Periodontal Review Q&A Second Edition Library of Congress Cataloging-in-Publication Data

Names: Termeie, Deborah, author. Title: Periodontal review Q&A / Deborah A. Termeie. Other titles: Periodontal review Description: Second edition. | Batavia, IL : Quintessence Publishing Co, Inc, [2020] | Preceded by Periodontal review / Deborah A. Termeie. c2013. | Includes bibliographical references and index. | Summary: “Study guide review of periodontal literature on topics such as periodontal anatomy, diagnosis and treatment planning, nonsurgical and surgical therapy, regeneration, and implants, presented in a question and answer format”-- Provided by publisher. Identifiers: LCCN 2019055802 (print) | LCCN 2019055803 (ebook) | ISBN 9780867158298 (paperback) | ISBN 9781647240110 (ebook) Subjects: MESH: Periodontal Diseases | Periodontics | | Examination Question Classification: LCC RK450.P4 (print) | LCC RK450.P4 (ebook) | NLM WU 18.2 | DDC 617.6/32--dc23 LC record available at https://lccn.loc.gov/2019055802 LC ebook record available at https://lccn.loc.gov/2019055803

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Printed in the United States Periodontal Review Q&A Second Edition

Deborah A. Termeie, dds Clinical Instructor Department of Periodontics School of University of California, Los Angeles Los Angeles, California About the Author

Deborah A. Termeie, dds, is a clinical instructor in the Depart- ment of Periodontics at the University of California, Los Angeles. She is a diplomate of the American Board of (ABP), and it was her experience preparing for the ABP qualify- ing exams that inspired her to write this book. Dr Termeie is also an editor and author of Avoiding and Treating Dental Compli- cations: Best Practices in Dentistry (John Wiley & Sons, 2016) and has published on the topics of evidence-based dentistry and implantology. She is the recipient of several awards, including the Excellence in Implantology Research award from the California Society of Periodontics, and has been invited to participate in the American Academy of Periodontics Leadership, Engagement, Action, and Development (LEAD) Program. She maintains a private practice in Beverly Hills, California. Contents Preface vi 1 Evidence-Based Dentistry 1 2 Periodontal Anatomy 6 3 Furcations 17 4 Epidemiology and Etiology 31 5 Pharmacology 53 6 Diagnosis 81 7 Prognosis 113 8 Occlusion 125 9 Nonsurgical Therapy 139 10 Surgical Therapy 163 11 Mucogingival Therapy 186 12 Regeneration 221 13 Implants 252 14 Inflammation 299 15 Oral Medicine 311 16 Oral Pathology 326 17 Lasers 347 18 Medical Emergencies 354 19 Treatment Planning 362

Appendix 408 Index 417

v Preface The first edition ofPeriodontal Review Q&A was very well received, and I am grateful for the opportunity to author this second edition. The new edition contains many new figures, tables, and treatment planning cases as well as a comprehensive review of new classifications. I wrote this book because despite a plethora of study materials and information, there is no comprehen- sive single source study guide to help students prepare for their examinations. Periodontal Review Q&A was specifically written to address this void. The material in this book is presented in a question and answer format for ease of study. The classic literature is cited as well as more recent and practical literature on topics such as diagnosis, nonsurgical therapy, surgi- cal therapy, regeneration, and implants. Literature evidence for opposing viewpoints is also presented throughout the book. Additionally, each chapter contains clear and relevant tables, illustrations, and pictures. This compre- hensive and yet concise approach to periodontics is aimed at preparing the candidate for periodontal examinations and clinical practice. Periodontal Review Q&A is a useful resource for residents, practicing periodontists preparing for board certification, dental students, and dental hygiene students seeking a broader appreciation and in-depth understand- ing of periodontics. Topics chosen are those emphasized in periodontal residency graduation examinations as well as the oral examination of the American Board of Periodontology. Readers are urged to study all literature preceding their examination, including literature that may be made available subsequent to this textbook’s publication.

Acknowledgments I would like to acknowledge my mentors, Drs Philip R. Melnick, Thomas N. Sims, Paulo M. Camargo, Thomas Han, Henry H. Takei, and Perry R. Klokkev- old, for their advice and guidance. Thank you to all the reviewers, Drs Dennis P. Tarnow, Russell Christensen, Jack G. Caton, Michael P. Rethman, Mary E. Neill, and Sejal R. Thacker. I would like to thank my loving husband, David; my children, Gabriella and Elliot; and my parents. Without their love and support this book would not have been possible. I appreciate Quintessence and the editorial staff, especially Zachary Kocanda and Bryn Grisham, whose knowledge and dedicated care to every word and idea made this book what it is. vi Background

Evidence-Based Dentistry 1

Background

Q: What is the evidence-based approach? Evidence-based dentistry is the merging of clinically pertinent scientific evidence to the patient’s oral and medical condition and history as well as the dentist’s experience (Fig 1-1). The dentist uses the evidence to make sound decisions about diagnosis, prognosis, and treatment. Evidence-based deci- sion making consists of formulating patient-centered questions (Population-Intervention-Comparison-Outcome [PICO]); examining and criti- cally evaluating the evidence; and relating the evidence to practice.1

Dentist’s expertise

EBD

Scientific Patient evidence needs and preferences

Fig 1-1 Three parts of the decision-making process. (Redrawn from the American Dental Association1 with permission.)

1 1 Evidence-Based Dentistry

Q: What is the PICO question? The PICO question is a question that includes a population to be examined, the nature of the intervention to be inspected, a comparison statement, and the type of outcome to be evaluated. It should be problem-focused and concise. Example: In patients with horizontal alveolar ridge deficiencies (population), what is the effect of horizontal bone augmentation procedures (intervention) compared with controls (comparison) on peri-implant health (outcome)?

Q: What is the step-by-step process for making an evidence-based decision in a dental practice? The steps involved in evidence-based decision making in a dental practice are shown in Fig 1-2.

Research Analyze the Apply the the PICO Formulate data that has data to question and Evaluate the a PICO been the dental collect results question collected practice evidence

Fig 1-2 Evidence-based decision making. (Based on data in Chiappelli et al.2)

Studies

Q: What are the different study types (ranked from highest level of evidence to lowest)? The different types of studies are shown, ranked in order of highest to lowest level of evidence, in Fig 1-3.

2 Studies

Systematic reviews and meta-analyses

Randomized and controlled clinical trials (patients are randomly placed in test or control groups)

Controlled trials not randomized

Cohort studies (analytical studies in which patients are studied longitudinally)

Case-control studies (observational studies that have test and control groups; usually retrospective)

Cross-sectional studies (studies done at one time point)

Case report studies

Fig 1-3 Different studies ranked from highest level of evidence to lowest. (Based on Nocini et al.3)

Q: Describe the difference between a cross-sectional study and a longitudinal study. A cross-sectional study is done at one time point, whereas a longitu- dinal study ranges over a period, allowing temporal relationships to be investigated.

Q: What is the P value? The P value is the probability of obtaining a test statistic at least as extreme as the one observed, assuming that the null hypothesis is true. The smaller the P value, the less likely the effect was due to chance. A P value less than or equal to .05 usually indicates statistical significance.

3 1 Evidence-Based Dentistry

Q: What is the difference between sensitivity and specificity? Sensitivity is the ability of a test to correctly identify diseased individuals. Specificity is the ability of a test to correctly identify a healthy individual. For instance, the diagnostic sensitivity of a clinical parameter (suppuration, gingival plaque) in predicting disease was expressed as the proportion of sites showing attachment loss that also exhibited the given parameter. Diag- nostic specificity was expressed as the proportion of sites not exhibiting the clinical parameter and not showing attachment loss.4

Q: What is the difference between internal and external validity? The difference between internal and external validity is shown in Fig 1-4.

