting augmentation. Two approaches to the ili- for a. r. a. Rarely performed augmenta- ac crest exist. Bone harvested from the an- tion procedure in which autogenous block terior iliac crest, as described by Kalk et and/or particulate grafts are covered by a al21,allows simultaneous surgery in the oral titanium mesh fixed to the alveolar cavity. Harvesting from the posterior iliac process with screws. While the graft is ex- crest, as described by Bloomquist and tremely stable, later removal of the titani- Feldman22, requires that the patient be ro- um mesh device could cause adverse out- tated in a prone position with a sandbag comes.26 placed under the anterior iliac crest to support the pelvis, thus precluding simultane- Alveolar ridge defect Circumscribed absence ous oral surgical access. The advantage of of tissue in a residual alveolar ridge. a posterior approach is that more than twice as much bone can be harvested, and Implant placement in a. r. d. Requires si- postoperative morbidity is much less than multaneous guided bone regeneration that for the anterior approach.Block grafts (GBR). Prerequisites for a simultaneous may be combined with iliac crest particu- approach are: (1) implant placement in a late, which is harvested simultaneously. correct prosthetic position, (2) good pri-

7 Alveolar ridge defect, Implant placement

mary stability of the placed implant, and A Transmucosal element analog (3) an appropriate defect morphology that Working allows for a predictable regenerative treat- surface is ment outcome. Vertical defects are more exact duplicate demanding than horizontal defects, as are one-wall, two-wall, and three-wall defects.

Morphology of a. r.d. Classified as horizon-

tal and/or vertical deficiencies. Classifica- Stone tion is important for determining the prog- cast nosis of bone augmentation procedures. Clinicians tend to differentiate between Analog/analogue. (Redrawn from Yanase and Preston28 with permission.) one-wall, two-wall, and three-wall defects, similar to periodontal intrabony defects. Analysis of variance (ANOVA) Statistical test to compare three or more groups on the mean Alveolar ridge preservation value of a continuous response variable.29 See: Bio-Col technique. Anatomic healing abutment Prosthetic im- Alveolectomy Surgical removal of parts of the plant component that may be cylindrical in alveolar process in the maxilla or mandible. cross section but widens in diameter toward the coronal surface. The three-dimensional Alveoloplasty Contouring of the alveolar process. design of a healing abutment is intended to guide healing of the peri-implant sulcus for a Alveolus Socket of the alveolar process in cross-sectional shape that simulates a soft tis- which the tooth is attached by the periodon- sue emergence profile. tal ligament. Abutment can be made wider at the coronal surface to create an emergence profile Amoxicillin Semisynthetic derivative of ampicillin effective against a broad spectrum of gram-positive and gram-negative bacteria. This antibiotic is often used in the treatment of infections caused by susceptible strains of Haemophilus influenzae, Escherichia coli, Pro- teus mirabilis, Neisseria gonorrhoeae, strepto- Bone cocci (including Streptococcus faecalis and S pneumoniae), and nonpenicillinase-producing 27 staphylococci of the oral cavity. Anatomic healing abutment.

Analog/analogue Prosthetic component or el- Anchorage, bicortical implant ement, the working surface of which is an ex- See: Bicortical stabilization. act duplicate of a specific surgical and/or prosthetic component. This element is typi- Anesthesia Loss of sensation when an anes- cally incorporated in dental laboratory proce- thetic drug is injected or topically applied to dures to facilitate fabrication of an accurate a particular area of the body.Local infiltration master cast and/or prosthesis and can be in- involves the application of an anesthetic corporated into a model for patient educa- agent to a localized area, whereas a nerve tion28 See also: Replica. block will affect a particular region.

8 Ankylosis

Angiogenesis Development of blood vessels Angled/angulated implant Relative position A in the embryo or any formation of new blood of an implant to other adjacent implants or vessels. (See figure below.) natural dentition.

Angle, Bennett See: Bennett movement. Animal model Use of animals in biomedical research for conducting experiments. The Angled/angulated abutment Prosthetic im- quality, species, and breeding of the animal plant component designed to change direc- can help establish the type of animal to be tion from parallel along the long axis of the used in the experiment.31 implant to a specified angle from parallel. Anisotropic implant surface Implant surface that is not isotropic and may have different characteristics when measured or loaded in different directions.

Ankylosis Union or fusion between two joint components or between a tooth and the alve- Abutment angle olar bone, often resulting from traumatic destruction of the periodontal membrane. When ankylosis is established, the tooth will

Long access of implant gradually be replaced by bone-replacement resorption. See also: Functional ankylosis. Angled/angulated abutment.

Primary vasculature Remodelled vasculature Angiogenesis. (Redrawn from Yancopoulos et al30 with permission.) A B

Artery Vein Artery Vein

Immature Stable unstable mature vessels vessels

D Unstable Stable vessel vessel F

9 Anodization

A Anodization Electrolytic treatment of a metallic Anterior nasal spine Triangular protuberance surface,imparting an oxidized surface.Dye may of bone extending anteriorly from the inferi- be used to create a colored surface.Anodization or aspect of the nasal cavity at the midline, in the manufacture of implant components fa- serving as an attachment point for the nasal cilitates color coding and/or recognition. cartilage. This bony structure is often used as an intraoral source of autogenous bone for Anodizing surface treatment Surfaces of var- grafting procedures of smaller volumes. ious implant-related components (eg, abutments, screws) may be anodized to produce Anteroposterior spread (AP spread) Distance coloration, which assists with recognition by from a line drawn between the posterior the clinician.Anodizing titanium with a yellow edges of the two most distal implants in an or golden color is thought to reduce the ten- arch and the midpoint of the most anterior dency for gray show-through of abutments implant in the arch. This measurement is when placed beneath thin tissues. See also: used to calculate the maximum posterior Anodization. cantilever length of the prosthesis, which is usually 1.5 times the AP spread.

AP spread

Anodizing surface treatment. Anteroposterior spread (AP spread). ANOVA Abbreviation for Analysis of variance. Antibiotic Substance, such as penicillin, pro- Anterior Indication of a forward location also duced by fungi, bacteria, or other organisms known as front. In oral anatomy, the anterior that can inhibit or destroy the growth of oth- region of the mouth includes the jaw sections er microorganisms. Antibiotics are widely containing the incisors and canines.32 used in the prevention and treatment of infectious diseases.34 See also: Amoxicillin; Anterior loop Anatomic phenomenon of the Penicillin. mental nerve that is a continuation of an anterior loop beyond the mental foramen. Antibiotic prophylaxis Prescribed for patients Attention should be paid to this potential pre- or peri-operatively to prevent postsurgi- anatomic variation during implant treat- cal infections. Widely used with different reg- ment planning. Often anterior loops cannot imens, although no consensus exists for use be identified by radiographic examination. in routine procedures.Clinicians may routine- A distance of 4 mm anterior to the mental ly use it in patients with large–volume aug- foramen has been recommended.33 mentations (eg,block grafting,sinus augmen-

10 Arm prosthesis

tation) or in patients (such as diabetics) with A compromised wound healing.In patients with a risk of endocarditis, a standard regimen has been established and is recommended for certain types of dental procedures.35

Antirotation Resistance to rotation or ability of implant stack components to resist loosen-

ing. See also: Stack. Apical offset

Antral floor Inferior bony wall of the maxillary sinus cavity. Apical offset.

Antral floor grafting Apically positioned flap See: Maxillary sinus floor elevation. See: Flap, apically positioned.

Antral mucosa Aplasia Incomplete development of an organ See: Maxillary sinus membrane. or tissue. Congenital absence may be characteristic. Antrostomy Surgically created opening into the antrum.36 Apoptosis Morphologic pattern of cell death affecting single cells and marked by shrinkage Antrum Cavity or chamber in the body, often of the cell, condensation of chromatin, forma- within bone. Maxillary antrum refers to the tion of cytoplasmic blebs, and fragmentation maxillary sinus. See also: Maxillary sinus. of the cell into membrane-bound apoptotic bodies that are eliminated by phagocytosis. Antrum of Highmore See: Maxillary sinus. Appositional bone growth See: Bone modeling. AP spread Abbreviation for Anteroposterior spread. Arch Bony arc formed by the maxillary or the mandibular teeth or residual ridge when Apex Anatomic end of a tooth root or root- viewed occlusally.38 form implant.10 Archwire Wire attached to two or more teeth Apical Referring to, or in the direction of, a or implants, generally used to guide or retain root apex. See also: Apex. teeth during orthodontic therapy.

Apical offset Design feature at the apical por- Arm prosthesis Artificial replacement for part tion of an implant that allows for expansion, or all of the human arm. See also: Somato- resulting in circumferential offset and an in- prosthesis. crease in the overall diameter of the implant at the apical portion.37

11 Artery

A Artery Blood vessel that carries oxygenated blood from the heart to tissues and organs.

Articulating tape Ink-impregnated paper or silk ribbon used to identify contacting occlusal or incisal surfaces.10

Articulation Static and dynamic relationships of contacting occlusal surfaces during function. It also pertains to the junctions or contacting surfaces of bones of the skeleton. See also: Canine-protected articulation.

Nonadjustable (Hinge-type) articulator. Articulator Apparatus designed to mechani- (Redrawn from Starcke and Engelmeier40 with permission.) cally orient the essential elements of mastication (ie, temporomandibular joints, jaws, Semi-adjustable a. Instrument capable of and teeth) in their simulated spatial relation- simulating vertical and horizontal move- ship outside the mouth. The design is based ment with or without temporomandibular on the degree of mandibular movement sim- joint orientation. Joint articular references ulation desired for the development of an oc- are commonly reversed with condylar guid- clusal scheme.10 ance developed according to mechanical equivalents based on anatomic averages. Fully adjustable a. Articulating instrument Some semi-adjustable articulators provide permitting the simulation of three-dimen- for temporomandibular joint orientation sional mandibular movement and capable and may be either Nonarcon (condylar ele- of accepting three-dimensional jaw regis- ments in the upper member) or Arcon tration records.39 (condylar elements in the lower member as in the human situation).39

Fully adjustable articulator. Semi-adjustable articulator. Nonadjustable a. Hinge-type instrument capable of retaining maxillary and mandibu- Artificial limb Artificial replacement for part or lar jaw casts in an established vertical rela- all of a human arm or leg. See also: Somato- tionship while providing possible vertical prosthesis. motion in an arcing pattern.39

12 Attachment screw

46,47 Asepsis The state of being free of living path- with a frictional fit. See also: Gold cylin- A ogenic microorganisms; the process of re- der attachment; Magnetic attachment; Nonro- moving pathogenic microorganisms; or pro- tating gold cylinder. tecting against infection by such organisms.41 Connective tissue a. Atherosclerosis Form of arteriosclerosis char- See: Connective tissue attachment. acterized by the deposition of atheromatous plaques containing cholesterol and lipids on Attachment element Part of the prosthetic the innermost layer of the walls of large- and component made as a separate unit fitting medium-sized arteries.42 onto the transmucosal element. “If there is no separate attachment element,the restora- Atresia Absence or closure of a natural body tion is part of and fabricated with the reten- passage. May also refer to loss of a body part tive element.“ It is the element onto which through degeneration.43 See also: Congen- the restoration is fabricated as cast-to, ce- ital atresia. mented, or screwed into position.48

Atrophic Reduced both in volume and substance.Bone loss in volume can be a reduction

both in width and height,and loss of substance Attachment can mean reduction in thickness of cortical element bone and width and number of trabeculae.

Atrophic alveolar bone Alveolar bone characterized by resorption after tooth removal. When functional stimulus disappears, the alveolar bone will atrophy.

Atrophy Wasting away or decrease in the size

of an organ or tissue, as from death and sub- Attachment element. sequent reabsorption of cells,diminished cel- (Redrawn from Yanase and Preston48 with permission.) lular proliferation, pressure, ischemia, malnu- trition, decreased function, or hormonal Attachment level Relative distance from a changes.44 See also: Alveolar atrophy; Resid- fixed reference point on a tooth or dental im- ual ridge resorption. plant to the tip of the periodontal probe during soft tissue diagnostic probing. Health of Attached gingiva Portion of gingiva that is the attachment apparatus can affect the meas- firm,dense,stippled,and tightly bound to un- urement. See also: Clinical attachment level. derlying periosteum and tooth.45 Attachment screw Element directly relating to Attachment Element incorporated into the the specific prosthetic component to which it design of a prosthesis to aid in the retention attaches. Typically, the prosthetic component and/or stabilization of the prosthesis. The re- is seated, and the attachment screw is thread- tention design can be classified as mechani- ed through the prosthetic component into an- cal, frictional fit, and/or magnetic. Comprised other component in the implant system, such of two parts,the matrix is the receptacle com- as the implant. It can be manufactured of var- ponent, and the corresponding patrix closely ious materials, such as gold alloy or titani- fits within the matrix either mechanically or um.49,50 (See figure next page.)

13 Attachment screw

A Autocrine Transfer of chemical compounds as Attachment screw Dental element hormones and growth factors within the cell.

Attachment element Autogenous bone graft Bone graft taken Retention from an intraoral or extraoral site and placed screw in the same individual. Origin of the graft will determine whether it is cortical, corticocan-

Transmucosal cellous, or cancellous in nature. Particulate element grafts may be harvested with hand instruments or prepared by introducing chips into Dental implant a bone mill. Block grafts can be harvested when a cortical component exists (ie, symphysis, ramus buccal shelf, calvarium, or iliac Attachment screw. crest), when volume is not sufficient, and/or (Redrawn from Yanase and Preston49 with permission.) if the need to retard resorption is required. Attachment system Design of a particular Autogenous bone grafts are often mixed with type of retentive mechanism employing com- allografts, alloplasts, or xenografts. Called al- patible matrix and patrix corresponding com- so autograft. See also: Alveolar ridge aug- ponents. Matrix refers to the receptacle com- mentation; Bone graft. ponent of the attachment system, and patrix refers to the portion that has a frictional fit Autogenous graft Tissue transferred from one and engages the matrix. Corresponding com- location to another within the same individ- ponents are passive once engaged and offer ual. See also: Autogenous bone graft; Bone resistance to displacement either through a graft; Soft tissue augmentation. direct mechanical mechanism or a frictional fit. See also: Adjustable attachment system; Autograft See: Autogenous bone graft. Ball attachment system; Bar attachment system; Magnet attachment system; Telescopic Autologous bone See: Autogenous bone graft. coping attachment system. Autopolymerizing resin Resin capable of Augmentation Grafting procedure designed polymerization via a chemical activator and to increase the volume of existing tissues, catalyzing agent. Called also cold- or self-cur- usually referring to bone for the purpose of ing resin. adequate bony support around implants and/or improving tissue contours for esthet- Avascular Lacking in blood supply or vasculature. ic purposes. Axial loading Application of load, usually by Auricular prosthesis Fixed/removable artifi- the forces of occlusion, in the direction of the cial replacement for all or part of a human long axis of an implant body or tooth. Com- ear.10,32 pare: Nonaxial Loading.

14 Bar

B B

Backscattered electron (BSE) imaging High- Balanced occlusion Existing or developed si- resolution imaging of a surface using elec- multaneous harmonious occlusal contact of tronics, similar to how a light microscope us- the teeth throughout the dental arch during es visible light. The advantages of BSE over mandibular centric and eccentric move- light microscopy include greater magnifica- ments; especially important for removable tion and much greater depth of field. This complete dentures to achieve stability during method is most commonly performed via ap- function.2,3 See also: Articulation. plication of accelerating voltages of 10 kV or more to the specimen while detecting high- Ball attachment system Specific design of a energy electrons that backscatter quasi-elas- mechanical attachment in which the patrix tically off the sample. For imaging of surface fits into the matrix in a ball-and-socket type of detail, the application of a lower-accelerating relation. Each element is incorporated into ei- voltage results in less beam penetration, ther the natural tooth as part of a restoration spread, and overall specimen damage. or as an abutment on the implant with the re- ciprocal element incorporated into the pros- Bacterial collagenase Any of various collage- thesis.The patrix,or ball,can be made of plas- nases purified from a variety of microbes; tic or metal alloy of various diameters and they preferentially cleave collagen on the N- with varied amounts of resistance.4 terminal side of glycine residues and occur in several classes of differing specificity.Bac- terial collagenases are used in tissue disrup- Matrix tion for cell harvesting.

Bacterial leakage Colonization and release of Patrix element bacteria at the interface of an oral implant abutment and implant.1

Bacterium (pl: bacteria) Member of a group of ubiquitous, single-celled microorganisms that have a prokaryotic (primitive) cell type. Many of these are etiologic in diseases that af- Ball attachment system. fect all life forms, including humans and other animals. See also: Actinobacillus actino- Bar Round, half-round, or elliptically shaped mycetemcomitans; Fusobacterium nucleatum. metallic segment with greater length than width. A bar is commonly used to connect BAHA Abbreviation for Bone-anchored hearing components of a prosthesis such as abut- aid. ments,crowns,or parts of a removable partial

15 Bar

denture. It also can be used to provide sup- Two-implant overdenture with b. a. s. Me- port, stability, and/or retention for a prosthe- chanical attachment incorporated into B sis.2,3 See also: Dolder bar; Hader bar. and fabricated as part of a prosthesis mesostructure supported by two implants. Bar attachment system Specific design of an attachment in which the patrix spans a specified width that the matrix matches. Each element is part of a prosthetic structure that spans two or more natural teeth and/or implants and is fixed intraorally with the matrix, which is incorporated within the prosthesis. Once the components are engaged by riders,clips,or mi- croplungers,there is resistance to displacement through either a mechanical mechanism or frictional fit. 5

Two-implant overdenture with bar attachment system.

Bar clip retention See: Clip bar overdenture; Retainer; Retention.

Matrix Bar overdenture (implant) See: Clip bar overdenture. Patrix

Bar splint Connecting bar for adding rigidity and/or stability between teeth or implants. It is also used to fixate displaced or movable Bar attachment system (in cross section). body parts as a result of trauma or surgery.2 See also: Splinting. Four implants with b. a. s. Mechanical attachment incorporated into and fabricated as part of a prosthesis mesostructure supported by four implants.

Bar splint.

Barium sulfate Alkaline earth metal (BaSO4). Barium is derived from the Greek word barys, meaning heavy and is generally a toxic substance in water-soluble compounds. Barium sulfate, however,is insoluble in water,and be- Four implants with bar attachment system. cause it is even insoluble in hydrochloric acid, it can be used as a medical contrast medium to examine the gastrointestinal tract.

16 Bennett movement

Barrier membrane Used in guided bone regen- Basic fibroblast growth factor (bFGF) eration (GBR) to locally augment deficient See: Fibroblast growth factor (FGF). sites in implant patients. By creating a seclud- B ed space, the barrier prevents epithelial cells Basic multicellular unit (BMU) Fully developed and fibroblasts from proliferating into the aug- cortical bone remodeling unit comprising an mentation site, whereas the slower-growing elongated cylindrical structure about 2 mm angiogenic and osteogenic cells have exclusive long and 0.2 mm wide, which travels through access to the membrane-protected space. The bone in a controlled direction. The BMU pre- first membranes were made of bio-inert ex- serves its size,shape,and internal organization panded polytetrafluoroethylene (e-PTFE), for many months. Maintenance of this unique which is nonresorbable and therefore required entity requires continued recruitment of new removal with a second surgical procedure. osteoclasts and osteoblasts in appropriate Bioresorbable membranes, either of synthetic numbers and the growth of new blood vessels, polymers or of animal-derived collagen,are of- nerves,and connective tissue.The end result of ten preferred in daily practice. Although their each new BMU is one new Haversian system or barrier function is limited in time, they do not osteon. require a second surgical procedure for membrane removal. Barrier membranes exclude

undesirable cell types from entering the se- OC cluded area of the bony or periodontal defect V during healing. Membrane configurations are

designed for specific applications; vary in OB shape, size, and thickness. See also: Guided bone regeneration (GBR); Guided tissue regeneration (GTR); Collagen membrane; Expanded polytetrafluoroethylene (e-PTFE) membrane. Basic multicellular unit (BMU). A BMU contains osteoclasts OC, as well as vascular structures V and osteoblasts OB. (Redrawn from Lang et al8 with permission.)

B cell White blood cell derived from bone marrow. As part of the immune system, B cells (or bursa-equivalent cells) may differentiate and become antibody-producing plasma cells. Called also B lymphocyte.

Barrier membranes specially designed for treatment of recession defects. (left Nonresorbable titanium-reinforced ex- Bending moment Rotary effect of a force po- panded polytetrafluorethylene (e–PTFE) membrane; right tentially causing deformation through torque. Bioresorbable polylactic acid and citric acid ester-based membrane.) (Reprinted from Lindhe et al6 with permission.) Bennett movement Translatory or bodily side shift of the mandible that occurs with lateral Basal bone Supporting bone in the mandible mandibular movement.During lateral mandi- that underlies and is continuous with the bular movement, as the advancing condyle alveolar process and houses the major nerves path intersects with the sagittal plane, an an- and vessels. It also functions as a site of mus- gle known as the Bennett angle is formed.3 cle attachment and is resistant to resorption.7 (See figure next page)

17 Bennett movement

Bidirectional crest distraction Distraction ap- Bennett angle proach designed to overcome the inherent B difficulty in controlling the distraction vector in conventional, unidirectional devices. An additional inclination rod allows for buccal- oral (lingual) distraction in addition to vertical distraction.10

Bilateral stabilization Solid line represents mandible at rest; See: Cross-arch stabilization. dotted line indicates active Bennett shift Bennett movement. Bioabsorbable material Solid polymeric ma- (Redrawn from Sharry9 with permission.) terial that can dissolve in body fluids without Beveled incision Technique by which inci- any change of the polymer or decrease in mo- sions are made at an acute angle (less than 90 lecular mass. degrees) to the gingival or mucosal surface, rather than perpendicularly. Bioactive glass Ceramic material that stimulates or otherwise promotes biologic activity. bFGF Abbreviation for Basic fibroblast growth It consists of silicophosphate chains that factor. See: Fibroblast growth factor (FGF). bond ionically to compounds such as CaO, CaF2,Na2O, ZnO, TiO2 and NiO, among oth- BIC Abbreviation for Bone-implant contact. ers. It may undergo ionic translocations in vivo, or exchange ions or molecular groups in Bicortical implant anchorage an osseous recipient site, and thereby os- See: Bicortical stabilization. seointegrate. Bioactive glass may be resorbable and is useful as a delivery system in Bicortical stabilization Practice of engaging bone engineering. See also: Ceramic. both the superior and inferior cortices of bone at the time of implant placement. For Bioactivity Effect of implant material that al- an edentulous anterior mandible, the tip of lows interaction and bond formation with liv- the implant engages the inferior cortex while ing tissues. Implant bioactivity may depend the neck of the implant engages the superior upon material composition, topography, and cortex to maximize initial stability of the im- chemical or physical surface variations. plant. Bioadhesion Result of a process whereby a chemical attachment between biologic and other materials is obtained.

Bio-Col technique Technique developed to preserve the ridge in the esthetic zone. A tooth is extracted via a low-trauma technique to maintain intact bony walls and surrounding gingival anatomy without flap reflection. The extraction socket is grafted up to the alveolar crest with an anorganic bovine bone Bicortical stabilization. (Courtesy of T.D. Taylor.) substitute, covered with a collagen plug, and sutured in place with a horizontal mattress

18 Biomaterial

suture. A removable or fixed provisional restoration with an ovate pontic extending 3 to 4 mm subgingivally is placed, compressing B the collagen plug and supporting the surrounding soft tissue. This technique has also been described in combination with immediate implant placement and with a buccal de- Biofilm (scanning electron micrograph; high magnifica- fect, whereby the defect is first lined with a tion). (Courtesy of C. M. Cobb.) collagen membrane.11 Bioglass See: Bioactive glass. Biocompatibility Condition whereby the body does not respond to a foreign substance (eg, Bioinert Describes a biomaterial that does metal) but recognizes it immunologically as not elicit a biologic response or is unaffected self. Biocompatible materials do not lead to by the adjacent biologic environment. acute or chronic inflammatory responses nor do they prevent proper differentiation of im- Biointegration See: Osseointegration. plant-surrounding tissues. Biologic width Structure of the attachment Biocompatible Capable of existing together; apparatus containing connective tissue at- acceptable to the body.This term is used to de- tachment,junctional epithelium,and gingival scribe blood, organs, or tissue that can be sulcus. transplanted or transfused into a patient’s body without being rejected.It describes a bio- dynamic process in which a material neither elicits an immune response nor is rejected by the host.12,13 Gingival sulcus 1mm Biodegradable material Solid polymeric ma- Junctional epithelium 1mm Connective tissue terial that breaks down because of macro- attachment 1mm molecular degradation with dispersion in vi- Biologic width vo; no proof for elimination from the body.

Bioengineering Use of engineering in biomedical technology such as the movement

analysis of body parts or prostheses. See Biologic width. also: Tissue engineering. (Reprinted from Nevins14 with permission.)

Bioerodible material Solid polymeric materi- Normal b. w. Measures 1 mm for each struc- al that shows surface degradation and re- ture,including the connective tissue attach- sorbs in vivo; reflects total elimination of the ment, junctional epithelium, and gingival foreign material. sulcus.

Biofilm Thin layer of microorganisms adher- Biomaterial Nonviable material used as a ing to the surface of a structure,organic or in- medical device, intended to interact with bi- organic,together with the polymers that they ologic systems. See also: Bioactive glass; secrete. See also: Plaque. Titanium (Ti).

19 Biomechanical load model

Biomechanical load model Simulation or ing proteins, thereby leading to osteoclastic model of load pattern in and adjacent to a apoptosis. Therapeutic treatment of diseases B structure. See also: Biomechanics. such as osteoporosis and Paget disease rely on oral bisphosphonates to inhibit osteoclastic Biomechanical test Examination of biologic function. See also: Osteonecrosis. tissues, systems, and artificial materials within biologic systems through mechanical Biting force Force generated by contraction of means. elevator muscles of mandible acting against the maxilla. Biomechanics Application of mechanical principles and design to biologic structures; the Black space See: Black triangle. interface between biology and mechanics. Black triangle Missing papilla between teeth Biomimetics Science of reconstructing or mi- when the interproximal bone has been re- micking natural processes with the expecta- duced in height. The coronal-apical distance tion that regeneration will follow. See also: between the bone crest level and the con- Tissue engineering. tact point of adjacent teeth will determine if a papilla can be consistently maintained. Biomineralization Formation or accumulation A similar relationship has been shown for of minerals into biologic tissues such as bone single-tooth implants. It has been proposed and teeth. The process of biologic mineraliza- that the distance between two adjacent im- tion is not completely understood. Interstitial plants is also important for the maintenance fluids are supersaturated with mineral hydrox- of interproximal bone height, which may yapatite,and calcium binding proteins such as then influence the height of interimplant osteocalcin are deposited and may play a role papillae.17-20 in the formation of crystal nuclei.15,16 Alveolar mucosa Bio-Oss Gingiva Black triangle See: Bovine-derived anorganic bone matrix.

Biopsy See: Bone biopsy.

Bioresorbable The capacity to become lysed or assimilated in vivo.

Bioresorbable material Solid polymeric material that shows bulk degradation and further resorbs in vivo, resulting in total elimination Black triangle. of the initial foreign material. Compare: Re- sorbable. Blade Flat instrument with one or more sharp edges used for cutting.21 Bio-stimulating laser See: Low-level laser therapy. Blade implant Design-specific type of implant that is categorized as an endosteal implant. Bisphosphonate Pyrophosphate analog that Blade implants can vary in width and length blocks osteoclastic activity by interfering with and are intended to be placed within bone as the function of guanosine triphosphate bind- a one-piece implant. Both the implant that is

20 Bone-anchored hearing aid (BAHA)

the endosteal portion and the transmucosal Blood clot Semisolidified mass in the blood- component that serves as an abutment intra- stream formed of an aggregation of blood orally are included.22-24 factors, primarily platelets and fibrin, with B entrapment of cellular elements. Called also coagulum.

Blood platelet See: Platelet.

B lymphocyte See: B cell.

BMD Abbreviation for Bone mineral density.

BMP Abbreviation for Bone morphogenetic protein.

Blade implant. BMPR Abbreviation for Bone morphogenetic protein receptors. Blanching Process by which soft tissues become pale or cyanotic with pressure. The red- BMU Abbreviation for Basic multicellular unit. ness of erythema decreases and then returns when pressure is applied and released. Bone Highest achievement in the evolution of supporting tissues. Mineralized collagen with Bleeding Condition involving the loss of blood enclosed cells, where formation of intercellu- internally (when blood leaks from blood ves- lar connections via cytoplasmic processes al- sels inside the body); externally through a low for transport of metabolites from surfaces natural opening (such as the oral cavity); or (lining cells) to deeper osteocytes. Excellent externally through a break in the skin. mechanical behavior and a unique potential for regeneration. See also: Alveolar bone; Bleeding on probing Process of bleeding from Atrophic alveolar bone; Basal bone; Bundle the gingival sulcus or periodontal pocket fol- bone; Cancellous bone; Cortical bone; Cortic- lowing standard measurement by periodon- ocancellous bone; Lamellar bone; Parallel- tal probe. fibered bone; Trabecular bone; Woven bone.

Block bone graft Includes blocks harvested Bone-anchored hearing aid (BAHA) Electron- either from the mandibular symphysis or ra- ic device affixed to the temporal bone in the mus buccal shelf that are used for localized peri-auricular area with skin-penetrating im- ridge augmentation procedures.25-27 See plant abutments for the amplification of also: Alveolar ridge augmentation; Bone sound in hearing-impaired patients.28,29 graft. (See figure next page.)

Blood cell Element found in peripheral blood. In humans the normal mature form is a nonnucleated, yellowish, biconcave disk, adapted by virtue of its configuration and its hemoglobin content to the transport of oxygen. See also: Erythrocyte.

21 Bone-anchored hearing aid (BAHA)

Bone expansion See: Alveolar ridge augmentation, Split-ridge technique for. B Bone fibers See: Sharpey connective tissue fibers.

Bone fill Clinical restoration of bone tissue in a treated osseous defect. It addresses neither the presence nor absence of histologic evidence of new connective tissue attachment nor the formation of a new periodontal ligament in the

Bone-anchored hearing aid (BAHA). case of tooth-supporting bone. Measurement can be accomplished radiographically, clinically Bone augmentation (by re-entry), or histologically. See: Alveolar ridge augmentation. Bone fracture Break in bone, usually the re- Bone biopsy Bone taken from a suspected sult of trauma. It can also be caused by an ac- area of pathology for diagnostic purposes. quired disease of bone or by abnormal formation associated with bone disease. Fractures Bone cell Bone cells include osteoblasts,which are further classified by their character and are responsible for bone formation,and osteo- location: greenstick, spiral, comminuted, clasts, which are responsible for bone resorp- transverse, compound, and compression. tion. The osteoblasts originate from mesenchymal stem cells, whereas the osteoclasts Bone graft Bone taken from a donor site of the (giant cells) belong to the hematopoietic sys- patient (autogenous) or from an outside source tem with granulocyte–macrophage progeni- (allograft,alloplastic graft,or xenograft).A bone tor cells as their precursors. The osteoblasts graft is used to augment a bone deficiency in become osteocytes and lining cells after a pe- the alveolar ridge. It can be used with simulta- riod of formative function. The osteoclasts neous or subsequent implant placement. See may disintegrate into mononuclear cells or also: Allogeneic bone graft; Alloplastic graft; undergo apoptosis after function. See also: Alveolar ridge augmentation; Autogenous bone Lining cells; Osteoblast; Osteoclast; Osteocyte. graft; Onlay graft; Xenograft.

Bone conduction See: Osteoconduction. Donor site for b. g. Source of an autogenous bone graft may be intraoral or extraoral in Bone curettage Removal of soft tissue either origin. Intraoral sources include adjacent from a bony surface by scraping with a curette cortical bone,anterior nasal spine,retromo- in preparation for implant placement and/or lar area, maxillary tuberosity, ramus, buccal alveolar ridge augmentation, or from a bony shelf,and the mandibular symphysis. Extra- cavity following the removal of pathology. oral sources of bone grafts include cranium, iliac crest, and tibia. Depending on the Bone derivative Left common denominator source, the graft is either more cortical or for bone substitutes developed via chemical more cancellous in nature. extraction processes.

22 Bone induction

Bone harvest Acquisition of bone from a pa- phies and materials. See also: Implant sur- tient for an autogenous graft, from deceased vival; Loading, Effects on bone-implant con- individuals for an allogeneic graft, or from tact; Stress distribution. B animals for a xenograft. See also: Cranial bone harvest; Iliac crest graft; Tibial bone har- Bone-implant interface Line of demarcation vest. between the nonliving surface of an endosseous implant and the living bone it con- Bone healing Cellular events, recapitulating tacts. Numerous factors may influence the embryogenesis. After initiation of woven degree to which bone heals in contact with bone formation,deposition of parallel-fibered the implant surface, including surface tex- bone ensues.These two primary types of bone ture,surface contamination,time since place- repair the defect within weeks; thereafter,the ment, and extent of functional loading, formation of perivascularly arranged lamellar among others. See also: Implant interface. bone takes place with simultaneous resorption of the two primary bone types. This sub- Immediate loading considerations for b.-i. i. stitution, which gives strength to the bone, See: Primary stability; Secondary stability. may take months to years, depending upon the size of defect. Finally, a structural re- Implant design and b.-i. i. Architecture of arrangement of trabeculae in response to the implant stack or its overall design, in- function (Wolff law) takes place. Healing of cluding thread design and pitch. It affects fractures of long bones may often be charac- the ability of the implant to be placed in- terized by a callus formation in the initial to its osteotomy with primary stability and stages, where woven bone is mixed with carti- is deemed necessary for osseointegration lage, resulting in a clinically as well as radio- to occur. logically visible thickening of the fracture site. This callus will disappear along with the os- Micromotion and b.-i. i. Micromotion dur- seous maturation. ing initial osseointegration may precipi- tate failure of osseointegration to oc- Bone-implant contact (BIC) Direct contact of cur. See also: Micromotion. bone with the surface of an endosseous implant as seen microscopically. The ratio of Overload and b.-i. i. Generally assumed bone contact to implant surface (percent) is that occlusal overloading can result in fail- used to evaluate implant surface topogra- ure at the bone-implant interface, although the limited scientific evidence does 31-35 Buccal Lingual not support this assumption. See also: Occlusal overload. First bone-to- First bone-to- implant contact implant contact

Horizontal Bone induction Interaction among pluripo- Horizontal bone width tential cells and bone morphogenetic pro- bone width teins (BMPs) that converts these cells to os-

BIC BIC teoblasts.

Regenerated Native bone bone

Bone-implant contact (BIC). (Reprinted from Von Arx et al30 with permission.)

23 Bone loss

Bone loss Physiologic loss of bone mass. The Bone modeling Processes producing function- peak of mineral density is reached between ally purposeful skeletal organs aimed at char- B 30 and 40 years of age; women lose about acteristic adult shape and form; includes lon- 35% of cortical bone and 50% of trabecular gitudinal,transversal,and appositional growth. bone, whereas men lose about two-thirds of these amounts. See also: Osteoporosis. Bone morphogenetic protein (BMP) Special group of the transforming growth factor beta Bone marrow Apart from cells of the hema- (TGF-β) superfamily of growth factors with topoietic system, the marrow contains mes- the unique property of stimulating mesenchymal stem cells, osteoprogenitor cells, enchymal stem cells to differentiate toward a and osteoblasts. Additionally, elements of fat chondro- and osteoblastic lineage. BMP–2, tissue and connective tissue are seen. BMP–3, and BMP–7 have proven to be pow- erful stimulators of bone healing. Several Bone mass Amount of bone, often estimated BMPs such as BMP–2, BMP–4, and BMP–7 by absorptiometry,viewed as a volume minus are known to induce the expression of core- the marrow cavity. Optimal balance in the binding factor alpha 1 (CBFα1). See also: composition of the bone is reached between Isoforms. 30 and 40 years of age. In this age period, the ratio between cortical and trabecular bone to Osteoinductive properties of b. m. p. The bone marrow assures that maximum strength BMP family of proteins, most notably is reached by a minimum of bone mass. BMP–2, BMP–4, and BMP–7, are known to promote de novo bone formation Bone matrix Contains collagen type I (90%) through the process of osteoinduction. and noncollagenous protein (about 10%): os- Bone may be formed with a cartilage inter- teonectin,osteopontin,bone sialoprotein,and mediate stage, as in the situation of endo- growth factors (cytokines) such as insulin-like chondral bone formation or directly, as in growth factors (IGF1 and IGF2), transforming intramembranous bone formation. growth factor beta 1 (TGF-β1),platelet-derived growth factor (PDGF), acidic and basic fibrob- Bone morphogenetic protein 2 (BMP–2) Poly- last growth factors (aFGF and bFGF),and bone peptide that belongs to the transforming morphogenetic proteins (BMPs). growth factor beta (TGF-β) superfamily of proteins. Like other BMPs, it plays an important Bone mill Device used intraoperatively to par- role in the development of bone and cartilage. ticulate autogenous bone chips into smaller It is involved in the Hedgehog pathway, TGF- particles for localized alveolar ridge augmen- β–signaling pathway, and cytokine-cytokine tation. receptor interaction, as well as cardiac cell differentiation and epithelial to mesenchymal Bone mineral Mineral in bone composed of transition. calcium carbonate (10%),calcium and magnesium fluoride (5%), and calcium phosphates Bone morphogenetic protein 4 (BMP–4) Poly- (85%), present primarily as hydroxyapatite. peptide belonging to the transforming growth factor beta (TGF-β) superfamily of proteins. Bone mineral density (BMD) Density of bone Like other BMPs,it is involved in bone and car- expressed in cm2, measured by dual-energy x- tilage development, specifically tooth and ray absorptiometry (DEXA). limb development and fracture repair,and has been shown to be involved in muscle development and bone mineralization.

24 Bone remodeling

Bone morphogenetic protein 5 (BMP–5) Poly- Bone regeneration Renewal or repair of lost peptide member of the transforming growth bone tissue. Also: Cellular events during factor beta (TGF-β) superfamily of proteins. wound healing; recapitulation of cellular B BMP–5 may play a role in certain cancers. events of embryogenesis. The quantitative Like other BMPs, BMP–5 is inhibited by mol- extent is defect dependent and influenced ecules chordin and noggin. It is expressed in by cellular race. See also: Bone remodeling; the trabecular meshwork, lung, liver,and optic Bone morphogenetic protein (BMP); Bone nerve, and may be involved in the develop- scaffold; Gene therapy; Growth factor; Guided ment and normal function of these organs. bone regeneration (GBR); Periodontal bone regeneration. Bone morphogenetic protein 7 (BMP–7) Mem- ber of the transforming growth factor beta Bone regeneration strategies Use of polypep- (TGF-β) superfamily of proteins. Similar to oth- tide growth factors to serve as mediators to er members of the BMP family of proteins, it promote osteoblast migration, mitogenesis, plays a key role in the transformation of mes- or matrix synthesis leading to bone regener- enchymal cells into bone and cartilage. It is in- ation. See also: Growth factor. hibited by noggin. BMP–7 may be involved in bone homeostasis and is expressed in the Bone remodeling Basic physiologic remodel- brain, kidneys, and bladder. BMP–7 has been ing of bone takes place in a biologically cou- shown to induce SMAD–1 as well as multiple pled system of activation, resorption, forma- biomarkers of osteoblast differentiation.Called tion (ARF). Histomorphologically, the process also Osteogenic protein 1. starts in cortical bone as a cutting cone, consisting of a group of osteoclasts, digs a tunnel Bone morphogenetic protein receptors (BM- with a breakdown of 20 μm per day with a si- PR) Transmembrane receptors that are pres- multaneous increase in diameter of the tun- ent in a wide variety of cells and mediate BMP nel in magnitude of 5 μm per day until a signals. They comprise serine or threonine ki- width of approximately 100 μm in radius is nase receptors composed of subtypes I and II. reached. When the resorption ceases, the osteoclasts are replaced by osteoblasts after a Bone necrosis See: Osteonecrosis. short resting period. The osteoblasts form new lamellar bone at a speed of 1 μm per day, Bone-plate device with external activation and thereby the tunnel is closed again. The screws See: Alveolar distraction osteogenesis. length of the entire cone is typically around 1,500 to 1,600 μm. The entire course is also Bone preparation Act of readying the bony named creeping substitution.Similar remodel- site for implant, transplant, or graft place- ing takes place in trabecular bone as surface ment. To achieve implant osseointegration, a resorption,creating a 60- to 70-μm–deep cra- low-trauma preparation of the implant bed is teriform cavity that is filled in with lamellar prerequisite. Bone preparation with several osteoid over a 4-month period. See also: drills of increasing diameter is performed us- Basic multicellular unit (BMU); Bone remodeling copious saline solution to provide cooling. ing unit (BRU); Bone structural unit (BSU). (See figure next page.) Bone quality See: Alveolar bone, Quality of.

Bone quantity See: Alveolar bone,Quantity of.

25 Bone remodeling

Resorption ReversalBone formation Rest B A B C

Coupling

Osteon formation Osteoclast

Osteoblast

Llamellar bone

AB C

Bone remodeling. (Redrawn from Buser et al36 with permission.)

Bone remodeling unit (BRU) Group of osteoblasts and osteoclasts involved in the process of bone remodeling. See also: Bone remodeling.

Bone scaffold Process of bone formation that occurs through the utilization of a scaffolding matrix that may deliver cells, genes, or pro- Rubber stopper

teins. The scaffold may be osteoinductive or Gingiva

osteoconductive and serves to maintain the Bone architecture of the anatomic defect. Bone sounding. Bone sounding Simple preoperative procedure performed under local anesthesia using Bone spreader See: Alveolar ridge augmenta- a fine needle with a rubber stopper.The nee- tion, Split-ridge technique for; Osteotome. dle is used to penetrate soft tissues to assess the form and volume of the existing alveolar ridge.

26 Bovine hydroxyapatite material

Bone stimulation Initiation of bone formation around endosseous implants by pulsed electromagnetic fields. Must be performed B within very early stages of healing, ie, during the first and second weeks; after 2 weeks, no effect can be measured.This principle has only been used in animal studies.37

Bone strength Resistance of bone to fracture. Bone strength depends upon bone structure. The more dense the trabecular pattern, the

stronger is the bone. This compressive Bone trephine. (Courtesy of D. Buser) strength of the vertebral bodies decreases with age. See also: Osteoporosis. Bony defect Alteration in the morphologic features of bone. Bone structural unit (BSU) Represents the end result of a remodeling cycle of mature bone. In cortical bone, it constitutes a Haver- sian system after a cortical remodeling unit has taken place.In cancellous bone,it is a wall or packet. See also: Bone remodeling unit (BRU); Basic multicellular unit (BMU).

Bone substitute Nonviable biomaterial for reconstruction of bone, producing only a scaf- Bony defect fold for formation of new bone. Supports the inherent potential for bone regeneration. It may be resorbable or remain in an unchanged Bony defect. (Reprinted from Rateitschack et al38 with permission.) version at the site of implantation. It also may assist in preservation of contour of an osseous reconstruction. See also: Osteoconduction. Bovine-derived anorganic bone matrix Par- ticular anorganic bovine bone substitute with Bone trap Device connected to the surgical a calcium-deficient carbonate hydroxyapatite suction to collect fine bone slurry within the having a crystal size of approximately 10 nm. surgical field during the drilling of bone or All proteins are removed from the bovine harvest of a bone block for alveolar ridge aug- xenograft via various chemical and physical mentation or maxillary sinus floor elevation. processes. Its porous structure, like normal Collected bone can be added to the particu- bone, is osteoconductive but resistant to re- late graft. sorption, although osteoclasts are identified in lacunae on the surfaces. The surface area Bone trephine Hollow, cylindrical cutting bur is very large, and the modulus of elasticity is of various diameters used to harvest cylindri- similar to that of normal bone. cal bone blocks. Bovine hydroxyapatite material See: Bovine- derived anorganic bone matrix.

27 Bridge

Bridge See: Fixed prosthesis; Partial denture.

B BRU Abbreviation for Bone remodeling unit.

