PERIODONTAL REVIEW - · PDF filePERIODONTAL REVIEW Quintessence Publishing Co, Inc ... 4 Epidemiology and Etiology 25 ... question and answer format

PERIODONTALREVIEW

Quintessence Publishing Co, Inc

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A STUDY GUIDE

Deborah A. Termeie, dds

Clinical Lecturer Department of Periodontics

School of Dentistry University of California, Los Angeles

Los Angeles, California

Foreword, by David Cochran, dds, ms, phd, mmsci vi Preface viii About the Author viii

1 Evidence-Based Dentistry 1

2 Periodontal Anatomy 5

3 Furcations 15

4 Epidemiology and Etiology 25

5 Pharmacology 41

6 Diagnosis 59

7 Prognosis 73

8 Occlusion 83

9 Nonsurgical Therapy 93

10 Surgical Therapy 113

11 Mucogingival Therapy 129

12 Regeneration 147

13 Implants 171

14 Inflammation 197

15 Oral Medicine 207

16 Oral Pathology 219

17 Lasers 233

18 Medical Emergencies 239

19 Treatment Planning 247

Index 281

Contents

vi

ForewordBecoming certified by the American Board of Periodontology (ABP) is an immense honor and an outward sign of a dedication to the specialty of peri-odontics and a drive to excel within the profession. According to the Ameri-can Academy of Periodontology, the ABP “evaluates standards of periodontic practice by examining the qualifications and competence of periodontists who voluntarily apply to the board for certification as diplomates.” After suc-cessful completion of a written qualifying examination, a candidate is consid-ered board eligible and must then complete an oral examination in a defined period of time. The ABP defines a diplomate as “a periodontist who has made significant achievements beyond the mandatory educational requirements of the specialty and who is certified by the ABP.” This reinforces board certifica-tion as a sign of dedication to the specialty and of committment to become the best periodontist possible.

To be educationally qualified for board certification, a candidate must be a certified dentist who has completed an accredited 3-year educational pro-gram in periodontology. The written and oral board examinations are com-prehensive, covering all phases of periodontal health and disease and its diag-nosis, treatment, and evaluation. In fact, the mission of the ABP is to “advance the art and science of periodontics and elevate the quality of periodontal care through the examination, certification, and recertification of periodontists and by encouraging the achievement and maintenance of diplomate status.” Thus, one can appreciate that mastery of the body of knowledge required to complete the written and oral examinations is intimidating and overwhelm-ing! Periodontal Review by Dr Deborah Termeie is an organized, detailed, and well-documented compilation of information designed to help candidates navigate the board certification examinations.

There are many periodontal specialty programs across the United States, and while each covers the components mandated by the Commission on Dental Accreditation of the American Dental Association, variation exists between programs because of different faculties and diverse patient experi-ences. Therefore, a comprehensive well-documented study guide can help standardize the information provided in the various educational programs. More important, the body of knowledge that one must know to become board certified is overwhelming, and as more publications in the peer-re-viewed literature become available every year, this body of knowledge grows exponentially. Learning the necessary material seems impossible. These are just two reasons why this study guide is helpful.

vii

In the past, study to become board certified would require months of prep-aration just to figure out how to organize the literature to understand the critical information. Dr Termeie has done this task for you. Chapters cover di-verse topics of periodontolgy, including health and disease conditions and ther- apeutic options, and the information is presented in an easy-to-understand question and answer format. The detail for treatment options alone is impres-sive; it includes nonsurgical and surgical therapy, chemotherapeutics, lasers, occlusal therapy, and bone and implant therapy for replacing missing teeth. Dr Termeie includes other material relevant to the board candidate, such as evidence-based medicine and dentistry, related human physiology and pathol-ogy, pharmacology, and oral medicine and pathology.

Another helpful aspect to this study guide is that Dr Termeie often pro-vides data for and against a question in a concise and understandable format. Additionally, simple diagrams, tables, and charts are used throughout, which makes the text easy to understand even when discussing difficult topics. Dr Termeie also provides clinical examples that demonstrate how patient cases are documented and presented during the board examinations.

Collectively this study guide provides a comprehensive and well-organized review of major concepts in the field of periodontology and can be used either to start the studying process or as a self-examination review prior to taking the examinations. I believe that this study guide will be an essential tool for anyone who is going through the periodontal certifying board examina-tions or the board recertification examination or who would like to have a comprehensive reference guide in periodontology. I would like to thank Dr Termeie for the time and effort that she expended to compile this infor-mation and for making it comprehensive, organized, and easy to understand. Present and future periodontal diplomates will be much better prepared due to this effort by Dr Termeie.

David L. Cochran, dds, ms, phd, mmsciProud Diplomate of the American Board of Periodontology

Professor and ChairmanDepartment of PeriodonticsDental SchoolThe University of Texas Health Science Center at San AntonioSan Antonio, Texas

viii

PrefaceAs periodontal residency graduates embark on their journey to board cer-tification, many of them come face to face with a plethora of study materi-als and information but no comprehensive study resource designed to help them prepare for their examinations. Periodontal Review was specifically writ-ten 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 practi-cal literature on topics such as diagnosis, nonsurgical therapy, surgical ther-apy, 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 comprehensive and yet concise approach to periodontics is aimed at preparing the candidate for periodontal examinations and clinical practice.