Internal validity External validity • Refers to the fundamental • Refers to the extent to soundness of the study which the evidence is rele- • Looks at the study’s bias vant and generalized to the and statistical approach population and the dental • May determine if the study practice should be included in a systematic review

Fig 1-4 Internal and external validity.

Q: Why practice evidence-based dentistry?5 1. There are thousands of articles published monthly in dental magazines. It would take hundreds of hours to read the dental literature. Using evidence-based review databases eases the necessary time spent evalu- ating dental literature. 2. Practicing evidence-based dentistry keeps dentists current on recent evidence and practice standards. 3. A thorough and analytical literature review should be carried out before proceeding in clinical research.

4 References

References

1. American Dental Association. About EBD. https://ebd.ada.org/en/about. Accessed 10 October 2019. 2. Chiappelli F, Brant XMC, Oluwadara OO, Neagos N, Ramchandani MH. Introduction: Research synthesis in evidence-based clinical decision-making. In: Chiappelli F, Brant XMC, Neagos N, Oluwadara OO, Ramchandani MH (eds). Evidence-Based Practice: Toward Optimizing Clinical Outcomes. London: Springer, 2010:5. 3. Nocini PF, Verlato G, De Santis D, et al. Strengths and limitations of the evidence-based move- ment aimed to improve clinical outcomes in dentistry and oral surgery. In: Chiappelli F, Brant XMC, Neagos N, Oluwadara OO, Ramchandani MH (eds). Evidence-Based Practice: Toward Optimizing Clinical Outcomes. London: Springer, 2010:151. 4. Haffajee AD, Socransky SS, Goodson JM. Clinical parameters as predictors of destructive peri- odontal disease activity. J Clin Periodontol 1983;10:257–265. 5. Boston University Alumni Medical Library website. Why practice EBM? www.bumc.bu.edu/ medlib/resources/tutorials/introduction-to-evidence-based-medicine/ebm-intro-p10/. Accessed 12 Nov 2019.

5 

Index

Page numbers followed by “t” denote tables; those followed by “f” denote figures

A Adrenal medulla, 319 Alprazolam, 67t Advanced glycation end ALT. See Alanine ABCDE staging of skin cancer, products, 306, 306f aminotransferase. 331, 331f Advanced periodontitis, 105 Altered active eruption, 213 Abfraction, 125–126, 126f, AED. See Automated external Alveolar bone 131 defibrillator. anatomy of, 12–13 Abrasion, 125–126, 126f Age, periodontitis risks and, 32 smoking effects on, 41 Abscess Aggregatibacter actinomycet- Alveolar bone proper, 13 gingival, 100 emcomitans, 44t, 48 Alveolar crest, 109 pericoronal, 100 Alveolar mucosa, 7f, 8 periodontal, 98–100, bacteria associated with, 47 , 7f 99f–100f, 403 description of, 37–38 Alveolar ridge pulpal, 99 generalized. See Generalized defects of, 193 Abutment teeth aggressive periodontitis. deformities of, Siebert’s Ante’s law, 8 localized. See Localized classification of, 223 platform switching, 272 aggressive periodontitis. splitting of, 237, 238f, 388 for soft tissue recession, 268 systemic antibiotics for, 54 Alveolar ridge augmentation Acellular , 13 AIDS, 47, 47f, 344 description of, 225 Acellular dermal matrix, 204– Airway obstruction, 357 horizontal, 237f, 237–238 205, 205t Alanine aminotransferase, 321 vertical, 238–239 Acetaminophen, 70–71 Alcohol consumption, 33 Alveologingival fibers, 9 Actinobacillus actinomycet- Alendronate sodium, 61t Alzheimer disease, 307 emcomitans, 54 AlloDerm, 204–205, 207t Ameloblastoma, 332 Actinomyces naeslundii, 47 Allogeneic block grafts, 225 American Academy of Actinomyces viscosus, 47 Allografts Periodontology, 21, 21t, Actisite, 59t demineralized freeze-dried 105 Active eruption, 213 bone. See Demineralized American Association of Tissue Acyclovir, 77, 328 freeze-dried bone Banks, 225 Adaptive immune response, allografts. American Society of 299f description of, 224–225, Anesthesiologists Adaptive remodeling, 135 237 blood pressure classification, ADM. See Acellular dermal freeze-dried bone. See 312 matrix. Freeze-dried bone physical status classification, Adrenal cortex, 319 allografts. 54 Adrenal gland, 319 Alloplast, 224 Amorphous calcium phosphate, Adrenal insufficiency, 75, 356f Alpha cells, 319 228

417 Index

Amoxicillin, 55t, 56 Articaine, 66t Bisphosphonates Amoxicillin and metronidazole, ASA. See American Society of definition of, 62 55t, 56 Anesthesiologists. osteonecrosis caused by, 62 Amyloid beta, 307 Aspartate aminotransferase, periodontal surgery in Analgesics, 322 321 patients receiving, 62 Anatomy Aspirin, 72 properties of, 60t for mucogingival therapy, AST. See Aspartate types of, 61t 203–204 aminotransferase. , 34–36, of periodontium, 6, 7f Atheroma, 315, 315f 87, 88t, 105–106, 153 Anesthetics, local, 65, 357– Ativan. See Lorazepam. Bleeding time, 311 358 Atridox (Atrix), 59t Block grafts, 225, 286 Angina, 359 Atrophic candidiasis, 338, Blood, 320–321 Angular defects, 167 403–404 Blood loss, during periodontal Ankylosis, 12 Attached gingiva surgery, 183–184 Anterior guidance, 85 anatomy of, 7f, 8 Blood pressure, 312–313 Anterior implants, 266–268, around restorations, 188, BMP. See Bone morphogenetic 391 194 proteins. Anterior pituitary gland, 320 and, 188 Body mass index, 311 Anterior segment, pockets in, widening of, 188 Bone cells, 222 169–170 Attrition, 125–126, 126f Bone decortication, 229 Anterior-posterior spread, 264 Augmentin, 56 Bone grafts and grafting Ante’s law, 8 Autogenous graft, 205, 224, allogeneic, 225 Antibiotics 388 block grafts, 225 commonly prescribed types Automated external defibrillator, case study of, 373f of, 55t 355 guided tissue regeneration dosage of, 56 Avitene, 180 with, for grade II furcation drug interactions with, 56t lesions, 19 locally delivered, 59, 59t B horizontal, 388 in membrane placement, B cells, 301 materials used in, 224 232–233 Bacteremia, 157 onlay grafts, 225 metabolism of, 322 Bacteria particle size, 228–229 prophylaxis uses of, 57–58, in , 47 saddle grafts, 225 257 in periodontitis, 43–48, studies of, 226–227 selection of, 54 44t–45t tetracycline added to, 229 systemic, 54–58 in refractory periodontal Bone induction, demineralized Anticoagulants, 73–74, 320 disease, 47, 47f freeze-dried bone Anti-convulsants, 74f sensitivity testing of, 368, allografts for, 227 Antifungals, 322 369t, 381 Bone loss Antigen-stimulated Bacterial complexes, 46 after implant placement, 253 lymphocytes, 301 Barrier, 374 alveolar crest level, 109 Antihistamines, 75 Bass technique, 144 case study of, 387 Antimicrobial agents, Benzocaine, 65 digital radiographs of, 109 supragingival irrigation Benzodiazepines, 69–70 etiology of, 387 with, 156–157 Beta cells, 319 marginal, 268 Antiplatelet therapy, 72 Bile, 319 in , 301 Anti-resorptive medications, Biofilms, 43 progressive crestal, around 61t, 61–65 Bio-Gide membrane, 233, implants, 279 Antiseptics, 143 233f, 390 retreatment for, 383 Antithrombin III, 320 Biologic mediators, 23 Bone morphogenetic proteins, Aphthous ulcers, 327, 328t Biologic width, 15 244–245 Apically repositioned flap, 150, BioMend membrane, 233, 233f Bone regeneration 168 Biopsies, 108, 327 amorphous calcium Apixaban, 74 Biotene gel, 75 phosphate for, 228 Apoptosis, 302 anatomical considerations, Arestin, 59t 235 Arthritis, 307–308 guided. See Guided bone regeneration. 418 