Brunski and Hurley model Set of equations that allows the user to predict the forces and moments acting on each implant in a group of implants that support a loaded prosthesis.39 Bundle bone

Bruxism Involuntary grinding, clenching, or gnashing of teeth. This parafunctional activi-

ty may occur either diurnally or nocturnally Bundle bone. and commonly results in excessive occlusal (Redrawn from Lindhe et al42 with permission.) wear, periodontal trauma, pain, and neuro- muscular problems. The etiology is not well Buser elevator Finely shaped instrument de- understood but thought to be related to emo- signed to gently elevate papillae and initiate tional stress and tension, occlusal irregulari- flap elevation. ties, or central nervous system disorder.7,40

BSE Abbreviation for Backscattered electron. See: Backscattered electron (BSE) imaging.

BSU Abbreviation for Bone structural unit. See also: Osteon.

Buccal Related to the surface of the dental arch or posterior teeth adjacent to the cheek.3

Buccal mucosal incision Incision made in Buser elevator. (Courtesy of D. Buser) buccal nonkeratinized mucosa; not routinely used in implant surgery. Button implant See: Mucosal insert.

Bundle bone Bone of ectomesenchymal origin that lines the tooth alveolus and also forms the cribriform plate. It is characterized by perpendicular striations formed by the insertion of Sharpey fibers and blood vessels derived from the periodontal ligament. This tooth-related bone structure plays an important role during initial ridge alterations following extraction. Radiographically, it is called the lamina dura.41

28 Cancer

C C

CAD/CAM Acronym for computer-aided design/ Calculus Hard concretion that forms on teeth computer-assisted manufacture. See: Com- or dental prostheses through calcification of puter-aided design/Computer-assisted manufac- bacterial plaque.5 ture (CAD/CAM). Caldwell-Luc approach Surgical approach us- CAD/CAM abutment Prosthetic implant com- ing a window into the buccal bone wall of the ponent fabricated through the use of com- maxillary sinus. The goal is sinus floor eleva- puter-aided design and/or computer-assisted tion to allow simultaneous or subsequent im- manufacture (CAD/CAM).1 plant placement in sites with insufficient bone height. Calcified algae Plants living in seawater, some in deep water, that are coral shaped Callus Hard bony tissue that develops around with mineralized cell walls. Corallina offici- the ends of a fractured bone during healing.6 nalis (coral algae), used for the production of porous marine-derived coralline hydroxyap- Callus distraction Basis for distraction osteo- atite, is approximately 5 cm in height with genesis in orthopedic surgery. See also: Dis- built-in joint and belongs to the red algae traction osteogenesis (DO). group. See also: Porous marine-derived coralline hydroxyapatite. Calvarial bone See: Cranial bone.

Calcified cartilage Calvarial bone harvest See: Endochondral ossification. See: Cranial bone harvest.

Calcium carbonate Calvarial graft See: Cranial bone harvest. See: Porous coralline hydroxyapatite. Canaliculus Minute canal extendig to the lacu- Calcium sulfate Used in bone regeneration as nae of bone See: Osteocyte. an alloplastic graft, a graft binder, or a graft extender,and as a barrier.This biocompatible Cancellous bone Composite of bone matrix material (CaSO4) resorbs following implanta- and bone marrow. Osteoblasts, osteoprogen- tion. It has been shown that tissue will often itor cells, and cytokines are transferred. Also migrate over calcium sulfate if primary clo- used to describe a graft derived from cancel- sure cannot be obtained. Calcium sulfate has lous bone, which is a spongy type of bone been proposed as a delivery vehicle for containing a trabecular structure with red growth factors and antibiotics.2-4 See also: bone marrow and most of the bone vascula- Medical-grade calcium sulfate; Dental stone. ture. See also: Trabecular bone.

Cancer See: Neoplasm.

29 Cancer reconstruction

Cancer reconstruction Tumor resection of the Cartilage-derived morphogenetic protein 1 jaws often leads to discontinuity defects that (CDMP1) Protein belonging to the trans- need extensive bone reconstruction and forming growth factor beta (TGF-β) superfam- restoration with implant-supported prostheses. ily involved in a variety of cellular functions. C This molecule has been identified as one of Canine guidance the regulators of limb skeletogenesis and ap- See: Canine-protected articulation. pendicular bone development.10 See also: Transforming growth factor beta (TGF-β). Canine-protected articulation Arrangement of teeth in which the vertical and horizontal over- Case report Descriptive study of either a sin- lap of the canines provide a guidance resulting gle patient or patient series that documents in separation of the posterior teeth during ec- the patient’s diagnosis, treatment, and man- centric movements of the mandible.7 agement.11,12

Cantilever Extension on one end of a fixed Cast Three-dimensional image of an actual prosthesis retained by single or multiple teeth body part reproduced in a castable materi- or implants. Also used to describe a beam sup- al.2,13 See also: Diagnostic cast; Master (de- ported at one end only.7,8 finitive) cast; Preliminary cast.

Castable abutment Prosthetic implant component made as a generic plastic pattern that can be designed or modified to specific dimensions. The pattern can be modified either by shaping via a rotary carbide bur or applying wax prior to alloy casting.

Cantilever.

A plastic pattern that can be modified and have wax added prior to casting in a dental alloy

Castable abutment.

CAT Acronym for computed axial tomography. See: Computed tomography (CT) scan. Cantilever. (Reprinted from Watzek9 with permission.) Cawood and Howell classification Classifica- tion of patterns of jaw bone atrophy serving to Capillary Small terminal blood vessel connect- simplify description of the residual ridge.In the ing arterioles and venules. study published in 1988, it was found that the shape of the basilar process of the mandible and maxilla remains relatively stable, whereas

30 Centric relation

changes in shape of the alveolar process are Temporary c. Binding or luting agent in- significant in both the vertical and horizontal tended for short-term use, eg, zinc oxide axes and follow a predictable pattern.14 See (powder) eugenol (liquid) mixture. also: Alveolar ridge, Classification of. Cement line Inactive bone surfaces are cov- C CBA Abbreviation for Cost-benefit analysis. ered by a thin-density, stained 50-nm-thick line, consisting of a mineralized bone matrix CBFα1 Abbreviation for Core-binding factor in which the inorganic component is hydrox- alpha 1. yapatite and the organics are proteoglycans and glycoproteins, with osteopontin as the CDMP1 Abbreviation for Cartilage-derived major glycoprotein. The same line is appar- morphogenetic protein-1. ent between implant surfaces and adjoining bone. Osteopontin functions as an adhesive CEA Abbreviation for Cost-effectiveness analysis. and, in bone, binds collagen fibrils of new bone matrix to that of the old bone matrix. Cell Microscopic mass of protoplasm enveloped by a semi-permeable membrane. Cementation Process involving the use of a Smallest structural unit of living matter able binding substance to join surfaces to become to function independently. See also: Ery- a unit.2 throcyte; B cell; Blood cell; Bone cell; Effector cell; Epithelial cell; Hematopoietic stem cell; Centric See: Centric occlusion; Centric relation; Mesenchymal stem cell (MSC). Maxillomandibular relationship.

Cell-occlusive membrane Centric occlusion Positional relationship of See: Barrier membrane. occluding tooth surfaces when the mandible is in centric relation. The coincidence of cen- Cellular process All of the functions that cells tric occlusion and centric relation is desir- perform to survive,including molecular trans- able when creating an occlusion, but the port, protein synthesis, DNA replication, re- maximal intercuspal relationship may not al- production, respiration, cellular metabolism, ways exist.3,15 See also: Maxillomandibular and signaling. relationship.

Cement Substance used to bind surfaces or Centric relation Clinically,the most retruded un- objects together. Commonly stored as sepa- strained position of the mandibular condyles rate powder and liquid components that, relative to the maxilla,from which lateral move- when mixed together, become a luting agent ments can be made at a given degree of jaw upon hardening.To cement is to join surfaces separation. Centric relation is a reference bor- by means of an appropriate medium.2,3 der position constant throughout life for each adult patient, provided the soft tissue struc- Permanent c. Binding or luting agent in- tures in the temporomandibular joint are tended for long-term use, eg, zinc phos- healthy. It is a reference relation from which a phate cement, which is composed of pow- planned occlusal scheme can be coordinat- der (zinc and magnesium oxides) and liquid ed.16 See also: Maxillomandibular relationship. (phosphoric acid,water,buffer agents).Oth- er types include resin and glass–ionomer cements.

31 Ceramic

Ceramic Crack-, heat-, and corrosion-resistant Chisel Metal instrument with a tip that is material fabricated from metal oxides of vari- beveled one side. Used in surgery to cut, ous sources. Also describes a field of research cleave, or carve hard tissue. The shank can be concerned with ceramic materials. See also: straight or offset.2 C Bioactive glass; Glass ceramic. Chi-square test Determines whether two at- Ceramic abutment Prosthetic implant compo- tributes of the sample are independent or nent composed of a ceramic biomaterial that whether the presence of one is, in fact, asso- is considered an esthetic material as com- ciated with the presence of the other.12 pared to unesthetic metal.The ceramic material used in fabrication of a prosthetic implant Chlorhexidine Antibacterial compound component varies as does the fabrication (C22H30Cl2N10) that is a biguanide derivative method of various manufacturers, which can used as a local antiseptic and disinfectant include use of CAD/CAM technology.17,18 (eg, as in mouthwash) especially in the form of a hydrochloride, gluconate, or acetate. Ceramic crown One type of ceramic restoration. See also: Ceramic restoration; Crown. Chondrocyte Mature cartilage-forming cell embedded in cartilage. Highly specialized Ceramic restoration Artificial substitute for connective tissue designed to withstand high tooth structure and anatomy fabricated en- compressive forces.Cartilage is nourished via tirely of ceramic material that covers and re- diffusion. In endochondral ossification, the stores the remaining coronal portion of the chondrocytes undergo apoptosis associated tooth. with vascularization, bone formation, and resorption of cartilage. Cervix (pl: cervices) Constriction or narrow- ing of an object; sometimes referred to as the Chondroitin sulfate Plays a major role in neck.19 See also: Implant neck. maintaining the high osmotic tension essential to the elasticity of hyalin cartilage.Hyalin Chamfer Marginal tooth crown or implant cartilage is composed of collagen type II that abutment preparation creating a curve from forms a meshwork, enclosing giant macro- the axial wall to the cavosurface.3 molecular aggregates of proteoglycans. Chondroitin sulfate is a main part of this Chemotaxis Directed cell migration controlled ground substance. by a biochemical concentration gradient. Chronic abscess Abscess of comparatively Chemotherapy Use of chemical agents in the slow development with minimal evidence of treatment or control of malignant disease. inflammation. Symptoms include intermit- Patients undergoing chemotherapy are content discharge of purulent matter and long- sidered at high risk to develop postsurgical standing collection of purulent exudate. May complications following implant placement. follow an acute abscess. Compare: Residual abscess. Chewing See: Mastication. Chronic infection Ongoing and often slowly Chewing cycle See: Mandibular movement. progressing infection. Usually develops from an acute infection and can last for days to Chin graft See: Bone graft, Donor site for. months to a lifetime.

32 Closed curettage

Cicatrix See: Scar.

Circulation, blood General term for blood supply and flow through blood vessels, organs, and tissues. C

Clamp, abutment See: Abutment clamp. Class I (lip only)

Clamping force Compressive force generated by bringing two distinct components together under pressure. It is created by external compressive forces or the tightening of a

screw joint. Class II (soft palate) Class III (soft/hard palates)

Cleft lip and/or palate Most common craniofacial anomaly, occurring 1 in 600 to 700 live births, characterized by failure of fusion between embryologic processes during facial morphogenesis. Failure of fusion between Class IV (unilateral Class V (bilateral the medial and lateral nasal and the maxillary complete cleft) complete cleft) processes results in a cleft of the lip and/or Classification of cleft lip and/or palate. (Redrawn from Terkla and Laney21 with permission.) alveolar process,whereas failure of fusion between the lateral palatine processes results in a cleft of the palate. The cleft may be com- Clip bar overdenture Overdenture prosthesis plete or incomplete, and it can occur unilat- receiving partial retention from a bar clip. It erally or bilaterally. Cleft lip may occur with- is embedded in the impression surface of the out clefting of the alveolar process or palate, restoration. See also: Implant overdenture. and cleft palate can also occur as an isolated phenomenon.20 (See figure.)

Clinical attachment level Distance from the cementoenamel junction or implant collar to the tip of a periodontal probe during soft tissue diagnostic probing. Health of the attachment apparatus can affect the measurement.

Clinical implant performance scale Quantita- Bar clip retainer tive scale to compare different implant systems in different indications, including the complications that occur and treatment pro- Clip bar overdenture. (Redrawn from Brudvik23 with permission.) cedures necessary in the aftercare period.22

Clip See: Attachment; Bar attachment system; Closed curettage Curettage performed via the Clip bar overdenture. gingival sulcus without flap reflection.5

33 Closed tray impression

Closed tray impression Collagen membrane Resorbable barrier mem- See: Indirect (closed tray) impression. brane made of heterogenic collagen, developed for guided tissue regeneration (GTR) or Closure force Force generated by muscles of guided bone regeneration (GBR) techniques. C mastication. See also: Biting force. The resorption time of collagen membranes can be controlled using methods of collagen Closure screw Surgical component inserted cross-linking. See also: Barrier membrane. into the head of the implant or the occlusal surface of an implant. It is intended to obtu- Collagenase Matrix metalloproteinase en- rate the access opening of the implant so as zymes that degrade collagen matrices derived to prevent debris from flowing into or plug- from either the host or bacteria. See also: ging the access. See also: Cover screw. Bacterial collagenase; Mammalian collagenase.

Clot See: Blood clot. Collar See: Implant collar.

Coagulum See: Blood clot. Color matching Art and science of combining the attributes of color and color mixtures to Coating Layer of material added to the surface include the properties of hue, value, satura- of a structure; an additive surface. tion, opacity,translucency,and pigment loading.25 See also: Maxillofacial prosthetics. Cohort study Study in which subjects who presently have a certain condition and/or re- Comfort cap Element designed to fit over a ceive a particular treatment are followed over component such as the transmucosal abut- time and compared with another group who ment. Intended to cover the component to are not affected by the condition under inves- protect the intraoral tissues from a de- tigation.24 tectible edge and/or prevent damage to the exposed surfaces of the component. See Col Valley-like depression of the interdental also: Healing abutment. gingiva that connects facial and lingual papillae and conforms to the shape of the inter- Commercially pure titanium (CPTi) Elemen- proximal contact area.5 tal titanium available commercially with residual contaminants (either accidental or Cold-curing resin See: Autopolymerizing resin. intentional) that reduce the purity of the elemental titanium. More than a dozen grades Collagen Insoluble fibrous protein of verte- of commercially pure titanium are available. brates that is the principal constituent of the Dental implants are most commonly fabri- fibrils of connective tissue and the organic cated from grades 1 through 4. See also: substance of bones. Composed of tropocolla- Implant surface. gen molecules. Compact bone See: Cortical bone. Collagen fleece Collagen-based biomaterial that improves hemostasis in surgery.It is essen- Compatible See: Biocompatible. tially a collagen sponge coated with fibrinogen and thrombin to control bleeding in surgery. Compensating curve See: Curve of Spee.

34 Connection, abutment

Complete subperiosteal implant See: Subpe- sues to be recorded by a variety of scintillation riosteal implant. detectors. The collected information can then be digitally coordinated and displayed on a Complication Unexpected deviation from the computer monitor or film. A CT scan must be normal treatment outcome. It is generally performed to provide image data for a three- C classified as either technical or biological, eg, dimensional guidance system for implant surgical complication, hemorrhage, damage placement. See also: Three-dimensional to the inferior alveolar nerve, infection, de- guidance system for implant placement. layed wound healing, or lack of osseointegration. See also: Esthetic complication. Computer-aided design/Computer-assisted manufacture (CAD/CAM) Computer technolo- Component, implant gy used to design and manufacture various See: Implant component. components.

Composite graft Graft composed of multiple Computer-aided navigation Computer sys- graft types (eg, autogenous-synthetic graft or tem for intraoperative navigation, which pro- autogenous-xenograft), which may be mixed vides the surgeon with current positions of or layered within the defect. the instruments and operation site on a three-dimensional reconstructed image of Composite resin Restorative resin usually the patient that is displayed on a monitor in formed by the reaction of an ether of the operating room. The system aims to bisphenyl-A with acrylic monomers initiated transfer preoperative planning on radi- by a benzoyl peroxide-amine system. Addi- ographs or computed tomography scans on tives include amorphous silica, glass beads or the patient, in real-time, and independent of rods, quartz, and/or tricalcium phosphate.2,3 the position of the patient’s head.

Compressive stress Force directed toward the Computer-assisted manufacture surgical guid- material being loaded. ance Computed tomography imaging augmented by implant placement planning to Compromised bone Bone impaired in quality fabricate a surgical template for osteotomy and/or quantity as a result of cellular, vascu- localization during surgery.27 lar,or structural factors.26 See also: Alveolar bone, Quality of; Alveolar bone, Quantity of. Configuration Pattern or assembly method by which various elements and/or components Compromised osteogenesis Any interference are arranged. “The shape or outline of some- with osteogenesis. Lack of primary stability thing, determined by the way its parts or ele- during the placement of implants in the os- ments are arranged.“28 teotomy site may lead to fibrous integration of the implant, instead of osseointegration, Congenital atresia Congenital closure or ab- for example. sence of normal body opening or tubular structures. Computed axial tomography (CAT) scan See: Computed tomography (CT) scan. Connecting bar See: Bar splint.

Computed tomography (CT) scan Imaging Connection, abutment method involving the narrow colimnation of a See: Abutment connection. radiographic beam passing through human tis-

35 Connective tissue

Connective tissue Tissue of mesodermal ori- Control See: Examination. gin consisting of various cells (eg, fibroblasts and macrophages) and interlacing protein Conventional tomography Film tomography. fibers (eg,collagen) embedded in a chiefly car- Outdated in medicine, this imaging technique C bohydrate ground substance that supports, is of great interest in implant dentistry because ensheathes, and binds together other tissues. it can be applied in private practice. The x-ray Includes loose and dense forms (eg, adipose tube is rigidly fixed with a bar to the image re- tissue, tendons, ligaments, and aponeuroses) ceptor to move around a fixed axis.When a pa- and specialized forms (eg, cartilage and tient is properly positioned, objects located in bone). See also: Fibrous connective tissue. this axis are projected on the same region in the image receptor and are clearly imaged.Ob- Connective tissue attachment Union of con- jects located outside this axis are blurred. nective tissue with the root surface. Original Thus, cross-sectional views can be obtained, connective tissue attachment includes inser- for instance,of the maxilla and mandible to de- tion of collagen fibers from the connective termine the width of the bone. Compare: tissue into the radicular cementum. Computed tomography (CT) scan.

Connective tissue graft Soft tissue augmenta- Conversion prosthesis See: Transitional pros- tion procedure adopted from periodontal sur- thesis. gery using connective tissue harvested from a palatal donor site. See also: Subepithelial Coolant Physiologic saline solution used to ir- connective tissue graft. rigate bone while during drilling procedures.

Connector, intramobile Coping In fixed prosthodontics,the metal sub- See: Intramobile connector. strate on which porcelain is applied in fabrication of a metal-ceramic restoration. Also Consensus General agreement or concord. used to describe the initial thin layer of wax on a die or a thin covering or crown.30,31 Consolidation period Final phase of distraction osteogenesis.Once the alveolar segment Coping design Specific coping shape or pat- has been repositioned, the device is main- tern, or the method by which it is made or tained in a static mode to act as a fixation de- planned. The coping is designed specifically vice for a given amount of time.29 See also: for use within an implant system. Alveolar distraction osteogenesis. Coping screw Prosthetic component (ie, Construction See: Prosthesis; Restoration. screw) incorporated as part of the anchorage by means of engaging threads so as to main- Contact osteogenesis Immediate primary ap- tain the position of a coping (eg, impression position of woven bone on an implant surface coping). A one-piece element can also serve as part of osseointegration. Compare: Dis- as the coping, which is threaded directly into tance osteogenesis. the anchorage component. See also: Pros- thetic retaining screw. Contraindication Any condition of the patient (ie, medical, psychological, or social) that Coping, telescopic See: Telescopic coping. makes a surgical procedure inadvisable.

36 Corticotomy

Coral-derived hydroxyapatite Ca2CO3 skele- riosteal deposition and endosteal resorption. ton of naturally occurring corals converted In adulthood, a balance in shape and thick- via a hydrothermic process to a non- ness is reached; in the elderly, the endosteal biodegradable porous hydroxyapatite. See resorption may exceed the periosteal deposi- also: Porous coralline hydroxyapatite; Porous tion, resulting in an increase in size of the C marine-derived coralline hydroxyapatite. marrow cavity and a decrease in cortical thickness. Primary osteons undergo continuous re- Corallina officinalis Calcifying marine al- modeling with formation of secondary os- gae. See also: Calcified algae. teons. Growth factors are released as part of the resorptive process of autografts. Coralline See: Porous coralline hydroxyapatite. See also: Bone remodeling.

Core-binding factor alpha 1 (CBFα1) An essential transcription factor for osteoblast differentiation and subsequent bone formation. Called also runt-related transcription factor 2 (runx2). See also: Bone morphogenetic protein (BMP).

Corrective soft tissue surgery Plastic surgery procedure aimed at correcting either an in- herited or acquired soft tissue defect. The surgery may include augmentation with a Cortical bone (polarized light; magnification x125). (Reprinted from Buser et al32 with permission.) soft tissue graft (either connective tissue or free gingival graft) or correction of previous surgical scarring. Cortical bone graft See: Bone graft.

Correlation coefficient Measure of the linear Corticocancellous bone Graft derived from association between two variables. It varies donor sites with both cortical and cancellous between +1 (perfect positive association) and components, such as the symphysis or iliac –1 (perfect negative association). A value of crest. Autogenous origin of this type of bone 0 indicates that the two variables are not as- graft is ideal because of the mechanical stabil- sociated.12 ity,the inherent supply of bone morphogenetic proteins (BMPs) in cortical bone,and the os- Corrosion resistance Surface passivity rather teogenic potential of cancellous bone. than intrinsic unreactivity. Corticocancellous bone graft See: Bone graft. Corrugation Addition of parallel folds or grooves to a surface so as to increase the relative sur- Corticosteroid See: Glucocorticoid. face area or the stiffness of the material. Corticotomy Partial osteotomy involving only Cortical bone Consists of primary and second- the cortical plate; used in distraction osteoge- ary osteons with a periosteal and endosteal nesis to separate the transporting segment. envelope. During growth, thickening and modeling of long bones takes place via pe-

37 Cosmetic periodontal surgery

Cosmetic periodontal surgery Surgical peri- Cover screw Screw with head design to fit over odontal procedures to improve gingival es- the implant and seal the occlusal surface of thetics and achieve an ideal soft tissue-teeth the implant prior to wound closure in a two- relationship. It includes treatment of gingival stage surgical implant procedure. See also: C recession, gingivectomy and gingivoplas- Closure screw. ty. See also: Gingival recession; Gingivecto- my; Gingivoplasty.

Suture present at Cost analysis Investigation and examination of initial surgery Cover screw factors related to the value.

Cost-benefit analysis (CBA) Study designed to assess all outcomes based on monetary costs and benefits. All study results are conveyed in dollars or euros. An economic conversion is used to express a monetary amount to intan- 12 gible results. Cover screw.

Cost-effectiveness analysis (CEA) Study comparing two or more therapies on the bases of CPTi Abbreviation for Commercially pure tita- monetary costs and clinical effectiveness.Re- nium. sults are usually reported in units of dollars or euros per clinical outcome. The outcome of Cranial bone Bone taken from any of the bones therapies to be compared with CEA must be surrounding the brain, comprising the paired expressed in the same units.12 bones (ie, parietal and temporal) and the unpaired bones (ie, occipital, frontal, sphenoid, Countersinking Bone preparation of the cre- and ethmoid). Called also calvarial bone. stal area using special countersinking drills to allow an apical implant placement resulting Cranial bone harvest Any of the bones sur- in a subcrestal position of the implant shoul- rounding the brain; the paired parietal and der or platform. temporal bones and the unpaired occipital, frontal sphenoid, and ethmoid bones.33 Primary implant preparation Craniofacial implant Bone See: Percutaneous implant.

Bone preparation for countersinking Craniofacial implant prosthesis See: Cranio- facial prosthesis.

Gingiva Craniofacial prosthesis Extraoral restoration Tooth replacing a portion of the cranium or face and Countersinking. retained by skin-penetrating implants or adhesives. See also: Maxillofacial prosthetics.

Crater Saucer-shaped defect of soft tissue or bone often seen interdentally.5 See also: Bony defect.

38 Cross-sectional study

Craterization See: Paracervical saucerization.

Creep Property of a material, usually metal, to deform or elongate under pressure that is either cyclic or constant. C

Anterior bar Creeping substitution See: Bone remodeling.

Crest Peak or top of an edentulous alveolar ridge. Palatal bar

Crestal bone loss See: Atrophic alveolar bone.

Crestal incision Incision placed at the crest or Cross-arch stabilization. on top of the alveolar ridge of an edentulous (Redrawn from McGivney and Castleberry35 with permission.) space.

Crevicular epithelium Epithelial lining of the Cross-bite occlusion Occluding tooth contact gingival crevice, sulcus, or periodontal pock- in which the natural or artificial mandibular et; generally a stratified squamous epitheli- teeth overlap the maxillary teeth. Called also um. Called also sulcular epithelium. reverse articulation.2,3

Crevicular fluid See: Gingival crevicular fluid (GCF).

Crevicular physiologic dimension See: Biologic width.

Critical-sized defect Smallest osseous defect that will never heal completely with osseous Anterior Posterior cross-bite cross-bite tissue components. The size varies according relation relation

to species and anatomic location of the pri- Cross-bite occlusion. mary defect. (Redrawn from Boucher36 with permission.)

Cross-arch stabilization Counteraction to pros- Cross-sectional study Study done at one time, thesis unseating forces provided by natural not over the course of time. A cross-sectional teeth or implants on the opposite side of the study of a disease (eg, aggressive periodonti- arch. This resistance may be provided by splin- tis) completed at a single point in time re- ted or fixed prosthetic units or components of veals the prevalence and distribution of the a removable partial prosthesis.3,34 See also: disease within a defined population. Called Splinting. also synchronic study.37

39 Crown

Crown Highest part of an object, such as with degradation, cross-linked telopeptides of type I the normally exposed part of a natural tooth collagen are released into the circulation.Since covered by enamel,or an artificial restoration cross-linked telopeptides result from posttrans- replacing part or all of the coronal portion of lational modification of collagen molecules, C a tooth or implant abutment for esthetic and they cannot be reused during collagen synthe- functional purposes.2,3 See also: Acrylic sis and are therefore precise indicators of bone restoration; Ceramic restoration. resorption. C-terminal telopeptides of type I collagen (ICTP) have been identified as bio- Crown-implant ratio Relation between the markers of bone resorption and bone turnover length of the restoration (ie, crown) and the in a variety of osseous metabolic diseases in- length of the implant embedded in bone.The cluding osteoporosis, rheumatoid arthritis, pe- crown is measured from the most coronal riodontal disease, and peri-implant disease. bone contact to the most coronal surface of the restoration and the implant is measured Cumulative success rate Estimate of the pro- from the implant apex to the most coronal portion of successful implants based on a pre- bone contact.3,34 defined set of criteria, from baseline to time of interest. See also: Life table analysis. Restoration height Cumulative survival rate Estimate of the proportion of successful implants that have not led to tooth or implant loss, from baseline to time of interest. See also: Life table analysis.

Coronal bone contact Cuneiform Wedge-shaped.

Curet or curette Instrument used to debride tissue.In periodontics,a curet is used for scal- Apex ing and planing of tooth roots or implant sur- Crown-implant ratio. faces and for debridement (also called curet- (Redrawn from Brånemark et al38 with permission.) tage) of periodontal pockets and bone.

CT Abbreviation for computed tomography. Curettage Scraping or cleaning of the walls of See: Computed tomography (CT) scan. a cavity or surface by means of a curet.5 See also: Bone curettage; Closed curettage; Gingi- C-telopeptide pyridinoline cross-links of type I val curettage; Open curettage. collagen Pyridinoline cross-links represent a class of mature collagen degradative molecules Curve of Spee Curved line produced by con- that include pyridinoline,deoxypyridinoline,N- necting the tip of the natural mandibular ca- telopeptides, and C-telopeptides. Following nine with the buccal cusps of the premolars procollagen synthesis and release into the ma- and molars and extended to the anterior bor- turing extracellular matrix, pyridinoline cross- der of the mandibular ramus. This anatomic links are formed in type I collagen by the en- observation was first made by F.G.Spee in the zyme lysyl oxidase on lysine and hydroxylysine 19th century. In the absence of natural teeth, residues in the carboxy- and amino-terminal this curve is developed to compensate for telopeptide regions,increasing the mechanical condylar path influence on occlusal contacts stability of the structure. Subsequent to osteo- in the creation of a balanced occlusion; hence clastic bone resorption and collagen matrix the term compensating curve.2,3

40 Cytotoxin

Cylinder wrench Instrument used clinically and can be modified for use in dental laboratory implant procedures. It is designed by the manufacturer to fit specific prosthetic components and used to adjust the component. C

Cylindrical implant Implant of variable design and configuration, depending on the implant system. One such design, determined either in cross-section or three-dimension, follows the shape of a cylinder for an endosteal im- Curve of Spee (compensating curve). (Redrawn from Daskalogiannakis20 with permission.) plant.

Cusp Peaked extension of the occlusal surface Cross-section of a molar or premolar. Cusp incline is determined by the mesiodistal or buccolingual slope from the peak to the deepest part of the central fossa of the tooth.3

Cusp inclination Relative cusp height of artificial teeth; affects the loading pattern of a supporting dental implant. Cylindrical implant (cross section view of a cylinder).

Custom abutment Cytokine Growth factor that stimulates See: Castable abutment; UCLA abutment. growth and differentiation via cellular receptors. Examples are platelet-derived growth Cutis See: Skin. factor (PDGF), insulin growth factors (IGS), transforming growth factor beta 1 (TGF-β1), Cutting cone See: Bone remodeling unit (BRU); bone morphogenetic proteins (BMPs), and Basic multicellular unit (BMU). epidermal growth factor (EGF).

Cutting torque Turning or twisting force pro- Cytotoxic Cell toxicity; the capacity to kill duced by a rotary device (ie, dental hand- cells. piece) to cut through a material such as bone. Cytotoxin Agent that has toxic effects on cells Cylinder-to-transmucosal element See: Gold or inhibits or prevents cell function. cylinder attachment.

Dentition, Artificial

D D

DBM Abbreviation for Demineralized bone Delayed loading Placing an implant into func- matrix. tion or a load-bearing situation following an extended period of healing after the initial Debridement Removal of inflamed, devital- placement. ized, or contaminated tissue or foreign material from or adjacent to a lesion. Demineralized bone matrix (DBM) Bone matrix, usually allogeneic in origin, that may in- Deciduous dentition See: Dentition, primary. duce bone formation via release of growth factors and bone morphogenetic proteins Decortication Intraoperative preparation of the (BMPs) from the matrix,occasionally after os- recipient bone bed by making numerous small teoclastic breakdown. Osteoinductive poten- perforations into the cortex to induce bleeding tial may vary,dependent on method of prepa- from the marrow cavity. This technique is rou- ration and degree of demineralization. tinely used in combination with onlay block grafts or guided bone regeneration (GBR) pro- Demineralized freeze-dried bone allograft cedures. See also: Bone preparation. (DFDBA) By demineralization, the mineral phase of freeze-dried bone allografts is partly Defect Genetic or acquired deficiency of an or completely removed so that the collagen anatomic structure (ie,bone or soft tissue) re- and non-collagenous matrix is exposed,there- quired for normal function or esthetics. See by making growth factors available. also: Critical-sized defect. Dental cast See: Cast. Definitive cast See: Master impression. Dental plaster Definitive prosthesis Orodental or maxillofa- See: Calcium sulfate; Dental stone. cial restoration designed and fabricated for long-term use. This term is preferable to final Dental stone Denser alpha-hemihydrate form prosthesis, since no artificial replacement can of calcium sulfate, stronger than the beta be considered permanent.1 form. It is commonly used for dental casts involved in the fabrication of denture prosthe- Dehiscence Buccal or lingual bone defect ses.An even denser,stronger die stone is used in the crestal area extending apically at an to create a positive likeness of a prepared implant. See also: Fenestration; Wound tooth for the fabrication of crown restora- dehiscence. tions.1 See also: Calcium sulfate.

Delayed implant placement See: Late implant Dentition Collective teeth in the dental arches.2,3 placement. Artificial d. Imitation replacement for natural teeth.

43 Dentition, Natural

Natural d. Normal living teeth that erupt Dermal graft Skin graft made with a thin split- into the oral cavity. thickness graft of dermis.4 See also: Acellu- lar dermal allograft. Permanent d. Natural teeth that succeed the primary teeth as the primary teeth are Developmental anomaly Aberration in the shed. Called also succedaneous dentition. normal sequence of events associated with D growth and development. This process could Primary d. Earliest natural teeth that erupt result over time in distortion of the face and into the dental arches of the oral cavity jaws, abnormality of tooth formation or posi- normally during childhood. Called also de- tion, and irregularity of function.2,5 ciduous dentition. Device Apparatus, instrumentation, or ma- Dentoalveolar distraction See: Alveolar dis- chine designed to carry out a specific purpose. traction osteogenesis. DFDBA Abbreviation for Demineralized freeze- Dentofacial orthopedics See: Orthodontics. dried bone allograft.

Denture Artificial replacement for natural Diabetes mellitus (DM) Encompasses a het- teeth and related structures. A conventional erogeneous group of disorders with the com- or traditional denture is a generic phrase for mon characteristic of altered glucose tolerance the long-standing concept of a dental pros- or impaired lipid and carbohydrate metabo- thesis, most commonly a removable prosthe- lism. DM develops from either a deficiency in sis.2 See also: Prosthesis. insulin production or an impaired utilization of insulin. Based on these two conditions, DM Denture prosthesis A generic term for the long- can be divided into Type 1 (formerly insulin-de- standing concept of artificial replacement of pendent diabetes mellitus) and Type 2 (former- natural teeth and related structures,most com- ly non-insulin-dependent diabetes).6 monly a removable device. The term is also used to denote its distinctness from an im- Diabetes mellitus–related surgical risk fac- plant-supported or a craniofacial prosthesis.1,2 tors Surgical risk factors for a diabetic patient include intraoperative hypo- or hyper- De-osseointegration State in which prior os- glycemia and delayed postoperative wound seointegration is subsequently lost. healing. Such patients may also be more susceptible to infection.6,7 Depassivation Removal or loss of an oxide layer from the surface of a metal. Diagnostic Pertaining to any measure used for the purpose of diagnosis. Deproteinized bovine bone material See: Bovine-derived anorganic bone matrix. Diagnostic cast Reproduction of actual teeth and associated oral structures used for analy- Depth gauge Gauge for measuring the depth of sis and treatment planning.1,2 grooves or holes or other concavities. In implant dentistry, used to measure the depth of Diagnostic imaging Visual representation of a the osteotomy during implant site preparation. body part made for diagnostic and/or treatment planning purposes. Such procedures in-

44 Disocclusion

clude radiography, computed tomography Disclosant Dye (tablet or solution) used to (CT), magnetic resonance imaging (MRI), ul- stain dental biofilm.It is primarily used as an trasound, and digital volume tomography. aid in oral hygiene instruction for dental plaque identification and enables the pa- Diagnostic wax-up Arrangement of artificial tient to determine the effectiveness of his or teeth or waxed occlusal and incisal surfaces her oral care routine. created in the laboratory for evaluation of D projected prosthetic restorations.The accept- Disclusion See: Disocclusion. ed arrangement can be used for treatment planning, surgical or radiographic template Disk implant Interpositional implant used fabrication, and prosthesis design.8 for placement in joints such as the temporomandibular joint following a meniscectomy. Diaphysis Shaft of long bones, consisting of Various materials have been used to fabri- compact bone and bone marrow cavity. cate interpositional implants including polytetrafluoroethylene (PTFE), an alloplastic Digital prosthesis Artificial replacement for material. Also, a disk made of commercially human fingers, including the thumb. See pure titanium that is designed with con- also: Maxillofacial prosthetics. cave-shaped ovoid perforations and “inserted from the lateral aspect of the host bone Direct (open tray) impression Impression and provides multicortical support.“ Addi- technique by which an occlusal opening is tional anchorage is achieved using an axial created in a fabricated custom tray that per- direction by threading a screw-type implant mits impression coping removal with the im- through the central opening of the multiple pression material as a single unit.8 disks.9

Direction indicator Device that fits into the Alveolar bone osteotomy or implant at the time of surgical placement.When two indicators are placed in adjacent osteotomies or implants, the relative parallelism can be evaluated and addi- Soft tissue flap tional corrective procedures can be accomplished at the surgical stage.

Multi-disk implant placed in maxilla

Soft tissue flap

Endosseous disk implant.

Disocclusion Separation of the mandible from the maxilla precipitated by tooth-guid- Direction indicator. ed contacts during mandibular excursive movements. Called also disclusion or disar- Disarticulation See: Disocclusion. ticulation.10

45 Distal extension

Distal extension Edentulous space posterior Bone to the most distal tooth or implant abutment. Distance osteogenesis

Implant

Contact osteogenesis

Implant Distance osteogenesis. (Redrawn from Schenk et al11 with permission.)

Distal extension (mandibular). Distraction, bidirectional crest See: Bidirec- tional crest distraction.

Distraction device See: Distractor.

Distraction implant Distraction device that incorporates an implant into its design. The implant may then be used for prosthetic reconstruction following distraction.

Distraction osteogenesis (DO) Surgical process for reconstruction of skeletal deformities that involves gradual, controlled dis- Distal extension (maxillary). placement of surgically created fractures to simultaneously expand soft tissue and bone Distal extension prosthesis As seen in the volume. In this approach to maxillary and median sagittal plane, a prosthesis addition mandibular augmentation, a favorable me- posterior to the most distal tooth or implant chanical strain is applied to the healing cal- abutment. The extension can be uni- or bilat- lus in the osteotomy gap, usually a week af- eral and in the form of an artificial tooth or ter osteotomy.By gradual traction (1 mm per teeth, a cantilever for a fixed prosthesis, or a day) the height may be increased by 10 mm denture base segment for a removable partial or more. Gavriel Ilizarov, a Russian orthope- denture.1 See also: Partial denture. dic surgeon, is credited with developing the technique for orthopedic limb deformities in Distance osteogenesis Immediate primary the 1960s. These concepts have been modi- apposition of woven bone on the surface of fied for use in maxillofacial surgery.12 See the osseous implant bed as part of the os- also: Alveolar distraction osteogenesis. seointegration process. Compare: Contact osteogenesis.

46 Dolder bar

Distraction rate Distance of distraction per Disuse In bone, the relationship between the day. Ideal rate depends on the ability of the bone’s strength and its usual imposed loads. soft tissue to respond with expansion and Disuse-mode remodeling results in local re- regeneration. Periodontal status of adjacent moval of bone. See also: Disuse atrophy. teeth may also limit the transport rate. In general, a rate of 0.4 mm per day is suffi- Disuse atrophy Wasting away or degeneration cient to allow the soft tissue to respond in any bone from lack of normal functional D while avoiding premature consolidation (ie, stimulus; ie, bone loss in paraplegia or alveo- fusion) across the vertical osteotomy com- lar bone loss after tooth extraction. ponents prior to completion of the transport process. If the distraction rate is too DM Abbreviation for Diabetes mellitus. slow, the risk for premature consolidation is increased.12 See also: Distraction osteogen- DO Abbreviation for Distraction osteogenesis. esis (DO). Dolder bar Prefabricated U-shaped bar used Distraction regenerate Newly regenerated to connect teeth, tooth roots, or implant tissue between the transported section and abutments to provide support and retention. the surgically cut base achieved following dis- The retentive feature of this design is a single traction osteogenesis (DO). See also: Alveo- sleeve incorporated in the impression surface lar distraction osteogenesis. of the prosthesis. The bar has two basic shapes: an egg-shaped bar allows movement, Distraction rhythm Number of increments of whereas a modified bar unit is rigid.13,14 distraction given over a day. See also: Dis- traction rate.

Distraction vector Three-dimensional direction in which the transported section is guided in distraction osteogenesis (DO). Egg-shaped configuration Modified Distraction zone Zone between the transport- configuration ed segment and its surgically cut base.

Distractor Device used for distraction osteogenesis (DO). See also: Alveolar distraction osteogenesis; Distraction osteogenesis (DO); (Redrawn from Brewer and Morrow14 with permission.) Intraoral distractor.

Endosseous d. See: Endosseous distractor.

Extraosseous d. See: Extraosseous distractor. Sleeve

Distribution force Pattern in which applied forces are distributed throughout a structure; ie, pattern of load distribution throughout an implant-supported fixed cantilever prosthesis.

Dolder bar configurations and sleeve.

47 Donor site

Donor site See: Bone graft, Donor site for. Dual-energy x-ray absorptiometry (DEXA) Means of measuring bone mineral density Doxycycline Semisynthetic broad-spectrum (BMD). It is the most widely used and most antibacterial of the tetracycline group,admin- thoroughly studied bone density measure- istered orally. This antibiotic is often used to ment technology. Bone density can be meas- treat periodontal and peri-implant disease. ured in every part of the body, preferably in D Low-dose formulations also possess inhibito- rib and vertebra, and has been measured as ry effects on matrix metalloproteinase (MMP) well in the jaw area. The patient’s bone is ex- enzymes responsible for destroying connec- posed to two x-ray beams of different energy tive tissues and bone. levels. The absorption of each beam by bone is correlated with the quantity of calcium Dressing Application of a gauze or bandage to crystals per volume. The value of absorption cover and protect a sore, ulcer,or wound. See calculates the bone density in mg/cm2. The also: Periodontal dressing. drawback of the method is that soft tissue absorption is subtracted out and the value of Drill extender Intermediate handpiece or wrench cortical bone and bone marrow has to be de- component used to lengthen the shaft of an in- termined by integral calculus. The effective strument connected to a rotary drill or implant radiation dose to the patient per examination mount.8 has been calculated as 0.01 mSv.

Drill guide A template,sleeve,other device,or Dynamic loading Situation in which the load- system used to direct/control a rotary cutting ing of an implant is continually changing as instrument when preparing an implant os- would happen during occlusal function. Both teotomy site. See also: Computed tomogra- the magnitude and direction of applied force phy (CT) scan; Three-dimensional guidance are in constant flux. system for implant placement. Dysesthesia Unpleasant abnormal sensation, Drilling sequence Sequence of a series of burs which can be spontaneous or evoked. and drills to methodically prepare an implant site.

48 Element

E Ear prosthesis Fixed/removable artificial re- Edentulous space Space interval between placement for all or part of a human ear.Called teeth that was previously occupied by a tooth also auricular prosthesis. or teeth.

Early implant loss Loss of an implant that oc- EDM Abbreviation for Electric discharge method. curs prior to implant osseointegration. Effector cell Cell that becomes active in re- Early implant placement Early implant place- sponse to stimulation. In immunology, a dif- ment takes place 4 to 8 weeks following tooth ferentiated lymphocyte capable of mounting extraction, providing sufficient time for soft a specific immune response,eg,antibody pro- tissue healing.This approach is often used by duction; lymphokine production; or helper, clinicians in esthetic sites, where implant suppressor,or killer function.Called also effec- placement often requires a simultaneous tor lymphocyte. guided bone regeneration (GBR) procedure and primary soft tissue closure is critical. It Effector lymphocyte See: Effector cell. helps to reduce the risk of post-restorative soft tissue complications. 1 EGF Abbreviation for Epidermal growth factor.