Periodontal Review is a useful resource for residents, practicing periodon-tists preparing for board certification, dental students, and dental hygiene students seeking a broader appreciation and in-depth understanding of peri-odontics. Topics chosen are those emphasized in periodontal residency grad-uation examinations as well as the oral examintation of the American Board of Periodontology.

Acknowledgments

I would like to acknowledge my mentors—Philip R. Melnick, DDS; Thomas N. Sims, DDS; Paulo M. Camargo, DDS; and Thomas Han, DDS—for their guid-ance and advice. I would also like to thank my program director at UCLA, Perry R. Klokkevold, DDS. Lastly, I would like to thank my loving husband, David, and my children, Gabriella and Elliot. Without their love and support, this book would not have been possible.

About the AuthorDeborah A. Termeie, dds, is a clinical instructor in the Department of Periodontics at UCLA in Los Angeles, California. She is a diplomate of the American Board of Periodontology (ABP), and it was her experience preparing for the ABP qualifying exams that inspired her to write this book. Dr Termeie has published on the topic of evidence-based dentistry and is the recipient of several awards, including the Excellence in Implantology Research award from the California Society of Periodontics. She maintains a private practice in Beverly Hills, California.

16

Furcations3

ClassificationQ: Describe the Hamp classification.

The classification by Hamp et al3 involves a horizontal measurement:

• F0: No furcation involvement.• F1: The probe can penetrate the furcation less than 3 mm.• F2: The furcation can be probed greater than 3 mm, but it is not a through

and through furcation involvement.• F3: Through and through furcation involvement.

Q: Describe the Glickman classification.

The Glickman4 classification is presented in Fig 3-1.

Grade I• Incipient suprabony

lesion.• Radiographic

changes are rarely found.

Grade II• Furcation bone loss

with a horizontal component.

• Radiographs may not show bone loss in the furcation.

Grade III• A through and

through lesion (bone is not attached to the fornix of the furcation) that is not clinically visible because it is filled with soft tissue.

• Radiographs show a radiolucency in the furcation.

Grade IV• A through and

through lesion that is clinically visible. The soft tissue has receded apically.

• Radiolucency is clearly visible in the furcation area.

Fig 3-1 Glickman classification.

17

Treatment Options

Q: Describe the Tarnow classification.

The classification by Tarnow and Fletcher5 is a subclassification of the Glick-man furcation classification that measures the vertical probing depth from the roof of the furca:

• A: 0 to 3 mm• B: 4 to 6 mm• C: Greater than 7 mm

Treatment Options

Q: What are the treatment options for furcation defects?

• Nonsurgical debridement• Surgical debridement• Surgical exposure of the furcation• Regeneration (guided tissue regeneration [GTR] and enamel matrix deriva-

tive [EMD])• Extraction• Root resection• Tunnel preparation

Q: Is open/closed flap scaling and root planing effective in furcation lesions?

A review by Cobb6 demonstrated a less favorable response to scaling and root planing by molars with furcation involvement compared with those without furcation lesions and single-rooted teeth. He surmised that this was related to the inability to remove all pathogenic microbial flora due to the furcal anatomy restricting access for mechanical therapy.

Bower7 found that 81% of the time the furcation entrance is 1 mm or less. The study also found that 58% of the time the furcation entrance is 0.7 mm or less. The blade width of commonly used periodontal curettes is 0.75 mm. The ultrasonic (smaller) tip would fit better than the tip of a Gracey curette in a grade II or III furcation.

Wylam et al8 found no significant difference between open and closed flap root planing. The study further concluded that root planing is inefficient in the debridement of furcation lesions and does not allow for periodontal re-generation.

68

Diagnosis6

Diagnostic ProcessQ: What are some important factors when determining a

diagnosis?

The medical history questionnaire and examination are vital and should in-clude the factors12 listed in Fig 6-5.

Chief complaint of the patient

Drug history

History of the complaint

Family history

Past and present medical history

Extraoral and intraoral examination

Fig 6-5 Factors to be included in a medical health questionnaire. The medical doctor may need to be contacted to determine if there is a possible dental contraindication.

Q: In which situations are biopsies required?

• A cancerous lesion is suspected• A positive histologic diagnosis has implications for other body systems• The lesion being diagnosed has variable clinical histologic features

If in doubt, the dentist should always refer.

Radiographs

Q: What may be some important signs seen in radiographs that suggest periodontal disease?

Radiographic signs of periodontal disease may include:

• Break/fuzziness in lamina dura • Wedge-shaped radiolucency• Crestal fuzziness may be an early sign of angular bone loss

Q: Are radiographs an accurate method of diagnosing periodontal disease?

Ortman et al13 found that the unaided eye is able to detect radiographic changes when approximately 50% of the bone has been lost (Fig 6-6).

69

Radiographs

Fig 6-6 Radiograph of a pa-tient with bone loss.