Bovine-derived bone xenograft, Cementum Cone beam computed 226 description of, 13–14 tomography, 110, 374 Bradycardia, 312 instrumentation used to Confusion, 357 Bradykinin, 302 remove, 144 Congenital heart defects, Brushing, 144 removal of, 143–144 57–58 Bruxism, 120, 129, 131–132 Cephalexin, 58 Congestive heart failure, 316, Buccal wall thickness, in Cephalosporins, 56t 359–360 esthetic area, 267–268 Cephradine, 58 Conical roots, 16 Bump, 339–340 Cervical enamel projections, 25 Connective tissue, 11 Bupivacaine, 66t Chest pain, 359, 359f Connective tissue attachment , 59t, 76, 156– anatomy of, 7f C 157, 281, 327, 336 cervical enamel projections CAF. See Coronally advanced Chromic gut sutures, 181f effect on, 25 flap. enamel pearls effect on, 27 Calcitonin, 319 bacteria associated with, 47 Connective tissue fibers, 7f Calcium channel blockers, 74f description of, 37 Connective tissue graft , 43 implant placement in patients acellular dermal matrix versus, Caloric restriction, 305 with, 261 205t Campylobacter rectus, 127 laser therapy for, 349 epithelium in, 197 Cancellous trabeculae, 13 metronidazole plus amoxicillin versus, 196 Candida, oral, 77 for, 57 guided tissue regeneration Candidiasis, atrophic, 403–404 Cigar smoking, 42 versus, 206 Canine protection, 128 Cigarette smoking, 42 harvesting of, 203 Canine-guided occlusion, 128 Circular fibers, 9 mean defect coverage using, Canker sores, 327 Circumferential occlusal access 207t Carbon dioxide laser, 347f, 352 procedure, 281 periosteum in, 197 Cardiopulmonary resuscitation, Circumscribed elevated lesion, placement of, 196f 354–355 340 subepithelial, 400 Cardiovascular disease, Circumscribed flat lesion, 340 Connective tissue lesions, 331 314–316 Citric acid, 158, 246 Conscious sedation, 68–69 Caries Clarithromycin, 56t Contraceptives, 33 pulpal changes and, 122 Class I MHC proteins, 308 Controlled clinical trials, 3f root coverage over, 215 Class II MHC proteins, 308 Coronally advanced flap, 400, tunnel preparation in furcation Class V resin, 195 401f lesion area and, 23 Clindamycin, 55t, 56, 58 Coronally positioned flap, 200 Case report studies, 3f Clinical attachment level, 82, Cortical bone, 12 Case studies, 3f, 362–404 107 Coumadin, 73, 320 Case-control studies, 3f CPR. See Cardiopulmonary Cathepsin C, 339 description of, 8 resuscitation. CD4+ cells, 302, 303f uneven marginal ridges effect C-reactive protein, 302 Cefazolin, 58 on, 131 Creeping attachment, 202 CEJ. See Cementoenamel Closed flap scaling and root Crestal bone loss, 279 junction. planing, 19, 141 Crestal sinus elevation, 290f Cellular cementum, 13, 23 Clotting factors, 320 Critical probing depths, Cemental tears, 104 COAP. See Circumferential 142–143 Cementicles, 28 occlusal access Cross-linked membranes, 233 Cementoblasts, 13 procedure. Cross-sectional study, 3 Cementoenamel junction Codeine, 71t lengthening, 213f, anatomy of, 7f, 8, 13 Co-destruction, 130 213–215, 340 greater palatine foramen to, Coe-Pak, 375 Crown restorations, furcation 203, 203f Cohort studies, 3f lesions in, 28 Cemento-osseous lesions, 345 Collagen, 14 C-terminal telopeptide, 62 Complex odontoma, 332 Cuboidal cells, 10 Compound odontoma, 332 Curette, 144

419 Index

Cyanotic congenital heart Diabetic coma, 318 mucogingival therapy use defects, 57 Diagnosis of, 207 Cyclosporine, 74f background on, 81–83 studies of, 244 Cysts, 327–328, 336, 337t biopsies for, 108 Enamel pearls, 16, 27 Cytokines, 40, 48 case study examples of, 367, ENAP. See Excisional new Cytomegalovirus, 48 386 attachment procedure. medical history questionnaire Endodontic lesions, 100–102 D used in, 108 Endodontic therapy, 20, 120 Dabigatran, 74 predictors of, 105–107 Endo-periodontal lesions, Delta cells, 319 Diazepam, 67t, 69 100–102 Demerol. See Meperidine. Digastric muscle, 16 Envelope flap, 168 Demineralized freeze-dried Digital radiographs, 109 Envelope technique, 200 bone allografts Dilantin, 74f Epidemiology bone formation induced by, Direct-acting oral prevalence. See Prevalence. 227–228 anticoagulants, 73–74 terminology associated with, description of, 224 Distal wedge excision, 168 33–34 expanded Distraction osteogenesis Epigenetics, 300 polytetrafluoroethylene definition of, 236 Epinephrine, 65 membrane and, 22 horizontal ridge augmentation Epithelial disorders, 329–331 freeze-dried bone allografts use of, 238 Epithelium attachment, 7f versus, 227 indications for, 388 EPL. See Endo-periodontal studies of, 226–227 phases of, 237f lesions. tetracycline and, 229 vertical ridge augmentation Epstein-Barr infection, 48 Denosumab, 61t, 64–65 use of, 239 Erosive lichen planus, 335t, DenSonic sonic scaler, 282– Divergent roots, 16 337t 283 DMPA. See Depot Er:YAG laser, 349 Dentin hypersensitivity, 149 medroxyprogesterone Erythema multiforme, 333, 337t Dentinogenesis imperfecta, acetate. Erythromycin, 56t 343t DNA methylation, 300 Erythroplakia, 330 Dentogingival fibers, 9 Double papilla flap, 199 Esthetic zone Dentoperiosteal fibers, 9 Doxycycline, 55t, 56, 59t buccal wall thickness in, Depot medroxyprogesterone Dressings, surgical, 179–180, 267–268 acetate, 33 180f, 377f deficiencies in, 234f Desmosomes, 10 Drug-induced gingival Ethylenediaminetetraacetic , 332 enlargement, 74, 85f, acid, 246 Developmental deformities, 90, 163f Evidence-based dentistry, 1, 4 102–104 Excisional new attachment DFDBA. See Demineralized E procedure, 179, 351 freeze-dried bone Early periodontitis, 105 Excursive positions, occlusal allografts. e-cigarettes, 42 contacts in, 131–132 Diabetes mellitus Edoxaban, 74 Expanded bacteria associated with, 48 EDTA gel, 158 polytetrafluoroethylene inflammation and, 306–307 Electric , 145–146 membranes, 22, 227 macrovascular complications EMD. See Enamel matrix External carotid artery, 7 of, 318f derivative. External validity, 4, 4f management of, 318 Emdogain, 207 Extrinsic cementum, 13 microvascular complications Emergency kit drugs, 355 Extrusion, 136 of, 318f Enamel oral manifestations of, 317f anatomy of, 7f F peri-implant mucositis and, cementum and, overlapping F.A.S.T., 360–361 279 of, 13 Fasting blood sugar, 311 periodontitis and, 32, 117 FDBA. See Freeze-dried bone proinflammatory molecules definition of, 244 allografts. associated with, 303 furcation lesions treated Fenestration, 186, 187t type 1, 317t with, 23 Fentanyl, 69 type 2, 317t