Early loading Placing of an implant into func- Elastic modulus Measure of elasticity; relative tion or a load-bearing situation following a re- stiffness of a material within the range of duced period of healing after the initial place- elastic deformation (below the point of plas- ment. It is generally considered to be loading tic deformation). Called also modulus of elas- more than 48 hours but less than 3 months ticity or Young modulus. after implant placement.2 Elastic modulus = Stress/Strain or E = σ/ε

Eccentric See: Maxillomandibular relationship, Eccentric. Electric discharge method (EDM) Fabrication of components through use of electrically in- ECM Abbreviation for Extracellular matrix. duced contact corrosion. Called also spark erosion. Edentulism Oral condition of being without teeth, completely (ie, complete edentulism) Element Separate, identifiable part or a dis- or in segments of a dental arch (ie, partial tinct group within a larger group; ie, any por- edentulism). tion of an implant prosthesis. It can be identified by position or function as transmucos- Edentulous Without teeth. al, retentive, attachment, or dental.3,4

49 Elevator

Elevator Surgical instrument.A luxating elevator is used to luxate teeth during extraction. A periosteal elevator is used to elevate a full- thickness or mucoperiosteal flap. Emergence profile Soft tissue crest Emergence angle Buser e. See: Buser elevator.

EMD Abbreviation for Enamel matrix derivative. E

Emergence angle Angle formed by the surface of the transmucosal element to the long axis 5 of the implant. See also: Emergence profile. Emergence angle and emergence profile. (See figure.) (Redrawn from Yanase and Preston7 with permission.)

Emergence profile Facial or buccal axial con- Endochondral ossification Formation of long tour of a tooth or crown, extending from the bones on the basis of a cartilaginous model. base of the epithelial sulcus past the soft tis- Longitudinal growth takes place both in sue margin to the height of contour. Control growth plates and in the articular cartilage.At of this surface is important in achieving ac- the growth plates, chondral ossification takes ceptable esthetics and maintaining soft tis- place. Cartilage cells calcify,serving as a basis sue health.6,7 See also: Emergence angle. for bone formation, and bone is deposited; cartilage is then replaced by bone. Enamel matrix derivative (EMD) Extract of embryonic enamel matrix derived from six- Endocrine Transfer of chemical compounds month-old piglets. It is composed of several such as hormones and growth factors from proteins, 90% of which are amelogenins, a secreting glands via blood to cells. family of hydrophobic proteins. EMD has been used as a periodontal regenerative Endodontic pin See: Endodontic stabilizer. treatment.

Fibrous layer (type I collagen) Zone of proliferation of prechondrocytes

Zone of biosynthesis of type II collagen and large prostaglandins

Zone of hypertrophic chondrocytes and cartilage mineralization

Zone of bone formation

Endochondral ossification. (Redrawn from Garant8 with permission.)

50 Endothelial progenitor cell

Endodontic stabilizer Tapered post made of a Endosseous provisional implant See: Provi- biocompatible alloy that is cemented into a sional implant. natural tooth, extending beyond the apex in- to the surrounding bone, on the assumption Endosseous ramus implant Single- or multi- that it would stabilize the tooth.9 Called also ple-piece implant in which the endosseous el- endodontic pin. ements are placed in the symphysis area and into the anterior portion of bilateral mandibu- Endodontic stabilizer lar rami. The transmucosal element extends E from the endosseous portion that supports a mesostructure. The mesostructure can con- Bone sist of a bar that follows the general outline of the residual mandibular bone. It is U-shaped as viewed from the occlusal.11-13

Remaining tooth structure

Endodontic stabilizer.

Endosseous distractor Distraction device designed to be placed within bone,between the bone base and transport segment. See also: Distraction osteogenesis (DO).

Endosseous implant Relative bony anatomic Endosseous ramus implant. position of an implant placed into an osteotomy site. “A device placed into the alveolar Endosteal Synonym for endosseous. See and/or basal bone of the mandible or maxil- also: Intraosseous. la and transsecting only one cortical plate.“ Classification term endosseous is inter- Endosteum Thin, vascular membrane that changeable with the term endosteal.10 lines the inner aspect of cortical bone surrounding the medullary cavity of bone. This Cross-section view delicate connective tissue is comprised of of mandibular alveolar ridge vessels, lining cells, and osteoprogenitor cells and has a marked osteogenic potential.

Endothelial progenitor cell Adherent cell obtained from peripheral blood-derived or bone marrow–derived mononuclear cells demon-

Cortical bone strating low-density lipoprotein (LDL) uptake and isolectin-binding capacity.These cells may Cancellous bone be used as a potential therapy for a variety of vascular diseases. The number of circulating Endosseous implant. endothelial progenitor cells is reduced in patients with cardiovascular disease and may be a surrogate marker for this disease risk.14

51 Endothelium

Endothelium (pl: endothelia) Epithelium of be cytotoxic or pyogenic, has been shown to mesoblastic origin composed of a single lay- induce and/or amplify inflammation,and has er of thin, flattened cells that line the cavities been implicated in the etiologies of periodon- of the heart, the lumina of blood and lymph titis. For most purposes, the terms endotoxin vessels, and the serous cavities of the body. and lipopolysaccharide (LPS) are used inter- changeably. See also: Lipopolysaccharide (LPS). E Smooth muscle Envelope flap Flap that is elevated without

Tunica adventitia vertical releasing incisions, thus creating an envelope or pouch; most often used in com- Tunica intima bination with connective tissue grafts. Tunica media

Epidermal cell Any of the cells making up the epidermis, the outer layer of the skin covering the exterior body surface.Epidermis com- Internal elastic lamina prises, from within, five epithelial layers: the basal layer (stratum basale), the spinous layer (stratum spinosum), the granular layer

External elastic lamina (stratum granulosum), the clear layer (stratum lucidum), and the cornified layer (stra- Endothelium.(Photomicrograph; magnification x122; elastic stain.) tum corneum). (Reprinted from Berman15 with permission.) Epidermal growth factor Mitogenic polypep- Endotoxin Potentially toxic, natural com- tide that promotes growth and differentia- pounds found inside pathogens such as bac- tion, is essential in embryogenesis, and is im- teria. Unlike an exotoxin, it is not secreted in portant in wound healing. 16 soluble form by live bacteria but is a structural component in the bacteria that is released Epiphysis End of a bone shaft, consisting of mainly when bacteria are lysed. Endotoxin is trabecular bone covered by a thin cortex. associated with the outer membranes of certain gram-negative bacteria, and its main ac- Epithelial apical migration Migration of gin- tive ingredient is the lipopolysaccharide (LPS) gival sulcular and junctional epithelia in the or lipo-oligo-saccharide (LOS) complex. It can apical direction as a result of periodontitis progression. During the healing process after periodontal therapy, the epithelial cells migrate apically attaching to the root or oral implant surface and preventing connective tis- Core glycolipid O-specific polysaccharide chain sue cell attachment.

Epithelial attachment Lipid A See: Junctional epithelium. n (Outer) (Inner) O-specific Core oligosaccharide oligo- Epithelial cell Cell that lines hollow organs and saccharide subunit glands and that makes up the outer surface of the body.Arranged in single or multiple layers, Endotoxin.

52 Examination

depending on the type, they help protect or Er:YAG laser Er:YAG is an acronym for erbium- enclose organs. Some produce mucus or oth- doped yttrium aluminum garnet, a compound er secretions,and others have tiny hairs called that is used as the lasing medium for certain cilia, which help remove foreign substances, solid-state lasers. Er:YAG lasers typically emit for example, from the respiratory tract. light with a wavelength of 2,940 nm, which is in the infrared range.The frequency of Er:YAG Epithelial implant See: Mucosal insert. lasers is at the resonant frequency of water, which causes it to be quickly absorbed; this E Epithelialization Healing by growth of epithe- limits its use in surgery. lium over connective tissue. Erythrocyte Mature red blood cell. The func- Epithelialized palatal graft See: Free gingival tion of this nonnucleated, biconcave disk con- graft. taining hemoglobin is to transport oxygen.

Epithelium (pl: epithelia) Covering of inter- Esthetic complication Complication caused nal and external surfaces of the body, in- by the malposition of an implant in either the cluding the lining membrane of vessels and mesiodistal,coronal-apical,or orofacial direc- other small cavities. It consists of cells joined tion, or by the lack of peri-implant bone or by small amounts of cementing substances soft tissues. Such complications can be a ma- and is classified on the basis of the number jor concern for clinicians,since removal of the of layers deep and the shape of the superfi- implant may be required.18 cial cells. See also: Crevicular epithelium; Junctional epithelium. Esthetic zone Teeth or restorations and their associated supporting structures that are vis- Epithesis (prosthesis) Craniofacial artificial ible when exposed by patient smile.6,19 replacement supported and retained by percutaneous (epi) implants.17 See also: Max- Esthetics Beauty or physical appearance provid- illofacial prosthetics. ed by the form and composition of the teeth, mouth, and face.20 See also: Esthetic zone. Eposteal implant Implant that rests on and is directly supported by bone.6 Compare: Sub- Etched surface See: Acid-etched implant. periosteal implant. Etching Act of creating an etched surface Epoxy resin Resin molecule characterized by through the application of corrosive chemi- reactive epoxy or ethoxyline groups serving as cals, usually acids. It is considered beneficial terminal polymerization points. It is used in for the promotion of osseointegration. See dentistry as denture base material and is ver- also: Acid etching. satile in its capacity to adhere to wood, glass, and metal. Examination Process of assessing a body part or parts to ascertain the state of health or dis- e-PTFE Abbreviation for Expanded polytetra- ease; may include visualization, digital palpa- fluoroethylene. tion, percussion, auscultation, radiographic analysis, ultrasound, and/or other laboratory Epulis (pl: epulides) Nonspecific term ap- and functional measurement techniques.The plied to tumors and tumor-like masses of the examination can be preoperative for diagnos- gingiva; peripheral ossifying fibroma. tic purposes or postoperative for treatment follow-up. Called also control.20

53 Exclusion criterion

Exclusion criterion (pl: exclusion criteria)Con- as potential postoperative complications fol- dition that precludes entrance of candidates lowing membrane exposure and subsequent into an investigation, even if they meet the in- infection, or the obligatory second surgical clusion criteria. Compare: Inclusion criterion. procedure for membrane removal, have led to the development of bioresorbable mem- Exenteration Removal of an organ. For max- branes as alternatives. See also: Expanded illofacial prosthetics, removal of the eye and polytetrafluoroethylene (e-PTFE). surrounding contents from the orbit, called E orbital exenteration; usually implies the fabri- Experimental study Study in which measure- cation of an orbital prosthesis.21 ments are made to one independent variable while everything else around that one vari- Exfoliation Physiologic shedding or loss of a able remains constant.23 primary tooth prior to the eruption of its permanent successor. Expert witness Person qualified by the court to possess special knowledge, skill, or experi- Expanded polytetrafluoroethylene (e-PTFE) ence (scientific, technical, or other) and who Characterized as a porous teflon polymer with can testify as an expert in a specific field. Ex- high stability in biologic systems. It is well tol- pert witnesses can give opinions based on erated, bioinert, resists breakdown by host tis- their special knowledge. sues and by microbes, and does not elicit immunologic reactions.22 See also: Expanded Exposure Postoperative condition in which a polytetrafluoroethylene (e-PTFE) membrane; membrane and/or implant is not covered by Polytetrafluoroethylene (PTFE). soft tissue because of wound dehiscence.

Expanded polytetrafluoroethylene (e-PTFE) External abutment connection Interface be- membrane Barrier membrane made of a tween a transmucosal component (abut- polymer of tetrafluoroethylene. e-PTFE is a ment) and the coronal surface of an implant. matrix of polytetrafluoroethylene (PTFE) The implant’s coronal surface may have an nodes and fibrils in a microstructure that external hexagon, which is engaged when can be varied in porosity to address the clini- the transmucosal component is seated. See cal and biologic requirements of its intended also: Abutment connection.24,25 applications. Recognized for its inertness and tissue compatibility, e-PTFE is used to make several medical products, including e-PTFE membranes in a variety of shapes and sizes, in both nonreinforced and titanium-reinforced configurations.Titanium-reinforced configurations create more space and better maintain External hexagon shape than nonreinforced configurations.This abutment connection was the first type of membrane used in demonstrating the principle of guided bone regeneration (GBR). Widespread application established it as the standard for bone regen- External abutment connection. eration. However, clinical shortcomings, such

54 Eye prosthesis

External bevel incision Reduces the thickness Extraction Removal of a tooth or teeth. of the mucogingival complex from the outside surface. Made from apical to coronal di- Extraction socket Open socket in the alveolar rection, it is used in gingivectomy proce- process following removal of a tooth. dures. Compare: Internal bevel incision; Sulcular incision. Extraction socket graft See: Bio-Col technique.

Extraosseous distractor Jack-like device at- E tached lateral to maxillary or mandibular basal bone for the purpose of creating incre- mental separation between jaw segments planned for distraction.6 See also: Distrac- tion osteogenesis (DO).

Extraoral graft Graft harvested from extraoral sources, such as the calvarium, iliac crest, or tibia.

External bevel incision. Exudate Fluid filtered from the circulatory sys- (Redrawn from Sato26 with permission.) tem into areas of inflammation. It contains proteins, solutes, and blood cells and results External hexagon abutment connection See: from the increased permeability of blood ves- External abutment connection; Hex. sels caused by an inflammatory process. Pus, on the other hand, is characterized by the External hex implant presence of bacteria and high concentrations See: External abutment connection; Hex. of white blood cells.Transudate,also different from exudate, is fluid resulting from a disreg- External irrigation Application of physiologic ulation of hydrostatic or osmotic pressure saline solution during bone preparation for and is not a result of inflammation. implant placement.It is provided by an external irrigation tube that is attached to the Eye prosthesis See: Exenteration. contra-angle handpiece.

Extracellular matrix (ECM) (pl: extracellular matrices (ECMS)) Material produced by cells and excreted to the extracellular space within the tissues. It takes the form of both ground substance and fibers and is composed chiefly of fibrous elements, proteins involved in cell adhesion, glycosaminoglycans, and other space-filling molecules. It serves as a scaffolding for holding tissues together, and its form and composition help determine tissue characteristics. The matrix may be mineralized to resist compression (as in bone) or dominated by tension-resisting fibers (as in tendon).

Fenestration

Facebow Instrument used to record the posi- Facial prosthesis Maxillofacial artificial re- tional relationship in the patient of the maxil- placement for a part of the face missing be- F lary arch to the horizontal condylar axis of the cause of surgical, traumatic, or congenital eti- mandible and to transfer this record to an ar- ology. See also: Craniofacial prosthesis; Max- ticulating device that can simulate mandibu- illofacial prosthetics.4 lar movements. A refinement to the conventional face-bow is known as a kinematic Facial symmetry Mutually balanced relation- (hinge-bow) type,which has adjustable condy- ship of facial parts relative to size, arrange- lar rods, allowing the accurate location of the ment, or measurements.6 horizontal axis of mandibular rotation.1,2 Facing Tooth-colored material used to restore the visible surface of a prepared tooth or prosthetic replacement.4 See also: Veneer.

Fatigue Property of metals that become em- brittled and prone to fracture; caused by grain growth through repeated loading or flexure.

FDBA Abbreviation for Freeze-dried bone allograft.

FEA Abbreviation for Finite element analysis. Facebow transfer to articulator. (Redrawn from Sharry3 with permission.) Fenestration Buccal or lingual window defect of either bone or soft tissue, occurring over a Facial Surface of incisors or canines and asso- tooth root, implant, or alveolar ridge. See ciated oral structures adjacent to the lips or also: Dehiscence. cheeks.4 Fenestration Facial moulage Impression of facial soft tissues and bony contours to obtain a working cast for the fabrication of an extraoral prosthesis.5 Fenestration

Bone Facial profile Sagittal outline form of the face seen in the median plane.4

Fenestration.

57 Festoon

Festoon Contour of the soft tissues covering elongated cell, with cytoplasmic processes at the roots of the teeth that tends to follow the each end and a large, oval, vesicular nucleus, cervical lines. Specifically in prosthodontics, secretes fibrillar procollagen,fibronectin,and a carving in the base material of a denture collagenase and is involved in extracellular that simulates the contours of the natural tis- matrix production and remodeling. sues being replaced by the denture. Fibroblast growth factor (FGF) Family of FGF Abbreviation for Fibroblast growth factor. growth factors with mitogenic properties for fibroblasts and mesoderm-derived cell types. F FHA Abbreviation for Fluorohydroxyapatite. They have important roles in angiogenesis, neurogenesis, wound healing, and tumor Fibrin clot Clump that results from coagula- growth. In humans, more than 20 proteins tion of the blood after a sequential process have been identified as members of the FGF by which the multiple coagulation factors of family. FGF-2, or basic FGF (bFGF), has been the blood interact in the coagulation cas- the most studied member of the FGF family cade. Essentially composed of fibrin, this infor therapeutic purposes in regenerative soluble protein is formed from fibrinogen by treatments, notably soft tissue healing. the proteolytic action of thrombin. Called also blood clot. Fibromatosis (pl: fibromatoses) Group of tumor-like lesions that have an infiltrative nature and can be locally aggressive, making them difficult to remove completely. They can recur following surgery but do not metastasize to other parts of the body. Fibro- matoses have also been known to undergo spontaneous regression and completely disappear. Fibrin clot (scanning electron micrographs; high magnification). Fibronectin Adhesive glycoprotein with a (Reprinted from Lang et high molecular weight (450 kd), composed of al7 with permission.) two disulfide-linked polypeptides.Functional domains of the molecule have an affinity for Fibrinolysis (pl: fibrinolyses) Enzymatic process cells and the extracellular matrix compo- of dissolution of fibrin. Plasmin, the main en- nents. It is found on cell surfaces, in connec- zyme involved, degradates the fibrin mesh, tive tissues, in the blood, and in other body leading to the production of circulating frag- fluids. Fibronectins are important in connec- ments that are cleared by other proteinases or tive tissue, where they cross-link to collagen, organs. promote cellular adhesion and/or migration, and are involved in aggregation of platelets. Fibrin-rich matrix Provisional matrix provided by the fibrin clot and fibronectin at the first Fibrosseous integration Direct attachment of phase of wound healing. It helps monocytes, bone to fibrous tissue without a definable in- fibroblasts, and epidermal cells migrate into tervening tissue.9,10 Compare: Osseointegra- the healing area.8 tion.

Fibroblast Cell derived from mesoderm, pre- Fibrous Property of being composed of, con- dominant in the connective tissue. This flat taining, or resembling fibers.

58 Fixed prosthesis

Fibrous connective tissue Type of connective cies. It was devised by British geneticist and tissue that has a relatively high tensile biostatistician R. A. Fisher (1890–1962).12,13 strength because of a relatively high concentration of collagenous fibers. Such tissues Fistula Abnormal connection between two form ligaments and tendons and are primari- anatomic cavities or an anatomic cavity and ly composed of polysaccharides,proteins,and the external body surface. They can form as a water. Called also dense connective tissue. result of trauma, infection, or inflammation.

Fibrous encapsulation Intervening growth of Fixation, bicortical See: Bicortical stabilization. fibrous connective tissue between an en- F dosseous implant and bone.11 See also: Fixation period See: Consolidation period. Fibrosseous integration. Fixation screw Type of attachment screw Fibrous integration of implant Interposition used to secure a prosthetic component.14 of healthy dense collagenous tissue between See also: Attachment screw. implant and bone. See also: Fibrous encapsulation. Fixation tack Element designed to resemble a simple tack. It is used to retain a membrane Fibula free flap Graft used in oral and maxillo- over augmentation material during ridge aug- facial surgery for jaw reconstruction following mentation surgery. tumor resection. It provides a long segment of bone and can include a large fasciocuta- neous component.Flap harvested as osteocu- Augmented sinus taneous or purely osseous. Fixation tack

Fibular bone graft with free flap See: Fibula free flap. Membrane

Finger-joint replacement Artificial replacement for human finger joints, including the thumb.

Cross-section view of maxillary Finite element analysis (FEA) Science of cre- sinus/residual alveolar ridge ating computer simulations of mechanical or Fixation tack. clinical situations. It is used to predict properties of structures and for structural design. Fixed hybrid prosthesis Nonremovable hybrid prosthesis. See also: Hybrid prosthesis. Finite element model Structural simulation generated by computer programming. Fixed partial denture Nonremovable partial prosthesis supported by teeth and/or im- First-stage surgery See: Stage-one surgery. plants. See also: Fixed prosthesis.

Fisher exact test Statistical test used in med- Fixed prosthesis Dental or maxillofacial pros- ical research, testing independence of rows thesis supported and retained by natural and columns in a 2 x 2 contingency table (with teeth,tooth roots,or dental implants,not read- 2 horizontal rows crossing 2 vertical columns, ily removed by the patient. Synonym for creating 4 places for data) based on exact bridge.See also: Hybrid prosthesis; Implant-sup- sampling distribution of observed frequen- ported prosthesis (ISP); Provisional prosthesis.

59 Fixture

Fixture Term used in early Brånemark litera- Fluorosis Condition that occurs because of ex- ture to refer to an implant.11 See also: cessive intake of fluoride either through nat- Endosseous implant. urally occurring fluoride in the water, water fluoridation, toothpaste, or other sources. Flap Soft tissue that is raised or elevated for Damage in tooth development from the over- surgical access. See also: Envelope flap; exposure to fluoride typically occurs between Mucoperiosteal flap; Partial-thickness flap. the ages of 6 months and 5 years. Teeth are generally composed of hydroxyapatite and Apically positioned f. Surgical flap that is carbonated hydroxyapatite, and when fluo- F moved apically to a new position. ride is present, fluorapatite is created. Exces- sive fluoride can cause yellowing of teeth, Coronally positioned f. Surgical flap that is white spots, and pitting or mottling of enam- moved to a new position coronal to its pre- el, and the teeth become hypocalcified. Al- vious position. though it is usually the permanent teeth that are affected, occasionally primary teeth may Flapless surgery Implant placement per- be involved. In mild cases, there may be a few formed without the elevation of a flap. white flecks or small pits on the enamel of the teeth. In more severe cases, there may be Fleece, collagen See: Collagen fleece. brown stains. Differential diagnosis for this condition may include Turner hypoplasia (al- Fluoride-modifying surface treatment Im- though this is usually more localized), some plant treatment that exposes the surface to a mild forms of amelogenesis imperfecta, and cleansing bath of hydrofluoric acid following other environmental enamel defects of dif- treatment with etching or blasting. This tech- fuse and demarcated opacities. nique has been shown to improve biomechanical anchorage and bone integration Follow-up Periodic monitoring of patient when compared to control implants treated health after medical or surgical treatment,in- without the hydrofluoric acid bath. cluding that of clinical study or trial participants.12 Fluorochrome Fluorescent substance used as a stain or label for biologic specimens. In im- Food and Drug Administration (FDA) Agency plant dentistry, it is used in research to eval- of United States Department of Health and uate the kinetics of osteogenesis and os- Human Services that regulates testing of ex- seointegration on implant surfaces. perimental drugs and devices.The FDA clears new drugs and medical products based on ev- Fluorohydroxyapatite (FHA) Pyrolytical seg- idence of safety and efficacy. mentation of natural algae and hydrothermal transformation of the calcium carbonate (Ca- Force Vector of load application creating ac- CO3) skeleton of algae into FHA celeration or deformation along the direction 1-x (Ca5(PO4)3OHxF ). Particles consist of a pore of its application. See also: Biting force; Clo- system (mean diameter 10 μm), periodically sure force; Distribution force; Pullout force. septated (mean interval 30 μm) and intercon- nectively microperforated (mean diameter of Axial f. Force directed axially or through perforations 1 μm). the long axis of an object.

Lateral f. In dentistry, forces other than axial in direction.

60 Frenotomy

Force vector Force applied through direction Freeze-dried bone allograft (FDBA) Most and magnitude. commonly used allograft, which is frozen and freeze-dried (lyophilized). It may form bone Fracture See: Bone fracture. or participate in new bone formation by osteoinduction or osteoconduction. It is effec- Porcelain f. See: Porcelain fracture. tive when used with barrier membranes. The freezing and freeze-drying process essential- Screw f. See: Screw fracture. ly lowers the antigenicity.

Framework Core component of implant pros- Freeze-drying Method of tissue preparation F thesis, generally fabricated of metallic or ce- in which a tissue specimen is frozen and then ramic material and veneered with ceramic or dehydrated at a low temperature under high- resin coatings.It is incorporated in fixed pros- vacuum conditions.In this process,the frozen theses for strength and retention of matrices water in material is sublimated directly from and teeth. For removable prostheses, it can solid phase to gas. See also: Lyophilization. be designed to provide prosthesis retention, support, and stability.4,15 Frenectomy Surgical excision of a frenulum, including its attachment to underlying bone, Artificial teeth are arranged on the prosthesis (bridge) that is objectionable either functionally or framework esthetically. This procedure can be accomplished with a conventional blade or a carbon 17 dioxide (CO2) laser. Called also frenulectomy.

Gingivectomy of the frenum Insertion of vertical a surgical incision scissor for dissection Cast of the sub- mucosal bilateral tissue Metal additional framwork Pink wax to simulate incisions Abutment replica gum tissue and hold the teeth on framework Framework. (Redrawn from Taylor and Laney16 with permission.) Frenotomy incision into the open wound surface Framework misfit Contacting surface discrep- attachment of ancy between an accurately fitting frame- the frenum work and one which does not fit accurately.

Free gingiva See: Marginal gingiva.

Free gingival graft Soft tissue graft taken from Frenectomy. the patient’s palate that includes the epithe- (Redrawn from Ito and Johnson18 with permission.) lium. Frenotomy Incision of the frenulum.17 Free-standing implant Implant that is not connected to a natural tooth or other implants.

61 Frenulum

Frenulum (pl: frenula) Fold of mucous mem- Functional ankylosis Concept developed by brane, usually with enclosed muscle fibers, Andre Schroeder in 1981 to describe the junc- that attaches the lips and cheeks to alveolar tion between an implant and surrounding mucosa and/or gingiva and underlying perios- bone. Elasticity of bone makes contact and teum.17 Called also frenum. connection a functional unit in which contact between implant and bone is main- Friction-fit Component retained and/or stabi- tained.19 See also: Osseointegration. lized through frictional contact with another component. Functional loading Load applied to teeth or F implant-supported prosthesis during normal Front See: Anterior. chewing function.

Full crown See: Crown. Fusobacterium nucleatum Gram-negative, nonmotile, anaerobic, rod-shaped bacterium Full-thickness flap See: Mucoperiosteal flap. commonly associated with periodontal and peri-implant disease. Full-thickness graft Gingival graft including the epithelium,connective tissue,and periosteum.

62 Gingiva

Gamma-linolenic acid (GLA) protein cell’s own protein synthetic machinery. See See: Osteocalcin. also: Gene therapy.

Gamma ray Part of electromagnetic radiation G with the smallest wavelengths and thus the most energy of any wave in the electromag- Endocytosis netic spectrum.

Endosome Gap See: Edentulous space. DNA entry to nucleus GBR Abbreviation for Guided bone regeneration. Transcription GCF Abbreviation for Gingival crevicular fluid. Translation Gene therapy Treatment of human disease by the transfer of genetic material into specific Gene transfer by an adenovirus vector. (Redrawn from Partridge and Oreffo2 with permission.) cells.1

Nonviral g. t. Method of gene therapy that Gingiva (pl: gingivae) That part of the mas- uses nonviral vectors to deliver genetic ma- ticatory mucosa covering the alveolar process terial into target cells, ie, plasmid DNA and and surrounding cervical portion of teeth. synthetic vectors (eg,lipoplexes,polyplexes). This fibrous connective tissue,covered by keratinized epithelium, is contiguous with peri- Viral g. t. Method of gene therapy that us- odontal ligament and mucosal tissues of the es viruses as gene-delivery vectors; virus- mouth.3 See also: Attached gingiva; Kera- es have a portion of their genome replaced tinized gingiva; Marginal gingiva. by a therapeutic gene. The most widely used viruses are adenovirus,adeno-associated virus, lentivirus, and retrovirus.

Gene transfer Introduction of genes into cells. Gingival margin

The viral particle binds to specific cellular re- Marginal gingiva Gingival groove ceptors and is taken up by endocytosis. Acid- Gingiva

ification of the endosome results in release to gingiva the cytoplasm and partial disassembly of the Mucogingival Attached junction viral particle. Transport through the nuclear Alveolar mucosa pore is by viral proteins. Once in the nucleus Vestibule

the DNA remains extrachromosomal, and Gingiva. transcription and translation are by the host (Redrawn from Genco et al4 with permission.)

63 Gingiva, Free

Free g. See: Marginal gingiva. sociated with this condition include calcium channel blockers, cyclosporin, and dilantin. Gingival abscess Localized purulent infection Called also gingival overgrowth.7 involving the marginal gingivae or interdental papillae.5 Gingival epithelium See: Epithelium.

Gingival cleft Vertical fissure in gingiva occur- Gingival graft Autogenous graft of masticato- ring over a dehiscence of bone covering a root. ry mucosa or collagenous tissue completely or partially detached from its original site Gingival crater Saucer-shaped defect of inter- and placed in a prepared recipient bed. See proximal gingiva.5 also: Free gingival graft. G Soft Gingival crevice See: Gingival sulcus. tissue graft Gingival crevicular fluid (GCF) Serum ultrafil- trate tissue fluid that seeps into the gingival sulcus from gingival connective tissue and Palatal donor site Recipient site vasculature through thin sulcular epithelia. GCF is increased in the presence of inflammation and contains multiple mediators in- Soft tissue graft volved in inflammation, connective tissue homeostasis, and host response. Gingival graft. Serum (Redrawn from Langer8 with permission.) Osteoclasts Fibroblasts Gingival hyperplasia Enlargement of the gin- Neutrophils giva associated with increase in number of Degradation products E cells,typically connective tissue-derived cells. Bacteria E Epithelium E Gingival hypertrophy Enlargement of the gingiva because of increase in size of cells.

Gingival margin See: Marginal gingiva.

Gingival overgrowth See: Gingival enlargement. Gingival crevicular fluid (GCF). (Reprinted from Uitto6 with permission.) Gingival papilla Portion of the gingiva that occupies interproximal spaces; interdental or Gingival curettage Process of debriding the interimplant extension of the gingiva. soft tissue wall of a periodontal pocket.5 Gingival recession Location of gingival mar- Gingival disease See: Gingivitis; Periodontal gin apical to the cementoenamel junction or disease; Periodontitis. implant connection. Marginal tissue reces- sions were classified by Miller in four classes Gingival enlargement Increase in size of the according to predictability of root coverage. gingiva. Gingival enlargement may result Class I: recession does not extend to the from systemic drug use. Drugs commonly as- mucogingival junction and there is no tissue

64 Glycosaminoglycan

loss in the interproximal area. Class II: recession extends to or beyond the mucogingival junction. There is no periodontal loss in the interproximal area.Class III: recession extends to or beyond the mucogingival junction.Bone or soft tissue loss is present in the interdental area, or there is malpositioning of the teeth which prevents total root coverage. Class IV: recession extends to or beyond the Gingivectomy. mucogingival junction. The bone or soft tis- (Redrawn from Lindhe et al10 with permission.) sue loss in the interdental area and/or malpositioning of teeth is so severe that root cover- Gingivitis Inflammation of the gingiva. See G age cannot be anticipated. also: Periodontitis.

Gingivoplasty Surgical reshaping of the gingiva.

Gingivostomatitis (pl: gingivostomatitides) In- flammation and ulcers affecting both the gingiva and the oral mucosa. The condition typi- Class I Class II cally is the result of a viral infection.

GLA protein Abbreviation for gamma-linolenic acid protein. See: Osteocalcin.

Glass ceramic Ceramic of silicon dioxide or sim- Class III Class IV ilar materials that solidify from molten state Gingival recession. without crystallizing. See also: Ceramic. (Redrawn from Miller9 with permission.) Glucocorticoid Group of C21 steroid hor- Gingival stippling Pitted,orange-peel appear- mones (eg, cortisol) that affect carbohydrate, ance frequently seen in attached gingiva. Al- fat, and protein metabolism. They are secret- though it is commonly seen in healthy gingi- ed from the adrenal cortex and used in treat- va, it is not a requirement for gingival health. ment of desquamative gingival lesions in the oral cavity. Called also corticosteroid. Gingival sulcus Shallow space coronal to attachment of the junctional epithelium. It is bound Glucoprotein See: Glycoprotein. by tooth and sulcular epithelium on either side.The coronal extent of gingival sulcus is the Glycoprotein Conjugated protein in which the gingival margin. Called also gingival crevice. nonprotein group is generally a carbohydrate. It can contain one or more covalently linked Gingivectomy Excision of a portion of the gin- carbohydrate residues. Called also glucopro- giva, usually performed to reduce soft tissue tein. wall of periodontal pocket or to remove excess tissue in the condition of gingival enlargement. Glycosaminoglycan Polysaccharide chain of In the figure, the spots are marks on the outer hexosamine alternating with another carbo- aspect of the gingiva to delineate the bottom hydrate residue. It is a component of proteo- of the pocket and indicate incision design. glycan, which is a major part of noncollage-

65 Glycosaminoglycan

nous matrix of bone and connective tissues. Granulation tissue Healing tissue consisting Called also mucopolysaccharide. of fibroblasts, capillary buds, inflammatory cells, and edema. Gnathology Division of the dental art and science concerned with the interrelationship of Grit-blasted implant surface Modification the biologic elements of the masticatory sys- of an implant or other surface through the tem in their occlusal static and functional application of sand, aluminum oxide, or oth- states. These elements include the anatomy, er abrasive material by intense air pres- histology, physiology, and pathology applica- sure. See also: Rough implant surface; ble to diagnosis and restorative treatment.11,12 Sandblasted implant surface.

G Gold cylinder attachment Attachment ele- Group function Simultaneous working-side ment comprising part of a prosthetic com- contact of primarily posterior teeth during ponent. This term specifically refers to the lateral movements of the mandible for broad alloy used in fabrication of the element. distribution of occlusal forces.12 Called also cylinder-to-transmucosal element.13 See also: Attachment element. Growth factor Diverse group of polypeptides with important roles in the regulation of Graft Organ tissue used for implantation or growth and the development of a variety of or- transplantation. Living tissue placed in con- gans. These factors control key aspects intact with injured tissue to repair a defect or volved in wound repair, including cellular mi- supply a deficiency. To induce union be- togenesis, matrix biosynthesis, chemotaxis, tween normally separate tissues. Graft op- and differentiation. See also: Cytokine; Fi- tions may include both vital and nonvital broblast growth factor (FGF); Insulin-like growth materials. See also: Allogeneic bone graft; factor (IGF); Plasma-containing growth factor; Alloplast; Alloplastic graft; Autogenous bone Platelet-derived growth factor (PDGF); Platelet- graft; Block bone graft; Bone graft; Extraoral rich plasma (PRP); Transforming growth factor graft; Fibula free flap; Free gingival graft; Full- (TGF); Vascular endothelial growth factor thickness graft; Gingival graft; Maxillary sinus (VEGF). floor graft; Nonvascularized free graft; One- stage grafting procedures; Onlay graft; Osteo- Growth hormone Protein hormone of about conductive graft; Soft tissue augmentation; 190 amino acids that is synthesized and se- Subepithelial connective tissue graft; Two- creted by cells called somatotrophs in the an- stage grafting procedures; Xenograft. terior pituitary. It is a major participant in control of several complex physiologic Graft healing The restoration of implanted processes, including growth and metabolism. living tissue to its original intergrity. Bone graft healing has two different routes: either GTR Abbreviation for Guided tissue regenera- it fails to incorporate and gradually disap- tion. pears, or it becomes incorporated as a mechanically functioning part of the host bone. Guide See: Radiographic template; Stereolitho- Osteoblasts or osteoprogenitor cells may be graphic guide, Surgical template. transferred to recipient site. Via resorption of bone graft, various growth factors are released from the noncollagenous part of bone matrix.

66 Gypsum

Guide pin Type of laboratory screw used in the Guided tissue regeneration (GTR) Surgical fabrication of a prosthetic restoration. Surgi- procedure aimed at regenerating lost peri- cal or restorative adjunctive marker used to in- odontal attachment. Creation of a secluded dicate implant angulation or location when space favoring angiogenic and osteogenic preparing osteotomy sites. See also: Incisal cells, protecting the vascular and cellular ele- guide pin. ments while probably supporting accumulation of growth factors. True periodontal re- Guide stent See: Surgical template. generation must include new cementum formation, periodontal ligament, and alveolar Guided bone regeneration (GBR) Follows the bone on a previously diseased root surface. principle of maintaining a surgically created GTR follows the principle of maintaining a space at a bony defect via a barrier mem- surgically created space around teeth via a G brane,thus excluding rapidly proliferating ep- barrier membrane, thus allowing the slow- ithelial cells and fibroblasts and permitting er–proliferating periodontal ligament cells, the growth of slower-growing bone cells and bone cells, and possibly cementoblasts to blood vessels. Graft material may also be populate the root surface. This term is not to used in combination with barrier membranes be confused with guided bone regeneration in GBR procedures to support the membrane (GBR), which describes a similar principle for and prevent its collapse. In addition, bone isolated bone defects following tooth loss and grafts provide a scaffold upon which new concerns the regeneration or augmentation bone can form. See also: Alveolar ridge aug- of bone only. mentation, Guided bone regeneration for; Bone regeneration. Gypsum See: Medical-grade calcium sulfate.

Healing abutment

H Abbreviation for Hounsfield unit. guidance (L) can then be calculated using the Hanau formula, L = H/8 + 12, where H is the HA Abbreviation for Hydroxyapatite. recorded horizontal condylar guidance.2,3

Hader bar Rectangular bar with rounded oc- Hand prosthesis Artificial substitute for a hu- clusal ridge that rigidly connects teeth or im- man hand. H plants and receives a plastic sleeve attachment for prosthesis retention.1,2 See also: Harvest Procurement of a graft from a donor Clip bar overdenture. site.

Haversian canal See: Osteon. Plastic sleeve Haversian system See: Osteon.

Hazard ratio The risk of an event occurring in one group compared with another when the primary response variable is the time to event. A hazard ratio of 1 indicates that neither group is more at risk for the event than Hader bar Hader bar retentive device the other. If the hazard ratio is, for example, 5, then one group is five times more likely to Hader bar. experience the event than the other.4 (Redrawn from Preiskel1 with permission.)

HBOT Abbreviation for Hyperbaric oxygen Hanau formula See: Hanau Quint. treatment.

Hanau Quint Five factors involved in develop- Healing Process of cure; repair or regeneration ing a balanced articulation for removable of injured, lost, or surgically treated tissue. complete dentures: incisal guidance,condylar guidance,cusp height,plane of occlusion,and Healing abutment Implant component compensating curve. First described by Ru- placed at stage-two surgery to guide peri- dolph Hanau in 1926 and incorporated in the odontal soft tissue healing prior to definitive design of a semi-adjustable articulator (Ha- prosthetic restoration. Typical cross-sectional nau H) that provided for horizontal condylar design is cylindrical. See also: Anatomic heal- guidance to be set using an intraoral protru- ing abutment. (See figure next page.) sive interocclusal record. Lateral condylar

69 Healing abutment

Healing cap See: Healing abutment. Abutment is used for an interim period to allow soft tissue healing Healing collar See: Healing abutment.

Healing screw Type of healing element.A covering screw to protect an implant and guide wound healing during the osseointegration process. See also: Healing abutment.

Hearing aid See: Bone-anchored hearing aid Bone (BAHA).

Healing abutment. Heat-curing resin Resin requiring external H Healing by first intention Restoration of conti- heat to activate polymerization. nuity of wound edges directly by fibrous adhesion without intervention of granulations. HEMA Abbreviation for hydroxyethylmethacry- Called also healing by primary intention; pri- late. See: Alloplastic graft. mary adhesion; primary union. Hematopoietic stem cell Progenitor or pre- Healing by secondary intention Wound clo- cursor cells found in the bone marrow from sure wherein the edges of the wound remain which all blood cell types of both the myeloid separated, and healing occurs from the base and lymphoid lineages are derived. and sides of the wound toward the surface via formation of granulation tissue. Called also Hemi-maxillectomy Partial surgical removal secondary adhesion; secondary union. of the maxilla.

Natural killer cell T lymphocyte Basophil Bone Neutrophil Lymphoid progenitor cell Eosinophil B lymphocyte

Hematopoietic stem cell

Multipotential Myeloid Monocyte/ stem cell progenitor cell macrophage

Platelets Red blood cells Bone (or cartilage) Hematopoietic Osteoblast supportive stroma Marrow adipocyte Stromal stem cell Lining cell

Osteocyte Pre-osteoblast

Hematopoietic Skeletal muscle stem cell? stem cell

Hepatocyte stem cell?

Hematopoietic stem cell. (Redrawn from Winslow and Kibink5 with permission.)

70 Hydroxyapatite implant surface

Hemorrhage Bleeding, often excessive and Host response Defense mechanism triggered may be uncontrollable. in graft recipient, often by pathogenic stimuli (eg, bacteria from the dental biofilm). Hemostasis Control of bleeding,via either the patient’s intrinsic clotting ability or clinical Hounsfield unit (H) Value on a quantitative measures taken to assist the process. scale indicating the degree of attenuation of x-rays by tissue in computerized tomography Heterogenous graft See: Xenograft. (CT) and thus describing radiodensity of the tissue. The name was given in honor of God- Heterograft See: Xenograft. frey N.Hounsfield,who presented the first CT scanner in 1972. Hex Implant design featuring a six-sided implant-abutment interface.6,7 Howship lacuna Small pit or groove formed by resorbing osteoclasts on the surface of H bone undergoing resorption. See also: Osteoclast.

Hybrid prosthesis Fixed, removable, or maxillofacial prosthesis designed and fabricated with an atypical combination of materials or structural components.8 Internal hex

Hydroxyapatite (HA) Bone substitute, External hex Ca10(PO4)6(OH)2, which may be ceramic or nonceramic. The ceramic form is manufac- Hex. tured by a sintering process, in which the HA is heated to 1100°C,whereby the crystals fuse Histomorphometry Method of quantifying and grow in size. See also: Bovine-derived and analyzing structures,eg,bone,soft tissue, anorganic bone matrix; Hydroxyapatite implant and vascularity,from histologic specimens; in- surface; Porous coralline hydroxyapatite; Porous volves a large range of measurements, includ- marine-derived coralline hydroxyapatite. ing numbers,length,surface area,volume,an- gles, and curvature. Hydroxyapatite-bone grafting Method of grafting in which granules of hydroxyapatite Hole See: Access hole. can be added to chips of autogenous bone to obtain the desired shape and compromise or Hollow cylinder See: Implant basket. delay resorption.

Homograft See: Allogeneic bone graft. Hydroxyapatite implant surface Primarily insoluble or partially soluble amorphous and Homologous graft See: Allogeneic bone graft. crystalline calcium phosphate coating applied to the surface of an implant, intended Horizontal osteotomy Horizontal surgical cut to enhance osseointegration. in bone.

