Marquette University e-Publications@Marquette School of Dentistry Faculty Research and Dentistry, School of Publications 2-1-2013 Principles of Periodontology Andrew R. Dentino Marquette University, [email protected] Seokwoo Lee Jason Mailhot Arthur F. Hefti Marquette University, [email protected] Accepted version. Periodontology 2000, Vol. 61, No. 1 (February 2013): 16-53. DOI. © 1999-2018 John Wiley & Sons, Inc. Used with permission. Marquette University e-Publications@Marquette Dentistry Faculty Research and Publications/School of Dentistry This paper is NOT THE PUBLISHED VERSION; but the author’s final, peer-reviewed manuscript. The published version may be accessed by following the link in the citation below. Periodontology 2000, Vol. 61, No. 1 (2013): 16-53. DOI. This article is © Wiley and permission has been granted for this version to appear in e-Publications@Marquette. 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Table of Contents Abstract ......................................................................................................................................................... 3 History ........................................................................................................................................................... 5 Early Observations .................................................................................................................................... 5 From scurvy of the gum to Riggs’ disease ................................................................................................. 5 Focal infection theory ............................................................................................................................... 6 Periodontal disease classifications ............................................................................................................... 7 Times of transition and consolidation ...................................................................................................... 7 1999 International Workshop for Classification of Periodontal Diseases and Conditions ....................... 8 Classification limitations and next steps ................................................................................................. 10 Etiology ....................................................................................................................................................... 11 Pathogenesis ............................................................................................................................................... 13 .................................................................................................................................................................... 14 Epidemiology............................................................................................................................................... 16 General trends ........................................................................................................................................ 16 Aggressive forms of periodontitis ........................................................................................................... 17 Necrotizing periodontal diseases ............................................................................................................ 18 Risk modifiers .......................................................................................................................................... 18 Smoking ................................................................................................................................................... 19 Genetics .................................................................................................................................................. 19 Diabetes .................................................................................................................................................. 20 Obesity .................................................................................................................................................... 20 Pregnancy................................................................................................................................................ 20 Medications ............................................................................................................................................ 21 Nutrition .................................................................................................................................................. 21 Systemic effects of periodontal disease ..................................................................................................... 22 Treatment modalities for gingivitis and periodontitis ................................................................................ 23 Historical overview.................................................................................................................................. 23 Systemic and acute phases of treatment ............................................................................................... 23 Active treatment and maintenance ........................................................................................................ 25 Non-surgical cause-related treatment .................................................................................................... 30 Plaque control ..................................................................................................................................... 30 Removing plaque-retentive factors .................................................................................................... 30 Scaling and root planing ...................................................................................................................... 30 Adjunctive treatments during initial-phase therapy ............................................................................... 31 Systemic antibiotics ............................................................................................................................ 31 Local antimicrobial treatment............................................................................................................. 31 Host modulation ................................................................................................................................. 31 Full-mouth disinfection ....................................................................................................................... 32 Lasers .................................................................................................................................................. 33 Surgical phase of treatment .................................................................................................................... 33 Access treatment ................................................................................................................................ 33 Resective procedures .......................................................................................................................... 34 Regenerative procedures .................................................................................................................... 34 Guided tissue regeneration and biological agents ............................................................................. 34 Mucogingival procedures .................................................................................................................... 35 Supportive phase of treatment ............................................................................................................... 35 Concluding remarks .................................................................................................................................... 36 References .................................................................................................................................................. 38 Principles of periodontology Andrew Dentino Seokwoo Lee Jason Mailhot Arthur F. Hefti Abstract Periodontal diseases are among the most common diseases affecting humans. Dental biofilm is a contributor to the etiology of most periodontal diseases. It is also widely accepted that immunological and inflammatory responses to biofilm components are manifested by signs and symptoms of periodontal disease. The outcome of such interaction is modulated by risk factors (modifiers), either inherent (genetic) or acquired (environmental), significantly affecting the initiation and progression of different periodontal disease phenotypes. While definitive genetic determinants responsible for either susceptibility or resistance to periodontal disease have yet to be identified, many factors affecting the pathogenesis have been described, including smoking, diabetes, obesity, medications, and nutrition. Currently, periodontal diseases are classified based upon clinical disease traits using radiographs and clinical examination. Advances in genomics, molecular biology, and personalized medicine may result in new guidelines for unambiguous disease definition and diagnosis in the future. Recent studies have implied relationships between periodontal diseases and systemic conditions. Answering critical questions regarding host-parasite interactions