420 

Fibers demineralized freeze-dried GBR. See Guided bone alveologingival, 9 bone allografts versus, regeneration. circular, 9 227 GCF. See Gingival crevicular connective tissue, 7f description of, 224, 226 fluid. dentogingival, 9 studies of, 226–227 Gender, periodontitis risks dentoperiosteal, 9 tetracycline and, 229 and, 32 gingival, 9 Fremitus, 128 Generalized aggressive periodontal ligament, 12 Frenectomy, 210 periodontitis transseptal, 9 Full-thickness flap, 167 antibiotics for, 57 Figure 8 suture, 182 Fungal infections, gingival description of, 37 First molars, root concavities diseases caused by, 85 Genetics, periodontitis and, 32 on, 26 Furcation defects and lesions Giant cell fibroma, 339 Fixed partial denture anatomical factors associated Gingiva description of, 123 with, 24f, 24–28 anatomy of, 7f implant-supported single biologic mediators for, 23 attached. See Attached implant versus, 290 cervical enamel projections gingiva. Flap(s) and, 25 excessive display of, 212 apically repositioned, 168 classification of, 18–19 healthy, 9 coronally advanced, 400, closed flap root planing for, keratinized attached, 8 401f 19 marginal, 8 coronally positioned, 200 entrance width, 26–27 narrowest zone of, 11 double papilla, 199 Glickman classification of, overgrowth of, 211 envelope, 168 18, 18f phenotype of, 102f, 194 full-thickness, 167 grade I, 18f, 21 thickness of, 11 laterally positioned, 199 grade II, 18f, 21 widest zone of, 11 modified Widman, 167–168 grade III, 18f, 21 zones of, 11 papilla preservation, 169 grade IV, 18f, 21 Gingival abscess, 100 partial-thickness, 165, 167 Hamp classification of, 18, Gingival connective tissue cells, single-flap approach, 172 21t 222 thickness of, 206 immediate bifurcation ridge Gingival crevicular fluid, 34 Floss/flossing, 144–145 effects on, 28 Gingival diseases Flumazenil, 69–70 in mandibular molars, 17, 26 of bacterial origin, 85 Follicle-stimulating hormone, in maxillary molars, 17, 27 of fungal origin, 85 320 molars with accessory non–plaque-induced, 85–86 Food and Drug Administration canals, 25 plaque-induced, 81 pharmaceutical Nabers probe for diagnosing of viral origin, 85 pregnancy categories, of, 17 , drug- 53 open flap root planing for, 19 induced, 74, 85f, 90, Food impaction, 39 prevalence of, 17 163f Force, on implant, 262 prognosis of teeth with, 119 Gingival epithelium, 9–11 Free gingiva, 7f restorations, 28 , 9 Free gingival graft root planing for, 19 Gingival fibroblasts, 40 connective tissue graft scaling for, 19 Gingival Index, 34–35 versus, 196 Tarnow classification of, 19 modified, 35 keratinized gingiva from, tooth loss secondary to, 114 Gingival recession 198–199 treatment of, 19–24 attached gingiva required to mean defect coverage using, tunnel preparation, 23, 397 avoid, 188 207t Furcation fornix, 17 case study of, 398–402 placement of, 196f , causes of, 189 wound healing of, 201 45t, 46 classification of, 191, 191f Freeze-dried bone allografts consequences of, 189, 189f alveolar ridge augmentation G decision trees for treating using, 389–390 Gastric inhibitory peptide, 320 defects caused by, case study of, 373, 390f Gastrin, 320 207–208, 209f definition of, 188

421 Index

illustration of, 103f Grafting Hemangioma, 340 intrasulcular restorative bone. See Bone grafts and Hemidesmosomes, 14 margin effects on, 194 grafting. Hemoglobin, 311–312 occlusal discrepancies effect socket, 241–243 Hemoglobin A1C, 311, 317 on, 131–132 Gram-negative bacteria, 47 Hemorrhagic stroke, 314, 360 pinhole surgical technique Gram-positive bacteria, 47 Heparin, 320 for, 201 Grand mal seizure, 357 Herpes zoster, 336 prevalence of, 190 Granular cell tumor, 340 Herpetic lesions, 327–328, tunnel technique for, 200, Granular cells, 10 328f 200f Greater palatine foramen, 203, High-density lipoprotein, 311 vestibular incision 203f HIV subperiosteal tunnel Group function, 128 description of, 47, 47f access technique for, Growth factor-enhanced matrix, periodontitis associated with, 201 245 338 worsening of, 190f Growth factors, 243–246 Horizontal ridge augmentation , 150, 163–164 GTR. See Guided tissue description of, 225 Gingivitis regeneration. options for, 237f, 237–238 bacteria associated with, 47 Guided bone regeneration Host modulation, 60 bleeding on probing in, 88t antibiotics after, 232 Host response, 257, 303 classification of, 84 description of, 223 Hydrocodone, 71t definition of, 81 membrane exposure effects Hydrocortisone, 355 desquamative, 332 on, 232 Hyperglycemia, 318 mouth breathing as risk factor technique for, 235 Hypermobility, 246 for, 40 vertical ridge augmentation Hypertension, 312–313 necrotizing ulcerative, 119 with, 238–239 Hyperventilation, 358 peri-implant mucositis versus, Guided tissue regeneration Hypoglycemia, 356f 257, 258t definition of, 223 periodontitis and, 82, 257 enamel matrix derivative I in periodontium, 89t versus, 244 Ibandronate sodium, 61t plaque-induced, 81 grade II furcation treated Ibuprofen, 71t time needed for development with, 22 IgA, 300, 322 of, 145 intrabony defects treated IgD, 300 Glickman classification, of with, 235, 246 IgE, 301, 322 furcations, 18, 18f mean defect coverage using, IgG, 301, 322 Glucagon, 355 207t IgM, 301, 322 Glycosylated hemoglobin, 311, membrane exposure effects Immediate bifurcation ridge, 28 317 on, 232 Immediate implant Gore-Tex membranes, 237 open-flap and, in esthetic zone, 267 Gore-Tex sutures, 181f, 390 comparison between, indications for, 270 Gracey curette, 19, 149 235, 236f maxillary soft tissue grafting Graft(s) smoking effects on healing after placement of, 268 autogenous, 205 response after, 247 osseointegration using, barrier versus, 374 soft tissue procedure versus, 270–271 bone, 224–229. See also 206 success rate of, 271 Bone grafts and grafting. Immune response, 299 connective tissue. See H Immune system, 322–323 Connective tissue graft. Halcion. See Triazolam. Immune-mediated disorders, free gingival, 195–196, 196f Hamp classification, of 332–336 thick versus thin, 202 furcations, 18, 21t Immunoglobulins, 300–301 Graft placement Hard tissue deficiencies, 254f Immunologic sounding, 315, on bone, 204 Hard tissue grafting, 216 315f microsurgery versus Healing, wound, 175, 176t, Immunosuppressants, 74f macrosurgery technique 201–202 for, 197 Heart attack, 316 on periosteum, 204 Heart rate, 312 shrinkage after, 202 Helper T cells, 302, 309