71 Hydroxyethylmethacrylate (HEMA)

Hydroxyethylmethacrylate (HEMA) well as reduced renal clearance of calcium and See: Alloplastic graft. increased intestinal calcium absorption. Sec- ondary hyperparathyroidism is usually the re- Hygiene cap See: Healing abutment. sult of chronic renal failure and resistance to the action of PTH. Hyperparathyroidism was Hyperalgesia Increased pain response to a previously thought to be associated with loss normally painful stimulus. of radicular lamina dura and brown tumors of the bone; however, a recent study in the con- Hyperbaric oxygen treatment (HBOT) Ther- temporary population of patients indicated apy used in irradiated cancer patients to im- that changes are much more subtle and in- prove wound healing and osseointegration of clude anticipated reductions in cortical bone implants. Administration of 100% oxygen un- but do not appear to have a significant impact der increased atmospheric pressure (usually 2 on periodontal health. New findings such as H atm or 10 m sea water). The elevated partial increased incidence of oral tori may reflect a pressure of oxygen to tissues has been shown form of anabolic action of PTH in bone.11 to improve angiogenesis, bone metabolism, and success of osseointegration. It has been Hyperplasia (pl: hyperplasias) Abnormal mul- recommended that patients receive several tiplication or increase in number of normal treatments in a hyperbaric oxygen chamber, cells, resulting in an increase in tissue mass or both pre- and postoperatively.This therapy al- organ size. To be distinguished from hypertro- so has been used to treat severe anaerobic in- phy, which is related to an increase in cell size. fections in the jaws.9 Hypertension Persistent, sustained high Hyperesthesia Increased sensitivity to noxious blood pressure of 140/90 mm Hg or above. or non-noxious stimuli. Hypertension becomes a surgical risk factor if the condition is uncontrolled. Hyperocclusion Premature or abnormal contact of opposing teeth, creating excessive or Hypertrophy Non-tumor-associated increase traumatic force.10 in tissue or organ size related to an increase in constituent cell size. A hypertrophic response Hyperparathyroidism Physical condition creat- may occur as a result of a particular condition. ed by excessive amounts of parathyroid hor- To be distinguished from hyperplasia, which is mone. Primary hyperparathyroidism is caused related to an increase in cell number. by the dysfunction of the parathyroid glands. This results in oversecretion of the parathyroid Hypoesthesia Decreased perception of stimu- hormone (PTH), leading to increased bone relation by noxious or non-noxious stimuli. sorption and subsequent hypercalcemia, as

72 Immediate loading

I-beam principle See: Moment of inertia. of the skeleton,located in the sidewall and anterior wall of the pelvis. It is made up of three ICTP Abbreviation for C-terminal telopeptide bones or parts: the ilium, ischium, and pubis. of type I collagen. See: C-telopeptide pyridinoline cross-links of type I collagen. Image guidance General technique of using preoperative diagnostic imaging with com- IGF Abbreviation for Insulin-like growth factor. puter-based planning tools to facilitate surgical and restorative plans and procedures.2-4 I IIL Abbreviation for Interleukin. Imaging guide Scan to determine bone vol- Iliac bone See: Ilium. ume, inclination and shape of the alveolar process, and bone height and width, which is Iliac crest Long, curved superior border of the used at surgical site. See also: Computed to- ilium.Serves as a donor site for most preferred mography (CT) scan; Three-dimensional guid- autogenous grafts for larger augmentation ance system for implant placement; Backscat- procedures.1 See also: Iliac crest graft; Ilium. tered electron (BSE) imaging.

Iliac crest graft Common extraoral cortico- Immediate functional loading Implant pros- cancellous autogenous bone graft used in thesis is seated at the time of implant place- cases where large block volumes for alveolar ment and immediately subjected to function- ridge reconstruction are required. See also: al loading. See also: Functional loading. Alveolar ridge augmentation; Iliac bone grafting for. Immediate implant placement Implant placement immediately following extraction of a Ilium The largest and uppermost portion of tooth. This procedure must be combined in hip bone. The hip bone is the broadest bone most patients with a bone-grafting technique to eliminate peri-implant bone defects. Back view Graft source Immediate loading Application of functional or nonfunctional load to an implant at the time of surgical placement or shortly there- Ilium after; generally considered to be loading within 48 hours of implant placement.5 See also: Immediate functional loading; Immedi-

Pubis ate nonfunctional loading.

Ischium

Ilium.

73 Immediate loading, Orthodontics

Orthodontics and i. l. Loading of tempo- antibody production, cell-mediated immuni- rary orthodontic implants immediately ty, or immunologic tolerance. after placement, without an intervening period of unloaded healing. See also: Impaction of tooth Developmental distur- Orthodontic anchorage implant. bance in which a tooth does not fully erupt in- to occlusion.It may be a tooth bud or fully de- Tooth extraction and i. l. Implant placed veloped tooth surrounded by bone, either and put into function at the time the nat- partially or fully.The most frequently impact- ural tooth is extracted. ed teeth are mandibular third molars.

Immediate nonfunctional loading Implant Implant Biocompatible alloplastic device, tis- prosthesis is seated at the time of implant sue, or substance surgically placed into recipi- placement but kept out of direct occlusal con- ent for the improvement of an existing condi- tact.Loading occurs from lip and tongue pres- tion. Generally placed for restorative purposes sure and contact with food, but not from con- but may also be used with diagnostic or exper- I tact with the opposing teeth. imental intentions.7,9 See also: Angled/angulated implant; Blade implant; Complete subpe- Immediate provisionalization Fabrication riosteal implant; Craniofacial implant; Cylindri- and seating of provisional restoration at time cal implant; Disk implant; Distraction implant; of implant placement.The provisional restora- Endosseous implant; Endosseous ramus im- tion may or may not be designed for immedi- plant; Eposteal implant; Free-standing implant; ate functional occlusal contact.6 Malpositioned implant; Mini-implant; Nonsub- merged implant; Nonthreaded implant; Ocular Immediate restoration Dental prosthesis implant; One-piece implant; Percutaneous im- placed immediately following the removal of plant; Provisional implant; Ramus frame im- a natural tooth or teeth.7,8 See: Immediate plant; Root-form implant; Skin-penetrating im- provisionalization. plant; Sleeper implant; Tapered implant; Threaded implant; Transosseous implant; Two- Immunity Condition of being immune; all piece implant; Zygomatic implant. mechanisms used by the body as protection against foreign environmental agents. See Implant abutment See: Abutment; Angled/ also: Acquired immunity; Innate immunity. angulated abutment; CAD/CAM abutment; Ceramic abutment; Castable abutment; Immunocompetence Ability or capacity to de- Nonangled abutment; Nonrotating abutment; velop a normal immune response following Transmucosal abutment. exposure to antigen. Implant-abutment interface Surface forming Immunoglobulin Glycoprotein composed of a common boundary between the abutment heavy and light peptide chains; functions as and implant.10 See also: Microgap. antibody in serum and secretions. There are five major classes (IgG, IgA, IgM, IgE, and IgD) Implant anchorage Use of endosseous implant on the basis of structure and biologic activity. for anchorage during tooth movement in orthodontic treatment. Used to provide resist- Immunologic response Bodily defense in re- ance to unwanted natural tooth movement. action to an invading substance (antigen, Also,use of implants in orthodontic treatment such as virus, fungus, bacteria, or transplant- to provide anchorage for prosthesis.11 ed organ) that produces a response,including

74 Implant dentistry

Implant axis Axis through the body of an im- Implant collar Most coronal portion of an implant dictated by its greatest dimension. plant or anchorage component. The collar can have the same surface finish as the re- Implant basket Design feature of an implant maining portion of the implant anchorage that has a hollow apical portion, which allows component or have a different surface finish a core of bone to remain in the preparation designed by a manufacturer. of the osteotomy site and fit within the confines of the hollow apical portion. Called also Collar without a Collar with a different 12,13 distinguishable surface finish inverted basket or hollow cylinder. surface finish

Hollow cylinder

Implant collar Implant basket.

Implant body Anchorage component embedded in tissue, usually bone, by which all other components in an implant system are supported. Other components are stacked or threaded one into another.14

Two-piece implant Implant collar.

Implant component “One of the principal portions of an implant system or one of the structural sections of a dental implant abut- Implant body ment.“15,16 Implant body Implant configuration Pattern or arrange-

One-piece implant Two-piece implant ment of the positions of two or more implants placed intraorally. Implant body. Implant-crown ratio See: Crown-implant ratio. Implant-bone interface When bone substitutes are applied, newly formed host bone Implant dentistry Field of dental art and sci- creates an interface between the implant sur- ence concerned with diagnosis and treatment face and alveolar bone as the implant be- planning for implant–supported restora- comes osseointegrated. tions,surgical placement of implants,and the

75 Implant dentistry

restorative treatment and subsequent main- Implant length Straight-line dimension of the tenance procedures.6,7 vertical axis of an implant body. Anchorage components (implants) available in various di- Implant design Conceptualization of an im- ameters and lengths.Dimensions vary for spe- plant form at the planning or designing stage cific applications among the various implant as carried through production. manufacturers.

Implant diameter Length of the horizontal Implant-level impression To record an im- axis through the center of an implant body. plant platform at the tissue level, a coping is Anchorage components (implants) are avail- attached to the implant and an impression is able in various diameters and lengths, and made for laboratory restorative procedures. the dimensions vary among the various im- The resultant cast usually contains an elas- plant manufacturers. The symbol used to re- tomeric material at the implant site.6 flect the diameter is Ø. Implant loading Act of placing forces on an I Implant exposure Postoperative condition in implant through function and/or parafunc- which an implant is not completely covered by tion. See also: Delayed loading; Dynamic soft tissues because of wound dehiscence. A loading; Early loading; Immediate functional second surgical procedure following implant loading; Immediate nonfunctional loading; placement is used to access the implant shoul- Static loading. der, remove the healing screw, and replace it with an abutment. This can be accomplished Alveolar bone growth and i. l. Phenome- with a punch technique or flap elevation. non observed beneath mandibular cantilever prostheses. Considered to be an ex- Implant head Most coronal part or area of an ample of Wolff Law of bone loading.18 implant. The same area, ie the coronal surface, can be referred to as the platform.

Implant insertion See: Implant placement.

Implant installation See: Implant placement.

Implant interface Contacting surface of living tissue (bone) and nonliving alloplast (im- 6,7 Alveolar bone growth and implant loading plant). See also: Osseointegration. (prosthesis placement).

Alveolar bone growth and implant loading (2 years, 8 months; increase in crestal bone height: 3mm). Implant interface (arrows). (Redrawn from Brånemark et al17 with permission.)

76 Implant overdenture Implant neck Implant neck

One-piece implant Two-piece implant Alveolar bone growth and implant loading (2 years, Implant neck. 8 months; osseous proliferation). (Reprinted from Taylor18 with permission.)

Implant loss Circumstances whereby the im- Implant osseointegration See: Osseointegration. I plant is removed from the patient. See also: Early implant loss; Late implant loss. Implant overdenture Complete or partial removable prosthesis that covers and is sup- Implant material See: Commercially pure tita- ported by dental implants, individual or nium (CPTi); Hydroxyapatite (HA); Titanium splinted, and related tissue structures.6 alloy; Zirconium oxide. Bar-clip attachment and i. o. Removable Implant micromotion, effects of prosthesis covering and supported by en- See: Micromotion. dosseous implants. The implants are connected by a bar,and support is provided by Implant micromovement Relative motion be- associated hard and soft tissue structures. tween an implant body and its investing tis- The overdenture receives its retention in sues at the microscopic level; not clinically part by a clip embedded in the impression visible. surface of the acrylic resin base. See also: Denture. Implant mobility Relative motion between an implant body and its investing tissues.

Implant mount Component positioned onto the implant facilitating surgical placement of the implant into the osteotomy site. May be removed by loosening the attachment mech- Clip anism to the implant, either through removal Resin of a screw or release of a frictional fit into the Bar-clip attachment implant.14,19 and implant overdenture (in cross section). Round bar (Redrawn from Brud- Implant neck Coronal portion of the implant vik21 with permission.) in which a constriction in diameter width may or may not be present below the platform area.20 See also: Cervix; Implant collar.

77 Implant periapical lesion

Implant periapical lesion Rarely seen radiolu- Implant pullout strength See: Pullout strength. cency at the apex of dental implants that can lead to fistula formation. It has been speculat- Implant reopening See: Implant exposure. ed that these osteolytic lesions may be caused by residual bacteria in the bony recipient site.22 Implant retention Resistance to displacement (vertically) in the plane of placement. Dental Implant placement Surgical procedure for the implant(s) may be used for prosthesis reten- placement of a dental implant in bone. See tion alone or as part of a coupling system pro- also: Early implant placement; Immediate im- viding retention, support, and stability for the plant placement; Late implant placement; prosthesis. Rarely could implants provide re- One-stage grafting procedures; Two-stage tention only without simultaneously provid- grafting procedures. ing some degree of prosthesis stability as well.

Bone grafting and i. p. See: Guided bone Implant shaft Portion of the implant between regeneration (GBR); Maxillary sinus floor the coronal and apical ends. See also: Im- I elevation. plant body.

Implant placement, after extraction Implant shape Design used to categorize the See: Immediate implant placement. type of implant, such as cylinder, blade, frame, or button.24 Implant placement, in irradiated bone Irradi- ated cancer patients are at higher risk for the Implant shoulder position Final apicocoronal failure of achieving osseointegration. Howev- position of the implant shoulder, as deter- er, the use of long implants, fixed retention, mined by the surgeon, relative to the alveolar and adjuvant hyperbaric oxygen therapy has crest, ie, supracrestal, crestal, or subcrestal. resulted in a decrease of implant failures. Clearly, the clinician and patient should be I. s. p., Crestal At the level of the bony ridge aware of the considerations involving irradi- crest. ated patients,and a team approach should be applied.23 I. s. p., Subcrestal Below the level of the bony ridge crest. (See figure next page.) Implant placement, with maxillary sinus floor elevation Implants may be placed simulta- I. s. p., Supracrestal Above the level of the neously with a sinus floor elevation when the bony ridge crest. (See figure next page.) residual bone height is sufficient for primary implant stability. Otherwise, a staged ap- Gingival epithelium Abutment proach must be considered. See also: Max- illary sinus floor elevation. Connective tissue Bone crest

Implant Implant prosthesis See: Implant-supported abutment prosthesis (ISP). interface

Alveolar bone Implant prosthodontics Subspecialty area of prosthodontics concerned with the replacement of missing natural teeth and associated tissues with restorations supported by dental implants.7 See also: Implant dentistry. Crestal implant shoulder position.

78 Implant surface

Gingival epithelium Implant stability Relative mobility of an implant in relation to its surrounding bone Abutment when tested manually or with a motion-sens- Connective tissue Bone crest ing device. See also: Stability.

Finite element analysis and i. s. Implant abutment See: Finite element analysis (FEA). interface Alveolar bone Implant stability quotient (ISQ) Ratio used to evaluate implant and/or abutment stability using resonance frequency analysis (RFA). See Subcrestal implant shoulder position. also: Resonance frequency analysis (RFA).

Gingival epithelium Implant stiffness Stiffness or rigidity of an Abutment implant body as determined by mechanical I Connective tissue testing. Influenced by implant body design, Bone crest Implant composition and diameter. See also: Mo- abutment interface ment of inertia.

Implant success See: Success rate. Alveolar bone

Implant-supported prosthesis (ISP) Replace- ment for missing natural teeth that receives retention, support, and stability from dental Supracrestal implant shoulder position. implants.6,7 (Redrawn from Broggini et al25 with permission.) Finite element model and i. s. p. Computer- Implant site Edentulous area in the alveolar generated models of implant-supported ridge where an implant is planned for support prostheses. See also: Finite element analy- of a restoration. sis (FEA).

Implant site development Alveolar ridge aug- Rigidity of i. s. p. Relative stiffness of an mentation for future implant placement; re- implant prosthesis. Rigidity is affected by quires a staged approach. See also: Alveolar the materials used to fabricate the pros- ridge augmentation. thesis, and the cross sectional area and shape of the prosthesis. See: Moment of Implant soft tissue management Procedures inertia. performed to maintain periodontal health of the soft tissues surrounding oral implants, in- Implant surface External surface of an implant cluding nonsurgical procedures such as scal- body; the façade of an implant, including its ing, polishing, and oral hygiene instruction at macro and micro surface shape and texture.In defined intervals. the manufacture of an implant, various surface treatments may be used, including, but Implant splinting Act of connecting dental im- not limited to, polishing, machining, acid- plants to each other or natural teeth to en- etching, and grit-blasting, to create the de- hance the strength,stability,and stress distribu- sired surface topography.26,27 See also: Acid- tion of the supporting units.8 See: Splinting. etched implant; Anisotropic implant surface;

79 Implant surface

Grit-blasted implant surface; Hydroxyapatite Impression Recording of a negative likeness of implant surface; Rough implant surface; Sand- an object from which a positive reproduction blasted implant surface; Sandblasted, large- (ie, cast) can be made.7,8 See also: Direct grit, acid-etched (SLA*) implant surface; Sub- (open tray) impression; Implant-level impres- tracted implant surface; Turned implant sur- sion; Master impression; Pick-up impression. face. Impression coping Commercially available Implant surgery Surgical procedure involving or custom-fabricated component connected the placement of an implant. to an implant for the purpose of impression making in the transferral of implant loca- Implant survival Existence of an implant in the tion or relationship to other implants with- oral cavity under stated criteria. It is generally in the dental arch to a laboratory cast.32 considered desirable to maximize the bone- See: Retained impression coping; Square im- implant contact (BIC) (ie, osseointegration) of pression coping; Tapered impression coping. a functionally loaded implant. It can be as- I sumed,subjectively,that increased BIC is asso- Tray ciated with high implant survival. See also: Impression Survival rate. Impression material coping Implant system Group of devices or artificial objects combined for use in a common purpose. Implant systems include all hardware and related instruments/devices used for their application.14,28

Implant thread Varied geometric extrusion from the body of a metal implant.Specific de-

sign feature of a threaded implant that is Impression coping (cross section). manufacturer specific. There are basics in standard screw thread design related to the I. c. for thread transfer Impression coping geometry of a screw. Variations between used to register the thread timing so as to manufacturers are based on the pitch or slant replicate positioning for the definitive of the thread and the frequency or number of prosthesis.33 threads per millimeter along the length of the anchorage component.29,30 See also: Thread- Impression making Act of recording the neg- ed implant. ative likeness of anatomic structures in a suitable medium for a positive reproduction in Implant type Classification according to the form of a cast or moulage. Preferred term anatomic position, material composition, to impression taking. configuration,shape,surface,and/or implant- tissue interface. Type of implant falls into the Impression taking See: Impression making. choice of classification system and varies among manufacturers.31 Impression tray Container used to transport impression medium to the mouth and to lim- Implant uncovering See: Implant exposure. it material flow around the structures to be recorded while the material sets to form an impression.8 * Trademark by Straumann

80 Infection

Incidence Rate with which new events or cas- Incision Deliberate cut with a scalpel into gin- es occur during a certain period of time.34 giva, mucosa, or skin for underlying surgical Compare: Prevalence. access. See also: Beveled incision; Buccal mucosal incision; Crestal incision; External Incisal Cutting surface of incisors or canines.7,8 bevel incision; Internal bevel incision; Releas- ing incision; Sulcular incision. Incisal guidance Effect of anterior maxillary and mandibular contacting teeth on mandibu- Incision line Path of an incision through the lar movements. When an occlusal scheme is soft tissues. developed in semi-adjustable and fully adjustable articulators that simulate mandibular Incisive foramen Foramen of the incisive movement, the incisal guide pin and guide canal containing the nasopalatal nerve and table provide this influence, which is under accompanying blood vessels. It is located just the control of the clinician.7 palatal to the two maxillary central incisors along the median suture. I. g. angle Angle formed by the intersection I of the occlusal plane and a line formed by Inclusion criterion Requirement (such as a di- connecting the maxillary and mandibular agnostic feature or clinical conditions) that central incisor tips in centric occlusion. must be met for eligibility to participate in a research project, as specified in the protocol. Compare: Exclusion criterion.

Index Core or mold used to record and/or register relative positions of teeth, anatomic structures, or implants to one another. The recording medium can have reversible or irre- versible characteristics.7 See also: Occlusal index; Remount index; Transfer index.

Indirect (closed tray) impression Impression technique by which a stock or custom fabricated tray with impression material is used to

Incisal guidance angle. record the negative likeness of placed cop- ings. Once the impression material is set and I. g. in semi-adjustable articulator See: the tray is removed from the mouth, the cop- Articulator, Semi-adjustable; Hanau Quint. ings are removed from the mouth and seated in the impression with attached laboratory Incisal guide pin Adjustable rod attached to analogs prior to pouring a cast.6 one member of an articulator that contacts the guide table on the opposing member to Infection Localized collection and growth of maintain the degree of cast and jaw separa- bacteria that cannot be contained by the host tion determined in the mouth.7 See also: and must be eliminated by systemic antibi- Articulator. otics and/or incision and drainage. Clinically, a distinction is made between acute and chronic infections. See also: Acute infection; Chronic infection.

81 Inferior alveolar artery

Inferior alveolar artery [arteria alveolaris infe- Infracture Surgical fracturing of a bony struc- rior] Runs with the inferior alveolar nerve ture into a neighboring body cavity with the and enters the mandibular foramen at the use of hand instruments, such as in the os- medial aspect of the ramus. It continues teotome technique where the maxillary sinus through the mandibular canal with the nerve floor is fractured into the maxillary sinus. See to the mental foramen, where it divides into also: Osteotome technique. the mental and incisive branches. Infrastructure Ceramic or metal implant-sup- Inferior alveolar canal See: Mandibular canal. ported structure to which a secondary framework or prosthesis is attached.6 See also: Inferior alveolar nerve See: Alveolar nerve. Framework.

Inflammation A localized protective response Initial stability See: Primary stability. elicited by proximate microbes and/or tissue injury, which serves to destroy, dilute, or wall Injury See: Trauma; Wound. I off both the injurious agent and the injured tissue. It is marked by capillary dilatation, Innate immunity Congenital immunity,based leukocytic infiltration, redness, heat, pain, on the genetic constitution of the individual. swelling, and often loss of function. Insert See: Implant placement; Place. Acute i. Intense, localized inflammation, which is the cellular and vascular reaction Insertion torque Rotational force applied to to injury. an object, usually a screw, during placement and/or tightening. Chronic i. Inflammation of slow progression that tends to persist long-term (from weeks Instability See: Primary stability; Secondary to years). It occurs when the injuring agent stability. persists in the lesion and the host tissues respond in a manner that is not sufficient Install See: Implant placement; Place. to overcome completely the continuing effects of the injuring agent. It may be a con- Insulin 1 Polypeptide hormone that regulates tinuation of an acute or a prolonged low- carbohydrate metabolism, which is produced grade inflammation and usually causes in the Islets of Langerhans in the pancreas. permanent tissue damage.Chronic inflam- Apart from being the primary effector in car- mation localized to the oral soft tissues, in- bohydrate homeostasis, it influences fat me- cluding alveolar and gingival mucosa. tabolism by changing the liver’s ability to release fat stores.Insulin’s concentration (more Informed consent Principle of biomedical re- or less, presence or absence) has widespread search stating that study participants have effects throughout the body. the right to know the risks and the benefits involved in participating in a research study Insulin-like growth factor (IGF) Polypeptides and that they may not be included in such structurally similar to insulin. The IGF family studies without their explicit written consent. consists of two ligands (IGF-I and IGF-II), two cell-surface receptors (IGF-1R and IGF-2R) Infrabony See: Intrabony. and several IGF binding proteins. They con-

82 Internal abutment connection

trol growth, differentiation, and the mainte- nate immunity.Two principal forms exist,des- nance of differentiated function in numerous ignated IL-1alpha and IL-1beta, with appar- tissues. In oral tissues, IGFs are involved in ently identical biological activity. At low con- tooth growth and development, in the biolo- centrations, IL-1 principally acts to mediate gy of several periodontal structures, and in local inflammation, causing mononuclear various aspects of salivary gland homeosta- phagocytes and endothelial cells to synthesis.35 size leukocyte-activating chemokines; at high concentrations IL-1 enters the blood stream Interdental bone height The distance be- and acts as an endocrine hormone. tween the bone crest and the contact point between two teeth. Interleukin-4 (IL-4) Lymphokine produced by antigen- or mitogen-activated T cells.Its prin- Interdental papilla See: Gingival papilla. cipal role is regulation of IgE- and eosinophil- mediated immune reactions. It stimulates Interdental soft tissue See: Gingival papilla. switching of B cells for production of immunoglobulin E (IgE), is a growth and differ- I Interdental space See: Interproximal space. entiation factor for T cells (particularly helper T cells [Th2], is a growth factor for mast cells, Interferon-gamma (IFN-γ) One of a group of and stimulates the expression of some adhe- heat-stable soluble basic antiviral glycopro- sion molecules on endothelial cells. Formerly teins of low molecular weight that are pro- called B lymphocyte stimulatory factor 1. duced by T-cells in response to either specific antigen or mitogenic stimulation. It regu- Interleukin-6 (IL-6) Lymphokine produced lates the immune response (eg, by the acti- by antigen- or mitogen-activated T cells, fi- vation of macrophages and natural killer broblasts, macrophages, and other cells that cells) and is used in a form obtained from re- induce differentiation and maturation of B combinant DNA technology in the control of cells and growth of myeloma cells. It acti- infections and in the treatment of neo- vates and induces proliferation of T cells and plasias. stimulates synthesis of immunoglobulin and plasma proteins such as fibrinogen. Interimplant papilla See: Gingival papilla. Interleukin-8 (IL-8) Chemokine produced by Interim prosthesis See: Provisional prosthesis. monocytes, endothelial cells, and other cells acting as a chemotactic and activator for neu- Interleukins Family of potent and multifunc- trophils; may play a role in the extravasation tional proteins that serves as a link between of neutrophils in inflammation. inducer and effector cells during immune and inflammatory responses; involved in the re- Intermaxillary relationship See: Maxillo- cruitment of immune and inflammatory pre- mandibular relationship. cursor cells. Some interleukins have been implicated in the pathogenesis of periodontal Internal abutment connection Connection and peri-implantar diseases. between an abutment and implant in which the coronal surface of the implant has a core Interleukin-1 (IL-1) An interleukin produced that is threaded or tapered or has a polygo- by macrophages and monocytes that medi- nal design. ates the host inflammatory response in in-

83 Internal bevel incision

Internal bevel incision Reduces the thickness Interquartile range (IQR) Range of values of the mucogingival complex from the sulcu- containing the central half of the observa- lar side. Made from a coronal to apical directions; ie, the range between the 25th and the tion, it is usually accomplished for reducing 75th percentiles. It is used with the median gingival thickness in the posterior segment. value to report data that are markedly non- normally distributed.34 See also: Median.

Interstitial collagenase See: Mammalian collagenase.

Intrabony Within a bone.Used for description of bony defects or periodontal pockets with their base apical to adjacent bone crest. Called also infrabony.

I Intramembranous ossification Bone formation in which connective tissue serving as a membrane becomes a template for bone dep- Internal bevel incision. osition without any intermediate formation (Redrawn from Sato36 with permission.) of cartilage. Flat bones are embryonically formed in this way. When sufficient vascular- Internal distractor See: Intraoral distractor. ity is present adjacent to the condensed mesenchyme, the osteoblasts begin to produce Internal hexagon osteoid. A similar process takes place in heal- See: Hex; Internal abutment connection. ing of bone defects.

Internal irrigation Irrigation of the implant Intramobile connector Implant-abutment con- bed through the contra-angle handpiece and nection incorporating a movable or flexible in- drill itself. This irrigation technique has not terpositional component intended to modify or succeeded in daily practice, since external ir- reduce the load transferred from the prosthesis rigation seems to be more efficient and cost- to the underlying implant and its surrounding effective. Compare: External irrigation. bone. A connector intended to simulate mobility of the periodontal ligament.It was first pop- Internally threaded ularized by Axel Kirsch with the IMZ implant See: Internal abutment connection. system. Called also intramobile element.

Interpore Proprietary product name for Intramobile element (IME) See: Intramobile porous coralline hydroxyapatite. connector.

Interproximal space Intervening distance be- Intramucosal insert See: Mucosal insert. tween adjacent teeth in the dental arch.7,37 Intraoral distractor Distraction device de- Interpupillary line Imaginary line connecting signed to be placed within the oral cavity for the pupils of the eyes. It is useful for evaluat- alveolar distraction osteogenesis. Called also ing frontal facial symmetry and orientation of internal distractor. See also: Distraction os- the occlusal plane when arranging artificial teogenesis (DO). teeth.11

84 ISQ

Intraosseous Internal aspect of bone mainly Irrigation Rinsing of the surgical field with a consisting of bone marrow and trabecular solution. Sterile physiologic saline solution is bone. Synonym for endosteal. recommended for this purpose.

Intraosseous distractor See: Endosseous Ischemia Blockage or inadequate supply of distractor. oxygenated blood to tissues or organs; may be caused by overzealous tight suturing. Intrasulcular incision Incision approach made along the sulcus of a tooth. Isoforms Approximately 20 BMP family members (isoforms) have been identified and Inverted basket See: Implant basket. characterized. Each isoform is involved in some developmental process, and BMP-2 has Investment casting See: Lost-wax casting been the most-studied isoform for therapeu- technique. tic purpose in bone regeneration.38

In vitro [Latin: in glass]. Artificial environ- Isograft Tissue graft obtained from a donor I ment created outside a living organism (eg, a who is genetically identical to the recipient.39 test tube or culture plate) that is used in experimental research to study a disease or Isotropic Quality of having the same properties process. Compare: In vivo. in all dimensions, irrespective of direction.

In vivo [Latin: in life]. Biologic processes that ISP Abbreviation for Implant-supported pros- take place within a living organism or thesis. cell. Compare: In vitro. ISQ Abbreviation for Implant stability quotient. IQR Abbreviation for Interquartile range.

Irradiation Process by which an organ or tissue is exposed to radiation. See also: Radiation.

Bone marrow effects and i. See: Osteoradionecrosis (ORN).

Hyperbaric oxygen treatment and i. See: Hyperbaric oxygen treatment (HBOT).

Junctional epithelium

Jig “A device used to maintain mechanically Junctional epithelium (pl: junctional epithe- the correct positional relationship between a lia) Single or multiple layers of nonkera- piece of work and a tool or between compo- tinizing cells adhering to the tooth or oral im- nents during assembly or alteration.”1 plant surface at the base of the gingival sulcus. A long junctional epithelium is an apical- Joint Articulation of two or more mechanical ly extended junctional epithelium resulting parts or bones with each other; interface be- from periodontal repair following treatment tween two or more elements. See also: of periodontal disease. Formerly called ep- Prosthetic joint. ithelial attachment. See also: Epithelium. J Joint replacement See: Prosthetic joint. Oral sulcular epithelium Joint-separating force Tensile force applied to Oral epithelium separate two or more contacting compo- Junctional epithelium nents. Generally applied to bolted or friction fit joints.

Connective tissue

Bone

Junctional epithelium. (Redrawn from Lindhe et al2 with permission.)

Knife-edge ridge

Kaplan-Meier analysis Statistical method Knife-edge ridge Severely atrophic edentulous used in survival (time-to-event) analysis to maxillary or mandibular alveolar ridge with a estimate the probability of an event, such as sharp crest resulting from progressive resorp- implant loss, at different times in the study.1 tion, especially after long periods of denture wearing. “Cawood & Howell class 4 for the an- Keratinized gingiva Marginal and attached terior maxilla and mandible.”3,4 See also: gingiva that excludes soft tissue of the inter- Alveolar ridge, Classification of. dental col region – interproximal gingival tissue between posterior teeth where epithelium is devoid of keratinization. K

Keratinized cell

Pyknotic nucleus

Granular cell

Stratum corneum

Keratohyalin granules Stratum granulosum Prickle cell

Stratum spinosum

Stratum basale

Basal cell Migration of cells from basal layer to gingival sulcus from of cells Migration

Keratinized gingiva. (Redrawn from Grant et al2 with permission.)

Laser

Laboratory analog Copy of a prosthetic or implant element used in laboratory fabrication procedures.1 See also: Analog/analogue. Osteoblasts

Laboratory screw Element used in dental lab- Osteoid oratory procedures in the fabrication of the

prosthesis. Laboratory screws can be modi- Mineralization front fied, eg, elongated or made from a different alloy, from the definitive design.2

Restoration

Laboratory L screw Lamellar bone.(Top: Von Kossatolnidine blue stain; magnification x800. Bottom: Fluorescence after double tetracycline labeling with 1-week-interval-mineralization rate 1–2 micron per day.) (Reprinted from Buser et al3 with permission.)

Implant Laminate Layered material.In dentistry,a thin layer or veneer of restorative material applied to the surface of a tooth, usually for cosmetic purposes. See also: Facing; Veneer. Laboratory screw. (Redrawn from Yanase and Preston2 with permission.) Lapping tool Instrument used with or without abrasives to improve the adaptation of two op- Lamellar bone Adult, mature bone consisting posing surfaces. In the laboratory, an instru- of 3- to 5-μm-wide layers of mineralized col- ment,often rotating,used to remove casting ir- lagen fibrils. The orientation of fibrils regularities by means of grinding or polishing.4 changes from layer to layer; this construction is often compared with that of plywood.It ap- Laser Acronym for light amplification by stimu- pears birefringent in polarized light and is lated emission of radiation; a source that emits found in mature cortical as well as trabecular photons in a coherent beam that can propa- bone. gate over long distances without significant divergence and can be focused on very small areas. Can have a very narrow bandwidth, compared with the broad spectrum emitted by most lamps. Light may be emitted contin- uously or in the form of short or ultrashort

91 Laser

pulses,with durations from microseconds to a tion of the sinus membrane, bone augmenta- few femtoseconds. These properties may be tion materials (ie,autografts,allografts,alloplas- the consequence of the very high coherence ts, xenografts, or combination mixtures) are of laser radiation. Usually includes an optical used to elevate the sinus floor and allow the cavity (resonator), in which light can circulate placement of dental implants. If the original (eg, between two end mirrors) and which bone height permits sufficient primary implant holds a gain medium that serves to amplify stability,then a simultaneous procedure can be the light. See also: Er:YAG laser; Low-level used. Otherwise, a staged approach is recom- laser therapy; Nd:YAG laser; Pulsed-mode laser. mended.5,6 Compare: Osteotome technique; See also: Maxillary sinus floor elevation. Laser etching Creation of an altered surface by the application of laser energy; frequently Maxillary sinus membrane used to apply permanent markings to metal objects, such as surgical instruments.

Late implant loss Outcome related to the loss of an implant that occurred after implant osseointegration. Compare: Early implant loss.

Late implant placement Implant placement

L at least 6 months following tooth extraction. Window preparation Sinus floor elevation The chosen time period should allow for sufficient bone regeneration of the extraction Lateral window technique. socket, and consequently,implant placement without bone augmentation procedure. Late Le Fort I downfracture See: Alveolar ridge implant placement bears the risk of bone at- augmentation, Le Fort I downfracture for. rophy in the orofacial direction, particularly in the anterior maxilla. Le Fort osteotomy Surgical sectioning of the maxilla from the rest of the skull. Le Fort I os- Latency period See: Consolidation period. teotomy sections the midface through the walls of the maxillary sinuses, the lateral Lateral Bennett shift See: Bennett movement. nasal walls, and the nasal septum, just superior to the apices of the maxillary teeth. Le Lateral cephalograph Extraoral radiograph showing the region of the skull that comprises the bones of the face (ie, the viscerocrani- um). It requires a 18 x 24-cm or 20 x 25-cm image receptor and is intended for diagnosis in orthodontics. It also has been used in the preoperative implant examination to determine size and length of implants to be placed in the interforaminal region.

Lateral window technique Surgical technique Le Fort I Le Fort II Le Fort III using a window into the lateral wall of the max-

illary sinus to gain access to the maxillary sinus Le Fort osteotomy levels. membrane. Following mobilization and eleva- (Redrawn from Daskalogiannakis7 with permission.)

92 Litigation

Fort II osteotomy is similar to Le Fort I, except modeling of bone by digesting the osteoclast- that instead of continuing anteriorly across resistant surface layer,whereby the bone ma- the pyriform aperture, the osteotomy contin- trix is opened and osteocalcin is released ues superiorly towards the orbit. Le Fort III os- from the bone matrix. The osteocalcin is osteotomy is designed to separate the entire fa- teoclast-chemotactic. cial mass from the cranial base along the in- terfrontofacial and interpterygomaxillary planes.7

Leukocyte Blood cell that is colorless,lacks hemoglobin,and contains a nucleus.Leukocytes are involved with host defense and are classified in two large groups: granular leukocytes (basophils, eosinophils, and neutrophils) and nongranular leukocytes (lymphocytes and monocytes). Called also white blood cell.

Leukotoxin Toxin produced by certain bacteria Lining cells that is specifically destructive to leukocytes, particularly polymorphonuclear leukocytes. L Life table analysis Study or examination of success/survival rates experienced by a specif- 8 ic population over a particular period of time. Lining cells (magnification x280). (Reprinted from Garant10 with permission.)

100 Lining mucosa Type A See: Alveolar mucosa; Oral mucosa. 80 Type B Success in % Success 60 Lip line Contour of the inferior border of the 40 upper lip at rest or during maximum muscular

20 retraction; reference for position of the residual ridge crest and for orientation of the oc- 0 clusal plane when planning for esthetics and 012345 Years following implantation function during restorative treatment. The lower lip line is the relative position of the low- Life table analysis (Courtesy of P.C. O’Brien.) er lip at rest or during voluntary retraction.11

Lingual Designation for areas adjacent to the Lipopolysaccharide (LPS) A large molecule tongue.Often used to identify a tooth surface consisting of lipids and sugars joined by or ridge segment. Called also oral.9 chemical bonds. It is a major component of the cell wall of gram-negative bacteria, a type Lining cells Old osteoblasts occupying the sur- of endotoxin, and an important group-specif- face of mineralized bone with the primary ic antigen. See also: Endotoxin. function of nutritional transfer from the surface to osteocytes via cellular extensions. Litigation See: Malpractice litigation; Product They participate in the normal physiologic re- liability litigation.

93 Load

Load Force applied to an object. In implant (termed simple regression) or more (termed dentistry, generally meant to be the place- multiple regression) explanatory variables.Lo- ment of a superstructure on an implant to gistic regression is when the response variable bring it into contact with the opposing teeth is a binary categorical variable (such as dis- during function. See also: Occlusal force. eased or not diseased) and it can be simple or multiple.”13 Loading Act of applying load to an object. Al- so,filling a receptacle,such as a syringe. See Longitudinal study Study that follows a pa- also: Axial loading; Biomechanical load mod- tient over an extended period of time.14 el; Brunski and Hurley model; Delayed loading; Early loading; Immediate loading; Implant Lost-wax casting technique Process of invest- loading; Progressive loading; Skalak models of ing a wax or plastic pattern in a refractory prosthesis loading; Wolff Law. mold, then applying heat to melt the pattern, resulting in a void into which molten metal Effects of l. on bone-implant contact It is can be cast.15 generally assumed that loading within a range of physiologic tolerance stimulates Low-intensity laser See: Low-level laser therapy. increased bone-implant contact, while loading in a magnitude greater than the Low-level laser therapy Type of laser therapy range of physiologic tolerance may cause applied for the stimulation of cell function. L loss of bone-implant contact. See also: Unlike high-power surgical lasers used to cut, Bone-implant contact (BIC). coagulate, and evaporate tissues for surgical procedures, their biologic effect is not ther- Effects of l. on framework Load distribu- mal. Called also bio-stimulating lasers or low- tion to supporting implants is affected by intensity lasers. the relative stiffness of the prosthesis connecting the implants. With a rigid prosthe- LPS Abbreviation for Lipopolysaccharide. sis, load is transferred relatively equally to all underlying implants. With a more re- Luting of crowns See: Cementation. silient prosthesis, loading tends to be greatest at the implant closest to the point Lymphocyte Mononuclear,nonphagocytic leu- of load application.12 kocytes that originate from stem cells and differentiate in lymphoid tissue (as of the thy- Screw joint effects on l. Mechanical effect mus or bone marrow).They are the typical cel- of loading, usually cyclic in nature, on the lular elements of lymph and constitute 20% to stability of bolted or screw-retained joints. 30% of the white blood cells of normal human Micromotion and fatigue are potential blood. Divided on the basis of ontogeny and negative occurrences that may result from function into two classes: B and T lympho- such loading. cytes,responsible for humeral and cellular immunity, respectively. See also: B cell; Macro- Localized ridge augmentation See: Alveolar phage; Mast cell; Monocyte; T cell. reconstruction; Alveolar ridge augmentation; Guided bone regeneration (GBR). Lyophilization Creation of a stable preparation of a biologic substance (eg, blood plas- Logistic regression analysis “Statistical ap- ma, serum) by rapid freezing followed by de- proach to predict or estimate the value of a re- hydration under high vacuum. See also: sponse variable from the known values of one Freeze-drying.

94 Magnetic resonance imaging (MRI)

Machined implant surface romagnetic alloy. Elements consist of a mag- See: Turned implant surface. net and a keeper,which is made of a ferromagnetic alloy. See also: Magnetic attachment. Macro interlock Connection between components such as the abutment-to-implant con- Magnetic attachment Retentive device used nection that possesses visible (macro) inter- in removable prostheses requiring the use of digitating or interlocking features. a magnet opposing a keeper fabricated of a ferromagnetic alloy.3 See also: Magnet at- Macromotion Motion that is substantial in na- tachment system. ture. It is generally applied to the implant body in situations where implant stability is lacking at the time of placement or as a result of loss of osseointegration. Magnet

Macrophage Any of a variety of forms of M mononuclear phagocytes in tissues. Deriva- tive hematopoietic stem cell in bone marrow. Keeper Relatively large cell with round or indented nucleus, well-developed Golgi apparatus, many endocytotic vacules, lysosomes and phagolysosomes, and a plasma membrane covered with microvilli. Magnetic attachment. (Redrawn from Staubli and Bagley3 with permission.)

Macrophage-derived angiogenic factor (MDAF) Macrophage-derived factor that promotes pro- Magnetic resonance imaging (MRI) Imaging liferation of new blood vessels.It is released by that uses magnetic fields and radio waves to hypoxic macrophages at the edges or outer produce high-quality two- or three-dimension- surfaces of wounds and initiates revasculariza- al images without use of ionizing radiation tion in wound healing. (x-rays) or radioactive tracers. During an MRI, a large cylindrical magnet creates a magnetic Magnet Certain metals or ferromagnetic al- field around the patient through which radio loys that demonstrate an attractive or repul- waves are sent. Medical MRI most frequently sive force between these materials.1,2 relies on the relaxation properties of excited hydrogen nuclei in water.The vast quantity of Magnet attachment system Retentive mech- nuclei in a small volume sum to produce a de- anism that is nonmechanical but dependent tectable change in a magnetic field, which can on the attraction properties of rare-earth com- be measured from outside the body.When the position, such as samarium-cobalt and a fer- magnetic field is imposed, each point in space

95 Magnetic resonance imaging (MRI)

has a unique radiofrequency at which the sig- or in a staged approach. Either vascular- nal is received and transmitted. Sensors read ized or free grafts are utilized. the frequencies and a computer uses the information to construct an image. Fracture of the m. Rare complication following implant placement in a severely Maintenance See: Examination. atrophic mandible or following peri-implant bone loss in an atrophic mandible.5,6 Malpositioned implant Atypical or faulty position of an implant, rendering it nonusable Mandibular block graft Intraoral source of au- for restoration. Implant placed incorrectly togenous block graft taken from the patient within the dental arch or prepared site so as and fixed to a defect site. The block may be to compromise its use. harvested either from the ramus buccal shelf or the mandibular symphysis. Malpractice litigation Legal proceeding in a court or a judicial contest to determine a M. b. g. from the ramus Ramus block graft dereliction from professional duty or a failure taken from the buccal shelf area. Advan- to exercise an accepted degree of profession- tages include less donor site morbidity; dis- al skill or learning by one rendering profes- advantages include limited block dimensional services that results in injury, loss, or sion and a low cancellous component.7 damage.4 M. b. g. from the symphysis Block graft tak- Mammalian collagenase Proteolytic enzyme en from the symphysis region apical to the M that degrades native collagen. After initial incisors. Advantages include greater block cleavage, less-specific proteases will com- dimensions, a greater cancellous portion plete the degradation. Collagenases from and easier surgical access. Disadvantages mammalian cells are metalloenzymes and include the potential of sensory distur- are collagen-type specific (collagenase 1, col- bances following surgery.8 lagenase 2, and collagenase 3). They may be released in latent form (proenzyme) into tis- Mandibular canal Bone canal of the mandible sues and require activation by other proteas- in which the inferior alveolar nerve and ac- es before they will degrade fibrillar matrix. companying vessels are housed. They are involved in the degradation of collagen during tissue repair or during embryonic Mandibular flexure Deformation of the man- and fetal development. Called also interstitial dible during function caused by the contrac- collagenase. tion of the elevator and depressor muscles of the mandible.9 Mandible Lower jaw consisting of the horizontal body and two perpendicular rami that Mandibular foramen Foramen located at the end in the coronoid and condylar processes. medial aspect of the ramus where the inferi- The condyle articulates in the temporal fos- or alveolar blood vessels and nerve enter the sae with the temporomandibular joint. mandible.