422 

Implant(s) antibiotic prophylaxis to Inflammation, 306–307 alternatives to, 290–291 prevent, 257 Alzheimer disease and, 307 anterior, 266–268, 391 bacteria associated with, 48 arthritis and, 307–308 anterior-posterior spread for, definition of, 278 description of, 35, 222 264 determination of, 278–279 insulin resistance secondary apex of, 265 factors associated with, to, 306f contraindications, 256f 254–255, 256f periodontal disease and, criteria for, 253 smoking as cause of, 273 304–305, 305f epithelium and, interface Implant placement plaque-induced, 399 between, 291 after , proinflammatory molecules, esthetics of, 265–268 243 302–303 evaluations of, at antibiotic prophylaxis before, signs of, 299 maintenance visits, 391 257 Inflammatory papillary force on, 262 case study of, 374, 375f hyperplasia, 331 hygiene of, 282–283 classification to consider Infraorbital nerve, 284 immediate. See Immediate before, 252, 252f Inhalation steroids, 75 implant. in clean conditions, 291 Innate immune response, 299f instruments used with, distance considerations, 265 Instrumentation 282–283 in esthetic area, 391 cementum removal using, interproximal contact point, guidelines for, 267, 267f 144 265 immediate, 267, 270–272 ultrasonic, 146–148 keratinized attached tissue improper, 255f Insulin resistance, 305, 306f around, 261 in irradiated bone, 291–292 Interdental brushes, 145 lasers used near, 351 in keratinized attached tissue, Interdental tissue maintenance, mean success rate of, 253 264f 171 mean survival rate of, 253 in mandible, 256, 264, 292 Interferon-τ, 302 mobile, 279 in maxilla, 256, 264, 292 Interleukin-1, 301–303 natural teeth versus, 257 osteotome technique for, 289 Interleukin-2, 302 occlusion for patients with, presurgical steps for, Interleukin-4, 302 128–129 262–263 Interleukin-6, 302, 307 peri-implantitis, 105, 257, remodeling after, 253 Interleukin-8, 302, 305 273, 274t–275t, 277– in sclerotic bone, 292 Interleukin-10, 302 278, 280–282, 282f single-stage, 264 Internal validity, 4, 4f in periodontal disease sinus elevation and, 287, 289 International normalized ratio, patients, 261–262 in sterile conditions, 291 73, 311 platform switching, 272 technique for, 263, 263f, Interproximal contact point, 265 prognosis of, 120, 122–123 375f Interradicular distance, 121 progressive crestal bone loss two-stage, 264–265 Interrupted suture, 182 around, 279 Implant survival Intrabony defects rough surface modifications maintenance effects on, 283 assessment of, 240f of, 260, 287 osteotome technique effects guided tissue regeneration screw-type, 287 on, 289 for, 235, 246 shape of, 269, 269f–270f Implantable cardioverter- smoking effects on healing short, 269 defibrillator, 148 response in, 247 single, 123 Implantitis. See Peri-implantitis. tooth movement for, 136 sinus elevation, 283–287 Incidence, 34 tooth vitality effect on smoking effects on, 272–273 Indices, 34–36 regenerative outcomes smooth surface modifications Infection in, 246 of, 260 after sinus elevation, 285, Intrinsic cementum, 13 surface modifications of, 260, 286f Irradiated bone, implant 260f description of, 183 placement in, 291–292 titanium, 287 oral, 336–338 Irrigation, 156–158 Implant failure postoperative, 285, 286f Ischemic stroke, 314 Inferior alveolar artery, 12

423 Index

ITM. See Interdental tissue drug metabolism in, 322 Marginal bone loss, 268 maintenance. Living cellular constructs, Marginal gingiva, 8 IV sedation, 68–70, 70f 198–199 Marginal ridges, uneven, 131 Local anesthetics Masseter muscle, 16 J description of, 65 Masticatory epithelium, 10, 10f Joint replacement, antibiotic metabolism of, 322 Matrix metalloproteinases, 302 prophylaxis indications reactions to, 357–358 Mattress suture, 182 for, 58 Localized aggressive Maxilla , 7f, 10, periodontitis dehiscence of, 186, 187t 10f, 14, 222 bacteria associated with, 47 fenestration of, 186, 187t Juvenile rheumatoid arthritis, description of, 37 grafting of, 390, 390f 308 Locally delivered antibiotics, implant placement in, 256, 59, 59t 264, 292 K Longitudinal study, 3 Maxillary incisors, 388, 389f Keratinized attached gingiva Long-term prognosis, 116, 368, Maxillary left quadrant, osseous around implant, 261, 264f 402 surgery on, 375, 376f description of, 8 Lorazepam, 67t Maxillary molars Keratinized epithelium, 11 Loss of consciousness, 356, furcations in, 17, 27 Keratinized tissue, 187 356f root resection in, 178 Keratinocytes, 10 Low birth weight, periodontitis Maxillary occlusal view, 364f Keratohyalin granules, 10 and, 38 Maxillary roots, 27 Kidneys, 319 Low-density lipoprotein, 311 Maxillary sinus, 283 Kwok and Caton classification Lupus erythematosus, 334 McGuire classification of system, 116–117, 117f Luteinizing hormone, 320 prognosis, 115, 116f, Lymphangioma, 339 368 L Medial pterygoid muscle, 16 Laboratory values, 311–312 M Medical emergencies ß-Lactams, 56t Macrosurgery versus cardiopulmonary Lamina propria, 8 microsurgery, for graft resuscitation, 354–355 LANAP. See Laser-assisted placement, 197 diagnosis of, 356f new attachment Maintenance therapy drugs used in, 355 procedure. bleeding on probing affected in office, 356–361 Langerhans cells, 10 by, 153 Medical history questionnaire, Laser-assisted new attachment case study of, 383 108 procedure, 348, 351 compliance with, 153 Medications Lasers, 347–352 effectiveness of, 150–151 antibiotics. See Antibiotics. Lateral periodontal cyst, 328, elements of, 151f bisphosphonates, 62–63 329f endpoints of, 151 pain relievers, 70–72 Lateral pterygoid muscle, 16 frequency of, 152 side effects of, 74–75 Lateral window sinus elevation, schedule of, 152 Melanocytes, 10 284f, 290f Major histocompatibility Membranes Laterally positioned flap, 199 complex proteins, antibiotics given during LCC. See Living cellular 308–309 placement of, 232–233 constructs. Mandible Bio-Gide, 233, 233f Leiomyoma, 340 dehiscence of, 186, 187t BioMend, 233, 233f Lekholm and Zarb classification, fenestration of, 186, 187t cross-linked, 233 252f implant placement in, 256, expanded polytetra- Leukoplakia, 329 264, 292 fluoroethylene, 227 Leydig cells, 320 muscles of, 16 exposure of, 231–232, 232f Lichen planus, 334, 335t Mandibular molars non–cross-linked, 233 Lidocaine, 66t furcations in, 17, 26 nonresorbable, 230f, Lipoma, 339 second, cervical enamel 230–231 Listerine, 76 projections in, 25 placement of, 232–233 Liver Mandibular occlusal view, 364f properties of, 230, 230f disease of, 321–322 Manual toothbrush, 145–146