Cancer-related discontinuity defects of the Mandibular movement Muscle- and liga- m. Defects resulting from mandibular or ment-activated border and/or intraborder maxillary tumor resection that require ex- movements of the lower jaw.10–12 (See figure tensive reconstruction.This can be accom- next page.) plished simultaneously with the resection

96 Matrix component

Marginal tissue recession See: Gingival recession.

Marrow cavity Central portion of bone between the cortices where marrow is formed.

P CO Mast cell Connective tissue cell with unknown CO CR CO R– RL HM specific physiologic function.Capable of elab- LateralHO Frontal Chewing orating basophilic, metachromatic, cytoplas- cycle mic granules containing heparin, hystamine, and in some species, serotonin. MO MO Mandibular movement.P-protrusive; CO-centric occlusion; Master (definitive) cast Final cast used for MO-max. opening; R-rest position; RL-right lateral, CR-cen- 10,16 tric relation; HM-hinge movement; HO-habitual opening. the fabrication of a prosthesis. (Redrawn from Sharry13 with permission.) Master impression Negative likeness acquired Mandibular overdenture for the fabrication of a cast on which a pros- See: Implant overdenture. thetic restoration is produced.10,11,17

Mandibular staple implant Mastication Act of grinding or crushing food See: Transosseous implant. (chewing) preparatory to deglutition and di- gestion. The masticatory cycle involves three- Marginal gingiva Most coronal portion of gingi- dimensional movements of the mandible ob- M va that surrounds the tooth but is not directly served in the frontal, horizontal, and sagittal attached to the tooth surface. A healthy gingi- planes.18 See also: Mandibular movement. val margin forms the wall of the gingival sulcus. Called also free gingiva and gingival margin.14 Masticatory mucosa Mucosa and gingival tissue that covers the hard palate. Alveolar mucosa Mucogingival junction Materia alba Loosely adherent, white curds of matter composed of dead cells, food debris, bacteria, and other components of the dental plaque that lack the organized struc- Cementum Alveolar bone ture of a biofilm and are found on tooth or Dentoperiosteal Attached gingiva oral implant prosthesis surfaces. fibers Circular fibers Dentogingival fibers Alveologingival fibers Matrix Extracellular substance in which tissue

Junctional Free gingival groove cells (eg, of connective tissue) are embedded. epithelium Formative cells or tissue of a fingernail, toe-

Gingival sulcus nail, or tooth. Mass by which something is en- Marginal gingiva. closed or in which something is embedded (or- (Redrawn from Grant et al15 with permission.) ganelles suspended in the cytoplasmic matrix).

Marginal peri-implant area That region sur- Matrix component The part of an attachment rounding the gingival crest adjacent to an oral that is designed specifically as a receptacle implant including the interimplant gingival for the matching or mate component (patrix), tissue. such that when engaged it provides mechan-

97 Matrix component

ical retention. Attachment systems that use Maxillary sinus augmentation mechanical retention are available in various See: Maxillary sinus floor elevation. designs. See also: Attachment system; Ball attachment system; Bar attachment system; Maxillary sinus floor elevation Augmentation Stud-type attachment system; Telescopic cop- procedure for the placement of implants in ing attachment system. the posterior maxilla where pneumatization of the maxillary sinus and/or vertical loss of Maxilla Paired bone making up a large part of alveolar bone have occurred. Autografts are the facial skeleton, including the body of the often mixed with bone substitutes to increase maxilla and the frontal, palatine, alveolar,and the volume of the augmentation material or nasal processes.19 See also: Resorbed maxilla. prevent graft resorption during remodeling. Two surgical techniques are well known and Computed tomography imaging of the m. routinely used in daily practice: the lateral Series of 25 to 45 1-mm axial scans to im- window technique, first described by Boyne age the maxilla. For radiation protection, and James in 198020; and the transalveolar os- the examined area should be restricted to teotome technique, first described by Sum- the region of interest.In implant dentistry, mers in 1994.21,22 See also: Lateral window 25 1-mm axial scans have proven suffi- technique; Osteotome technique. cient. Effective radiation dose for this examination should range from 2.5 mSv to Maxillary sinus floor graft Graft used to aug- 6 mSv and, not exceed this value. ment the vertical height in the maxillary sinus for implant placement.A particulate mix- M Maxillary antrum See: Maxillary sinus. ture of autogenous bone and a bone substitute is often used. See also: Maxillary sinus Maxillary artery Artery divided into three parts, floor elevation. based on its location relative to the lateral pterygoid muscle, and further divided into various Maxillary sinus membrane Thin mucous branches. Different branches supply the man- membrane lining the sinus cavity and charac- dibular teeth, gingiva, and chin; the maxillary terized by respiratory epithelium. Formerly teeth, gingiva, and maxillary sinuses; as well as called Schneiderian membrane. the hard palate and the lateral nasal walls.19 Perforation of the m. s. m. Iatrogenic per- Maxillary cross-arch splint foration or tear of the maxillary sinus See: Cross-arch stabilization. membrane during sinus floor elevation; the most common complication of this Maxillary overdenture procedure. Small perforations may not See: Implant overdenture. need treatment if the elevation can continue uneventfully; larger perforations Maxillary sinus Large pyramidal cavity within may be covered by collagen membranes the body of the maxilla. Its walls are thin and and/or by a fibrin sealant. Incidence of correspond to the nasal, orbital, anterior,and maxillary sinus membrane perforation infratemporal surfaces of the body of the does not appear to affect the outcome of bone.The maxillary sinus communicates with implant success.23,24 See also: Valsalva the nose at the infundibulum of the middle maneuver. meatus through the maxillary sinus ostium.

98 Median

Maxillary sinus pneumatization The maxil- Maxillomandibular relationship Any possible lary sinuses are usually fluid-filled at birth. spatial relationship of the mandible to the Pneumatization, or filling of the sinus cavity maxilla.10,11,27 See also: Centric relation. with air,takes place during the latter phase of growth as the permanent teeth develop and Eccentric m. r. Any position of the mandible erupt. Pneumatization can be so extensive as relative to the maxilla other than centric re- to expose tooth roots with only a thin layer of lation or centric occlusion.11 soft tissue covering them. Later with tooth loss, further pneumatization can take place, McGill Consensus Statement Conclusion leading to a reduced vertical height in the from a 2002 meeting of experts held at alveolar bone. This often requires sinus floor McGill University in Montreal, Canada, dis- elevation procedures to allow the placement cussing implant overdenture therapy.Consen- of dental implants. sus statement on the use of overdentures was that a two-implant supported overdenture Maxillary sinusitis Infection in the maxillary was the first choice for restoration of the sinus,either acute or chronic in nature,which edentulous mandible and not a conventional can be caused by dental pathology, such as denture.28 root tips, periapical lesions, overfilled endodontic material, and oroantral fistulae or MDAF Abbreviation for Macrophage-derived openings, among others. Acute sinusitis is an angiogenic factor. absolute contraindication for surgery, whereas, chronic sinusitis is a relative contraindica- Mean Arithmetic average of a group of values. tion where implant and/or sinus floor eleva- The mean is a common descriptive statistic M tion procedures may still be performed. best used to summarize the central tendency of normally distributed data. In this use, it is Maxillary tuberosity Most distal aspect of the usually accompanied by the standard devia- maxillary alveolar process. Bone structure in tion.29 See also: Standard deviation (SD). the tuberosity is often characterized by low density and fatty tissue.25 Mechanical failure Failure of a component caused by mechanical forces. It may be cata- Maxillectomy Complete surgical removal of strophic in nature or the result of wear, fa- the maxilla. tigue, or plastic deformation.

Maxillofacial prosthesis Restoration replac- Mechanicoreceptor Nerve ending (receptor) ing oral, stomatognathic, or craniofacial that is excited by mechanical pressure. The structures with a fixed or removable prosthe- mechanical pressure may result from muscle sis. Support and/or retention is provided by contraction, external pressure (including natural teeth and supporting tissues, en- sound), or touch. dosseous implants, or adhesives.26 Median Value that separates the highest 50% Maxillofacial prosthetics Branch of prosthet- of the scores from the lowest 50%. Useful in ic dentistry concerned with the restoration describing the central tendency of abnormal- and/or replacement of stomatognathic and ly distributed data, because it is less influ- craniofacial structures with fixed or remov- enced by the outlier data (ie, extreme values) able prostheses.11 that skew the distribution and can have a dis- proportionate effect on the mean.29

99 Medical device

Medical device Instrument, apparatus, ma- Mental nerve The inferior alveolar nerve chine, or other related article, including any emerges from the mental foramen as the components (part or accessory), intended for mental nerve to innervate the skin of the chin use in the diagnosis of disease or other con- and the lower lip.31 ditions,for the cure,mitigation,treatment,or prevention of disease in humans.30 Mesenchymal cell Type of pluripotential cell that constitutes the mesenchyme. Medical-grade calcium sulfate A ceramic, the oldest resorbable biomaterial currently in Mesenchymal progenitor cell (MPC) use, which has been used as a filling material See: Mesenchymal stem cell (MSC). in bone cavities for more than 100 years. Cal- cium sulfate dihydrate [CaSO4-2(H2O)] (also Mesenchymal stem cell (MSC) Contributes to known as gypsum) is mined from the earth. the regeneration of mesenchymal tissues (eg, bone, cartilage, muscle, ligament, tendon, Medicolegal risk analysis The probability of a adipose, and stroma) and is essential in pro- patient suffering harm as applicable to med- viding support for the growth and differenti- icine and law. ation of primitive hemopoietic cells within the bone marrow microenvironment for the Medullary bone Any substance resembling repair of bony defects. The most accessible marrow in structure. Bone formed as an out- source of mesenchymal stem cells is bone growth from the endosteal lining of the shaft marrow, although they have been isolated of long bones in birds. The main purpose is from a number of tissues, including the liver, M accumulation of calcium to be used in the fetal blood, cord blood, and amniotic fluid.32 formation of an egg shell. When the shell is (See figure next page.) being calcified, the medullary bone is de- structed and the calcium is released. Mesenchyme Mass of tissue that develops primarily from the mesoderm (ie, the middle Megapascal (MPa) Equivalent to 145 psi layer of the trilaminar germ disc) of an em- (lb/in2) or 9.87 kg/cm2. bryo. Viscous in consistency, mesenchyme contains collagen bundles and fibroblasts and Membrane See: Barrier membrane. See also: later differentiates into blood vessels, blood- Collagen membrane; Expanded polytetrafluo- related organs, and connective tissues. roethylene (e-PTFE) membrane; Nonresorbable membrane; Resorbable membrane. Mesostructure Intermediate or middle supporting framework connected to the infra- Membranous bone structure and providing support and/or reten- See: Intramembranous ossification. tion for the suprastructure in an implant-supported prosthesis.17,34 Mental foramen Foramen from which the mental nerve branch of the inferior alveolar Meta-analysis Summary and statistical analy- nerve emerges from the mandibular canal; lo- sis combining the results of two or more stud- cated most often inferior to the apices of the ies of similar design to provide a larger sam- mandibular premolars.31 See also: Mandibu- ple and more statistical power.It is the statis- lar foramen. tical technique used in a systematic review to integrate the results of the included studies.29

100 Microgap

Proliferation

Commitment and lineage progression

Differentiation and maturation

Osteocyte Chondrocyte Myocyte Stromal cell Tenocyte Adipocyte

Mesenchymal stem cell (MSC) differentiation potential. (Redrawn from Goldstein33 with permission.)

M Metal-ceramic restoration Crown or fixed Metronidazole Antiprotozoal and antibacter- dental prosthesis supported by a natural ial drug (C6H9N3O3) with a spectrum con- tooth or implant. It consists of a metal sub- fined to obligate anaerobes, some mi- structure to which a ceramic veneer is croaerophilic organisms,and some anaerobic fused.11 See also: Crown. protozoa that act to damage or inhibit DNA synthesis; may induce a disulfiram-like reac- Metal encapsulator See: Metal housing. tion. This antibiotic is commonly used to treat periodontitis and peri-implantitis infec- Metal housing Metallic enclosure in a remov- tions caused by gram-negative anaerobic able prosthesis into which replaceable plastic pathogens. retentive elements are placed to stabilize the restoration.17 Microgap Microscopic space between two components, specifically between an implant and Metal tap See: Tapping. an abutment. It is usually considered to be a source of chronic irritation or contamination Metaphysis Growing part of a long bone, con- creating an inflammatory response. See sisting of the epiphysial cartilage plate unit- also: Implant-abutment interface. (See figure ed with the diaphysis by columns of trabecu- next page.) lar bone.

Methylmethacrylate See: Resin.

101 Microgap

Microtia Human developmental anomaly in which there is aplasia or hypoplasia of the pinna of the ear and closure or absence of the external auditory meatus.10,36

Midcrestal incision Incision made on the peak of an edentulous area of the alveolar crest.

Millipore filter One of the first barrier mem- Microgap between implant and machined abutment.(scanning electron micrograph; magnification x200). branes used as proof of principle for the re- (Courtesy of T.D. Taylor.) generation of membrane-protected defects. Millipore filters have been used in initial Microinterlock Mechanical joining of two or studies for guided tissue regeneration for pe- more components through microscopic riodontal defects.37-41 shapes or undercuts. Mineralization front Transitional area of bone Microleakage Microscopic movement of flu- mineralization; a seam that separates the os- ids or contaminants across a barrier or be- teoid zone from the mineralized part of the tween chambers that cannot be observed bone. See also: Tetracycline bone labeling. without magnification. See also: Microgap. Mini-implant Implant fabricated of the same M Micromotion Relative motion on a microscop- biocompatible materials as other implants ic scale.It generally describes the relative mo- but of smaller dimensions. Implant can be tion between an implant and its osteotomy made as one piece to include an abutment site during the initial healing period or rela- designed for support and/or retention of a tive motion between mechanical compo- provisional or definitive prosthesis. nents of the implant stack. Minimum effective strain (MES) Derived Micromovement See: Implant micromove- from Frost’s mechanostat theory for bone ment; Micromotion. adaptation,the MES is essentially a minimum value of strain that must be exceeded to pro- Microradiography Radiographic recording of voke an adaptive response in bone; stimulus the details within the structure of thin speci- for bone remodeling.Called also minimum ef- mens at a high magnification. Also known as fective strain for remodeling (MESr).42 x-ray micrography. “The technique of passing x-rays through a thin metal section in contact Minimum threshold strain range with a fine-grained photograph to obtain a ra- See: Minimum effective strain (MES). diograph which can be viewed at 50 x to l00 x to observe constituents and voids.”35 Misfit Lack of precise adaptation of one component to another, particularly the lack of Microtextured surface treatment Treatment ideal passive fit of a multiple-unit prosthesis providing a microscopically roughened surface. to two or more implants. Misfit is considered to be detrimental in that it may lead to increased occurrence of component loosening or fracture and may contribute to attachment loss adjacent to an implant.

102 Mucocele

Mobility Presence of relative motion be- Morphogen Morphogenetic proteins guiding tween two objects; eg, the relative stability cellular morphodifferentiation. of an implant in its osteotomy. See also: Implant mobility. Morse taper connection Taper of 3 degrees (6 degrees total convergence) or a reduction Mode Value with the largest number of obser- of 5/8 inch per linear foot of cylinder length. vations, namely the most frequent value or It describes one method of internal abutment values. connection, although the Straumann implant-abutment connection to which the Model See: Animal model; Cast. term is applied is not technically a Morse taper but rather an 8-degree (16 degrees total Modeling See: Bone modeling. convergence) cylindrical taper.

Modified occlusal anatomy Application of nonanatomic occlusal surfaces of artificial Abutment teeth in an attempt to control or modify the direction and/or magnitude of forces generated during function or parafunction.

Modulus of elasticity (pl: moduli of elasticity) See: Elastic modulus. Implant Morse taper con- Moment Rotation of a body when force is ap- nection (scanning electron photomi- M plied; the rotary effect of a force. crograph). (Courtesy of T. D. Moment bending See: Bending moment. Taylor.)

Moment of inertia Resistance to rotation of a Mount See: Implant mount. body; used to explain the relative change if bending moments are based upon the cross- MPC Abbreviation for mesenchymal progeni- sectional radius of a structure. Called also tor cell. See: Mesenchymal stem cell (MSC). I-beam principle or second moment principle. See also: Implant stiffness. MRI Abbreviation for Magnetic resonance imaging. Monocyte Mononuclear phagocytic leukocyte, 13 to 25 μm in diameter, with an ovoid Mucocele “Epithelium-lined sac containing or kidney-shaped nucleus. Precursor to a mucus.Mucous cysts in the sinus may appear macrophage, it is formed in the bone marrow as spherical, radiopaque areas.” Pathologic from a promonocyte and is transported to tis- condition of chronic inflammation in the si- sues such as the lung and liver, where it de- nus cavity that is destructive and expansile velops into a macrophage. and can lead to erosion of the sinus walls and possibly life-threatening conditions when in Morgan and James model of prosthesis load- the proximity of the orbit. Radiographically, ing Model of implant prosthesis loading the presentation is usually a diffuse radiopac- with rigid implant-to-prosthesis connections.43 ity that fills the sinus space and eventually ex- pands beyond the bony walls when erosion of the sinus walls has already taken place. In

103 Mucocele

contrast, a mucous retention cyst represents Mucosa (pl: mucosae) Membrane rich in mu- a benign,usually localized,well-defined opac- cous glands. This is the mucous lining of body ity at the sinus wall (or within soft tissues, ie, passages and cavities that face the lumen, lip). Histologically, a mucocele is lined by res- which communicates directly or indirectly piratory epithelium with extensive goblet-cell with the exterior. It functions in protection, metaplasia. Mucous retention cysts are gen- support,nutrient absorption,and secretion of erally asymptomatic, represent a cystic for- mucus, enzymes, and salts and consists of ep- mation of an individual gland and not a con- ithelium, basement membrane, lamina pro- traindication to sinus floor elevation, where- pria mucosae, and lamina muscularis mu- as a true mucocele must first be resolved pri- cosae. Mucosa that covers the dorsum of the or to sinus grafting. Often these two terms tongue is known as specialized oral mucosa. are confused with one another.44,45 Called also tunica mucosa or mucous membrane. See also: Alveolar mucosa; Masticato- Mucogingival junction Borderline of union of ry mucosa; Oral mucosa. keratinized gingiva and alveolar mucosa. Mucosal button implant See: Mucosal insert. Mucogingival surgery Group of surgical procedures used in periodontics to augment the Mucosal cell Cells that secrete mucous, such band of keratinized mucosa around teeth, to as those found in the oral cavity. See also: cover recession-type defects, or to augment Mucosa. other types of soft tissue defects. Techniques include the use of free gingiva grafts, subep- Mucosal insert Anchorage component placed M ithelial connective tissue grafts, pedicle flaps, into soft tissue, an intramucosal anatomic use of barrier membranes,among others.Sim- position. “Any metal form attached to the tis- ilar techniques have been adopted for implant sue surface of a removable dental prosthesis patients. See also: Periodontal surgery. that mechanically engages undercuts in a surgically prepared mucosal site.”48 Called also Mucogingival therapy Nonsurgical and surgi- button implant or epithelial implant. cal treatment procedures for correction of de- Soft tissue fects in morphology,position, and/or amount Bone of soft tissue and underlying bone support at teeth and implants.46

Mucoperiosteal flap Full-thickness mucosal flap, generally including gingiva, alveolar mu- Mucosal insert Denture flange cosa, and periosteum. Called also full-thickness flap.

Mucoperiosteum (pl: mucoperiostea)Com- plex of mucous membrane and periosteum that surrounds and invests the maxilla, 47 mandible, and teeth. Mucosal insert.

Mucopolysaccharide See: Glycosaminoglycan.

104 Multiple regression

Mucosal peri-implant tissue Mucosal tissue Mucositis Inflammation of a mucous mem- around dental implants, which forms a tight- brane,specifically of the mucosal peri-implant ly adherent band consisting of a dense col- tissues. See also: Peri-implant mucositis. lagenous lamina propria covered by stratified squamous keratinizing epithelium.49 The sul- Mucous membrane See: Mucosa. cular and junctional epithelium are similar to a natural tooth. The difference is noticed in Multicenter study Clinical trial carried out at the connective tissue which is not attached to more than one site. the implant like in the tooth.49 Multidisciplinary treatment Team approach

Peri-implant soft to provision of patient treatment, encom- tissue margin passing the services of clinicians from various Apical termi- nation of disciplines and adjunct laboratory person- junctional 51–53 epithelium nel.

Abutment- implant- Multiple regression “To predict the value of a junction single response variable from a combination Marginal bone crest of explanatory variables.”54

Mucosal peri-implant tissue. (Redrawn from Misch50 with permission.) M

105

Nerve transpositioning

N Abbreviation for Newton. 1,064 nm,which is in the infrared range.How- ever, there are also transitions near 940, Nasal prosthesis See: Nasal reconstruction. 1,120, 1,320, and 1,440 nm. Nd:YAG lasers operate in both pulsed and continuous mode. Nasal reconstruction Prosthetic restoration of defects of the nose resulting from surgery, Necrosis Death of one or more cells or a por- trauma, or congenital etiology.1 tion of a tissue or organ; typically characterized by pyknosis (shrunken and darkly ba- Nasopalatine nerve One of the terminal sophilic nuclear staining), karyolysis (swollen branches of the maxillary nerve (second and pale basophilic nuclear staining), or kary- branch of the trigeminal nerve) descending orrhexis (nuclear rupture or fragmentation). through the hard palate from the incisive It occurs when insufficient blood is supplied canal to supply palatal structures around the to the tissue, whether from injury, radiation, central and lateral incisors.2 or chemicals. Once necrosis occurs, it is irre- versible. See also: Osteonecrosis. Natural tooth intrusion Apical movement of a tooth produced by an external force. Phe- Neoplasm Abnormal tissue mass that, if ma- N nomenon reported in literature as being a lignant, can have the capacity to metastasize complication of connecting a natural tooth to locally or systemically. When malignant, the a dental implant with a fixed prosthesis.3 disease entity is generically known as cancer.

Navigation See: Computer-aided navigation. Nerve lateralization Surgical procedure that repositions the inferior alveolar nerve for the Ncm Abbreviation for Newton centimeter. purpose of implant placement without bone augmentation. The buccal cortex surrounding Nd:YAG laser Nd:YAG is an acronym for the mandibular canal is removed to allow the neodymium-doped yttrium aluminum garnet, repositioning of the nerve. This procedure rais- a compound that is used as the lasing medi- es the risk of neuropathies, such as para-, dys-, um for certain solid-state lasers. The YAG and/or anesthesia of the inferior alveolar nerve. crystal is doped with triple-ionized neodymi- Because of the high risk of complications,wide- um, an active medium that replaces another spread use has not been achieved.4-7 element of roughly the same size,typically yttrium. Nd:YAG lasers are optically pumped Nerve repositioning See: Nerve lateralization. using a flashlamp or laser diodes. One of the most common types of laser,they are used for Nerve transpositioning many different applications. Nd:YAG lasers See: Nerve lateralization. typically emit light with a wavelength of

107 Neurovascular bundle

Neurovascular bundle Anatomic unit comprising a nerve and its related blood vessels.

Neutrophil See: Polymorphonuclear leukocyte.

New attachment Union of connective tis- Nonangled abutment sue or epithelium with a root surface that has been deprived of its original attachment apparatus. New attachment may be epithelial adhesion and/or connective tis- Long axis of implant sue adaptation or attachment and may in- 8 clude new cementum. Nonangled abutment.

Newton (N) Unit of force required to acceler- Nonangulated abutment ate a mass of 1 kg at a rate of 1 m/s2; equiva- See: Nonangled abutment. lent to 0.2248 lb or 102 gm. Nonaxial loading Loading of an implant body Newton centimeter (Ncm) Unit of torque. that is not along the long axis of an implant Work performed by a force of 1 N applied at body. Compare: Axial loading. an arm distance of 1 cm. Nonbiodegradable Property of tissue substi- Newton meter (Nm) Unit of torque.Work per- tute that remains unchanged at the site of formed by the application of 1 N from a dis- implantation, with no dispersion in vivo. tance of 1 m; equal to 1 J. N Noncollagenous matrix protein Protein pre- Nightguard See: Occlusal guard. sented in the organic matrix of collagen- based calcified tissues together with the sup- Nonabsorbable Property of materials that are porting collagen meshwork. It contributes to not capable of being absorbed by the biologic determining the structure and biomechanical activities of the body. properties of the tissues.

Nonangled abutment Prosthetic implant Nonfunctional loading Load placed on an im- component designed to parallel the long axis plant that is not generated through normal of the implant; considered straight to indi- occlusal function or parafunction; for exam- cate no deviation from the long axis of the ple, applying load through the tightening of implant. Called also nonangulated abutment. an abutment screw.

Nonhexed Property of an implant or a prosthetic component that does not incorporate a mechanical design using a six-sided or six- angled hexagonal elevation or shape.

Nonocclusal loading See: Nonfunctional loading.

Nonresorbable See: Nonabsorbable.

108 Null hypothesis

Nonresorbable membrane Membrane made of nonabsorbable biomaterial, most often of expanded polytetrafluoroethylene (e-PTFE). Use of a nonresorbable membrane requires a second surgery to remove it from the site. See also: Guided tissue regeneration (GTR).

Nonrotating abutment Prosthetic implant component designed to prevent rotation of subsequent component, similar to a natural tooth preparation onto which a restoration or other prosthetic component is placed in a predictable position. A portion of the component incorporates a flat side or similar design Nonsubmerged healing (center figure). to prevent 360-degree rotation (ie, spins) of (Redrawn from Cochran and Mahn14 with permission.) subsequent component.9-11 Nonsubmerged implant Implant that is placed with a transmucosal element to allow Flat side as anti-rotation feature for subsequent soft tissue healing immediately after initial restoration placement and to prevent the need for a second surgical procedure.Soft tissue healing occurs around the transmucosal element of either a one- or two-piece implant. See also: Nonsubmerged healing; One-piece implant; Two-piece implant. N

Nonthreaded implant Implant design that does not incorporate threads circumferentially on the external surface of the implant.

Nonrotating abutment. Nonvascularized free graft Graft harvested solely as an osseous graft and without accom- Nonrotating gold cylinder Attachment ele- panying vasculature. ment designed so that the interface between the gold cylinder and the transmucosal ele- Nonworking side Segment of the dental arch ment does not allow 360-degree rotation. (right or left) that is opposite the side at which the teeth occlude during mandibular Nonsubmerged healing Implant placement function.15 See also: Occlusion. procedure incorporating a transmucosal extension for healing guidance. Special healing Normal distribution Data that have a sym- cap is required to extend the implant shoul- metrical, bell-shaped distribution where the der above the soft tissue level, allowing the mean, median, and mode are identical.16 suturing of wound margins around the implant neck/healing cap. This approach does Null hypothesis Hypothesis being tested about not require a second surgical procedure and a population,typically that no difference exists is often used in posterior implant sites.12-13 between the mean values of two groups.16

109

Occlusive membrane

Occlusal adjustment Modification of the oc- Occlusal index Record of the intraoral hori- clusal surfaces of a tooth or teeth to improve zontal maxillomandibular relationship.Facial form and/or function. and/or buccal surfaces may also be recorded for repositioning artificial teeth, pontics, or Occlusal anatomy, modified veneers in the laboratory. See: Modified occlusal anatomy. Occlusal load Force applied to natural or Occlusal force Force generated by the elevator prosthetic teeth, implants, and surrounding muscles of the mandible. Occlusal force may structures by the elevator muscles of the be functional (eg,chewing and swallowing) or mandible. See also: Occlusal force. parafunctional (eg, clenching or bruxing). Occlusal load factor Force factor involved Occlusal guard Removable adjunctive device with occlusal or masticatory function and the attached to the incisal and/or occlusal sur- resultant loading of underlying teeth, im- faces of the natural teeth or prosthetic plants or bone. See also: Occlusal force. restoration for protection from adverse forces related to parafunctional habits, malocclu- Occlusal overload Application of occlusal sion, or trauma. It can also be used as a carri- loading, through function or parafunction, in er for gels applied to teeth for the treatment excess of what the prosthesis, implant com- O of xerostomia and may be fabricated from a ponent, or osseointegrated interface is capa- resilient or nonresilient material.1 Called also ble of withstanding without structural or bio- bite splint. logic damage.

Occlusal table Collective surface anatomy of the posterior teeth inclusive of molar and premolar cusps, inclined planes, marginal ridges, grooves, and fossae.2 See also: Occlusion.

Occlusion The state of being closed or shut off. In dentistry, the occluding of teeth or artificial replacements.2,3 See also: Balanced occlusion; Centric occlusion; Cross-bite occlusion; Disocclusion; Protrusive occlusion; Work- ing occlusion. Occlusal guard. Occlusive membrane See: Barrier membrane.

111 Ocular implant

Ocular implant Prosthetic conformer placed tightened, either by clinical or radiographic following enucleation or evisceration of the visualization of the prosthesis relative to the eye to preserve space for ocular prosthesis.4 implant-abutment position. Ideally, there should be no movement or lift-off of the pros- Ocular prosthesis Artificial human eye or thesis from its passive seating. globe.4 One-stage grafting procedures Grafting pro- Oligodontia Congenitally related oral condi- cedures combined with simultaneous im- tion that presents less than a normal com- plant placement; the remaining bone height plete natural dentition, often atypically must be sufficient for primary stability, and shaped.3,5 the defect must be self-contained with at least two bone walls. Compare: Two-stage One-piece abutment Transmucosal element grafting procedures. in which the abutment and attachment mechanism are manufactured as one unit; One-stage implant Misnomer for an implant used instead of a separate fixation screw that placed with a one-stage procedure. threads through the abutment into the implant. One-stage implant placement Protocol that involves one surgical procedure for implant One-piece implant Anchorage unit and con- placement. In the single stage the osteotomy tiguous prosthetic component manufactured site is prepared,the implant is placed,and the as one piece. Implant and transmucosal ele- transmucosal element exits the soft tissue. ment as an abutment are manufactured as Use of a single-stage implant eliminates the one component.6,7 need for a second surgical procedure to expose the coronal portion of the implant.

O One-stage surgical approach Category of sur- Transmucosal element gical procedures that can be performed with a single intervention. This group includes standard implant placement with nonsubmerged healing or implant placement with si-

Implant body multaneous bone grafting procedures.

Onlay graft Graft used in block form and fixed upon the cortical surface of the recipient bed with a screw. Origin may be autograft, allo- One-piece implant. graft, alloplast, or xenograft.

One-screw test Test to determine passive fit Open curettage Curettage facilitated by re- when trying in or delivering a multiple-unit flection of a soft tissue flap.8 implant-supported prosthesis. By inserting a screw in one end of the prosthesis and then Open tray impression observing whether the prosthesis lifts off of See: Direct (open tray) impression. other implant or abutment platforms, the clinician can determine the presence or ab- OPG Abbreviation for Osteoprotegerin. sence of movement when that single screw is

112 Orthodontics

Oral See: Lingual. O-ring Retention element resembling a round gasket shape,fitting onto the stud-type patrix Oral epithelium See: Epithelium. of a mechanical attachment.The patrix is soldered or cast to the coping that is cemented Oral health impact profile (OHIP) Measure- into the tooth root. ment of people’s perceptions of the social impact of oral disorders on their well-being.9

Oral health–related quality of life Multidi- mensional concept assessing how orofacial Removable prosthesis concerns affect well-being, including func- O-ring Transmucosal in metal housing tional factors, psychological factors, social element-patrix factors, and the experience of pain and/or discomfort.10

Oral hygiene Personal maintenance of the cleanliness of teeth and/or oral implants and other oral structures by removal of bacterial Bone plaque and food debris with brushes, dental O-ring (cross section). floss, or other auxiliary devices. Called also oral physiotherapy and plaque control. Oro-antral fistula Communication created Oral implantology See: Implant dentistry. between the sinus and the oral cavity. A true fistula is epithelialized. Oral mucosa Mucosa that covers the tissues of the oral cavity. Orthodontic anchorage implant Endosseous dental implant commonly used as anchorage O Oral physiotherapy See: Oral hygiene. for orthodontic tooth movement. Osseointe- grated interface is exceptionally well suited Oral prophylaxis Removal of plaque, calculus, for use as an orthodontic anchor because of and stains from exposed and unexposed sur- its ankylotic nature. Implant may be minia- faces of the teeth and/or dental implants by ture or standard sized. scaling and polishing as a preventive measure for the control of local irritational factors. Orthodontics “The area and specialty of dentistry concerned with the supervision, guid- Orbital exenteration See: Exenteration. ance and correction of the growing or mature dentofacial structures, including those con- Orbital prosthesis Artificial replacement of ditions that require movement of teeth or the contents of the human orbit to contain correction of malrelationships and malfor- the globe. See also: Ocular prosthesis. mations of their related structures and the adjustment of relationships between and Orientation index Mold or form used as a among teeth and facial bones by the appli- three-dimensional record to register posi- cation of forces and/or the stimulation and tions between adjacent structures. See also: redirection of functional forces within the Index. craniofacial complex.“5 Called also dentofacial orthopedics. See also: Immediate load- Orientation jig See: Orientation index. ing, Orthodontics.

113 Orthopantomograph

Orthopantomograph Osseous coating Bone marrow response to os- See: Panoramic radiograph. teophilic surfaces.

Orthopedic implant applications Application Osseous graft See: Bone graft. of osseointegration to orthopedic procedures such as artificial shoulder or hip replacement. Osseous regeneration Restoration of original osseous tissue through recapitulation of em- Osseointegration Direct structural and func- bryologic events. tional connection between ordered, living bone and the surface of a load-carrying tita- Osseous restoration Re-establishment of con- nium implant. (Original definition attributed tinuity of osseous tissue; usually restoring to P-I Brånemark published in 1985 based on form and function. microscopic findings.) The implication is that an interface between an inert metallic sur- Osseous rehabilitation Re-establishment of face and living bone is created without an in- form and function of deficient osseous tis- terpositional tissue.Commercially pure titani- sue, aimed at restitutio ad integrim. um (CPTi) and titanium alloy (Ti-6Al-4V) have been proven clinically and microscopically to Osseous repair Restoration of form and func- be biocompatible materials for achieving os- tion of deficient osseous tissue. seointegration. Osseointegration is considered to be the phenomenon of direct apposi- Ossification Formation and development of tion of bone on an implant surface, which bone, of which two types are distinguished: subsequently undergoes structural adapta- endochondral and intramembranous ossifi- tion in response to a mechanical load.11,12 cation. See also: Osteogenesis.

Biomechanical failure of o. Loss of os- Ostectomy Surgical removal of bone using O seointegration or failure to osseointegrate drills or chisels. initially caused by mechanical forces. Dur- ing the initial healing phase, comparative- Osteitis deformans See: Paget disease. ly small forces may act to preclude osseointegration from occurring. Osteoblast Mature, polarized, matrix-secreting cell developed from multipotential mes- Osseoperception Special sensory perception enchymal stem cells via immature and ma- that patients with osseointegrated implants ture osteoprogenitor cells which progress de- may develop within months following im- velopmentally to preosteoblast and mature plant placement. A peripheral feedback path- osteoblast forms. After a period of function, way can be restored, allowing physiologic in- approximately 10% of osteoblasts turn into tegration of the implant in the human body osteocytes after stopping matrix extrusion and more natural function.13 and become entrapped in calcified matrix; the remaining turn into lining cells or under- Osseous coagulum Mixture of autogenous go apoptosis. bone shavings from areas adjacent to the surgical site mixed with blood. Allogeneic, xeno- Osteoblast, growth factors secreted by Mono- geneic, or alloplastic graft materials may be nucleated differentiated cells arising from added to increase volume and delay resorp- mesenchymal progenitors and associated tion.

114 Osteodistraction

with the production of bone by secreting bone lating factor 1 (CSF-1).Osteoprotegerin (OPG) matrix and enzymes that facilitate mineral produced by osteoblasts acts as a decoy re- deposition within osteoid matrices. ceptor for RANKL and inhibits osteoclastogenesis and osteoclast activation by binding to Osteocalcin Protein found in the extracellular RANKL. matrix of bone, dentin, and the serum of circulating blood. This vitamin K–dependent, calcium-binding protein is produced by os- Myleoid Osteoclast Mature progenitor precursor osteoclast teoblasts and is the most abundant noncolla- gen protein in bone.Because of calcium-bind-

ing sites, it plays a role in bone matrix miner- RANK CSF-1 OPG OPG alization or in regulation of crystal growth. In RANKL addition,its increased serum concentration is β TGF- TRAIL a marker of increased bone turnover in dis- 17-β-estradiol ease states (eg, Paget disease or post- Osteoblast/stromal cell menopausal osteoporosis).It has a low molecular weight and contains three a-carboxyglu- tamic acid residues per molecule. Called also Osteoclastogenesis. (Redrawn from Theill et al 14 with permission.) gamma-linolenic acid (GLA) protein.

Osteoclast Cell capable of bone resorption de- Osteoconduction Physical aid to osteoid for- rived from the hematopoietic monocytical cell mation via species-specific or alloplastic scaf- lineage.Osteoclasts are giant cells with a num- fold with nonending porosity. ber of nuclei from 3 to 30 and cell diameters varying from 30 to 100 μm. When actively re- Osteoconductive graft Autografts, treated al- sorbing, they adhere to the bone surface and lografts, and bone substitutes that provide a produce lacunar grooves called Howship lacu- scaffold for osteoid formation. O nae.In the central part of the active osteoclast, the surface is ruffled and hydrogen ions are re- Osteocyte An osteoblast entrapped in the bone leased for acid production, dissolving the min- matrix during bone formation. eral. After mineral dissolution, the exposed fibrils are digested via enzymatic activity.

Osteoclastogenesis Mechanism of osteoclast generation through differentiation of precur- Osteocyte sor cells of the hematopoietic lineage induced by regulatory molecules. Calcitropic factors,such as vitamin D3,prostaglandin E2, interleukin-1 (IL1), interleukin-2 (IL2), tumor necrosis factor (TNF-alpha), and glucocorticoid induce receptor activator nuclear factor- Osteocyte (undecalcified section stained with basic fuchsin; kappa ligand (RANKL) expression on os- magnification x 250). 15 teoblasts (see figure). RANKL binding to the (Redrawn from Buser et al with permission.) RANK expressed on hematopoietic progenitors activates a signal transduction cascade Osteodistraction that leads to osteoclast differentiation in the See: Distraction osteogenesis (DO). presence of the survival factor colony-stimu-

115 OsteoGen

OsteoGen Proprietary product name for an os- bone formation is induced by osteoprogeni- teoconductive,nonceramic,synthetic hydrox- tor cells in heterotopic sites, mostly via endo- yapatite that is a bioactive, resorbable graft chondral ossification. Traditionally: the initi- material used for contouring defects of the ation of heterotopic bone formation. Biolog- alveolar ridge. As new bone is formed, it is re- ically: the initiation of osteogenesis via sorbed over 6 to 8 months. It is composed of growth factors. a mixture of calcium phosphates. Osteointegration Ankylotic anchorage of a ti- Osteogenesis Generation, regeneration, and tanium implant in living bone to achieve a sol- remodeling of bone via concerted action of id bond. Histologically and radiographically bone cells. See also: Compromised osteoge- described by André Schroeder and colleagues nesis; Contact osteogenesis. in 1991.16 See also: Osseointegration.

Osteogenetic Quality of any substance, bio- Osteomyelitis Infection of the jaw bone in logic or nonbiologic, that is able to initiate or adults, especially the mandible, as a further stimulate normal osteogenesis. development of localized infections such as periapical pathosis, tooth extractions, re- Osteogenic Refers to the stimulation of bone moval of impacted teeth, or fractures. It is formation produced by modulations of natu- caused by oral bacteria, especially anaerobes ral biochemical processes such as growth fac- as Bacteroides, Porphyromonas, or Prevotel- tors and bone autografts, that initiate and la. Early stages of osteomyelitis may be treat- maintain and/or support bone formation dur- ed by removal of focus and administration of ing a healing response. antibiotics. In later stages, surgical treatment (ie, decortication) is necessary. Osteogenic protein 1 See: Bone morphogenetic protein 7 (BMP–7). Osteon Cylindrical structure with a diameter O of 150 to 300 μm and a length varying from 2 Osteoid The beginning organic matrix of bone. to 10 μm,composed of concentric lamellae of Initial deposit in bone formation starts with bone surrounding a Haversian canal with a di- the deposition of osteoid,which is secreted by ameter of 50 μm. In this canal nutritive ele- mature osteoblasts at a speed of 1 to 2 μm per ment, nerves, and connective tissue are pres- day. When concerned with lamellar bone, a ent. Between the individual osteons and in- matrix comprised of a scaffold of interwoven terstitial lamellae, cementing lines are seen. collagen fibers (mainly type 1) and noncol- The longitudinal direction of the osteons is lagenous proteins are sedimented as osteocal- parallel to the axis of the bone. Lamellae are cin and bone sialoprotein – unique for the birefringent in polarized light because of mineralized tissues – as well as osteonectin, changing orientation of the collagen fibers.In osteopontin, and a number of growth factors. the trabecular osteon, the lamellae run paral- The mean thickness of osteoid in lamellar lel to the bone marrow interface. bone formation is 10 μm; when this thickness is reached, mineralization as sedimentation Osteonecrosis Literally, bone death; however, of crystals of carbonated hydroxyapatite the term designates the localized necrosis of [Ca10(PO4)6(OH2)] takes place. maxillary and mandibular bone as a side effect of using bisphosphonates in the treat- Osteoinduction Transformation of osteoprog- ment of myelomatosis and metastatic breast enitor cells to active osteoblasts via paracrine cancer as well as in the prevention of osteo- signals to appropriate receptors. Therefore, porosis.Osteonecrosis is most often located in

116 Osteotome

the mandible and usually occurs in relation to membrane material for promoting bone heal- tooth extraction and dental infections. See ing and regeneration by encouraging the bio- also: Osteoradionecrosis (ORN). logic or mechanic environment of the healing or regenerating tissues; however, resorbable Osteonectin Most abundant noncollagenous collagen membranes are equal in value. protein in bone. It may have a role in initiation of mineralization, but the exact role is Cell Membrane not known. A number of cells, periodontal fibroblasts, and endothelial cells produce osteonectin.

Osteoplasty Surgical recontouring of bone.

Osteopontin Noncollagenous protein with an arginine-glycine-aspartic acid (RGD) tripeptide sequence having specificity toward cell- Osteopromotion. surface antigens. It is found in the lamina (Redrawn from Buser et al17 with permission.) limitans of the bone surface, possibly playing a role in bone mineralization and attachment Osteoprotegerin (OPG) Glycoprotein mem- of osteoblasts and osteoclasts to bone ma- ber of the tumor necrosis factor (TNF) recep- trix. It forms a cross-link with fibronectin and tor superfamily regulating bone resorption is found in cement lines, suggesting a func- by inhibition of osteoclast precursor cells dif- tion as biologic matrix-bonding agent. ferentiation into mature osteoclasts. It binds to receptor activator nuclear factor-kappa B Osteoporosis Generalized bone disorder char- ligand (RANKL) on osteoblast-stromal cells, acterized by low mineral density and a mi- thus blocking the receptor activator factor- croarchitectural change of the bone with thin- kappa B (RANK) to RANKL interaction be- O ning of the cortical bone and reduction in tween osteoblast-stromal cells and osteoclast number and size of the trabeculae in trabec- precursors.18 ular bone. Diagnosis is made by measuring a fall in bone mineral density (BMD) measured Osteoradionecrosis (ORN) Necrosis of jaw via dual-energy x-ray absorptiometry (DEXA). bone as a late effect of ionizing radiation, which is used in treatment of malignancies of Osteoprogenitor cell Relatively undifferenti- head and neck. It causes vascular changes ated cell found on all or nearly all of the free with reduction in blood flow resulting in hy- surfaces of bone. Under certain circum- povascularity, hypocellularity, and hypoxia. stances these cells undergo division and Spontaneous necrosis of jaw bone may ap- transform into osteoblasts or coalesce, giving pear with subsequent ischemic necrosis of rise to osteoclasts. covering mucous membrane and exposure of the necrotic bone to the oral cavity with a sec- Osteopromotion Sealing off of a bone defect ondary invasion of the necrotic bone with mi- from the surrounding soft connective tissue croorganisms. Called also radiation-damaged by placement of a mechanical barrier (mem- bone and soft tissues. brane), thereby creating a secluded space in- to which only cells from the walls of the bone Osteotome Circular shafted instrument used to defect can migrate. Expanded polytetrafluo- increase dimensions of an osteotomy laterally roethylene (e-PTFE) is the best-documented or apically; available in various dimensions.

117 Osteotome sinus floor elevation

Osteotome sinus floor elevation Outcome, secondary Outcome other than the See: Osteotome technique. primary outcome of a study that is also of interest in the experimental study. Osteotome technique Surgical technique using a transalveolar approach to elevate the si- Overdenture See: Implant overdenture. nus floor by using osteotome instruments. Anatomic aspects, such as an oblique sinus Overdenture prosthesis floor or insufficient bone height,can limit the See: Implant overdenture; Denture. use of this delicate surgical technique in daily practice.19,20 Compare: Lateral window tech- Overload Application of force to an object in nique. See also: Maxillary sinus floor elevation. excess of the force it was intended or designed to withstand. It has the potential for Edentulous site Evaluation Final osteotomy causing permanent deformation or damage to the structure or its support. See also: Occlusal overload.

Oxide surfaces Oxygen-containing compounds and complexes formed at the surface of an ab- Maxillary sinus Maxillary sinus Implant placement sorbent. In the case of titanium dental im- floor infracture floor elevation plants,oxidation of the implant surface creates titanium oxide of various chemical formulas Osteotome Composite through exposure to air or through treatment of the surface at the time of fabrication.21

Osteotome technique. Oxidating surface treatment Creation of metallic oxides on the surface of metal.In the O Osteotomy Cut in bone. See also: Horizontal case of titanium, oxidation occurs immedi- osteotomy; Pilot osteotomy. ately upon exposure to air.As a result, dental implants made of titanium are coated with ti- Ostium of the maxillary sinus Communica- tanium oxides critical for the success of os- tion between the maxillary sinus and the seointegration. nasal cavity located at the middle meatus. Oxygen therapy See: Hyperbaric oxygen treat- Outcome Variable determined prior to exper- ment (HBOT). imentation to be the result of the study.

Outcome, primary One outcome determined to be the principal result of an experimental study.

118 Papilla-sparing incision

Paget disease Osteitis deformans. Disease of and/or respecting certain parameters when unknown etiology, characterized by enlarge- placing implants, such as apicocoronal posi- ment of the cranial bones and often the max- tion and inter-implant distance. illa and mandible. Cotton-wool appearance of bone on a radiograph may be a diagnostic Papilla regeneration Creating a papilla be- feature. tween an implant and an adjacent tooth or between adjacent implants. This may involve Palatal graft See: Free gingival graft. surgical procedures using small rotational pedicle flaps, use of connective tissue grafts, Palatal implant Endosseous implant placed in and/or prosthetic techniques to condition the hard palate, which is an anatomic loca- peri-implant soft tissues. The term is a mis- tion for an implant in the maxilla, or an nomer,since the papillae flatten in the eden- anatomic location option for use of an im- tulous space following tooth extraction once plant as anchorage in orthodontic treatment. the transseptal inserting fibers are lost.A flattened papilla cannot be truly regenerated, Palatal vault Superior surface of the hard palate. but the clinician may optimize its appearance by prosthetic means. The appearance of a Panoramic radiograph Tomographic survey papilla is mainly determined by the interden- radiograph of the maxillofacial complex in tal bone height, which has a documented two dimensions. Image displays the maxilla threshold of approximately 5 mm.1–4 P and the mandible in its curvature and is produced by conventional tomography. Some x- Papilla-sparing incision Incision that does ray machines allow the image to be obtained not include the papilla and thus avoids the el- in sectors. evation of these tissues.

Papilla (pl: papillae) Portion of gingiva extending interdentally below the contact points of two adjacent teeth.

Papilla preservation Measure taken to maintain the interdental papillae following tooth extraction to avoid black triangles between an implant and an adjacent tooth or between adjacent implants.This may include an atrau- matic extraction, alveolar ridge preservation, Papilla-sparing incision. (Courtesy of D. Buser).

119 Paracervical saucerization

Paracervical saucerization Progressive bone Partial-thickness flap Surgical flap that is el- resorption occurring around the cervical por- evated within connective tissue only, thus tion of implants. Plausible etiologic factors leaving the periosteum intact and undis- can include: surgical trauma, peri-implantitis, turbed. occlusal overload, microgap, implant crest module, and compromise of the biologic Particulate autogenous graft width. Also, the excavation of tissue to form a See: Autogenous bone graft. shallow shelving depression, usually to facilitate drainage from infected areas of bone. Particulate graft Graft used in particulate Called also craterization. form,which may be an autograft,allograft,alloplast, or xenograft. Particulate grafts differ Paracrine Transfer of chemical compounds concerning osteogenic potential, osteocon- such as hormones and growth factors from ductivity, hydrophilicity, pore and particle cell to cell. size, and substitution rate.6–8

Parallel-fibered bone Repair bone deposited Particulate marrow cancellous bone (PMCB) onto woven bone and old bone surfaces in a Graft material obtained from donor sites,such healing situation as parallel layers of bone. as the iliac crest, with extensive marrow con- The collagen fibers run parallel to the surface tent. PMCB of an autogenous nature is the but are not organized in a lamellar fashion. most osteogenic graft material; the number of multipotential stems cells is especially high. Parallel(ing) pin See: Direction indicator. Passivated surface oxide Surface treatment Parallel-sided implant Implant with an unta- of an oxidized implant surface resulting in pered body when viewed in profile,lengthwise. lower surface energy and increased corrosion resistance. This may be the result of inten- Parallel-walled implant tional treatment of the surface by the manu- See: Parallel-sided implant. facturer or simply by exposure to air over P time. Paresthesia Abnormal sensation of pricking, tingling, or burning related to injury or irrita- Passivation Formation of an oxide layer on tion of a sensory nerve. the surface of metal exposed to air- and/or oxygen-containing solutions. Partial denture Fixed or removable dental prosthesis supported and retained by teeth or Passive fit Adaptation of one component to implants for the replacement of less than a full another in a manner that does not impart complement of natural teeth and related hard strain. In dental implant prosthodontics, the and soft tissues.5 Called also partial prosthesis. creation of passively fitting prostheses is desirable. Implant supported p. d. See: Fixed prosthesis. Patient assessment See: Patient evaluation.

Partially edentulous State of being without Patient-based measure Descriptive term re- one or more, but not all, of the natural ferring to the array of questionnaires, inter- teeth.5 See also: Edentulous. view schedules and other related methods of assessing health, illness, and benefits of healthcare interventions from the patient’s

120 Penicillin

perspective. A patient-based outcome meas- Pedicle flap Rotated or laterally moved flap re- ure that addresses constructs such as health- ceiving its blood supply from the original base related quality of life, subjective health sta- of the flap. It is used to cover an adjacent sur- tus, and functional status; used as primary or gical site or improve the thickness of soft tis- secondary end-points in clinical trials.9 sue contours.11 See also: Soft tissue augmentation. Patient evaluation Process by which a patient’s condition is determined. Called also patient assessment.

Patient examination Clinical examination Split- of the patient, including extraoral and intra- thickness flap oral findings. Called also control. See also: Examination.

Patient history Record of the patient’s medical and dental histories. Bone Patient satisfaction Individual’s perceived Pedicle flap. fulfillment of a need or a want; can be meas- (Redrawn from Ito and Johnson12 with permission.) ured by obtaining reports or ratings from patients about services received from an organization, hospital, physician, or healthcare Peer-reviewed journal Periodical publication provider.10 for which individuals who are of an academic and/or professional standing equal to that of Patient selection Selection of patients who the author(s) have determined that all articles are appropriate candidates for a particular are of sufficient quality and completeness. therapy based on risk assessment, including P medical, dental, and anatomic factors, as well Peer-reviewed literature analysis Analysis of as smoking habits and psychologic aspects. published research reports by individual(s) with expertise similar to that of the author(s). Patrix component The part of an attachment system that is designed specifically to insert Penicillin A generic name for a related group and engage the matching receptacle or mate of natural or semi-synthetic antibiotics de- component (matrix) for mechanical reten- rived directly or indirectly from strains of fun- tion. Attachment systems that use mechani- gi of the genus Penicillium,which exert a bac- cal retention are available in various designs. tericidal as well as a bacteriostatic effect on See also: Attachment system; Ball attachment susceptible bacteria by interfering with the fi- system; Bar attachment system; Stud-type at- nal stages of the synthesis of peptidoglycan, tachment system; Telescopic coping attach- a substance in the bacterial cell wall. The ment system. penicillins have relatively low toxicity for the host and are active against multiple organ- PDGF Abbreviation for Platelet-derived growth isms, especially gram-positive pathogens factor. (streptococci, staphylococci, pneumococci); clostridia; some gram-negative forms (gono- PDL Abbreviation for Periodontal ligament. cocci, meningococci); some spirochetes and fungi. They are classified as penicillin G and

121 Penicillin

congeners (penicillin V), anti-staphylococcal Pericrestal incision Incision placed not direct- penicillins (methicillin, dicloxacillin), extend- ly over the crest, but in either a more buccal ed spectrum penicillins (ampicillin and amox- or lingual location. icillin), and extended spectrum penicillins with beta-lactamase inhibitors (amoxicillin Peri-implant Around an implant. Often used and clavulanate, ampicillin and sulbac- to describe soft or hard tissues surrounding tam).13 See also: Amoxicillin. an oral implant, eg, peri-implant mucosa or bone. Percentage bone-implant contact Area of bone in direct contact with the implant sur- Peri-implant crevicular epithelium Epitheli- face; usually measured from histologic um of the marginal peri-implant mucosa that specimens.14 bounds the peri-implant mucosal crevice and faces the abutment region of the oral im- Percutaneous implant Implant placed and plant. positioned through the skin, eg, implants placed extraorally for reconstruction of fa- Peri-implant disease Disease that affects the cial structures or those used in the treat- tissues associated with an oral implant and/or ment of fractures in buccomaxillofacial and abutment. Bacteria play a major role in the orthopedic areas. etiology of peri-implant diseases, which can be restricted to soft tissue (mucositis) or progress to the supporting bone and induce its destruction (peri-implantitis).

Gingival margin Flange at neck of implant Apical border of junctional epithelium Threaded portion Apical border of connective P tissue Bone crest Percutaneous implant. (Redrawn from Brånemark and Tolman15 with permission.)

Perforation Inadvertent tear or dehiscence Peri-implant disease (right) compared to periodontal dis- within a flap created during surgery,either by ease (left). (Redrawn from Grant et al16 with permission.) overthinning the mucosa, improper blade direction while making periosteal releasing incisions, or excessive flap retraction. Peri-implant mucositis Progressive bone loss and inflammatory tissue pathology resulting Peri-abutment Region surrounding an im- from plaque accumulation and bacterial infil- plant abutment. Usually refers to the soft or tration around implants.17 hard tissues surrounding the abutment. Peri-implant soft tissue Keratinized or nonker- Periapical radiograph Radiograph taken in- atinized mucosa around an oral implant. traorally showing the entire tooth from the occlusal plane to the apex. The radiograph Peri-implant tissue recession Location of the should reach 3 mm beyond the structures of receding marginal peri-implant tissues apical the tooth. to the prosthesis-implant interface.

122 Periodontal plastic surgery

Peri-implantitis Condition of inflamed peri- Periodontal disease General term that in- implant soft tissues, bone loss, and increased cludes all pathologic processes that affect the probing depth combined with exudation. periodontal tissues. They can be restricted to the soft tissues (gingivitis) or involve all the Periodontal abscess Localized purulent in- periodontal support tissues (periodontitis) flammation of the periodontal tissues.Called and induce periodontal attachment loss. also lateral periodontal abscess. Advanced p. d. Chronic or aggressive peri- Periodontal biotype Categorization deter- odontitis characterized by clinical attach- mined by variable biologic or physiologic ment loss of 5 mm or more. Teeth with re- characteristics of periodontal tissue. To eval- sorption of more than a third of the sup- uate the periodontal biotype, a periodontal porting alveolar bone constitute advanced probe can be placed at the facial aspect of the or severe disease. periodontal (or peri-implant) sulcus. It is categorized as thin if the outline of the underly- Periodontal dressing Protective material ap- ing probe can be seen through the gingiva or plied over the wound created by periodontal mucosa, or thick if the probe cannot be seen. surgical procedures.

Thick p. b. Periodontal biotype character- Periodontal ligament (PDL) Specialized fi- ized by a thick and wide keratinized tissue brous, richly vascular, cellular connective tis- at the facial aspect of teeth and oral im- sue of the periodontium that surrounds the plants. This biotype is prone to pocket for- roots of the teeth and is attached to the root mation instead of gingival recession in the cementum, separating it from and attaching presence of periodontal disease. it to the alveolar bone. Main functions are to hold a tooth in its socket and to permit tooth Thin p. b. Periodontal biotype character- mobility and force distribution and absorp- ized by a thin periodontal tissue at the fa- tion by the alveolar process. Called also peri- cial aspect of teeth or oral implants. This odontal membrane. P biotype is prone to gingival recession following mechanical or surgical manipula- Periodontal maintenance Procedure perform- tion. ed at selected intervals to assist the periodontal patient in maintaining oral health. As part Thin-scalloped p. b. Classification of peri- of periodontal therapy,this procedure is under odontium according to its facial aspects, the supervision of the dentist and not synony- distinguished by a pronounced disparity mous with a prophylaxis. Called also support- between the height of the gingival margin ive periodontal therapy (SPT),preventive main- on the direct facial and that found inter- tenance, and recall maintenance. proximally (ie, noticeable rise and fall of marginal tissue). The underlying bone is Periodontal membrane usually thin on the facial aspect with de- See: Periodontal ligament (PDL). hiscences and fenestrations common. Periodontal plastic surgery Surgical proce- Periodontal bone regeneration Regeneration dure performed to correct or eliminate of tooth-supporting alveolar bone that in- anatomic,developmental,or traumatic defor- cludes new cementum and periodontal liga- mities of the gingiva or alveolar mucosa.18 ment (PDL) on the root surface of a previous- See: Mucogingival surgery. ly diseased tooth.

123 Periodontal pocket

Periodontal pocket Pathologic fissure be- Aggressive p. Group of uncommon, often tween a tooth and the crevicular epithelium, severe, rapidly progressive forms of peri- limited at its apex by the junctional epitheli- odontitis frequently characterized by an um; caused by migration of the junctional ep- early age of clinical manifestation and a ithelium along the root as the periodontal lig- distinctive tendency for cases to aggregate ament (PDL) is detached by a disease process. in families. Usually there is no contributo- See also: Peri-implant disease. ry medical history, and patients exhibit amounts of microbial deposits inconsistent Periodontal probe Long, thin manual instru- with the severity of periodontal tissue de- ment usually blunted at the end and calibrat- struction.Some patients display phagocyte ed in millimeters; used to measure the gingi- abnormalities and elevated proportions of val sulcus or pocket depths around a tooth or Actinobacillus actinomycetemcomitans and, an oral implant during a periodontal or peri- in some populations,Porphyromonas gingi- implant clinical diagnostic examination. valis. See also: Periodontal disease.

Periodontal regeneration Restoration of lost Chronic p. Infectious disease resulting in periodontium, including development of inflammation within the supporting tis- functionally oriented periodontal ligament sues of the teeth and progressive attach- (PDL), alveolar bone, and gingiva, on the root ment and bone loss; characterized by surface of a previously diseased tooth with de pocket formation and/or recession of the novo formation of cementum. gingivae. Recognized as the most frequently occurring form of periodontitis, it Periodontal soft tissue Nonmineralized peri- is prevalent in adults but can occur at any odontal supporting tissue comprising the gin- age. Disease is usually associated with the giva and the periodontal ligament (PDL) tis- presence of plaque and calculus. Progres- sues; usually refers to the gingival tissues. sion of attachment loss usually occurs slowly,but periods of rapid progression can Periodontal surgery Surgical procedure for occur.Associated with a variable microbial P treatment of the periodontium. Includes flap pattern. See also: Periodontal disease. elevation for access, guided tissue regeneration (GTR) for narrow and deep intrabony de- Periodontium (pl: periodontia) Comprises fects, as well as mucogingival procedures for the tissues that invest and support the teeth, recession and soft tissue corrections around including the gingiva, alveolar mucosa, ce- teeth and implants. mentum, periodontal ligament (PDL), and alveolar bone. Periodontal treatment Surgical or nonsurgical approaches to the treatment of periodon- Periosteal Pertaining to, relating to, or involv- tal diseases. ing the periosteum.

Periodontitis Inflammation of the periodon- Periosteum (pl: periostea) The thin outer sur- tal supporting tissues of the teeth from gin- face covering of the mineralized structure of giva into the adjacent bone and ligament. any bone; may be either a delicate connective Usually a progressively destructive change tissue structure or a dense fibrous membrane leading to loss of bone and periodontal liga- (an exception is the articulating surfaces of ment (PDL). joints, which are covered by a synovial membrane).Has bone-resorptive and bone-forming

124 Pillar

potential. Osteoprogenitor cells are located in Permucosal Occurring, passed, performed, or the vicinity of blood vessels, and the vascular effected through the mucosa. channels in the cortical bone are continuations of the periosteal and endosteal envelope. In Permucosal extension See: Healing abutment. adults,it consists of two layers: the external layer being a network of dense connective tissue Permucosal seal Seal or tissue barrier at the containing blood vessels and the deep layer base of the peri-implant sulcus provided by comprising more loosely arranged collagenous the epithelial tissue; prevents the penetra- bundles with spindle-shaped connective tissue tion of chemical and bacterial substances cells and a network of thin elastic fibers. from the oral cavity to the internal environment of the peri-implant tissues. Fibroblastic layer of p. External of the two layers of periosteum. This network of PG Abbreviation for Proteoglycan. dense connective tissue contains collagen fibers, fibroblasts, and blood vessels. PGA Abbreviation for Polyglycolic acid.

Periotest Instrument used to measure the rel- Phase-I bone regeneration First steps in heal- ative mobility of teeth and dental implants. ing of a bone defect with formation of woven Device utilizes a tapping piston to percuss a bone and consolidation of particulate grafted tooth or an implant four times per second. bone, if used, by bridges of woven bone. Rate of deceleration recorded at the point of contact is measured as the relative stiffness Photon A quanta that has both wave and par- of the tooth or implant. Periotest values ticle properties. Has zero invariant mass and range from -08 to +50, with the -08 to +09 travels at the constant speed c, the speed of range indicating no discernable movement, light in empty space. In the presence of mat- +10 to +19 just discernable movement, +20 ter,it is slowed or even absorbed, transferring to +29 obvious movement, and +30 to +50 energy proportional to its frequency. mobile on pressure.19 P PHSC Abbreviation for Pluripotential hematopoietic stem cell. See: Hematopoietic stem Propulsion Measuring coil coil cell. Start Accelero- button Support Magnet meter Tapping head Physiologic rest position Passive state of mandibular musculature in which the muscles are in equilibrium in tonic contraction Labial or buccal and the condyles are in a neutral, unstrained tooth Operational control surface position. The dentition is nonoccluding.5,20 Analysis of signals cable Pick-up impression Impression of seated su-

Periotest. perstructure on abutments following surgical (Redrawn from Falkner et al19 with permission.) implant placement and healing. The superstructure is removed in the impression to ob- Periotome Small pointed or spoon-shaped in- tain a cast incorporating contours of the ad- strument used to free the ligamentous at- jacent soft tissues.5,20 tachments of a tooth before removal. Pillar See: Stack.

125 Pilot drill

Pilot drill Rotary cutting instrument used to The most common plasma spray coatings are ti- create crestal openings in bone for the pur- tanium and hydroxyapatite plasma sprays. See pose of directing subsequent osteotomy also: Additive surface treatment. preparation.20

Pilot osteotomy Initial bone preparation in the series of drilling for implant placement.

PLA Abbreviation for Polylactic acid.

Place To set in or position an implant in a desired location. See also: Implant placement.

Plaque Organized mass, consisting mainly of microorganisms, that adheres to teeth, pros- Plasma spray. (scanning electron micrograph; magnification x200). theses, and oral surfaces; found in the gingival (Courtesy of D. Buser.) crevice and periodontal pockets.Other components include an organic, polysaccharide-pro- Plasma-sprayed cylinder Cylindrical (non- tein matrix consisting of bacterial by-products threaded) implant with a surface coating of ti- such as enzymes, food debris, desquamated tanium plasma spray (TPS) or hydroxyapatite cells, and inorganic components such as calci- plasma spray. um and phosphate. See also: Biofilm. Plasma-sprayed implant Dental implant with Plaque control See: Oral hygiene. a plasma-sprayed surface.

Plasma cell Antibody-producing B lympho- Plasmid Extrachromosomal, typically circular cyte that has reached the end of its differen- double-stranded DNA molecule capable of au- tiation pathway. Plasma cells are oval or tonomous replication.Found in the cytoplasm P round-shaped with extensive rough endoplas- of a variety of bacterial species and often con- mic reticulum,a well-developed Golgi appara- tains genes that confer a selective advantage tus, and a round nucleus. Principal effector to the bacterium harboring them (eg,the abil- cell involved in humoral immunity. Called al- ity to make the bacterium antibiotic resistant so plasmocyte or plasma B cell. [R plasmid]; conjugation [F plasmid]; produc-

Plasma B cell See: Plasma cell. Replication origin Region into (ORI) sequence which DNA Plasma-containing growth factor Insulin-like can be inserted growth factor 1 (IGF-1) is the major growth factor derived from human plasma and found in a variety of tissues and organs including Plasmid bone matrix. cloning vector

Plasma spray Method of attaching material to

the surface of a structure such as an implant Selective gene body.The coating is produced by heating the sin- (e.g. antibiotic resistance)

tered coating material in an argon environment Plasmid. at extremely high temperatures (>15,000°C). (Redrawn from Lodish et al21 with permission.)

126 Platelet-rich plasma (PRP)

tion of enzymes, toxins, and antigens; and the Platelet-derived growth factor (PDGF) Mito- metabolism of sugars and other organic com- genic growth factor found in the granules of pounds). Plasmids are also used as vectors for platelets and released during blood clotting.It gene therapy applications. consists of two polypeptide chains linked by bonds containing two sulfur atoms each and Plasmocyte See: Plasma cell. regulates cell growth and division (as in connective tissue, smooth muscle, and glia). Plaster A gypsum material that hardens when PDGF plays a role in embryonic development, mixed with water, used for making impres- cell proliferation, cell migration, wound heal- sions and casts. See: Dental stone. ing, and angiogenesis. PDGF exists in several isoforms based on different polypeptide P.of Paris Calcium sulfate hemihydrate re- chains (termed PDGF-A,-B,-C,and -D) and can duced to a fine powder; the addition of wa- exist as homo- or heterodimers. ter produces a porous mass that hardens rapidly. It has been used extensively for Platelet gel Platelet concentrate is combined pouring dental impressions and subse- with thrombin and calcium to form a viscous quent casts. coagulum (gel) used during surgeries to improve adhesive properties and wound-healing Platelet Colorless anucleate disk-shaped characteristics.Additionally,platelet gels form structure, 2 to 4 μm in diameter,found in the a bioactive matrix that, when activated, re- blood of all mammals. It is derived from frag- leases multiple growth factors that affect tis- ments of megakaryocyte cytoplasm and re- sue regeneration. Platelet concentrate is ob- leased from the bone marrow into the blood. tained through a process of differential cen- Contains active enzymes and mitochondria trifugation, which can rapidly concentrate au- and has an important role in blood coagula- tologous platelets and fibrinogen from whole tion by adhering to other platelets and to dam- blood. In this process whole blood is cen- aged epithelium. Called also blood platelet, trifuged, and the platelet- and fibrinogen-rich thrombocyte. plasma component is harvested.23 See also: P Platelet-rich plasma (PRP).

Platelet-poor plasma (PPP) Preparation obtained from whole blood by differential centrifugation. PPP has a relatively high concentration of fibrinogen and is used for autologous fibrin glue preparation, which is employed in surgeries to obtain hemostasis and glue down the flaps.

Platelet-rich plasma (PRP) Preparation consisting of a limited volume of plasma en- riched in platelets and obtained from the pa-

Platelet (electron micrograph; magnification x12,936). tient’s blood by differential centrifugation. (Reprinted from Berman 22 with permission.) End product is the platelet fraction, which is suspended in plasma. This platelet concentrate is activated by way of thrombin generation with calcium, resulting in a three-dimensional and biocompatible fibrin scaffold used

127 Platelet-rich plasma (PRP)

in regenerative surgical approaches. The au- Polyglactin Type of braided multifilament ma- togenous platelets contain a large number of terial made of purified lactides and glyco- growth factors, including platelet-derived sides. Used as a biomaterial for the synthesis growth factor (PDGF); vascular endothelial of absorbable sutures and surgical mesh. growth factor (VEGF); transforming growth factor beta (TGF-β); and proteins, both of Polyglass Variety of resin-ceramic composite which are known to play major roles in soft materials for use as direct restorative materi- and hard tissue healing. PRP has been used als or as computer-aided design/computer-as- for a variety of intraoral applications such as sisted manufacture (CAD/CAM) indirect rest- maxillary sinus floor augmentation, peri- orative materials. odontal or peri-implant bone regeneration as well as a variety of soft tissue reconstructive Polyglycolic acid (PGA) Biodegradable, rigid procedures.24, 25 See also: Growth factor. thermoplastic polymer of glycolic acid and the simplest linear,aliphatic polyester used as Platform Elevated horizontal surface at the a material for the synthesis of absorbable su- coronal end of an endosseous implant to tures and barrier membranes and as a carri- which components such as abutments or er for bone morphogenetic proteins (BMPs). prostheses can be connected.26 When exposed to physiologic conditions,PGA is degraded by random hydrolysis and appar- Platform switching Act of changing an implant ently also broken down by certain enzymes, abutment to one with a smaller diameter,so as especially those with esterase activity. The to place the implant-abutment interface medi- degradation product, glycolic acid, is nontox- al to the edge of the implant platform.26 ic and can enter the tricarboxylic acid cycle, after which it is excreted as water and carbon Pluripotential hematopoietic stem cell (PHSC) dioxide. A part of the glycolic acid is also ex- See: Hematopoietic stem cell. creted by urine. See also: Guided tissue regeneration (GTR). PMCB Abbreviation for Particulate marrow P cancellous bone. Polylactic acid (PLA) Biodegradable, hydrophobic,thermoplastic,and aliphatic polyester PMMA Abbreviation for Polymethylmethacry- derived from lactic acid.PLA can be processed late. in fiber and film and has extensive applicabil- ity.In the biomedical field, it is used in a num- Pneumatization ber of applications, including sutures, drug- See: Maxillary sinus pneumatization. delivery devices, membranes, and as a carrier for bone morphogenetic proteins (BMPs). Polished implant surface Implant surface in- Called also polylactide. See also: Guided tis- tentionally made extremely smooth using sue regeneration (GTR). abrasives or electrical polishing methods. Compare: Turned implant surface. Polylactide See: Polylactic acid (PLA).

Polishing cap An abutment analog or implant Polymer Chemical compound or compound analog that is connected to the prosthesis mixtures created by molecular reaction to and used to protect the intermediate connec- form larger organic molecules containing re- tion surface during dental laboratory finish- peating structural units. A long-chain hydro- ing and polishing procedures.27 carbon.5,20 See also: Resin.

128 Porous marine-derived coralline hydroxyapatite

Polymethylmethacrylate (PMMA) Bone ce- ed in the area of the natural tooth crown(s) ment, a polymer of methylmethacrylate, being replaced.5,20 which polymerizes in situ with curing temperatures exceeding 100°C; completely nonbio- Porcelain fracture The cohesive failure of degradable. porcelain. Etiology of the fracture may be im- perfections or stresses residual from fabrica- Polymorphonuclear leukocyte Fully devel- tion, incompatibility with substrate (thermal oped granular white blood cell whose nucle- coefficient of expansion), substructure defor- us contains multiple lobes joined by slender mation because of misfit or inadequate struc- threads of chromatin and cytoplasm; con- tural integrity, or overload caused by occlu- tains fine inconspicuous granules and is sion or trauma. stainable by neutral dyes. Comprising up to 70% of the peripheral white blood cells, it is important in infection and injury repair and may have impaired function in some forms of aggressive periodontitis.

Polymorphonuclear neutrophil See: Polymorphonuclear leukocyte.

Polytetrafluoroethylene (PTFE) Homopoly- mer of tetrafluoroethylene (CF2-CF2)n that is a nonflammable,tough,inert resin with good Porcelain fracture. (Courtesy of T.D. Taylor.) resistance to chemicals and heat. Used as a surgical implant material for guided tissue Porcelain-fused-to-metal restoration regeneration (GTR), guided bone regenera- See: Metal-ceramic restoration. tion (GBR), prostheses such as artificial vessels and orbital floor implants, and for many Porous Property of allowing ingress of fluid or P applications in skeletal augmentation and gas within a material or surface; sponge-like skeletal fixation.Also used widely in industry, quality. eg, to insulate, protect, or lubricate appara- tuses. Porous bovine-derived hydroxyapatite See: Bovine-derived anorganic bone matrix. Pontic Artificial tooth replacement affixed to a fixed or removable partial prosthesis to re- Porous coralline hydroxyapatite Bone substi- store function and esthetics. Generally locat- tute developed from the Porites or Goniopo- ra coral, in which the CaCO3 skeleton of the Saddle Ridge-lap Modified coral via a hydrothermal process is converted ridge-lap into a hydroxyapatite (HA) substitute with trace levels of β-tricalciumphosphate. It is nonresorbable but osteoconductive because of the nonending porous structure.

Porous marine-derived coralline hydroxyapatite Bone substitute manufactured from

Pontic designs. calcifying marine algae (Corallina officinalis). (Redrawn from Zarb et al28 with permission.) The process of manufacturing involves py-

129 Porous marine-derived coralline hydroxyapatite

rolytical segmentation of the native algae Preparable abutment Prosthetic component and hydrothermal transformation of the cal- that can be modified using rotary instrumen- cium carbonate (CaCO3) into fluorohydroxya- tation. 1-x patite (FHA [Ca5(PO4)3OHxF ]). Preparation Planned and executed definitive Porphyromonas gingivalis Gram-negative, non- form of a natural tooth or implant abutment motile, anaerobic, non-spore-forming bacillus following instrumentation to receive a pros- occurring primarily in the oral cavity and asso- thetic restoration.20 ciated with some forms of severe periodontitis. This nonfermentative, pigmented Porphy- Preprosthetic vestibuloplasty Surgical proce- romonas produces a cell-bound, oxygen-sensi- dure that deepens or lengthens the vestibu- tive collagenase and is isolated principally from lum. Several techniques exist, often involving the gingival sulcus. healing by secondary intention or using mucosal or dermal free grafts or split-thickness Posterior dentition Natural teeth or tooth re- skin grafts. placements other than the incisors and canines.20 See also: Dentition. Press-fit Joint held together by friction of the parts. Mode of attachment used (either by it- PPP Abbreviation for Platelet-poor plasma. self or in conjunction with a screw) by several implant manufacturers for approximating Prefabricated Manufactured in a standard- the abutment into the implant body. Also ap- ized form or method in anticipation of appli- plies to the close adaptation of a root-form cation.29 (ie, cylindrical) implant to its osteotomy site at the time of placement. Prefabricated abutment Prosthetic component manufactured to fit an implant follow- Presurgical consideration See: Patient selection. ing a design specific to the manufacturer’s implant system dimensions. Prevalence Proportion or rate of persons in a P population who had a condition at any given Preliminary cast Obtained from an initial im- time. 32 Compare: Incidence. pression of teeth and associated structures; used for study and/or custom impression tray Preventive maintenance fabrication.30 See: Periodontal maintenance.

Preload In bolted joint mechanics, signifies Prevotella Intermedium Gram-negative, non- the residual stretch or elongation that re- motile, anaerobic, non-spore-forming bacil- mains within the body of the screw after the lus isolated from oral and other body sites. A tightening procedure is completed; the common inhabitant of the gingival crevice, it clamping force of the joining screw across a has been associated with infections of the bolted joint. head, neck, and pleura; also has been associated with inflammatory gingival conditions Premarket notification Submission to the during pregnancy. Food and Drug Administration (FDA) for permission to market certain devices intended for Primary adhesion human use in the United States of America.31 See: Healing by first intention.

130 Proprioception

Primary bone See: Woven bone. as the degree of tissue inflammation, the pressure applied on the instrument during Primary closure Surgical wound closure by probing, the thickness of the probe, and mal- close flap adaption and complete coverage of position of the probe related to anatomic the surgical site. This approach leads to heal- features. ing by primary intention. Product liability litigation Legal proceeding Primary implant failure See: Early implant loss. in a court or a judicial contest to determine if a specific product resulted in injury, loss, or Primary soft tissue healing damage. See: Healing by first intention. Profilometer Instrument used to measure the Primary stability Clinically, implant immobili- relative roughness of a particular topography. ty at the time of surgical placement, resulting In dental applications, it is used to measure from intimate contact of the implant with the the relative roughness of implant surfaces.36 bony walls of the osteotomy.Primary stability decreases with time as osseous remodeling Progenitor cell Relatively undifferentiated occurs. It is distinct from secondary implant cells that have the capacity for both replica- stability, which is the result of new bone for- tion and differentiation and give rise to one or mation and osseointegration.33,34 Compare: more types of specialized cells. Secondary stability. Mesenchymal p. c. See: Mesenchymal stem Primary union See: Healing by first intention. cell (MSC).

Primitive bone See: Woven bone. Progressive loading Concept of gradually increasing the amount of functional load ap- Probing depth Distance from the soft tissue plied to a newly integrated dental implant or (gingival or mucosal) margin to the tip of the implants by modifying the design and the P periodontal probe during usual periodontal material of the prosthesis.Based upon the as- or peri-implant diagnostic probing. Measure- sumption that Wolff Law applies to the bone ment can be affected by several factors, such adjacent to newly osseointegrated dental implants. See also: Wolff Law.

Prophylaxis Measure taken for the prevention of a disease or condition. See also: Antibiot- ic prophylaxis; Oral prophylaxis.

Long Proprioception Perception of movement and junctional epithelium spatial orientation of the body or parts of the Short body. In the oral cavity, the periodontal liga- junctional epithelium ment (PDL) possesses refined mechanorecep- tors that provide highly sensitive neural feedback. This perception is lost or damaged following tooth extraction.It has been proposed that osseoperception of dental implants ex-

Probing depth. ists, although on a much lower level than pro- (Redrawn from Newman et al35 with permission.) prioception of natural teeth.37,38

131 Prospective study

Prospective study Study planned in advance of data collection. Considered to be more re-

liable than retrospective studies, because po- Proximal interphalangeal tentially confounding variables can be better (PIP) joint controlled when the study question is known before data are collected.32 Compare: Retro- Metacarpo- spective study. phalangeal (MCP) joint

Prostaglandin Group of lipid compounds de- Carpal bone S L rived enzymatically from unsaturated 20-carbon fatty acid, primarily arachidonic acid via Radius the cyclo-oxygenase pathway. They have sev- Ulna eral hormone-like functions and are potent regulators of a variety of biologic processes, Prosthetic joint. (S = scaphoid; L = unate bone) (Redrawn from Lundborg39 with permission.) eg, contraction and relaxation of smooth muscle,the dilation and constriction of blood vessels, control of blood pressure, and modu- Prosthetic retaining screw Prosthetic compo- lation of inflammation. nent serving as a retention screw; used to connect the prosthetic component to the Prosthesis (pl: prostheses) Artificial replace- mesostructure or to a transmucosal element.40 ment for a missing human body part (in dentistry, teeth and adjacent supporting struc- Access channel tures and parts of the jaws,face,and cranium). Restoration Dental prostheses can replace single, multiple, or all natural teeth and the associated hard and soft tissues.5,20 See also: Arm pros-

thesis; Auricular prosthesis; Craniofacial pros- Prosthetic thesis; Definitive prosthesis; Denture prosthesis; retaining P screw Digital prosthesis; Epithesis (prosthesis); Facial prosthesis; Hybrid prosthesis; Immediate

restoration; Implant overdenture; Maxillofacial Implant prosthesis; Ocular prosthesis; Partial denture; Provisional prosthesis; Removable prosthesis;

Somatoprosthesis. Prosthetic retaining screw. (Redrawn from Yanase and Preston40 with permission.) Prosthesis bar, Dolder See: Dolder bar.

Prosthesis construction Fixed or removable Prosthetic screw orodental,maxillofacial,or cranial prosthesis. See: Prosthetic retaining screw. See also: Restoration. Prosthetic table See: Occlusal table. Prosthetic joint Artificial replacement for a natural joint. Usually indicated as the result Protein Any of a group of complex organic of arthritic degeneration or trauma in a nat- compounds which contain carbon, hydrogen, ural human joint.39 oxygen, nitrogen, and usually sulfur,the characteristic element being nitrogen. Proteins, the principal constituents of the protoplasm

132 Pullout strength

of all cells, are of high molecular weight and Provisional prosthesis Fixed, removable, or consist essentially of combinations of α- maxillofacial tooth- or implant-supported amino acids in peptide linkages. Twenty dif- prosthesis designed and fabricated for limit- ferent amino acids are commonly found in ed-term use. proteins, and each protein has a unique genetically defined amino acid sequence which Provisional restoration determines its specific shape and function. See: Provisional prosthesis. Their roles include enzymatic catalysis, transport and storage, coordinated motion, nerve Provisionalization Act of planning and fabri- impulse generation and transmission,control cating a prosthesis amenable to alteration of growth and differentiation, immunity, and and use for a limited time period.43 See mechanical support.41 also: Provisional prosthesis.

Proteoglycan (PG) Extracellular and cell-sur- PRP Abbreviation for Platelet-rich plasma. face macromolecules derived from a class of glycoproteins of high molecular weight occur- Pterygoid implant Implant placement through ring primarily in the matrix of connective tis- the maxillary tuberosity and into the ptery- sue and cartilage.Proteoglycans are composed goid plate.Treatment approach can be used in of a protein core with sites for the attachment patients with severe maxillary atrophy or fol- of one or more polysaccharide chains, partic- lowing tumor resection. Implant is placed in- ularly glycosaminoglycan; they assemble poly- to pterygoid bone structure to serve as distal saccharides rather than proteins in their side abutments for implant restorations.44,45 Com- chains. PGs function in cell adhesion, growth, pare: Zygomatic implant. and organization of the extracellular matrix.

Protocol Precise and detailed set of instructions or directions for performing a study. The instructions state what the study will do P and how and why it will be performed. It explains how many subjects will be included, who is eligible to participate (ie, inclusion and exclusion criteria), what and how often study agents or other interventions will be performed, what controls and tests will be in- Zygomatic implant Pterygoid implant cluded, what information will be gathered, and how the information will be analyzed.32,42 Pterygoid implant.

Protrusive occlusion Occluding tooth contact Pullout force Force applied to dislodge an im- when mandibular movement is anterior from plant along its long axis and opposite from its centric relation.5 direction of placement. See: Pullout strength.

Provisional implant Endosseous implant Pullout strength Mechanical testing method made to smaller dimensional specifications used to determine the relative resistance to with narrow widths. Can be used for a defined removal of a dental implant. The test may be period of time (ie, immediate, temporary, used immediately following implant place- and/or transitional) or to support a transition- ment to determine primary implant stability al prosthesis. See also: Mini-implant. or at various times following placement and

133 Pullout strength

during the healing period. Determines the Punch technique See: Tissue punch technique. relative advantages (or disadvantages) of various shapes, materials, and surface textures Pure titanium See: Titanium (Ti). for dental implants. P value Probability that an outcome would oc- Pulsed-mode laser Nd:YAG lasers operate in cur by chance. P values (probability values) both pulsed and continuous mode. Pulsed range from 1 (absolutely certain) to 0 (ab- Nd:YAG lasers are typically operated in the so- solutely impossible). A P value equal to or less called Q-switching mode. In this mode, out- than 0.05 means that the observed outcome put powers of 20 MW and pulse durations of is not likely (≤ 5%) the result of chance.32 less than 10 nanoseconds are achieved. See also: Laser

134 Quality of life

Quality of life See: Oral health-related quality of life.

135

Ramus frame implant

Radiation Process of emission of energy in Radiology Medical specialty directing medical the form of waves or particles. When radia- imaging technologies for the diagnosis and tion impinges on matter, it is absorbed (ie, possible treatment of diseases. transformed), transmitted, or reflected. Radionecrosis Osteonecrosis induced by radi- Radiation-damaged bone and soft tissues See: ation. It can occur in patients who have un- Osteoradionecrosis (ORN). dergone radiotherapy because of a malignant process in the ear, nose, and throat (ENT) or Radiograph Portrayal of hard tissue structures other maxillofacial region. on film sensitive to x-rays and light. See also: Panoramic radiograph. Radiopaque marker Marker made of metal, or any radiopaque material (eg, radiopaque Radiographic guide filling material) that is placed into the mouth See: Radiographic template. before taking radiographs.Detected in the radiograph, the markers help to interpret the Radiographic marker See: Radiopaque marker. image mostly for length, angulation, or localization assessment. Radiographic prosthesis Prosthesis that represents the position of missing teeth and den- Ramus Bilateral posterior vertical extensions toalveolar tissues for radiographic imaging. of the mandibular body. At the superior bor- Structure or marking that directs the motion der, each ramus ends in two processes: the or positioning of something. It is used to coronoid, which is anterior, and the condyle, transfer the intended position of the implant which is separated posteriorly by a deep con- from the diagnostic cast to the patient and to cavity. R record its relationship to the underlying bone. Compare: Radiographic template; Ramus frame implant One-piece implant of Surgical template. tripodal design consisting of a horizontal supragingival connecting bar with right and Radiographic template Acrylic resin guide left posterior extensions that extend into bi- used by the surgeon to direct placement of an lateral ascending rami and one area that ex- implant into its proper position.It is based on tends from the U-shaped frame into the an- the information from two-dimensional pano- terior symphysis area. Later design changes ramic radiographs or three-dimensional com- incorporated multi-pieces for the same U- puted tomography (CT) or digital volume to- shaped frame.1–3 (See figure next page.) mography (DVT) images to achieve optimal implant body placement within the available bone and to preserve vital structures.

137 Ramus frame implant

RBM Abbreviation for Resorbable blast media.

Reactive bone See: Wolff Law.

Reattachment To attach again; the reunion of epithelial and connective tissue with root surfaces and bone such as occurs after an incision or injury. It should not be confused with new attachment.6

Recall appointment after implantation Sched- Ramus frame implant. uled dental visits after endosseous implants have been placed in a patient. Ramus graft See: Alveolar ridge augmentation; Bone graft, Donor site for; Mandibular Recall maintenance block graft, from the ramus. See: Periodontal maintenance.