424 

resorbable, 230f, 230–231, loss of, tooth-related factors NCCLs. See Noncarious 389 for, 114–115 cervical lesions. tacks used to stabilize, 234 restorations, furcation lesions Nd:YAG laser, 347f, 351 titanium-reinforced, 231 in, 28 Neck lumps, 342 Meniscal derangement, 14 root coverage of, 216 Necrotizing gingivitis, 119 Mental nerve, 265 root debridement in, 141 Necrotizing periodontal Meperidine, 69 uprighting of, using diseases, 47, 47f, 97–98 Mepivacaine, 66t orthodontics, 136 Necrotizing ulcerative Merkel cells, 10 Mouth breathing, 40 periodontitis Meta-analyses, 3f Mouthrinses, 76 features of, 338, 338f Metabolic disorders, 305–306 MTA pulp capping, 121t prognosis of, 119 Metastases, 330 Mucocele, 336, 337t treatment of, 338 Metronidazole, 55t–56t, 56, Mucoepidermoid carcinoma, Neurofibroma, 339 157, 338 345 Neutropenia, 311 Micro-macroporous biphasic Mucogingival defects, Sullivan New attachment, 221 calcium phosphate, 228 and Atkins classification Nikolsky test, 333 Microsurgery of, 192, 192f Nitrous oxide, 68, 355 advantages of, 175 Mucogingival deformities, Noncarious cervical lesions, macrosurgery versus, for 102–104 125 graft placement, 197 , 7f Non–cross-linked membranes, Midazolam, 68–69 Mucogingival surgery, smoking 233 Miller classification effects on, 202 Nonfunctional contacts, 132 of gingival recession-type Mucogingival therapy Nonresorbable membranes, defects, 209f anatomy for, 203–204 230f, 230–231 of mobility, 126–127 definition of, 186 Nonspecific plaque hypothesis, of soft tissue resection, 192f enamel matrix derivative for, 43 Minimally invasive surgery, 207 Nonspecific ulcer, 340 170–173 endpoints of, 187 Nonsteroidal anti-inflammatory Minimally invasive surgical side effects of, 188 drugs, 60t technique, 171 Mucositis, peri-implant Nonsurgical root canal therapy, Minocycline, 55t, 56, 59t adjunctive therapy for, 281 121t MIS. See Minimally invasive causes of, 277–278 Nonsurgical therapy surgery. chlorhexidine for, 281 irrigation, 156–158 Misch bone density scale, 223 definition of, 273 . See MIST. See Minimally invasive description of, 104–105 Scaling and root planing. surgical technique. diabetes and, 279 surgical therapy versus, 154t, M-MIST. See Modified gingivitis versus, 258t 177 minimally invasive illustration of, 280f types of, 139 surgical technique. incidence of, 280 Nystatin, 77 Mobile implant, 279 laser treatment for, 350 Mobility, 126–128 peri-implantitis and, 257, O Moderate periodontitis, 105 274t–275t, 280 Obesity Modified Gingival Index, 35 prevalence of, 280 inflammation and, 305–306 Modified minimally invasive Mucous membrane osteoarthritis risks, 307 surgical technique, 172, pemphigoid, 333f, 337t periodontitis risks, 33 227 Mucus retention cyst, 336, 337t Occlusal adjustment, 133f, Modified Widman flap, 167– Mycelex troches, 77 133–134 168 Mylohyoid muscle, 16 Occlusal contacts, 131–132 Moi-Stir moistening solution, 75 Myocardial infarction, 316, 359, Occlusal discrepancies, Molars 404 131–132 with accessory canals, 25 Occlusal forces, 131, 134–135 implant therapy versus root N Occlusal overload, 129 resection in, 122–123 Nabers probe, 17 Naloxone, 70 definition of, 125

425 Index

description of, 104 prognosis affected by, Pain relievers, 70–72 periodontal attachment loss 136–137 Palatal approach to osseous and, 131 recession and, relationship surgery, 168–169, Occlusion between, 210 169tPancreas, 319 canine-guided, 128 Orthokeratinization, 11 PAOO. See Periodontally endodontic therapy affected Osseointegration, 256, 270– accelerated osteogenic by, 120 271 orthodontics. group function, 128 Osseous recontouring, 177 Papilla for implant patients, 128– Osseous surgery. See also height loss, 211 129 Periodontal surgery; loss of, 210–211 implant therapy affected by, Surgical therapy. reconstruction of, 211 120 contraindications, 166 Papilla preservation flap, 169 theories of, 130–131 definition of, 165 Papilla preservation technique, types of, 128 failure of, 166 171 Occlusive stroke, 360 indications for, 165 Papillary lesion, 341 Odds ratio, 33 lingual approach to, 169 Papillon-Lefèvre syndrome, 97, Odontogenic keratocyst, 328, materials used in, 179–180, 339–343 329f 180f Parakeratinization, 11 Odontogenic tumors, 332 on maxillary left quadrant, Partial prothrombin time, 321f Odontoma, 332 375, 376f Partial-thickness flap, 165, 167 OFD. See Open-flap after, 177–178 Passive eruption debridement. palatal approach to, 168– active eruption versus, 213 Office emergencies, 356–361 169, 169t altered, 212 Onlay grafts, 225, 239 periodontal flap surgery, 165 PDGF. See Platelet-derived Open flap curettage, 177 postoperative period, growth factor. Open flap scaling and root 182–183 Pedicle graft, for mean defect planing, 19, 141 rationale for, 165–166 coverage, 207t Open-flap debridement, 235, sutures, 180–182, 181f Pemphigus vulgaris, 333f, 337t 236f techniques, 168–169 Penciclovir, 328 Opioid overdose, 69–70 wound healing after, 175, Penicillin, 58 Oral anticoagulants, 73–74 176t Pepsin, 320 Oral cancers, 330 Ossix, 233 Pepsinogen, 320 Oral candida, 77 Ostectomy, 166, 375 Peptostreptococcus micros, Oral epithelium, 10, 10f Osteoarthritis, 307–308 127 Oral hygiene Osteoblasts, 260, 302 Percocet, 71t after osseous surgery, Osteoclasts, 302 Percodan, 71t 177–178 Osteoconductive, 224 Pericoronal abscess, 100 brushing, 144–145 Osteogenesis imperfecta, 343t Pericoronal radiolucency, 341 flossing, 144–145 Osteogenic, 224 Peri-implant health, 104 overhanging dental margins Osteogenic protein-I, 24 Peri-implant mucosa effect on, 39 Osteoinductive, 224 recession of, 255 periodontitis and, 31 Osteonecrosis, thickness of, 267–268 supragingival irrigation as bisphosphonate- Peri-implant mucositis adjunct in, 156 associated, 62, 64t adjunctive therapy for, 281 Oral infections, 336–338 Osteoplasty, 166, 375 causes of, 277–278 Oral malodor, 323–324, Osteotome, 288–289 chlorhexidine for, 281 402–403 Ovate pontic, 215 definition of, 273 Oral medicine, 311–325 Overhanging dental margins, description of, 104–105 Oral mucosa, 9, 9f 39 diabetes and, 279 Oral mucous membrane, 7f Overload, occlusal, 129 gingivitis versus, 258t Oral sedation, 65 Oxycodone, 71t illustration of, 280f Oral , 10, 10f incidence of, 280 Oral viral infections, 77 P laser treatment for, 350 Organs, 319–320 P value, 3 peri-implantitis and, 257, Orthodontics Pacemakers, 148 274t–275t, 280

426 

prevalence of, 280 gingivitis. See Gingivitis. lack of, 153–154 Peri-implant tissue host response inhibition mobile teeth effects on, 127 periodontal tissue and, effects on, 303 results of, 379t, 379–383 comparison between, host-based tests for Periodontally accelerated 258t–259t susceptibility to, 107 osteogenic orthodontics, probing of, 255 implant placement in patients 210 Peri-implantitis with, 261–262 Periodontitis causes of, 277–278 inflammation and, 304–305, advanced, 105 circumferential occlusal 305f aggressive. See Aggressive access procedure for, necrotizing, 47, 47f, 97–98 periodontitis. 281 periodontitis. See antibiotics for, 54 definition of, 273 Periodontitis. atherosclerotic description of, 105 predictors of, 105–107 cardiovascular disease illustration of, 280f probing depth as predictor risk factors, 316 incidence of, 280 of, 107 bacteria found in, 43–48, laser treatment for, 350 progression of, 304 44t–45t management of, 282f pulpal changes and, 122 biofilms, 43 pattern of, 280–281 radiographic evaluations, bleeding on probing in, 88t peri-implant mucositis and, 108–110, 109f caloric restriction effects on, 257, 274t–275t, 280 recurrent, 154 305 periodontitis and, comparison refractory, 47, 47f, 54 cardiovascular disease and, between, 277t rheumatoid arthritis as 315–316 prevalence of, 280 predictor of, 110 chronic. See Chronic risk factors for, 278 risk factors for, 394–395 periodontitis. severity of, 280–281 viruses in, 48 classification of, 90–91 treatment of, 281–282, 282f Periodontal Disease Index, 36 conditions associated with, PerioChip, 59t Periodontal flap surgery, 165 38–40 Periodic fever, aphthous Periodontal health, 87, 87f, 88t definition of, 82 pharyngitis and cervical Periodontal Index, 36 diabetes mellitus and, 32, adenopathy. See PFAPA Periodontal ligament 117 syndrome. anatomy of, 7f, 12 early, 105 Periodic fever, aphthous description of, 131, 133 endodontic lesions stomatitis, pharyngitis, widening of, associated with, 100– and adenitis, 344 and, 107 102 , 98–100, Periodontal ligament cells, 222 epigenetic modifications in, 99f–100f, 403 Periodontal plastic surgery, 186 300 Periodontal cyst, 329f Periodontal pocket. See Pocket. extraction of hopeless teeth Periodontal disease Periodontal regeneration in patients with, 118 American Academy definition of, 221 generalized aggressive, 37 of Periodontology goals of, 221 genetic risks, 32 classification system for, growth factors for, 246 gingivitis and, 81, 257 105 Periodontal supporting tissues, grading of, 93–95, 94t bacteria associated with, 96–97 implant placement in patients 46–48, 47f Periodontal surgery. See also with, 261–262 bleeding on probing as Osseous surgery; localized aggressive, 37, 47 predictor of progression Surgical therapy. low birth weight and, 38 of, 105–107 blood loss during, 183–184 moderate, 105 bone loss in, 301 cell types that repopulate the necrotizing ulcerative. See bruxism effects on, 132 root surface after, 222 Necrotizing ulcerative cardiovascular disease and, postinfection rate after, 183 periodontitis. 315 technique of, 175 nontreatment effects, 142 classification of, 83–87 Periodontal tissue, peri-implant oral hygiene and, 31 clinical attachment level as tissue and, 258t–259t overhanging dental margins predictor of, 107 Periodontal trauma, 126 and, 39 etiologic factors, 394–395 Periodontal treatment/therapy