Ramus implant “A type of endosseous blade Receptor activator of nuclear factor-kappa B implant placed into the anterior border of ligand (RANKL) A 317–aminoacid pep- the mandibular ramus.“3 See also: Implant tide, member of the tumor necrosis factor type. (TNF) superfamily that stimulates osteoclast differentiation and activity as well as inhibits Random assignment Process of assigning osteoclast apoptosis. It is expressed by os- study participants to experimental or control teoblast-stromal cells, fibroblasts, and activat- groups at random, such that each participant ed T cells. In the bone tissue, RANKL binds di- has an equal probability of being assigned to rectly to its receptor (ie, receptor activator of any given group. This method of assignment nuclear factor-kappa B [RANK]) on the sur- helps to prevent bias in a study.4 face of osteoclasts or preosteoclasts, stimulating both the differentiation of osteoclast Random controlled trial Experimental study progenitorcells and the activity of mature os- in which participants are randomly assigned teoclasts. It exists as either a 40- to 45-kd cel- R to a treatment or a control group.4 See also: lular, membrane-bound form or a 31-kd solu- Random assignment. ble form derived by cleavage of the full-length form at position 140 or 145.It also has a num- Range Distance between the highest and the ber of effects on immune cells, including ac- lowest values of distribution. tivation of c-Jun N-terminal kinase (JNK) in T cells,inhibition of apoptosis of dendritic cells, Rank sum test Comparison of two groups on induction of cluster formation by dendritic the median values of the response variable. cells, and proliferation of cytokine-activated Called also Wilcoxon rank sum test.4 T cells.7

RAP Abbreviation for Regional acceleration Recipient site Position or site in the alveolar phenomenon. bone crest that is to receive a graft and/or implant. Ratchet Instrument with “a mechanism consisting of a metal wheel operating with a catch that permits motion in only one direction.“5

138 Remodeling

Reconstruction Restoration of an anatomic Regenerative medicine Field of medicine organ or structure to its original appearance concerned with developing and using strate- and function. In dentistry,it is the restoration gies to repair or replace damaged, diseased, or replacement of a tooth,teeth,or portion of or metabolically deficient organs,tissues,and a jaw or craniofacial structure using an artifi- cells via tissue engineering, cell transplanta- cial prosthesis. See also: Alveolar recon- tion, artificial organs, and bioartificial organs struction; Prosthesis. and tissues.

Record Information or data recorded in any Regenerative therapy for alveolar ridge de- medium (eg, handwriting, print, tapes, film, fect Use of barrier membranes for guided microfilm,microfiche,any electronic form).It bone regeneration (GBR) to provide a more provides evidence of what was planned, the predictable restoration of form. This method treatment provided, and the results. often permits placement of implants simultaneous to defect restoration. Record base Temporary prosthesis base used to carry registration materials to the mouth Regional acceleration phenomenon (RAP) for the recording of maxillomandibular posi- Increase in all metabolic activities in a soft or tional relationships.8,9 See also: Maxillo- hard tissue (including modeling and remod- mandibular relationship. eling activity in the skeleton) that is initiated by a provocative stimulus (eg, fracture, crush Records, legal requirements for maintaining injury). Typical RAP is induced by periosteal Laws that specify the length of time that stimulation.10 records must be kept. Regression Class of procedures for predicting Re-entry Second surgical procedure to place the values of a response variable when the an implant in a staged approach,such as alve- value of one or more explanatory variables is olar ridge augmentation or sinus grafting pro- known.4 See also: Logistic regression analy- cedures.It can be combined with the removal sis; Multiple regression; Simple regression. of an inert biomaterial (eg, nonresorbable membranes or bone graft fixation screws). Rehabilitation Restoration to a former state Can also be performed to improve, enhance, of appearance,well-being,and function using or evaluate results obtained from the initial artificial replacements.8 See also: Osseous R operation. rehabilitation; Restoration.

Regenerate Rejection Immune response to incompatibili- See: Alveolar distraction osteogenesis. ty in a transplanted organ or grafted tissue that may result in failure of the graft or organ Regenerate maturation to survive. See: Consolidation period. Releasing incision Made to enhance the mo- Regeneration Regrowth or reconstitution of a bility of a periodontal flap. From the gingival lost or damaged body part to restore its for- margin or from the base of another incision, mer architecture and function. See also: it is extended in a vertical or oblique direc- Bone regeneration; Guided bone regeneration tion. See also: Incision. (GBR); Guided tissue regeneration (GTR); Os- seous regeneration. Remodeling See: Bone remodeling.

139 Remount index

Remount index Record of the definitive posi- Reparative regeneration See: Regeneration. tion of maxillary occlusal surfaces on the articulator for remounting restorations (usual- Replica Prosthetic component or element ly complete dentures) on the articulator for made as a duplicate in every dimension of a occlusal refinement. See also: Index. specific surgical and/or prosthetic component. A replica can be incorporated in dental laboratory procedures to facilitate making an accurate master cast and/or accurate prosthesis.It can also be incorporated into a model for the purpose of patient education purposes.11 See also: Analog/analogue.

Stone or soft tissue material

Exact implant Remount index. duplicate in all dimensions

Remount record Record of positional registration of maxillary occlusal surfaces to be affixed to the lower member of an articulator Stone cast for occlusal refinement following complete Replica. denture prosthesis processing.9 See also: (Redrawn from Yanase and Preston11 with permission.) Remount index. Residual abscess Abscess produced by the Removable denture See: Removable prosthesis. residues of a previous inflammatory process, including periodontal or endodontic infec- Removable prosthesis Conventional com- tion. Compare: Chronic abscess. R plete or partial denture or maxillofacial prosthetic restoration readily placed in and re- Residual ridge Edentulous part of the maxilla moved from the mouth.9 or mandible that once contained the alveolar process. Following removal or loss of teeth, Removal torque Rotational force required to the alveoli heal by new bone formation and remove an implant from its osteotomy. See remodeling, which leads to some resorptive also: Reverse torque value (RTV). alterations of the alveolar ridge, especially buccal resorption.12 See also: Alveolar ridge. Removal torque value See: Reverse torque value (RTV). Residual ridge resorption After tooth removal, alveolar bone undergoes resorption Repair Biologic process where continuity of dis- and remodeling.The pattern,timing,and clas- rupted or lost tissue is regained by new tissue sification for the completely edentulous max- without restoring structure.Healing occurs via illa and mandible was described by Cawood formation of scar tissue.Normal function may and Howell in 1988. See also: Alveolar not be obtained without restoring structure. ridge, classification of.

140 Restitutio ad integrim

Resin Organic substance that forms a plastic Resorbable membrane Membrane made of material following polymerization initiated absorbable natural or synthetic materials by heat or chemical activation. It is usually used to avoid a second surgery for its re- transparent or translucent, not water soluble, moval. After implantation in the body, mem- and named according to chemical composi- branes are degraded by enzymatic activity tion, physical structure, or means of activa- (collagen membranes) or by hydrolyses (poly- tion or curing.8,13 See also: Acrylic resin; Au- lactic acid and copolymers of polylactic and topolymerizing resin; Composite resin; Epoxy polyglycolic acids membranes). resin; Heat-curing resin. Resorbed maxilla Extensive resorption of the Resonance frequency analysis (RFA) Deter- alveolar process of the maxilla leads to a near- mination of the relative stiffness of an im- ly complete loss of trabecular bone. Remain- plant within the bone via attachment of a res- ing as an alveolar process, it is then almost onance frequency transducer containing two only a cortical plate, often forming the bot- piezo-ceramic elements to an implant. One tom of the sinus and the nasal cavity. piezo element is excited by an electrical signal, and the resulting vibration is measured Resorption Essential cellular process execut- by the second element. The higher the resulted through osteoclastic activity; part of the ing frequency (in kHz),the stiffer the implant- bone healing process as well as the physiolog- to-bone connection.14 ic remodeling of bone.

Transducer Surface of the root Transmitter element Breakdown of the periodontal membrane

Frequency Alveolar bone Receiver response element Charge analyser amplifier

Cantilever beam Osteoclastic resorption Implant abutment of the root surface Personal computer

Implant

Osseous contact between alveolar bone and the surface of the root Resonance frequency analysis (RFA). (Redrawn from Meredith et al14 with permisson.) Resorption. 15 Resorbable Natural or synthetic material that (Redrawn from Andreasen and Andreasen with permission.) can be removed by a cellular process, osteoclasts, or foreign body giant cells and macrophages. Resorption quantification See: Residual ridge resorption. Resorbable barrier membrane See: Resorbable membrane. Restitutio ad integrim Re-establishment of original form and function. Resorbable blast media (RBM) Particles of a resorbable abrasive used to produce a specific surface topography of a dental implant.

141 Restoration

Restoration Material or prosthesis used to re- Retraction cord Slender woven or twisted store or replace teeth, parts of jaws, or cran- string-like fabric (usually cotton or similar ma- iofacial structures.9 See also: Acrylic restora- terial) used to retract gingival or mucosal tis- tion; Osseous restoration; Prosthesis. sues for the exposure of prepared tooth or abutment margins prior to impression making. Restorative dentistry Branch of dentistry It is usually impregnated with an appropriate concerned with the replacement or recon- substance to stiffen the cord and provide vaso- struction of a tooth or teeth and their sup- constriction.8,20 porting structures altered or lost through trauma, surgery, disease, or congenital etiolo- Retractor Instrument used to draw back in- gy.8 See also: Restorative phase. cised tissues to allow access to a wider oper- ative field or examination. Restorative phase Portion of patient treatment concerned with the diagnosis,treatment Retrievability Capacity of a prosthesis, dental planning, and provision of prosthetic therapy. restoration, attachment, or screw to be removed without compromising its structure.21 Restorative platform See: Platform. Retrospective study Study conducted after da- Retained impression coping Impression cop- ta have already been collected.4 Compare: ing fixed intraorally either through frictional Prospective study. fit or by being screwed into position. Imme- diately after removal of the impression, it re- Reverse articulation See: Cross-bite occlusion. mains intraorally.16 Reverse torque test (RTT) Experimental pro- Retainer Device or structure used to retain or cedure in which an implant is subjected to stabilize a prosthesis; ie, direct (clasp, clip, or unscrewing to determine the relative attachment),indirect (partial denture compo- strength of attachment between the implant nent such as a rest or bar), or restoration (in- and bone. It is usually done on a comparative lay, crown, pontic, among others). In ortho- basis between differing implant surface dontics, a fixed or removable appliance used topographies or roughnesses. It is assumed to maintain the position and stabilize teeth that the reverse torque value (RTV) will in- R following treatment.9,17 crease as the process of osseointegration progresses. RTT of implants to a torque of 20 Retaining screw Ncm has also been described as a method for See: Prosthetic retaining screw. determining the success of machined – surfaced, threaded implants in clinical situa- Retention Capacity of a prosthesis or dental tions.22 restoration to maintain its intended position in function. For a removable prosthesis, the Reverse torque value (RTV) Resulting value resistance to displacement in the designed of the torsional force required to unscrew an path of insertion.9,18 implant body from its osteotomy. It is assumed that RTV would increase as osseointe- Retentive element Portion of a prosthetic gration progresses during the healing component that is the cylinder-to-implant po- phase. See also: Reverse torque test (RTT). sition, directly in contact with the implant.19

142 RPM

Revolutions per minute (RPM) Speed at Ridge resorption which a shaft turns. It is recorded as the num- See: Residual ridge resorption. ber of complete (360-degree) revolutions the shaft makes in a minute. Ridge sounding See: Bone sounding.

RFA Abbreviation for Resonance frequency Ridge splitting See: Alveolar ridge augmenta- analysis. tion, Split-ridge technique for.

Ribbon See: Articulating tape. Rigid fixation Process of becoming fixated or rendered immobile,inflexible; applicable to a Ridge See: Alveolar ridge; Residual ridge. prosthesis or prosthesis component.8,21

Ridge atrophy See: Residual ridge resorption. Rigidity Stiffness or inflexibility of an object.

Ridge augmentation Risk assessment Process of predicting an in- See: Alveolar ridge augmentation. dividual’s probability of disease.24

Ridge defect Risk factor Exposure that has been shown. See: Alveolar ridge defect,Implant placement in. through data collection and research to increase the probability that a disease or a par- Ridge expansion See: Alveolar ridge augmen- ticular medical condition will occur (eg,smok- tation, Split-ridge technique for. ing is a risk factor for implant failure).25

Ridge lap design Tissue-contacting surface of Root “The portion of the tooth apical to the ce- an artificial tooth prepared to accommodate mentoenamel junction that is normally covered the residual ridge contour on the facial, buc- by cementum and is attached to the periodontal cal, and lingual or palatal aspects. A fixed or ligament and hence to the supporting bone.“26 removable prosthesis incorporating such features may be designated a ridge lap–de- Root-form implant Inaccurate term often signed restoration.8,9 used to describe an endosseous implant. A cylindrical implant does not resemble the Desirable posterior ridge Modified posterior ridge 27 lap design for oral health lap design root form of a single-rooted natural tooth. R

Buccal Buccal Rough implant surface Implant surface with a varying degree of macro- and microirregulari- ty in contrast with a machined or polished, smooth surface. A rough implant surface is generally considered to be superior to a smooth or polished surface in its ability to osseointegrate from both the rate of integration Ridge lap design. and the relative surface area of bone-implant (Redrawn from Stein et al 23 with permission.) contact (BIC). Surface roughness of implants can be categorized into three basic levels: min- Ridge mapping See: Bone sounding. imally rough, 0.5 to 1 μm; moderately rough, 1 to 2 μm; and rough, greater than 2 μm.28 Ridge preservation See: Bio-Col technique. RPM Abbreviation for Revolutions per minute.

143 Ruffini receptor

Ruffini receptor Highly sensitive nerve end- runx2 Abbreviation for Runt-related transcrip- ing of the periodontium in close approximation factor 2. tion with collagen fibers that allow refined proprioception around teeth. R value Measurement of roughness of surface topography. Specifically, R is the height pa- Runt-related transcription factor 2 (runx2) rameter of roughness, which also includes See: Bone morphogenetic protein (BMP); Core- spacial and hybrid parameters.29 binding factor alpha 1 (CBFα1).

144 Scaffold tissue engineering

Salivary calculus See: Calculus.

Sandblasted implant surface Implant surface that has been treated by exposure to silica sand particles propelled under high pressure, thus creating a rough surface texture. See also: Rough implant surface.

Sandblasted, large-grit, acid-etched (SLA*) implant surface A surface treatment that improves surface roughness to enhance osseointegration through greater bone-implant contact (BIC) as well as an increased rate at which osseointegration occurs.

Sandblasting Act of modifying or roughening the surface of an implant body by propelling silica sand onto the surface at high velocity under high pressure.

Satisfaction of patient See: Patient satisfaction. Scaffold (scanning electron micrographs of polymer nanofibrous scaffolds with low magnification at x200 (upper fig.) and high magnification at x100000 (low- Saucerization Part of surgical treatment for er fig.)). osteomyelitis in which an essentially closed (Reprinted from Wei et al1 with permission.) cavity is opened to the surface by excavation, converting the cavity into a saucer-like defect. Scaffold tissue engineering Appropriate three- S dimensional material with pores and an inter- Scaffold Biocompatible, synthetic or natural connected pore network with proper surface supporting structure for growing cells and for attachment, proliferation, and differentia- tissues. It is used in tissue engineering as a tion. It has matching mechanical properties carrier of cells or molecules to induce tissue and is bioresorbable with controllable degrada- regeneration. In genetics, the chromosome tion. structure consisting entirely of nonhistone proteins remaining after all the DNA and his- tone proteins have been removed from a chromosome. See also: Bone scaffold.

* Trademark by Straumann

145 Scaler

Scaler Instrument for removing calculus or Screw “A helically grooved cylinder for fasten- other deposits from the surface of teeth or ing two objects together or for adjusting the oral implants. position of an object resting on one end.“ The head of the screw has either a groove or Scaling Instrumentation of the crown and slot or other mechanical inset by which it is root surfaces of the teeth to remove plaque, rotated and driven into something.2,3 See calculus, and stains from these surfaces. also: Abutment, Screw design of; Attachment screw; Closure screw; Coping screw; Cover Scalloped Curved design of an incision or bor- screw; Prosthetic retaining screw; Sealing der, eg, the marginal gingival tissue border. screw; Set screw.

Scalloped implant A root-form implant design Screw design Common design for cylindrical that has the level of the implant-abutment endosseous dental implants; the screw shape junction elevated interproximally to accom- allows for increased primary stability. The modate the papilla-crestal bone relationship. time of placement and the screw threads may provide additional load-carrying capacity, although this has not been shown to be signif- Scalloped icant clinically. neck

Screw fracture Breakage of occlusal or abutment screws comprising part of an implant supported/retained restoration. Facial surface Lingual surface

Screw implant See: Screw-type implant; Threaded implant.

Screw joint Interface or junction of two pros- Scalloped implant. thesis components connected by a screw.4

Scanographic template Generic term for a Screw loosening Loss of screw preload,resulting shaped piece of metal, wood, resin, or other in destabilization of a prosthesis or abutment.4 material used as a pattern for processes such as painting, cutting out, shaping, or drilling. Screw preload Clamping or stretching force S Examples include a radiopaque marker,radio- that occurs across the interface of implant graphic guide, or radiographic prosthesis. components being attached together via screw tightening. See also: Preload. Scar Area of fibrous tissue resulting from the biologic process of wound repair that replaces Screw tap See: Tapping. normal tissues destroyed by injury or disease. Called also cicatrix. Screw, Teflon-coated Implant/prosthesis retention screw that has been modified with a Schneiderian membrane polytetrafluoroethylene (PTFE) surface coat- See: Maxillary sinus membrane. ing.5 See also: Screw.

Schneiderian membrane perforation See: Maxillary sinus membrane, Perforation of.

146 Sensory mapping

Screw tightening Act of turning a screw into its Second moment principle receptacle until resistance is met, resulting in See: Moment of inertia. increased tightness of the screw. See also: Preload. Second-stage permucosal abutment See: Transmucosal abutment. Screw-type implant An implant with threading on the surface, resembling a screw shape, Second-stage surgery See: Stage-two surgery. sometimes referred to as screw-shape. See also: Threaded implant. Seesaw model (of prosthesis loading) Model describing the mechanical loading aspects of SD Abbreviation for Standard deviation. implants or teeth arranged linearly.8

Sealing screw Healing component used to cover the coronal portion of the implant or as part of a transmucosal healing component that seals the occlusal portion of that component.6 See also: Healing abutment.

Seating surface See: Platform.

Secondary adhesion 2m 1m See: Healing by secondary intention. 350 N 700 N

Secondary closure Misnomer,since the gener- 1050 N al goal of surgery is to have close flap adap- Seesaw model (of prosthesis loading). tation and complete closure of the surgical (Redrawn from Rangert et al8 with permission.) site, and hence healing by primary intention. However, certain situations, incomplete clo- Segmental defect Resulting defect following sure is indicated, which leads to healing by removal of jaw segments in tumor patients. secondary intention. See: Healing by secondary intention. Self-curing resin See: Autopolymerizing resin.

Secondary implant failure Self-tapping Ability of certain implant profile See: Late implant loss. designs to cut their own threads into the os- S teotomy walls at the time of implant place- Secondary stability Implant stability within ment. A self-tapping implant may be screwed its prepared bony site, created by osseointe- into the osteotomy without first having to gration and the formation of new bone sub- pretap the thread grooves. sequent to loss of the bone initially in contact with the implant at the time of placement. Semi-adjustable articulator See: Articulator. This delayed clinical implant immobility may follow osteotomy site augmentation with Sensory function evaluation Clinical evalua- bone substitutes and/or healing adjuncts.7 tion that tests sensory function. Compare: Primary stability. Sensory mapping Anatomic mapping of sen- Secondary union sory function that determines if loss or im- See: Healing by secondary intention. pairment exists. Technique is used longitudi-

147 Sensory mapping

nally to monitor the improvement of sensory ture and suprastructures.9 See also: Pros- dysfunction. thetic retaining screw.

Septum Lining or wall separating two cavities Sharpey connective tissue fibers Terminal or chambers within the body. portions of principal fibers that insert into the cementum of a tooth. These collagenous Maxillary sinus s. Cortical bone wall within fibers pass from the periosteum and are em- the maxillary sinus that divides the maxil- bedded in the outer circumferential and inter- lary sinus floor partially or completely into stitial lamellae of bone.Called also bone fibers. two or more chambers. Extent of a septum can vary. It is most common in edentulous Osteocyte maxillae, usually located between the sec-

ond premolar and first molar region, and Sharpey fiber may cause complications during sinus floor elevation procedures. Called also Under- Bundle wood septum. bone

Periodontal Sequestration Formation of a sequestrum; ligament

separation of necrotic bone from the sur- Osteocyte rounding healthy bone.

Sequestrum Fragment of nonvital bone that Osteoblasis has become separated from the sound, healthy bone during the process of necrosis.

Set screw Type of retention or attachment Sharpey fiber screw that is made in smaller dimensions and used to connect a suprastructure and a mesostructure with lingual or palatal horizontal access. Sometimes it is configured as a metal tube with an internally threaded bore and screw system in which prefabricated components are incorporated into the mesostruc- Sharpey connective tissue fibers (high magnification). (Reprinted from Lindhe et al10 with permission.) S Shear stress State of stress occurring when two objects in contact are loaded parallel to their surfaces.

Sialoprotein Noncollagenous protein with a set screw molecular weight of approximately 33,000 KDa that contains the arginine-glycine-aspartic acid (RGD) tripeptide sequence, characteristic for attachment proteins, which interact with cell surface integrins. It has a high calcium-binding potential and binds tightly to hydroxyapatite (HA) as well as to cells. Set screw. (Redrawn from Staubli and Bagley9 with permission.)

148 Sinus lift surgery

Signaling molecule Molecules that partici- Single-tooth implant Implant and implant pate in intracellular and intercellular mecha- restoration used in a single-tooth gap for the nisms involved in chemical transmitting of in- replacement of one tooth. formation between cells. Such molecules are released from the cell sending the signal, Sinter Process of fusing small particles or cross over the gap between cells, and interact powder into a solid mass through heating. with receptors in another cell, triggering an intracellular signaling cascade that results in Sinus augmentation See: Maxillary sinus floor a cellular response to the impulse. elevation; Maxillary sinus floor graft.

Signed rank test Nonparametric form of the Sinus disease Pathology of the maxillary sinus. paired t test for comparing two samples.11 Sinus elevation Misnomer used to describe Silicone Polymeric organic silicon compound surgical techniques for maxillary sinus floor el- in which some or all of the radical positions evation. See: Maxillary sinus floor elevation. that could be occupied by carbon atoms are occupied by silicon.Used for heat- or water-re- Sinus graft See: Maxillary sinus floor elevation; sistant lubricants, binders, and insulators.12,13 Maxillary sinus floor graft.

Simple regression “To predict the value of a Sinus Graft Consensus Conference Confer- single response variable from a given value of ence in which a panel of experts developed a single explanatory variable.“14 and voted on multiple consensus statements derived by committee review of retrospective Simulation Imitative representation of the func- information for bone–grafting materials, tioning of one system or process by means of type of implants, timing for implant place- the functioning of another. For example, in ra- ment, failure analysis, radiographic analysis, diology it could be an image obtained with the indications and contraindications, prosthet- same source-to-skin distance, field size, and ics, and nomenclature. Several consensus orientation as the diagnostic beam for visuali- statements were obtained, the most signifi- zation of a treated area on a radiograph.15,16 cant being that the sinus graft should now be considered a highly predictable and effective Simultaneous implant placement Implant therapeutic modality.17 placement with a simultaneous bone-grafting procedure. See also: Alveolar ridge de- Sinus grafting See: Maxillary sinus floor eleva- S fect, Implant placement in. tion; Maxillary sinus floor graft.

Single-stage implant Misnomer used for an Sinus grafting technique See: Lateral window implant that is placed with a one-stage proce- technique; Maxillary sinus floor elevation; Max- dure. See also: One-stage implant placement. illary sinus floor graft; Osteotome technique.

Single-stage surgery Used to describe surgi- Sinus lift Misnomer used to describe surgical cal procedures that could be performed in techniques for maxillary sinus floor eleva- one surgical step. Currently, procedures are tion. See: Maxillary sinus floor elevation. described either as a staged or a simultaneous approach. See also: One-stage implant Sinus lift surgery Misnomer used to describe placement; Simultaneous implant placement; surgical techniques for maxillary sinus floor Two-stage implant placement. elevation. See: Maxillary sinus floor elevation.

149 Sinus lining

Sinus lining Fixed partial denture supported by six implants (n1–n6). See: Maxillary sinus membrane. Horizontal load (P) has eccentricity (e) with respect to center (O). y n Sinus membrane P p n1 See: Maxillary sinus membrane. e R R n6 6 O 1 Sinus perforation Oro-antral fistula following x R5 R2 tooth extraction or perforation of the maxil- n2 lary sinus membrane during a sinus grafting R4 R3 procedure. n 5 n3 n Sinus pneumatization 4 See: Maxillary sinus pneumatization. Horizontal load Skalak model of prosthesis loading I. Sinus septum See: Septum.

Sinusitis Inflammation of the maxillary sinus Fixed partial denture supported by six implants (F1–F6). from bacterial, viral, fungal, allergic, or au- Vertical load (P), center of gravity (O), eccentricity of load (e). toimmune origin.While acute sinusitis is usu- y y x ally caused by infection with a single type of 6 6 bacteria or virus, chronic sinusitis is usually F6 x1 caused either by allergies or by infection with P several types of bacterium.Infections may be O xp of either dental or otolaryngeal origin. F5 F1 y Site development p y1 See: Implant site development. x F2 F4 Vertical load Site preservation See: Bio-Col technique. F3 Skalak model of prosthesis loading II. Skalak models of prosthesis loading Biome- chanical models created by Richard Skalak explaining implant loading by forces applied Load distribution with distributed supports (implants) 18 S to an attached rigid prosthesis. (See figure.) and small overhang ≈ P Distributed support F1 P Skin Two-layered outer integument or covering of the body, consisting of the dermis and the epidermis and resting upon the subcuta- F F F neous tissues. The outer ectodermal epider- 1 2 3 mis is more or less cornified and penetrated Load distribution with closely spaced supports (implants) with by the openings of sweat and sebaceous large overhang (cantilever) P Cantilever F ≈2P glands, and the inner mesodermal dermis is 1 composed largely of connective tissue and richly supplied with blood vessels and nerves. Called also cutis. F1 F2 F3

Skalak model of prosthesis loading III. (Redrawn from Skalak19 with permission.)

150 Soft tissue augmentation

Skin-penetrating implant Endosseous im- Smile line Imaginary line following the con- plant placed in an extraoral site requiring skin tour of the upper lip in the act of smiling. The penetration for prosthesis attachment as op- contour of the lower lip generally parallels the posed to wet-surfaced gingiva or mucosa. curvature of the incisal edges of the maxillary Maintenance of adequate hygiene in the anterior teeth.In arranging maxillary artificial skin-penetration area can be problemat- teeth, the incisal-occlusal plane parallels the ic.20 See also: Percutaneous implant. smile line to project a pleasing appearance.24,25 See also: Lip line. Skull simulator Dummy of a skull to elucidate anatomy and execute phantom surgery.

SLA* Abbreviation for Sandblasted, large-grit, acid-etched.

Smile line. (Reprinted from Aiba26 with permission.)

x8,000 Socioeconomic factors Issues included when describing the relationship between financial activity and social life. For example, as a patient cost-reduction factor,the use of implants for patients with an edentulous mandible with considerable bone loss has enabled overdenture placement supported by two anterior implants to provide enhanced treatment results for this population.

x1,600 Socket See: Extraction socket. Sandblasted, large-grit, acid-etched (SLA*) implant surface S (scanning electron micrograph). Socket graft See: Bio-Col technique. (Reprinted from Cochran et al21 with permission.)

Socket preservation See: Extraction socket. Sleeper implant Nonfunctioning endosseous implant retained in bone and covered by mu- Soft tissue Any noncalcified tissue.In the oral cosa for subsequent exposure and/or use for cavity,usually refers to the oral mucous mem- bone conservation.22 branes, including the gingiva.

Smile Expression of the face in which the lip Soft tissue augmentation Grafting procedure commissures are elevated to connote pleas- aimed at increasing soft tissue volume. ure,approval,or joy. Act of producing a smile.23

* Trademark by Straumann

151 Soft tissue cast

Soft tissue cast Working cast in which the im- Spacemaking Property of surgical site capable plant analog is enveloped in an elastic mate- of maintaining a space under a membrane for rial simulating mucosal tissues to facilitate the purpose of guided bone regeneration laboratory procedures.4 See also: Implant- (GBR). This may be provided by: (1) defect level impression. morphology in either three-wall or two-wall defects; (2) use of bone grafts or substitutes to support the membrane; (3) membrane itself, which is rigid and stable enough to maintain a secluded space below; or (4) using a reinforced membrane to avoid membrane collapse.

Spark erosion See: Electric discharge method (EDM).

Speaking space Available distance between Soft tissue cast. the incisal and/or occlusal surfaces of the teeth (Reprinted from QDT27 with permission.) or trial occlusion wax rims during directed acts of speech.22,29 See also: Vertical dimension.

Specialized oral mucosa See: Mucosa; Oral mucosa.

Spiral drill Cutting instrument with a three- dimensional continuous curving surface around a shaft used to create cylindrical openings in bone. Soft tissue cast. (Reprinted from Watzek28 with permission.) Spirochete General term for any microorgan- Soft tissue defect Defect of soft tissue that ism of the order Spirochaetales. This spiral, may include scarring from previous surgeries, gram-negative, highly motile bacterium is inadequate soft tissue margins,or inadequate characterized by a flexible cell wall. It is soft tissue volume related to an underlying markedly increased in number in diseased bone defect following trauma or infection. periodontal pockets. The major genus in dis- S eased periodontal tissues is the Trepone- Soft tissue graft See also: Soft tissue augmen- ma. See also: Treponema denticola. tation.

Solder joint Interface of adjacent metallic surfaces united with appropriate metal alloys to produce a continuous unit.13,22

Solid screw Retentive element without an open or hollow interior bore.

Somatoprosthesis Artificial body part. Spirochete (scanning electron micrograph; high magnification). (Reprinted from Ingraham and Ingraham30 with pe- Sounding See: Bone sounding. mission.)

152 Staggered offset

Splinting Process of stabilization via connect- resistance to displacement of a prosthesis or ing teeth, implants, bars, or other prosthetic restoration in the horizontal plane.22,32 See devices to create a stronger unit.Splinting may also: Primary stability; Secondary stability. be provided by fixed or removable prostheses that are supported by natural teeth or im- Stabilization See: Bicortical stabilization; Bi- plants. Surgical applications may involve any lateral stabilization. material or device to immobilize a body part compromised by trauma,surgery,or disease.13,31 Stack Vertically aligned and assembled combination of a prosthetic restoration, abutment and implant.

Screw access Restoration

Abutment

Extraoral splint. (Courtesy of W.R. Laney.) Implant

Split-crest technique See: Alveolar ridge augmentation, Split-ridge technique for. Stack. Split-ridge technique See: Alveolar ridge aug- (Redrawn from Brånemark33 with permission.) mentation, Split-ridge technique for. Staged protocol Split-thickness graft See: Stage-one surgery; Stage-two surgery. See: Subepithelial connective tissue graft. Stage-one surgery Placement of an implant Spongy bone See: Trabecular bone. with a healing screw in a submerged fashion. Followed by stage-two surgery. SPT Abbreviation for supportive periodontal therapy. See: Periodontal maintenance. Stage-two surgery Following stage-one sur- S gery, the uncovering or reopening of an im- Square impression coping Impression coping plant site at a later date by a small gingival ex- designed as a square when viewed in cross cision or tissue punch to remove the healing section. The height varies as does the manu- screw and replace it with an abutment. facturer’s design; it may include indentations (ie, concavities or convexities) along the Staggered offset Positioning of multiple im- length of the square. See also: Impression plants (minimum of three) such that the im- coping. plant bodies are not in a linear relationship; the purpose is to increase the mechanical Stability Property of a material,implant,pros- stability of the resulting assembly. See also: thesis, or dental restoration to maintain an Tripodization. intended physical position or state when subjected to forces disturbing its equilibrium; eg,

153 Standard abutment

Standard abutment Prosthetic implant com- Stent Fabricated device used surgically to main- ponent meeting the recommended design for tain tissue position (eg, graft) or maintain lu- restoration. Early use of the term was specif- men or intended defect patency. See also: ic to a particular implant company. Surgical template.

Standard deviation (SD) Measure of the dis- Stepped implant Specific implant shaft de- persion or variability of a set of values.Defined sign that incorporates concentric steps that mathematically, it is the square root of the narrow in width toward the apex of the im- variance of these observations. By definition, plant. approximately 68% of the values in the normal distribution (or bell-shaped curve) fall within one SD on either side of the mean. If the SD exceeds one half the mean, the data are not normally distributed.11 See also: Variance.

Standard error (SE) Measure of the dispersion of the possible differences between samples of two populations, usually the difference between the means of the samples.11

Standard of care Treatment that experts Stepped implant. agree is appropriate, accepted, and widely used. Healthcare providers are obligated to Stereognosis Ability to perceive weight and provide patients with the standard of care.34 form of an object by touch.

Staple implant See: Transosseous implant. Stereolithographic guide Surgical guides that assist placement of implants in vivo in the Static loading Placement of an implant into a same locations and directions as those in a constant loading situation.Static load is applied planned computer simulation. to an implant through a non passive or misfit- ting prosthesis in a multiple implant restora- Stereolithography Technique for creating sol- tion. Static loading of an implant also occurs in id plastic, three-dimensional objects from situations where the implant is used for ortho- computer-aided design (CAD) drawings by se- S dontic anchorage. See also: Loading. lectively solidifying an ultraviolet-sensitive liquid resin (photopolymer) using a laser beam. Statistical significance In implant dentistry, these physical models See: Null hypothesis; P value. can reproduce the true maxillary and mandibular anatomic dimensions. A stere- Stem cell Primary undifferentiated cell that olithography machine has four important retains the ability to produce an identical parts: a tank filled with several gallons of liq- copy of itself when divided (self-renew) and uid photopolymer,which is a clear,liquid plas- differentiated into another cell type. See tic; a perforated platform immersed in the also: Hematopoietic stem cell; Mesenchymal tank,which can move up and down in the tank stem cell (MSC). as the printing process proceeds; an ultraviolet laser; and a computer that drives the laser and the platform.Called also three-dimensional layering or three-dimensional printing.

154 Submerged healing

Sterile technique Method of placing implants Stripped thread Screw (or an internal screw under sterile, conventional operating room channel) that has lost its thread architecture conditions. because the screw was inserted and tightened incorrectly or because the screw was Stippling Gingival appearance of fine light or pulled from its channel without unscrewing. dark dots, or a spotted appearance. It is a normal adaptive condition in which the attached Stripping Removal of the surface of an object; gingiva presents a lobulated surface, with an the act of creating a stripped thread. See orange-peel appearance. also: Stripped thread.

Straight implant See: Parallel-sided implant. Student t test See: t test.

Strain Deformation of a structure when exter- Stud-type attachment system nal load is applied. Compare: Stress. See: Ball attachment system; O-ring.

Stress Force per unit area. Compare: Strain. Subantral augmentation See: Maxillary sinus floor elevation. Stress bending Load applied to a structure that tends to deform. For an implant, bend- Subepithelial connective tissue graft Graft ing stress deforms the long axis of the im- of connective tissue taken from the palate for plant body. See also: Nonaxial loading. root coverage in instances of recession or lack of keratinized tissue.This procedure has been Stress concentration Area within a structure adopted in implant dentistry with the pur- at which applied external force creates pose of enhancing soft tissue contours for es- heightened internal strain. It is also the point thetics. The advantage of this procedure as at which a structure is more likely to fail cat- compared to a free gingival graft is its esthet- astrophically or through fatigue loading. ic superiority, dual blood supply, and less donor-site postoperative morbidity.36 Stress distribution The pattern of distribution of stress as seen when a load is applied Sublingual artery The sublingual artery arises to an object or series of objects. For example, at the anterior margin of the hyoglossus and the stress distribution in bone associated runs forward between the genioglossus and with an implant–supported restoration de- mylohyoideus to the sublingual gland. It sup- pends on the number and location of implies the gland and gives branches to the my- S plants, the design of the prosthetic super- lohyoideus and neighboring muscles, as well structure, and the anatomy of the surround- as to the mucous membrane of the floor of ing bone.35 the mouth and lingual gingiva.37

Stress shielding Situation, particularly in or- Submerged healing Implant placement with thopedic joint replacement, in which an im- complete primary soft tissue closure, requir- plant is stiffer than the bone in which it is ing a second surgical procedure to expose the placed. Under loading the implant bears the implant and initiate prosthetic restoration load, and the surrounding bone undergoes following healing. (See figure next page.) disuse atrophy. The shaft of the implant shields the bone from functional loading.

155 Submerged healing

Submerged healing (right). Subperiosteal implant. (Redrawn from Cochran and Mahn38 with permission.)

Submerged implant See: Submerged healing. Subtracted implant surface Implant surface created through removal of material by expo- Subperiosteal s. i. See: Complete subpe- sure to acid,abrasives,or electrolysis.Subtrac- riosteal implant; Eposteal implant; Unilater- tive process generally creates roughness in- al subperiosteal implant. tended to enhance cell proliferation and osseointegration. Submergible implant Implant that is “submerged beneath the oral mucosa at time of Subtraction radiography Technique requiring surgical placement.“39 See also: Two-stage digital imaging. Differences in gray values are implant placement. stored in an image matrix and can be made visible when a baseline radiograph is subtracted Subnasal elevation Rarely performed surgical from a follow-up radiograph. When the same technique to enhance anterior bone height in object is exposed at least two or more times in the anterior maxilla. Surgically,it can be com- the same way, the changes over time in hard pared with a sinus floor elevation; instead of tissue structures like bone or enamel can thus elevating the maxillary sinus membrane, the be detected.This technique permits detection nasal mucosa is elevated. of mineral loss in both enamel and bone before it is visible in conventional radiography. Subperiosteal implant Custom-fabricated im- S plant frame to fit directly on bone. As origi- Subtractive surface treatment nally designed, the fabrication procedure re- See: Subtracted implant surface. quires two surgical procedures, the first of which allows impressioning of the supporting Succedaneous dentition bone; the second for framework placement. See: Dentition, Permanent. Framework is made in a latticework configuration to cover an extensive bony surface and Success criterion Condition established to de- can be made to incorporate permucosal posts termine whether data have satisfied their ob- and/or an additional, continuous bar super- jectives and met the requirements for success. structure.40 See also: Eposteal implant. Success rate Percentage of patients or units that have completed a study after a specified period of time and have met defined success criteria. See also: Cumulative success rate.

156 Surgical stage

Sulcular epithelium See: Crevicular epithelium. Supportive periodontal therapy (SPT) See: Periodontal maintenance. Tissue punch for s. e. See: Implant exposure; Tissue punch technique. Suppuration Formation or discharge of pus; associated with an acute or chronic infec- Sulcular incision Incision that maintains the tion.43 entire marginal gingival tissue.It is made from the base of the gingival sulcus, parallel to the Surface bonding Additive surface applied to root surface, reaching the alveolar bone crest. the implant body.

Surface of implant See: Implant surface.

Surface treatment Modification to the implant surface, either structural or chemical, which alters its properties. It may be additive or subtractive in nature. See also: Additive surface treatment; Anodizing surface treatment; Fluoride-modifying surface treatment; Microtextured surface treatment; Oxidating surface treatment; Subtracted implant surface.

Sulcular incision. Surgical Any condition pertaining to or cor- (Redrawn from Sato41 with permission.) rectable by surgery.

Summer osteotome technique See: Maxillary Surgical bed Surgically prepared site, ready to sinus floor elevation; Osteotome technique. receive an implant, bone graft, or soft tissue graft. Superstructure Framework skeleton for the attachment of a matrix holding artificial teeth Surgical dressing See: Periodontal dressing. comprising the prosthesis, which is connected directly to dental implants, an infrastructure, Surgical guide See: Surgical template. and/or as mesostructure.4,22 Called also suprastructure. Surgical implant Device made from a non living material and surgically placed into the S human body where it is intended to remain for a significant period of time to perform a specific function.44

Surgical navigation Computer-aided intraoperative navigation of surgical instruments and operation site, using real-time matching to patients’ anatomy. During surgical navigation, deviations from a preoperative plan can 45 Pink wax to simulate be immediately observed on the monitor. gum tissue and hold the teeth on framework Superstructure. Surgical stage 42 (Redrawn from Taylor and Laney with permission.) See: Stage-one surgery; Stage-two surgery.

157 Surgical stent

Surgical stent See: Stent. Symphysis Anterior line of fusion of the two halves of the mandible, which ossifies during Surgical template Laboratory-fabricated guide the first year of life. based on ideal prosthetic positioning of implants used during surgery.Called also surgical Syngeneic graft See: Isograft. guide. Synthetic bone material See: Bone substitute. Survival rate Percentage or estimated percentage of subjects in which a given censored event Synthetic graft material See: Bone substitute. (eg, implant failure, prosthesis failure) has not occurred during a time period measured from Systematic review Summary of medical liter- a given starting point. It is usually used to de- ature, which uses explicit methods to per- scribe the percentage of implants that remain form a thorough literature search and is fol- in the mouth over a specified period of lowed by a critical appraisal of individual time.11 See also: Kaplan-Meier analysis. studies using appropriate statistical techniques to combine studies that meet defined S value In the study of surface roughness and inclusion and exclusion criteria. topography of dental implants, S values are measurements of irregularities in three dimensions.46

158 Telescopic coping

Tannerella forsythensis Fusiform, fastidious, Tapping Final bone preparation of the screw anaerobic gram-negative member of the thread configuration prior to implant place- Cytophaga-Bacteroides family implicated in ment. periodontal and peri-implant diseases. T forsythensis, Porphyromonas gingivalis, and Tarter See: Calculus. Treponema denticola form a red complex of species associated with aggressive peri- T cell Thymus-dependent lymphocytes that odontal infections. This organism, previous- are spherical cells of the lymphoid series and ly described as Bacteroides forsythus, was among the principal cells involved in the cell- subsequently reclassified to T forsythensis mediated immune response. based upon its phylogenetic position. TCP Abbreviation for Tricalcium phosphate. Tantalum (Ta) Malleable metal used in the past to fabricate plates, wires, and discs for Team approach Multidisciplinary combina- implantation; atomic number 73 and atomic tion and collaboration of care and/or thera- weight 180.948. py providers in the restorative management of a patient whose treatment involves den- Tape See: Articulating tape. tal implants.2-4

Tapered implant Shape of an implant body Teflon compression ring Prosthetic compo- when viewed in profile,lengthwise. A tapered nent made of polyoxymethylene intended to implant usually narrows apically. provide resilience between the implant and the prosthesis. This ring is placed between Tapered impression coping Impression cop- the transmucosal element and the prosthe- ing designed to narrow toward the occlusal sis.5 See also: Intramobile connector. surface; varies in length.1 Telescopic coping Concept in fixed prosthodontics in which an intermediate coping can T be designed to compensate for a malaligned retainer. Stacked crowns are fabricated with the contours to fit within the confines defined by a single restoration, without causing clinical or prosthetic complications associated with overcontoured crowns. This technique is used in overdenture therapy in which natural teeth are retained and restored using a crown (ie, telescopic coping)

Tapered impression designed with minimal thickness to serve as coping. a patrix component; the matrix component

159 Telescopic coping

(ie, telescopic crown) is then incorporated aments supporting the joint are the temporo- into the prosthesis.6,7 mandibular, capsular, sphenomandibular, stylo- mandibular,and the articular disk or meniscus. The joint facilitates mandibular movements involving depression and elevation, as well as for- Telescopic crown ward, backward, and lateral combinations.10,11 Telescopic coping Natural tooth Natural tooth preparation preparation Temporal bone

Zygoma

Capsule Mandible Telescopic coping. Temporomandibular ligament Telescopic coping attachment system Reten-

tive mechanism that employs a frictional fit External view between the matrix and patrix components. External surface of the patrix mirrors the internal surface of the matrix and fits within the confines of the matrix for a frictional, 8,9 Spine of passive fit. See also: Telescopic coping. sphenoid Capsular ligament Spheno- Template See: Surgical template. mandibular Styloid- ligament processus Lingula of the Temporary abutment Implant component inferior used for a limited period of time prior to fab- mandibular Stylo- foramen rication of the definitive prosthesis. mandibular ligament

Temporary cement See: Cement. Angle of jaw Internal view Temporary cylinder See: Temporary abutment. Temporomandibular articulation. (Redrawn from Gray12 with permission.) T Temporary healing cuff See: Healing abutment. Temporomandibular joint Articulation be- Temporary prosthesis See: Provisional prosthe- tween the mandibular condyles and glenoid sis. fossa of the temporal bone is capable of translation and rotation movements. The disk is Temporomandibular articulation Ginglymo- composed of dense fibrous connective tissue, arthrodial-type articulating joint involved in the while the posterior attachment is highly vas- bilateral connection of mandibular condyles to cularized and innervated. The joint is sur- the temporal bone. Anatomic structures com- rounded by the capsular ligament, a fibrous prising the joint are: the anterior part of the gle- capsule. See also: Temporomandibular artic- noid cavity of the temporal bone, its articular ulation. eminence, and the mandibular condyle; the lig-

160 Thread flank

Tensile strain Tetracycline bone labeling Permanent labeling Elongation Ϭ original length ϫ 100 %. of osteoid (bone matrix) as it mineralizes in a two-phase process.With up to 80% of complete Tensile stress Force applied to an object that mineral uptake regulated by osteoblasts,the re- elongates or stretches. maining 20% is regulated by osteocytes. The osteoid zone is separated from the mineralized Tension-free wound closure Wound closure part of the bone by a layer called the mineral- that can be obtained without flap tension. ization front. This layer is able to bind tetracy- Underlying periosteum may need to be re- cline,resulting in a permanent fluorescent line. leased to provide coverage of an augmented site. See also: Releasing incision. Textured surface See: Rough implant surface.