427 Index

peri-implantitis and, nitrous oxide, 68 , 44t, comparison between, oral sedation, 65 127, 307 277t pain relievers, 70–72 Postoperative chart, 397f–398f plaque and, 43 Phenytoin, 74f Postoperative infection, 285, in pregnancy, 38 Photodynamic therapy, 348, 286f preterm birth and, 38, 39f 350–351 Postoperative instructions, 378 prevalence of, 37 PICO question, 1–2 Postoperative period, 182–183 prognosis of, orthodontics Piezoelectric instrument, 285 Postoperative photographs, effect on, 136–137 Pigmented lesions, 341f 397f pulpal changes and, 122 Pinhole surgical technique, 201 Posttreatment report record, refractory, 40 Pipe smoking, 42 380f risk factors for, 31–33 Pituitary gland, 320 Postural hypotension, 356f risk indicators for, 32–33 Plaque Pregnancy severe, 37 definition of, 43 Food and Drug smoking and, 32, 40–41, flossing to remove, 144 Administration 41f, 117 gingival diseases caused pharmaceutical staging of, 90–93, 92t by, 81 categories, 53 systemic antibiotics for, 54 gingivitis onset after periodontitis treatment systemic diseases associated incomplete removal of, during, 38 with, 96–97 145 precautions during, 324 tobacco use and, 32, 40–41 host defense against, 323f pyogenic granulomas in, 331 tooth extractions caused effects on, 75 Prehypertension, 312 by, 37 Plaque Index, 36, 153 Preoperative chart, 393f types of, 90 Plaque lichen planus, 335t Preoperative radiographs, 393f Periodontium Plaque-induced gingivitis, 81 Preterm birth alveolar bone, 12–13 Plaque-induced inflammation, bacteria associated with, 48 anatomy of, 6, 7f 399 periodontitis and, 38, 39f cementum, 13–14 Platelet count, 311 Pretreatment report record, connective tissue, 11 Platelet-derived growth factor, 365f gingival epithelium, 9–11 245 Prevalence innervation of, 7 Platelet-rich plasma of furcation defects and phenotype of, 102f, 194 furcation lesions treated lesions, 17 removable partial denture with, 24 of gingival recession, 190 effects on health of, 123 sinus elevation use of, incidence versus, 34 vascular supply of, 7 286–287 of periodontitis, 37 Perioscopy, 170 Platform switching, 272 Prevident, 76 Periosteal suture, 182 Pocket , 44t, 46 Periosteum food impaction and, 39 Prevotella nigrescens, 47 description of, 11 occlusal adjustment effects Primary hypertension, 312 graft placement on, 204 on depth of, 134 Primary occlusal trauma, 125 Peripheral blood neutrophils, recurrent, 15 Primary wound healing, 175 302 supragingival and subgingival Probing Peripheral ossifying fibroma, irrigation projection into, bleeding on, 34–36, 105– 339 158 107, 153 PFAPA syndrome, 344 surgical reduction of, 372 of peri-implant tissue, 255 Pharmacology Pocket depths Probing depths antibiotics. See Antibiotics. enamel matrix derivative critical, 142–143 bisphosphonates, 62–63 effects on, 244 definition of, 83 Food and Drug occlusal adjustment effects periodontal disease and, 107 Administration pregnancy on, 134 Procaine, 65 categories, 53 scaling and root planing Prognosis host modulation, 60 effects on, 140 case study of, 388 IV sedation, 68–70, 70f unresolved, 176–177 definition of, 113 medication side effects, Pontic, 215 of endodontic therapy, 120 74–75 of implants, 120, 122–123

428 

long-term, 116, 368, 402 Recombinant human periodontitis, 31–33 McGuire classification of, osteogenic protein-I, 24 risk indicator versus, 31 115, 116f, 368 Recombinant human platelet- Risk indicators of necrotizing ulcerative derived growth factor, definition of, 31 gingivitis, 118 245 periodontitis, 32–33 orthodontics effect on, Recontouring, osseous, 177 risk factor versus, 31 136–137 Recurrent periodontal disease, Rivaroxaban, 74 short-term, 116, 368, 402 154 Root(s) of teeth with furcation Red blood cell count, 311 concavities of, 16, 26 lesions, 118 Red lesions, 341f conical, 16 Progressive crestal bone loss, Reevaluation report record, curvatures of, 16 around implants, 279 371f, 372 divergent, 16 Proinflammatory molecules, Refractory periodontal disease, maxillary, 27 302–303 47, 47f morphology of, tooth support Proliferative verrous leukoplakia, Refractory periodontitis, 40, 54 and, 16 329 Regeneration surface area of, 28 Prophylaxis, antibiotic, 57–58, bone. See Bone Root canal therapy 257 regeneration; Guided nonsurgical, 121t Prostaglandin E2, 302 bone regeneration. success rates for, 290 Protectins, 300 distraction osteogenesis for, Root conditioning, 158 Prothrombin time, 321f 237f, 237–238 Root coverage PR P. See Platelet-rich plasma. factors that affect, 222f, attachment apparatus for, Pseudoepitheliomatous 222–223 201 hyperplasia, 329 goals of, 221 connective tissue graft PST. See Pinhole surgical growth factors for, 246 effects on, 197 technique. guided bone, 223 flap thickness and, 206 Pulp hypermobility effects on, 246 molars, 216 caries and, 122 measurement of, 247 over caries lesions, 215 periodontal disease and, 122 root surface demineralization soft tissue resection treated periodontitis and, 122 effects on, 246 with, 192f scaling effects on, 149 smoking effects on, 247 success of, 201 Pulpal abscess, 99 tooth vitality effects on, 246 technical factors that Pyogenic granuloma, 331, 339 Remodeling, after implant enhance, 207 placement, 253 Root fracture, 16, 117f, 178 R Removable partial dentures, Root planing. See also Scaling Race, periodontitis risks and, 123 and root planing. 33 Repair, 221 definition of, 139 Radiographs Resolvins, 300 endpoints of, 139–140 case study uses of, 367f Resorbable membranes, 230f, factors that affect, 140 periodontal disease 230–231, 389 furcation defects and lesions evaluations, 108–110, Respiratory distress, 357, 358f treated with, 19 109f Restorations modified Widman flap, Randomized clinical trials, 3f attached gingiva around, 167–168 RANKL inhibitors, 64–65 188, 194 Root resection Reattachment, 221 furcation lesions and, 28 contraindications for, 178 Receptor activator of nuclear pulpal changes and, 123 endodontic therapy before, factor kappa-B ligand Reticular lichen planus, 335t 20 inhibitors. See RANKL Rhabdomyosarcoma, 340 guidelines for, 20 inhibitors. Rheumatoid arthritis, 110 indications for, 178 Recession rhPDGF. See Recombinant in molars, 122 gingival. See Gingival human platelet-derived success rate of, 178–179 recession. growth factor. technique for, 20–21 orthodontics and, 210 Risedronate sodium, 61t Root sensitivity, 159 peri-implant mucosa, 255 Risk factors Root surface soft tissue, 191–192, 268 definition of, 31 biomodification of, 198