Tent pole procedure Operation in which the Texturing Application of texture; to roughen. anterior part of an atrophic mandible is exposed by extraoral approach; periosteum and TGF Abbreviation for Transforming growth factor. soft tissues are elevated to expose the superior aspect of the mandible. Dental implants TGF-β Abbreviation for Transforming growth fac- are placed by tenting the soft tissue matrix to tor beta. prevent graft resorption. Particulate autogenous bone chips are onlayed under the pe- Thick flat periodontium riosteum and around the implants. See: Periodontal biotype, Thick.

Tenting screw Metal screw used in guided Thin scalloped periodontium bone regeneration (GBR) procedures to sup- See: Periodontal biotype, Thin. port barrier membranes retaining space for new bone formation.13 Thread Grooves cut into the walls of a cylinder making it a screw (positive) or a screw chan- Test, chi-square See: Chi-square test. nel (negative). These structures guide the insertion and removal of a screw or bolt. Also, Tetracycline Group of wide-spectrum antibi- the act of inserting a screw or bolt into its re- otics seldom used in treatment of oral infec- ceiving channel. Example: The next step is to tions but may be used for rhinogenic infections. thread the occlusal screw into the abutment. Some are natural (ie, isolated from certain species of Streptomyces) and others are pro- Major diameter of t. Greatest thread diam- duced semisynthetically.Tetracyclines and their eter of a tapered screw. The diameter by analogues inhibit protein synthesis by their ac- which the screw is designated. Compare: T tion on microbial ribosomes and have anti-ma- Thread, Minor diameter. trix metalloproteinase (MMP) activity. All have similar toxic and pharmacologic properties,dif- Minor diameter of t. Smallest thread diam- fering mainly in their absorption and suitabili- eter of a tapered screw. Compare: Thread, ty for various modes of administration.They are Major diameter. effective against a broad range of aerobic and anaerobic gram-positive and gram-negative Thread flank Side of a thread between the bacteria,as well as rickettseae,chlamydiae,and crest of the thread and the depth of the mycoplasmas. Because of the binding to calci- thread. In most applications the thread angle um,it is not advisable to use tetracyclines in the between the flanks of a thread is 60 degrees. treatment of infections in children. (See figure next page.)

161 Thread lead

Thread lead Distance between screw threads Three-dimensional imaging as measured in the direction of the long axis See: Stereolithography. of the screw. Compare: Thread pitch. Three-dimensional layering Thread pitch Distance between threads, in See: Stereolithography. millimeters, as measured perpendicularly to the thread axis. In American units, thread Three-dimensional modeling pitch is given in threads per inch. Compare: See: Stereolithography. Thread lead. Three-dimensional printing See: Stereolithography.

Thread Thread Thrombocyte See: Platelet. lead pitch

Thread Ti Abbreviation for Titanium. flank

Tibia Bone located medial and anterior to the fibula. The tibia articulates superiorly with the femur and patella, laterally with the fibula, and inferiorly with the ankle.14

Tibial bone harvest Extraoral source of auto-

Thread flank, thread lead, thread pitch. genous cancellous bone harvested from the lateral proximal tibia, which can be performed in an ambulatory setting under intra- Threaded implant Implant body design resem- venous sedation. This procedure is rarely bling a screw,including helical threading devel- used in daily practice.15 oped into the external surface of the implant. Term does not describe the connnection pres- Tissue Composed of cells of a given degree of ent between the anchorage component and specialization, differentiation, maturation, the prosthetic component, which may or may and a characteristic intercellular substance. not include an internal bore within the anchor- Although the intercellular substance may age component. See also: Implant thread. comprise the major volume, tissues are primarily classified according to the predomi- Three-dimensional guidance system for im- nating types of cells they contain. T plant placement A computed tomography (CT) scan is performed to provide image da- Bone t. Consists of 70% mineral and 30% ta for a three-dimensional guidance con- organic material. Hydroxyapatite (HA) struct for implant placement. A guide is a comprises 95% of the mineral and the oth- structure or marking that directs the motion er 5% comprises complex salts with mag- or positioning of something, thus in implant nesium, fluorine, sodium, potassium, and dentistry this term should not be used as a chlorine. The organic part consists of 98% synonym for surgical implant guide. A radi- matrix, where collagen type I comprises ographic guide is rather used as a positioning 95% and noncollagenous proteins 5%.The device in intraoral radiography. See also: remaining 2% of organic material are the Radiographic prosthesis. cells, osteoblasts, osteocytes, osteoclasts, and lining cells.

162 Titanium (Ti)

Soft t. See: Soft tissue. Tissue integration Interdigitation of soft or hard tissues with an implant biomaterial. Tissue bank Centers for acquiring, character- izing, and storing human organs or tissue for Tissue punch Surgical instrument used to cre- future use by other individuals. It may also ate a circular soft tissue incision for exposing designate storage of information about tis- a submerged implant. sues (eg, bone bank, skin bank). Tissue punch technique Surgical technique to Tissue conditioner Elastomeric material with gain access to an implant following a complet- limited flow properties used to massage ed healing period; removes the overlying soft abused or healing soft tissues.Usually a mod- tissues using a blade,disposable tissue punch, ified acrylic resin consisting of a polymer (eg, or laser. The disadvantage of this method is ethyl methacrylate or co-polymer) and an aro- the loss of valuable keratinized mucosa. matic ester–ethyl alcohol mixture is often used in an existing prosthesis.16-18 Tissue recession Drawing away of a tissue from its normal position (eg, gingival reces- Tissue conditioning Process of restoring health sion). See also: Gingival recession; Peri-im- to oral stress-bearing soft tissues following sur- plant tissue recession. gical or mechanical trauma using the occluding prostheses to transmit continuous stress of Tissue-supported Support of a prosthesis force and motion to the basal-seat tissues. A based entirely or partially on soft tissues tissue conditioner is often used.19 overlying residual bone.13

Tissue engineering Combination of principles Titanium (Ti) Relatively inert and corrosion- of life and engineering sciences used to devel- resistant metal because of its thin (approxi- op materials and methods to repair dam- mately 4 nm) surface oxide layer. Commer- aged, lost, or diseased tissue. It is also used to cially pure, grade 4 Ti consists of more than create entire tissue and organ replacements. 99% pure Ti. Ti readily absorbs proteins from biologic fluids; in contact with liquids, the Tissue-integrated prosthesis Screw-connect- surface is passivated immediately. This very ed, fixed or removable, orodental, maxillofa- stable passivity explains its corrosion resist- cial restoration retained by osseointegrated ance even against sodium chloride solu- endosseous implants.Term was originally pro- tions, including physiologic saline. The pure posed by P.-I.Brånemark and colleagues (Swe- form is not available or economical for com- den) and intended for a full-arch prosthesis mercial use. Ti is a relatively rare metal with fabricated for an edentulous arch.2 anatomic number 22, atomic weight 47.90, T and specific gravity of 4.5.

Commercially pure t. See: Commercially pure titanium (CPTi).

Pure t. Elemental titanium with no impu- rities; not available commercially. See also: Commercially pure titanium (CPTi). Tissue-integrated prosthesis. (Reprinted from Branemark et al20 with permission)

163 Titanium alloy

Titanium alloy Metallic material utilized in Tomography See: Computed tomography (CT) the manufacture of endosseous implants. scan; Conventional tomography. The most common titanium alloy used for dental implants is Ti-6Al-4V. Tooth extraction Removal of a tooth or teeth.

Titanium mesh Network of flexible interlock- Tooth fracture Breakage of natural tooth or ing titanium metal links in a fabric-like struc- polymer-based or ceramic prosthetic teeth. ture used to maintain created space in a bone regeneration procedure during healing. See Torque Twisting or turning force applied to an also: Alveolar ridge augmentation, Titanium object. Specifically the force applied to an im- mesh–autogenous bone grafting for. plant or screw during placement or removal. Compare: Moment; See also: Cutting Titanium mesh crib, autogenous bone with torque; Insertion torque; Removal torque. See: Alveolar ridge augmentation, Titanium mesh-autogenous bone grafting for. Torque controller Device that limits the potential torque that can be applied to an ob- Titanium oxide Naturally occurring com- ject; generally considered to be a safety pounds of titanium and oxygen in various mechanism. See also: Torque driver. configurations. Chemical formula for titanium oxides are: TiO, TiO2,Ti2O3, and Ti3O5.Ti- Torque driver Instrument used to apply tor- tanium oxide occurs naturally on the surface sional force to an object; generally includes a of titanium when it is exposed to air,and it is wrench and a method of gauging the torque critical to osseointegration between living being applied. bone and a titanium implant.

Titanium plasma sprayed (TPS) See: Plasma spray.

Titanium reinforced Property of a material that is reinforced by a titanium structure for increased rigidity.

Titanium-reinforced expanded polytetrafluoroethylene membrane Expanded polytetrafluoroethylene (e-PTFE) membrane rein- T forced by an attached titanium structure that allows increased rigidity when performing Torque driver. guided bone regeneration (GBR) procedures.

Titanium root-form implant Torque gauge See: Torque indicator. See: Endosseous implant. Torque indicator Device that registers the tor- Titanium skin-penetrating implant sional force being applied; usually registered See: Percutaneous implant. as Newton meters, centimeters, or foot pounds. See also: Torque driver. TMJ Abbreviation for Temporomandibular joint.

164 Transitional implant

Torque wrench Device designed to apply a tight- Transduction Process by which genetic ma- ening force (ie, torque) with a self-limiting fea- terial (DNA) is transmitted from one bacte- ture to prevent over- or undertightening.It may rial cell to another via a bacterial virus be manual or electric. See: Torque driver. (phage), thereby changing the genetic constitution of the second organism. Torsion stress See: Torque. Transfer coping Covering or cap used to posi- Torus Bony protuberance occurring either at tion a die in an impression; most often made the midline of the palate or on the lingual as- from metal or acrylic resin.22 See also: Coping. pect of the mandible. Transfer index Core or mold used to record TPS Abbreviation for Titanium plasma sprayed. and/or register the relative positions of teeth, See: Plasma spray. anatomic structures, or implants to one another. The fabrication material is rigid and Trabecula (pl: trabeculae) Supporting or an- stable, so that the index can be used to trans- choring strand of connective tissue, such as a fer the three-dimensional information accu- strand extending from a capsule into the sub- rately. See also: Index. stance of the enclosed organ. Transfer jig See: Transfer index. Trabecular bone Trabecular cancellous bone consists of bone trabeculae, thin plates or Transforming growth factor (TGF) Any of sev- spicules with thickness ranging from 50 μm to eral proteins secreted by transformed cells 400 μm. Trabeculae are interconnected in a that stimulate growth of normal cells, al- honeycomb nonending, porous system. The though not causing transformation. TGF-α pattern of the trabeculae is oriented accord- (TGF-a-amino acid polypeptide, binds to the ing to mechanical stress to ensure maximal epidermal growth factor receptor (EGFR) and adaptation to a given stress pattern. See also stimulates growth of microvascular en- also: Cancellous bone. dothelial cells. TGF-β (TGF-beta or TGF-B) exists as several subtypes,all of which are found in hematopoietic tissue and promote wound healing.

Transforming growth factor beta (TGF-β) One of the two classes of transforming growth factors (TGF).TGF-β exists in at least three known subtypes in humans (ie, TGF-β1, TGF-β2, and T TGF-β3), all of which are found in hematopoietic tissue, stimulate wound healing, and play crucial roles in tissue regeneration, cell differentiation, and embryonic development. They are upregulated in some human cancers and in vitro are antagonists of lymphopoiesis and myelopoiesis.

Transitional implant See: Provisional implant. Bone remodeling of trabecular bone. (Von Kossa-McNeal; magnification x320). (Reprinted from Buser et al21 with permission.)

165 Transitional prosthesis

Transitional prosthesis Prosthetic restoration osteotomy sites in an apical-coronal direc- designed to facilitate the progression of pa- tion, into the mandibular basal bone, and tient treatment from one phase to another. through the occlusal of the residual alveolar Called also conversion prosthesis. ridge using an extraoral approach.25

Transitional restoration See: Transitional prosthesis.

Transmandibular implant See: Transosseous implant.

Transmucosal Property of a structure extending from internal anatomic structures and commu- nicating through the mucosa to the external environment; eg, a restored dental implant.

Transmucosal abutment Prosthetic implant Transosseous implant. component that passes through intraoral tissues (attached and/or alveolar mucosa), is Transosteal implant See: Transosseous implant. accessible intraorally, and may be available as a one-piece component.23,24 Transport segment Alveolar segment that has been surgically prepared for alveolar distrac- Abutment tion osteogenesis. See also: Alveolar dis- passes through mucosal soft traction osteogenesis. tissue Thickness of soft tissue Trap See: Bone trap.

Trauma Bodily injury. Called also injury.

Osteoradionecrosis secondary to t. Osteo- radionecrosis (ORN) that occurs in a cancer patient undergoing a radiation therapy dose greater than 70 Gy.Any trauma in the Transmucosal abutment. irradiated area,including the surgical trauma of implant placement, may lead to T Transmucosal healing See: Nonsubmerged ORN because of impaired wound healing. healing. This clinical situation is considered high risk.26–28 Transmucosal loading Loading of an implant through the overlying soft tissue during the Trauma reconstruction Surgical and/or pros- healing phase. thetic reconstruction of the craniofacial complex, alveolar ridge, and/or teeth by means of Transosseous implant Implant that is placed bone grafting, implant placement, and soft through the residual bone. This arch-shaped tissue reconstruction. implant crosses the mandibular midline (anterior symphyseal region) and is placed into Treatment See: Adjunctive treatment.

166 Turnover

Treatment planning Organization and se- Try-in Placement of a wax pattern of a tooth quencing of treatment procedures and restoration, tooth arrangement, or any other providers (eg, surgeons, prosthodontists) fol- tentative restoration in the mouth for jaw lowing patient diagnosis.29 record verification, evaluation, and/or alteration prior to completion. Metal castings (eg, Trephine See: Bone trephine. single-tooth restorations, frameworks, cop- ings, or attachments) can also be placed in Treponema denticola Long, thin, corkscrew- the mouth for evaluation of fit prior to like, gram-negative, anaerobic spirochete restoration completion.29,30 that has been implicated as a possible etiologic agent of chronic periodontitis and peri- T.of framework See: Framework. implantitis. Characteristic motility and morphology of the organism may be discerned T. of unglazed restoration Try-in of a ce- by darkfield microscopy. ramic or metal-ceramic restoration in the patient’s mouth to evaluate contour,color, Trial fit gauge Replicate of an implant body occlusion, and proximal contact tightness. used to assess the size and shape of an os- The try-in is completed prior to the appli- teotomy. cation of the final ceramic glaze to minimize the need for final adjustments and to Tricalcium phosphate (TCP) [Ca3(PO4)2] Bio- create as optimal a restoration as possible. degradable bone substitute that may be used as a carrier; the biodegradation profile is un- t test Statistical test often used to compare predictable. It is similar in composition to two groups on the mean value of a continu- naturally occurring bone mineral,provides an ous response variable. The test is used when osteoconductive matrix, and is resorbed the variables have normal distribution. It was through cellular activity. developed by William Gossett, a student of Karl Pearson, and published under the pseu- Tripodization Placement of three dental im- donym Student. Called also Student t test.31 plants using a staggered offset (ie, not in a See also: Standard deviation (SD). straight line) to increase resistance to nonaxial loading. See also: Staggered offset. Tuberosity, maxillary See: Maxillary tuberosity.

Tunica mucosa See: Mucosa.

Turned implant surface The surface texture of an implant as generated by milling machines T used in manufacturing of the final implant shape. The surface is not altered subsequent to the machining process. Called also machined implant surface. Compare: Polished implant surface.

Turnover Rate at which certain biomolecules or cells are lost and/or regenerated through Tripodization. cell division.

167 Twist drill

Twist drill Rotary cutting instrument with nu- Two-stage implant placement Protocol fol- merous deep spiral grooves extending from lowed using two separate surgical procedures the tip to the smooth part of the shaft.30 for implant placement. In the first stage, an osteotomy site is prepared, the implant is Two-implant overdenture placed, and primary closure is accomplished. See: Implant overdenture. The second stage occurs after a specified healing period in which a soft tissue exposure Two-piece implant Anchorage component is necessary to uncover the implant and allow and element of the prosthetic component connection to transmucosal components pri- manufactured as two separate pieces. Im- or to definitive implant restoration. plant and transmucosal abutment are assembled as separate components or elements.32,33 Two-stage surgical approach Category of surgical procedures that must be performed in two interventions. This group includes implant placement with submerged healing that requires a separate uncovering procedure or ridge augmentation procedures with secondary implant placement.

Implant body Type 1 bone See: Alveolar bone, Quality of.

Type 2 bone See: Alveolar bone, Quality of.

Two-piece implant (without transmucosal element). Type 3 bone See: Alveolar bone, Quality of.

Two-stage grafting procedures Grafting pro- Type 4 bone See: Alveolar bone, Quality of. cedures are performed when the bone defect is too large for simultaneous implant placement and sufficient primary implant stability; implant placement is delayed. Compare: One-stage grafting procedures.

168 Unit load

UCLA abutment Prosthetic implant compo- Unilateral subperiosteal implant Subpe- nent developed as a plastic castable pattern riosteal implant used to restore a segment of that can be modified by adding wax for cus- the arch. For example, it can be used in a par- tom shape and dimensions. This is a founda- tially edentulous patient requiring restoration for creating a cast-to-custom option.The tion and replacement of several teeth with component is screw retained directly into the natural teeth adjacent to the partially eden- implant, which circumvents the attachment tulous area and on the contralateral side. screw. 1,2 See also: Castable abutment. See also: Subperiosteal implant.

Ultrasound stimulation Treatment modality traditionally used in physiotherapy to treat soft tissue disorders by deep heating tissues. It has been used with good results in treatment of fractures or delayed union and/or nonunions in extremities via a pulse sound wave at 1.5 MHz with an intensity of 30 mW per square cm. It does not seem to stimulate healing of either defects or vertical distraction of the mandible.3

Underwood septum See: Septum, Maxillary sinus. Unilateral subperiosteal implant.

Unit load Load calculated as being applied to an individual implant within a multiple-implant restoration. Also, part of the total load on bone imposed by an endosseous implant. Unit compression load usually equals the unit U compression stress.

169

Verification index

Vacuum tube See: X-ray tube. Nonviral v. See: Gene therapy, Nonviral; Gene transfer. Valsalva maneuver Forceful intraoperative attempt at nasal expiration by the patient with Viral v. See: Gene therapy,Viral; Gene Transfer. the nostrils held closed by the clinician to test the possible loss of integrity of the maxillary VEGF Abbreviation for Vascular endothelial sinus membrane.1 growth factor.

Variance Degree of dispersion of data about Veneer Coating of predetermined thickness, the mean. The square root of the variance is usually resin or ceramic, attached to a crown the standard deviation. For bell-shaped restoration or pontic by bonding, cementa- curves, the larger the variance, the flatter the tion, or mechanical retention.3,4 distribution curve; the smaller the variance, the more peaked the curve.2 See also: Stan- Vent Hole placed in an indirect restoration to dard deviation (SD). reduce seating pressure and to allow escape of excess cement during cementation. Also a VAS Abbreviation for Visual analog scale. verb explaining the act of creating the hole in a restoration. Vascular endothelial growth factor (VEGF) Pep- tide factor,existing in four forms with different Verification cast New cast made from the re- lengths (ie, 121, 165, 189, and 206 amino assembled index of implants following the val- acids) that is mitogenic for vascular endothe- idation of fit.5 See also: Verification index. lial cells and promotes tissue vascularization. Its levels are elevated in hypoxia, and it is im- Verification index Assembled recording of portant in tumor angiogenesis. the positional relationship of implants made on a cast or in the mouth for the interchange- Vascular supply Supply of nutrients from the able validation of fit. If the fit is incorrect, the vasculature to an elevated flap or surgical site. index is sectioned and reassembled.5

Vascularization See: Angiogenesis. V VDO Abbreviation for Vertical dimension of occlusion.

Vector Quantity described both in magnitude and in direction. A force vector is the application of force of a given magnitude applied in a given direction. Verification index. (Redrawn from Procera Laboratory Manual6 with permission.)

171 Verification jig

Verification jig See: Verification index. stimuli (ie, worst pain ever). The pain or stimuli perception is marked by making a point Vertical alveolar distraction Alveolar distrac- along the defined line.2 tion in an apicocoronal direction. See also: Alveolar distraction osteogenesis. Vital biomechanics Subfield of biomechanics that concerns the manner of biologic re- Vertical bone height Height of the mandible in sponse to mechanical usage and loads as well the midsagittal plane measured from the infe- as other physical stimuli. rior border of the edentulous mandible to the top of the crest of the alveolar ridge.This meas- Vitamin D receptor (VDR) Member of the urement may also be made on a panoramic ra- steroid hormone receptor superfamily through diograph. For the maxilla, a superior landmark which vitamin D and its analogs exert their ac- is defined and the height is measured from tions. Vitamin D is a potent modulator of the there to the crest of the residual ridge. immune system and involved in regulating cell proliferation and differentiation.9 Vertical dimension Available distance between the incisal and/or occlusal surfaces of the Vitreous carbon Biocompatible carbon that teeth or trial wax occlusion rims during direct- is processed to reduce its brittleness. It is ed acts of speech.Called also speaking space.7,8 made from carbon containing aldehydes by a thermic degradation via high temperatures Vertical dimension of occlusion (VDO) Mea- (1,000 to 3,000°C),resulting in a 99.98% pure surement between facial reference marks carbon. Implants of vitreous carbon were de- when the teeth or wax occlusion rims are in signed and used in the 1970s; however, fi- contact.4 See also: Occlusion. brous encapsulation without osseointegration took place. It is therefore not currently Vestibular Common reference to the trough used as material for implants. or space between the lateral or buccal surfaces of the teeth or residual ridges and the Volkmann canal Oblique channel that connects lips and cheeks; may also refer to the trough osteons to each other and the periosteum. or space between the lingual surfaces of the teeth or residual ridges and the tongue.4 V-Y advancement flap Flap designed to lengthen an area of soft tissue and/or assure primary Vestibular incision Incision placed in the buc- coverage without tension following tissue re- cal mucosa of the vestibulum. moval. Incision is first made in the form of a V and then sutured in the form of a Y.10 Vestibuloplasty Surgical procedure that in- Removed creases vestibular depth. See also: Prepros- superficial thetic vestibuloplasty. layer V Visual analog scale (VAS) Rating scale used to determine the degree of conditions or stimuli (ie, pain) a patient is experiencing. Visual analog scales represent a line with clearly defined endpoints expressing on one side of the scale

the absence of stimuli (ie, no pain) while the Incision Underlying connective tissue opposite side represents the highest degree of V-Y advancement flap.

172 Wound healing

Wax trial prosthesis Preliminary prosthetic Working occlusion Occluding tooth contact restoration seated in the mouth for the eval- on the side of the arch toward which the uation of maxillomandibular records, fit, and mandible is moved.2 appearance.1,2 Working side See: Occlusion. Waxing sleeve Prefabricated, open-ended, castable plastic pattern (ie, coping) used for Wound Damage to living tissue; forcible inter- the direct shaping of contours for a restora- ruption of the continuity of any tissue. Called tion framework.3,4 also injury or trauma.

Wound closure Approximation of mucoperiosteal or mucosal flaps at the end of a surgical procedure. Wound margins are secured by sutures. See also: Tension-free wound closure.

Sutures for w. c. Sutures that assist in keep- ing flap margins well adapted to each other without tension. Varying suturing techniques may be used.

Waxing sleeve. Wound dehiscence Incomplete wound healing because of insufficient blood supply, ex- Waxup Wax and/or plastic pattern contoured cessive postsurgical edema, or compromised to the desired form for a trial denture or healing. castable framework.1,2 Hyperbaric oxygen treatment for w. d. White blood cell See: Leukocyte. Use of hyperbaric oxygen in cases of severely compromised wound healing. See Wilcoxon rank sum test See: Rank sum test. also: Hyperbaric oxygen treatment (HBOT).

Witness See: Expert witness. Wound healing Natural process of restoration of integrity to traumatized tissue in the body. Wolff Law Principle of bone healing and/or re- It comprises a set of events that take place in W modeling based upon the understanding that a predictable fashion to repair the damage. bone remodels in response to physical stress These events overlap in time and are catego- by depositing bone in locations of increased rized into separate phases: the inflammato- stress and resorbing bone in areas of little or ry, proliferative, and maturation phases. no stress.5,6

173 Woven bone

Woven bone Collagen fibrils oriented in a ran- Wrench Device or tool used to apply torsional dom or felt-like manner; primarily formed in force to an object, as in tightening or loosen- embryos. In adults it reappears when acceler- ing a screw or bolt. See also: Cylinder ated bone formation is required (ie, healing wrench. bone).It has interlacing fibrils,numerous and large osteocytes, and a rather high mineral density.The mineralization process starts 1 to 3 days after osteoid formation. See also: Osteogenesis.

Woven bone. (Reprinted from Watzek7 with permission.)

174 Young modulus

Xenograft Graft taken from a donor of anoth- Young modulus See: Elastic modulus. er species. Called also heterograft.

X-ray Limited part of the spectrum of electromagnetic radiation; a self-propagating transverse oscillating wave of electric and magnetic fields.

X-ray tube Vacuum tube designed to produce x-ray photons. In the tube, there is a cathode to emit electrons into the vacuum and an an- ode to collect the electrons, where the x-rays are produced by bremsstrahlung.

X Y

175

Zygomatic implant

Zirconium oxide Ceramic material used for Zygomatic implant Endosseous implant placed implant components; generally attributed to into the zygoma as a “partial or complete al- have excellent mechanical properties. It is ternative to bone augmentation procedures used in situations where esthetics are of pri- for the severely atrophic maxilla.“ Designed mary importance and metal show-through of and fabricated as a long, screw-shaped im- the tissues is a potential problem. Called also plant. Implant is placed surgically using a zirconia. placement appliance to help guide the position and angle of placement.1,2 Compare: Pterygoid implant.

Zygomatic Maxillary implant implant

Maxillary Maxillary tuberosity tuberosity

Zygomatic implant.

177

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192 Trademark Appendix

A. Titan, Instruments Aseptico, Inc. 97 Main Street 8333 216th Street, SE Hamburg, NY 14075, USA Woodinville, WA 98072-1548, USA Phone (877) 284-8261; (716) 648-9272 Phone (425) 487-3157; (800) 426-5913 Fax (716) 648-9296 Fax (360) 668-8722 www.atitan.com www.aseptico.com

AccuDental Guided Implant Modeling AstraTech, Inc. Medical Modeling, LLC 890 Winter Street, Suite 310 17301 West Colfax Avenue, Suite 300 Waltham, MA 02451, USA Golden, CO 80401, USA Phone (800) 531-3481; (781) 890-6808 Phone (888) 273-5344 Fax (781) 890-6808 Fax (303) 273-6463 www.astratech.com www.medicalmodeling.com Atlantis Components, Inc. ACE Surgical Supply Company, Inc. 25 First Street 1034 Pearl Street Cambridge, MA 02141, USA Brockton, MA 02301, USA Phone (877) 828-5268 Phone (800) 441-3100; (508) 588-3100 Fax (617) 661-9063 Fax (800) 583-3150; (508) 583-3140 www.atlantiscomp.com www.acesurgical.com Attachments International, Inc. Advanced Implant Technologies, Inc. 600 South Amphlett Boulevard 8920 Wilshire Boulevard, Suite 305 San Mateo, CA 94402-1325, USA Beverly Hills, CA 90211, USA Phone (Ordering) (800) 999-3003 Phone (800) 876-4620; (310) 652-9314 Phone (Technical Support) (650) 340-1426 Fax (800) 298-2383; (310) 659-1594 Fax (650) 340-8423 www.aitdental.com www.attachments.com

Alphadent N.V. Bicon Dental Implants Ceka Center 501 Arborway Noorderlaan 79 Boston, MA 02130, USA 2030 Antwerpen, BELGIUM Phone (800) 882-4266; (617) 524-4443 Phone (32) 3 542 25 27 Fax (800) 882-4266; (617) 524-0096 Fax (32) 3 542 24 30 www.bicon.com http://alphadent.ys.be/ceka/en/about/

193 Trademark Appendix

BioHorizons Implant Systems, Inc. Central Florida Tissue Bank One Perimeter Park South, Suite 230 S 8663 Commodity Circle Birmingham, AL 35243, USA Orlando, FL 32819, USA Phone (888) 246-8338; (205) 967-7880 Phone (800) 852-0346; (407) 226-3888 Fax (205) 870-0304 Fax (407) 226-3885 www.biohorizons.com www.tissuebank.org

BioLok International, Inc. CollaGenex Pharmaceuticals, Inc. (formerly Minimatic Implant Technology, Inc.) 41 University Drive 368 South Military Trail Newtown, PA 18940, USA Deerfield Beach, FL 33442, USA Phone (215) 579-7388 Phone (800) 789-0830; (954) 698-9998 Fax (215) 579-8577 Fax (954) 698-9925 www.collagenex.com www.biolok.com Columbia Scientific/Materialise Dental, Inc. Bredent USA – XPDent Corporation 810-X Cromwell Park Drive 12145 SW 131 Avenue Glen Burnie, MD 21061, USA Miami, FL 33186, USA Phone (888) 327-8202; (443) 557-0121 Phone (800) 328-3965; (305) 233-3312 Fax (443) 557-0036 Fax (305) 233-2002 www.materialise.com www.xpdent.com Columbus Dental CAMLOG Biotechnologies USA 1000 Chouteau Avenue Granite Woods St. Louis, MO 63188, USA Corporate Center, Buildg. 2 Phone (800) 325-7357 350 Granite Street Braintree, MA 02184, USA C.V.Mosby/Elsevier, Inc. Phone (877) 537-8862 11830 Westline Industrial Drive Fax (877) 418 2365 St. Louis, MO 63146, USA www.camlogimplants.com Phone (800) 545-2522; (314) 872-8370 Fax (800) 535-9935; (314) 432-1280 CAMLOG Vertriebs GmbH www.elsevier.com Maybachstrasse 5 71299 Wimsheim, GERMANY DENTSPLY Friadent CeraMed Phone 49 (0) 7044-9445-0 12860 West Cedar Drive, Suite 110 Fax 49 (0) 7044-9445-722 Lakewood, CO 80228, USA www.camlog.de Phone (800) 426-7836; (303) 985-0800 Fax (303) 989-5669 L.D. Caulk Company, Dentsply, International www.dentsplyfc.com 38 West Clarke Avenue Milford, DE 19963-0359, USA DENTSPLY Friadent GmbH Phone (800) 532-2855 Steinzeugstrasse 50 Fax (800) 788-4110 68229 Mannheim, GERMANY www.caulk.com Phone (49) 621-4302-000 Fax (40) 0621-4302-001 www.friadent.de

194 Trademark Appendix

DENTSPLY Prosthetics Division Henry Schein, Inc. 570 West College Avenue 135 Duryea Road York, PA 17405-0872, USA Melville, NY 11747, USA Phone (808) 877-0020 Phone (631) 843-5500; (631) 843-5325 Fax (717) 854-2343 Fax (631) 843-5676 http://prosthetics.dentsply.com www.henryschein.com

Designs for Vision, Inc. Impla-Med Implant Group of APM-Sterngold 760 Koehler Avenue 13794 N.W. Fourth Street, Suite 209 Ronkonkoma, NY 11779, USA Sunrise, FL 33325, USA Phone (800) 727-6407; (631) 585-3300 Phone (800) 421-7321; (305) 846-0226 Fax (631) 585-3404 Fax (305) 948-6081 www.designsforvision.com www.sterngold.com

DiskImplant Impladent Ltd. Victory S.A. 198-45 Foothill Avenue Rue la Martine 11 Holliswood, NY 11423, USA 06000 Nice, FRANCE Phone (800) 526-9343 Fax (718) 464 9620 Friadent USA, Inc. www.impladentltd.com Also See DENTSPLY Friadent CeraMed Implant Direct, LLC. Geistlich Pharma AG 27030 Malibu Hills Road Division Biomaterials Calabasas Hills, CA 91301, USA Bahnhofstrasse 40 Phone (818) 444-3333 CH-6110 Wolhusen, SWITZERLAND Fax (818) 444-3400 Phone 41 (41) 492 56 30 www.implantdirect.com Fax 41 (41) 492 56 39 www.geistlich.com Implant Innovations,Inc.– A BIOMET Company 4555 Riverside Drive GlaxoSmithKline Palm Beach Gardens, FL 33410, USA One Franklin Plaza Phone (800) 342-5454; (561) 776-6700 Philadelphia, PA 19101, USA Fax (561) 776-1272 Phone (888) 825-5249; (215) 751-4638 www.biomet3i.com Fax (919) 315-3344 www.gsk.com Implant Tracking Systems, LLC. 47 Norwood Road Global Surgical Corporation West Hartford, CT 06117, USA 3610 Tree Court Industrial Boulevard Fax (425) 790-2942 St. Louis, MO 61322-6622, USA http://implanttracker.com Phone (805) 861-3585; (636) 861-3388 Fax (636) 861-2969 IMTEC Corporation www.globalsurgical.com 2401 North Commerce Ardmore, OK 73401-6324, USA Phone (800) 879-9799; (580) 223-4456 Fax (800) 986-9574; (580) 223-4561 www.imtec.com

195 Trademark Appendix

IMZ Dental Implant System Luitpold Pharmaceuticals, Inc. Also See Attachments International Osteohealth Company One Luitpold Drive Innova Corp.- Kerr Sybron Dental Specialties Shirley, NY 11967, USA 522 University Avenue, Suite 1200 Phone (800) 874-2334; (631) 924-4000 Toronto, Ontario M5G 1W7, CANADA Fax (631) 924-1731 Phone (800) 898-6261; (416) 340-8818 www.luitpold.com Fax (416) 340-0415 www.innovalife.com Maxillon Laboratories, Inc. P.O.Box 850, Hollis, NH 03049-0850, USA Interpore Cross International – Phone (888) 629-4566, (603) 594-9300 A BIOMET Company Fax (603) 594-9399 181 Technology Drive www.maxilon.com Irvine, CA 92618, USA Phone (949) 453-3200 Medesco Attachment Company Fax (949) 453-3225 23461 South Point Drive www.interpore.com Laguna Hills, CA 92652-1523, USA Phone (800) 633-3726 KaVo Dental Corporation Fax (714) 588-9844 340 East Route 22 Lake Zurich, IL 60047, USA Medical Modelling, LLC Phone (800) 323-8029; (847) 550-6800 Also See AccuDental Guided Implant Modeling Fax (847) 550-6825 www.kavousa.com Medizintechnik Gulden Eschenweg 3 Kerr/Sybron Dental Specialties 64397 Modautal, GERMANY 1717 West Collins Phone 49 (0) 6254-94 38 40 Orange, CA 92867, USA Fax 49 (0) 6254-94 38 41 Phone (800) 537-7123; (714) 516-7400 www.med-gulden.com Fax (800) 537-7345; (714) 516-7635 http://kerrdental.com MMM – 3M ESPE Dental Products 3M Center Building 275-2SE-03 KLS Martin, L.P. St. Paul, MN 55144-1000, USA 11239-1 St.Johns Industrial Parkway S. Phone (800) 634-2249 Jacksonville, FL 32246-7652, USA Fax (800) 728-0956 Phone (904) 641-7746; (800) 625-1557 www.3mespe.com Fax (904) 641-7378 www.klsmartinusa.com Nobel Biocare USA, Inc. 22715 Savi Ranch Parkway Lifecore Biomedical, Inc. Yorba Linda, CA 92887, USA (Formerly Implant Support Systems, Inc.) Phone (800) 993-8100; (714) 282-4800 Oral Restorative Division Fax (714) 998-9236 3515 Lyman Boulevard www.nobelbiocare.com Chaska, MN 55318-3051, USA Phone (800) 752-2663; (952) 368-4300 Fax (800) 651-8521; (952) 368-3411 www.lifecore.com

196 Trademark Appendix

OCO Biomedical, Inc. Pacific Coast Software, Inc. 8500 Washington St., NE, Suite A-1 23470 Olivewood Plaza Drive, Suite 240 Albuquerque, NM 87113, USA Moreno Valley, CA 92553, USA Phone (800) 228-0477; (505) 293-0025 Phone (888) 263-3556 Fax (505) 293-0447 Fax (909) 243-6178 www.ocobiomedical.com Pacific Coast Tissue Bank Oral-B Laboratories, Inc. 2500-19 South Flower Street Prudential Tower Building Los Angeles, CA 90007, USA Boston, MA 02199-8004, USA Phone (213) 745-5560 Phone (617) 421-7000 Fax (213) 745-3031 www.oralb.com Panadent Corporation Orascoptic, Inc. 22573 Barton Road 3225 Deming Way, Suite 190 Grand Terrace, CA 92313, USA Middleton, WI 53562, USA Phone (800) 368-9777; (909) 783-1841 Phone (800) 369-3698; (608) 831-2555 Fax (909) 783-1896 Fax (608) 828-5265 www.panadent.com www.orascoptic.com Park Dental Research Osseous Technologies of America 19 West 34th Street, Suite 301 4500 Campus Drive, Suite 662 New York, NY 10001, USA Newport Beach, CA 92660, USA Phone (800) 243-7372; (212) 736-3765 Phone (866) 901-5050 Fax (212) 268-6845 Fax (949) 250-0184 www.parkdentalresearch.com www.osseoustech.com Periodontal Health Brush (PHB, Inc.) OsteoHealth, Co. P.O.Box 668 One Luitpold Drive Osseo, WI 54758-9116, USA Shirley, NY 11967, USA Phone (800) 553-1440; (715) 597-3935 Phone (800) 874-2334; (631) 924-4000 Fax (715) 597-3802 Fax (631) 924-1731 www.phbinc.com www.osteohealth.com Pfizer, Inc. Osteo-Implant Corporation 235 East 42nd Street 2415 Wilmington Road New York, NY 10017, USA New Castle, PA 16105-1956, USA Phone (212) 733-2323 Phone (800) 654-5560; (724) 658-5321 www.pfizer.com Fax (724) 654-7640 Preat Corp. Osteo-Med Corporation 2976 Long Valley Road 3885 Arapaho Road Santa Ynez, CA 93460, USA Addison, TX 75001, USA Phone (800) 232-7732; (805) 693-8666 Phone (800) 456-7779; (972) 677-4600 Fax (805) 693-8106 Fax (972) 677-4601 www.preat.com www.osteomedcorp.com

197 Trademark Appendix

Proctor & Gamble Distributing, Co. Salvin Dental Specialties, Inc. 1 Proctor & Gamble Plaza 3450 Latrobe Drive C6-172, Box 36, Cincinnati, OH 45202, USA Charlotte, NC 28211-4847, USA Phone (513) 983-1100 Phone (800) 535-6566; (704) 442-5400 Fax (513) 983-9369 Fax (704) 442-5424 www.pg.com www.salvin.com

Pro-Dentec Sandoz, Inc. (Professional Dental Technologies, Inc.) 506 Carnegie Center Drive, Suite 400 PO Box 4160, Batesville, AR 72501, USA Princeton, NJ 08540, USA Phone (870) 698-2300 Phone (800) 525-8747; (609) 627-8500 Fax (870) 793-5554 Fax (609) 627-8659 www.prodentec.com www.us.sandoz.com

Quintessence Publishing Co., Inc. Sargon Dental Implants 4350 Chandler Drive 16101 Ventura Boulevard, Suite 350 Hanover Park, IL 60133, USA Encino, CA 91436, USA Phone (800) 621-0387; (630) 736-3600 Phone (888) 688-6684; (818) 380-09050 Fax (630) 736-3633 Fax (818) 380-9059 www.quintpub.com www.sargondentalimplants.com

Raintree Essix, Inc. W. B. Saunders Company 4001 Division Street The Curtis Center, Independence Square West Metairie, LA 70002, USA Philadelphia, PA 19106-3399, USA Phone (800) 883-8733; (504) 488-0080 Phone (215) 238-7800 Fax (504) 488-2429 Fax (215) 238-7883 www.essix.com Septodont, Inc. Rapid Injection System Corp. 245-C Quigley Boulevard 40 Roselle Street New Castle, DE 19720, USA Mineola, NY 11501, USA Phone (800) 872-8305 Phone (516) 746-2622 Fax (302) 328-5653 Fax (516) 741-8147 www.septodontinc.com

Rhein’3 USA, Inc. Sonicare 132 Monroe Street c/o Philips Domestic Appliances & Personal Care Hoboken, NJ 07030, USA 1010 Washington Boulevard Phone (877) 778-8383; (201) 217-0440 Stamford, CT 06912, USA Fax (201) 217-0660 Phone (800) 682-7664 www.rhein83.com www.sonicare.com

Rocky Mountain Tissue Bank Sterngold/Sterngold Dental, LLC 2993 South Peoria Street, Suite 390 23 Frank Mossberg Drive Aurora, CO 80014, USA Attleboro, MA 02703-0967, USA Phone (800) 424-5169; (303) 337-3330 Phone (800) 243-9942; (508) 226-5660 Fax (303) 337-9383 Fax (800) 531-2685; (508) 222-3593 www.rmtb.org www.sterngold.com

198 Trademark Appendix

Straumann Holding AG Universal Implant Systems, Inc. Peter Merian-Weg 12 4400 Jennifer Street, N.W., Suite 220 CH-4002 Basel Washington, DC 20015, USA SWITZERLAND Phone (202) 244-9200 Phone 41 (61) 965 11 11 Fax (202) 244-3277 Fax 41 (61) 965 11 01 www.straumann.com Walter Lorenz Surgical Instruments, Inc. 1520 Tradeport Drive Tekscan, Inc. Jacksonville, FL 32218-2480, USA 307 West First Street Phone (904) 741-4400; (800) 874-7711 South Boston, MA 02127-1309, USA Fax (904) 741-4500; (904) 741-5521 Phone (800) 248-3669; (617) 464-4500 www.lorenzsurgical.com Fax (617) 464-4266 www.tekscan.com Warner Chilcott 100 Enterprise Drive Tel-Med Technologies Rockaway, NJ 07866, USA P.O.Box 595852 Phone (973) 442-3200 Fort Gratiot, MS 48059, USA Fax (973) 442-3283 Phone (800) 243-4145 www.warnerchilcott.com Fax (810) 987-4909 Zest Anchors, Inc. Teledyne Water Pik 2061 Wineridge Place, Suite 100 1730 East Prospect Road Escondido, CA 92029, USA Fort Collins, CO 80553-0001, USA Phone (800) 262-2310; (760) 743-7744 Phone (800) 525-2774; (800) 854-9316 Fax (800) 487-1357; (760) 743-7975 www.zestanchors.com Thommen Medical USA, LLC. Idea Center Zimmer Dental 1375, Euclid Avenue 1900 Aston Avenue Cleveland, OH 44115, USA Carlsbad, CA 92008-7308, USA Phone (866) 319-9800 Phone (800) 854-7019; (760) 929-4300 Fax (216) 583-9801 Fax (760) 431-7811 www.thommenmedical.com www.zimmerdental.com

199