429 Index

demineralization of, effect on Shrinkage, after graft Sonic toothbrush, 148 regeneration, 246 placement, 202 Specific plaque hypothesis, 43 Er:YAG laser effects on, 352 Siebert’s classification, of Specificity, 4, 34 modification of, 158, 246 alveolar ridge deformities, Spleen, 319 Rough surface modifications, of 223 Splinting, 134 implants, 260, 287 Silk sutures, 181f SPPF. See Simplified papilla Round bur, 285 Simplified papilla preservation preservation flap. flap, 171 Squamous cell carcinoma, 330 S Single implants, 123 Staging Saddle grafts, 225 Single-flap approach, 172 ABCDE, 331, 331f Salivary gland disorders, 336 Single-stage implant TNM, 326 Scalers, 146–148, 147t placement, 264 Steroids, inhalation, 75 Scaling and root planing Sinus Stomach, 320 attachment level benefits maxillary, 283 Stratum basale, 10 after, 57 septa with, 283 Stratum corneum, 11 closed flap, 19, 141 Sinus augmentation, 286, 288f Stratum granulosum, 10 definition of, 139 Sinus elevation Stratum spinosum, 10 effectiveness of, 140–144 bone-added osteotome, 288 Streptococcus mitis, 47 factors that affect, 140 implant placement and, 287, Streptococcus sanguis, 47 furcation defects and lesions 289 Stress, periodontitis risks and, treated with, 19 infection after, 285, 286f 33 lasers and, comparison lateral window, 284, 284f, Stroke, 314, 360–361 between, 349–350 290f Studies open flap, 19, 141 sinus membrane perforation case, 362–404 photodynamic therapy and, during, 285 types of, 2–3, 3f 350 Sinus membrane perforation, Subantimicrobial dose pulpal effects of, 149 285 doxycycline, 60t reevaluation after, 150 Sjögren syndrome, 336 Subepithelial connective tissue single versus weekly Skin cancer, 331, 331f graft, 400 appointments, 143 Sling suture, 182 Subgingival irrigation, 156–158 Sclerotic bone, implant Smear layer, 158 Sulcus, 7f placement in, 292 Smoking Superior alveolar artery, 12 SCTG. See Subepithelial cessation of, 42 Superior alveolar nerve, 284 connective tissue graft. cigarettes versus pipe or Suppuration, 107 Secondary hypertension, 312 cigars, 42 Supracrestal tissue attachment, Secondary occlusal trauma, implants affected by, 272– 15 125 273 Supragingival irrigation, 156 Secondary wound healing, 175 mucogingival surgery Surface modifications Sedation affected by, 202 of implants, 260, 260f, 287 conscious, 68–69 periodontitis risks, 32, 40– of root, 158, 246 IV, 68–70, 70f 41, 41f, 117 Surgical dressings, 179–180, oral, 65 regeneration affected by, 247 180f Sedatives, 322 wound healing affected by, Surgical pocket reduction Seizures, grand mal, 357 247 therapy, 372 Semilunar technique, 199 Socioeconomic status, Surgical root canal therapy, Sensitivity, 4, 34 periodontitis risks and, 121t Sensitivity testing, 368, 369t, 32 Surgical therapy. See also 381 Socket grafting, 241–243 Osseous surgery; Sensodyne, 76 Socket preservation, implant Periodontal surgery. Severe periodontitis, 37 placement after, 243 envelope flap, 168 Sex, periodontitis risks and, 32 Soft tissue deficiencies, 254f full-thickness flap, 167 Sharpey fibers, 13 Soft tissue grafting, 215 gingivectomy, 150, 163–164 Short-term prognosis, 116, Soft tissue recession, 191– modified Widman flap, 368, 402 192, 268 167–168 Sonic scalers, 146–148, 147t

430 

nonsurgical therapy versus, socket grafting after, 241 Unconsciousness, 356 154t, 177 wound healing after, 241– Uneven marginal ridges, 131 osseous surgery, 164–167 242 Uprighting of molars, using partial-thickness flap, 167 Tooth loss orthodontics, 136 postoperative instructions, amount of, 115 378 Hirschfeld and Wasserman V Surgicel, 180 studies on, 113t, Validity, 4, 4f Sutures, 180–182, 181f 113–114 Valium, 355. See also Suturing, 182 McFall study on, 113–114, Diazepam. Systematic reviews, 3f 114t Vaping, 42–43 Systemic antibiotics, 54–58 Tooth mobility, 107 Vasodepressor syncope, 356f Systemic conditions, gingival Versed. See Midazolam. manifestations of, 85–86 changing of, 146 Vertical ridge augmentation, electric, 145–146 225, 239 T manual, 145–146 Vertical root fracture, 117f T cells, 301 sonic, 148 Vestibular incision subperiosteal Tachycardia, 312 ultrasonic, 148 tunnel access technique, , 45t Toothpastes, 76 201 Tarnow classification, of Transforming growth factor ß, Vestibule, 216 furcations, 19 302 Vicodin, 71t Temporalis muscle, 16 Transseptal fibers, 9 Vicryl sutures, 181f Temporomandibular joint, 14 Trauma Viral infections, oral, 77 Teriparatide, 63 occlusal. See Occlusal Viruses Tertiary wound healing, 175 trauma. gingival diseases caused Testosterone, 320 periodontal, 126 by, 85 Tetracycline Treatment planning, 362–404 periodontal disease and, 48 bone graft and, 229 , 45t VISTA technique. See Vestibular description of, 55t Triazolam, 67t incision subperiosteal drug interactions with, 56t ß-Tricalcium phosphate, 245 tunnel access technique. root surface modification Triclosan, 75–76 using, 246 Trigeminal nerve, 7 W T-helper cells, 302, 309 Tumor(s) Warfarin, 73, 320 Thrombosis, 313f biopsy of, 327 White blood cell count, 311 Thyroid gland, 319 odontogenic, 332 White lesions, 341f Tissue responses, to occlusal TNM staging system of, 326 Widman flap, 150 forces, 134–135 Tumor necrosis factor α, 301, modified, 167–168 TNM staging system, 326 303 Wound healing Tobacco use, periodontitis risks Tunnel preparations, in furcation after osseous surgery, 175, and, 32, 40–41 lesion area, 23 176t, 201–202 Tonofilaments, 11 Tunnel technique, 200, 200f after tooth extraction, Tooth extractions Two-stage implant placement, 241–242 case study of, 372–374, 264–265 smoking effects on, 247 373f Tylenol #3, 71t decision-making Type 1 diabetes mellitus, 317t X considerations in, 121 Type 2 diabetes mellitus, 317t Xanax. See Alprazolam. of hopeless teeth, 117f, 118 Xenografts, 224, 227 periodontitis as cause of, 37 U Xerostomia, 75 saving the tooth versus, 121 Ulcers, 327–328, 340 single anterior implant Ultrasonic scalers, 146–148, Z placement after, 268 147t Zoledronic acid, 61t Ultrasonic toothbrush, 148

431