Deas et al14 found that the furcation arrow is an accurate predictor of furcation invasion 70% of the time. However, when furcation invasions are known to be present, the furcation arrow is seen in less than 40% of sites.

Q: What alveolar crest level represents bone loss on a bitewing radiograph?

Hausmann et al15 suggested that the radiographic threshold for crestal bone loss is greater than 2 mm from the CEJ to the alveolar crest on bitewing radiographs.

Q: Are digital radiographs equivalent to conventional radiographs in revealing bone loss?

Digital radiographs have dose advantages and are able to enhance images. Khocht et al16 noted that digital radiographs showed a higher number of sites with bone loss than did conventional radiographs. Bruder et al17 found that digital radiographs saved time, exposed the patient to less radiation (50% to 60%), allowed versatility in viewing the image, and produced no chemical waste.

Q: When should cone beam computed tomography (CBCT) be used?

According to the American Dental Association,18 “clinicians should perform radiographic imaging, including CBCT, only after professional justification that the potential clinical benefits will outweigh the risks associated with expo-sure to ionizing radiation. All radiographic examinations should be indicated clinically and justified appropriately.”

76

Prognosis7

Q: Describe the prognostic classification by Kwok and Caton.6

The Kwok and Caton6 classification system is based on the probability of disease progression. The four proposed classifications are shown in Fig 7-2.

HopelessThe tooth must be extracted.

UnfavorableThe periodontal status of the tooth is influenced by local and/or systemic factors that cannot be controlled.

QuestionableThe periodontal status of the tooth is influenced by local and/or systemic factors that may or may not be controlled.

FavorableThe periodontal status of the tooth can be stabilized with comprehensive periodontal treat-ment and periodontal maintenance.

Fig 7-2 Kwok and Caton6 classification.

They identified the following general factors:

• Amount of patient compliance.• Cigarette smoking: Smokers have a greater prevalence of periodontal dis-

ease and bone loss.• Diabetes mellitus: Patients with diabetes have a greater prevalence of peri-

odontal disease and attachment loss.• Other systemic conditions (neutrophil dys-

function, Papillon-Lefèvre syndrome, Down syndrome, and immunologic dysfunctions).

They further identified the following local factors:

• Deep probing depths and attachment loss• Anatomical plaque-related factors (furca-

tion involvement, enamel pearls, cervical enamel projections, open contacts, crowd-ing, root proximity, and overhanging resto-rations)

• Trauma from occlusion and parafunctional habits

• Root fractures (Fig 7-3)• Mobility Fig 7-3 Hopeless tooth with a

vertical root fracture.

77

Prognosis of Different Diseases and Therapies

Past Periodontitis and Its Effect on PrognosisQ: Is there any harm in not extracting hopeless teeth

when treating a periodontitis patient?

DeVore et al7 studied 17 patients who received open flap de-bridement with frequent maintenance on retained hopeless teeth. The study found that retained hopeless and periodontally compromised teeth have no effect on the proximal periodonti-um of adjacent teeth prior to and following periodontal therapy.

Machtei et al8 studied 145 teeth and concluded that retained hopeless teeth (with severe periodontal breakdown) without periodontal treatment had a negative effect on the adjacent teeth. They found that it was 10 times more likely for the adja-cent teeth to have bone loss.

Q: Does a history of periodontal disease predispose to future disease?

McGuire and Nunn9 found a strong association between prognosis and initial probing depth, furcation involvement, and mobility.

Prognosis of Different Diseases and Therapies

Q: What is the prognosis of a patient with necrotizing ulcerative gingivitis, necrotizing ulcerative periodontitis, and localized aggressive periodontitis?

• Necrotizing ulcerative gingivitis: Good prognosis with the control of plaque and secondary factors.

• Necrotizing ulcerative periodontitis: Many are immunocompromised; prog-nosis depends on systemic factors.

• Localized aggressive periodontitis: Good prognosis with treatment.

Q: What is the prognosis of a tooth that has been diagnosed with a furcation lesion?

Cobb10 reported that over a 15-year period, 19% to 57% of teeth with furca-tion lesions and only 5% to 10% of teeth without furcation lesions were lost.

Ramfjord et al11 discovered that 16 of 17 teeth extracted in 5 years during maintenance and following active treatment initially presented with furcation involvement.

160

Regeneration12

Q: What is distraction osteogenesis?

Distraction osteogenesis is based on the concept that new bone fills a gap created when two pieces of bone are separated slowly under tension. It is important to have a minimum of 6 to 7 mm of bone height above vital struc-tures. The ridge defect should be greater than 3 to 4 mm, and the edentulous ridge span should be three or more missing teeth.7 Figure 12-9 presents the phases of distraction osteogenesis.

Latency 7 days for soft tissue healing

Distraction Two pieces of bone un-

dergo separation at a rate of 1 mm per day

Consolidation Allows bone regeneration

in the created space

Fig 12-9 Distraction osteogenesis phases.

Q: What are the options for horizontal ridge augmentation?

• Bone and membrane (Fig 12-10): Fuggazotto42 completed 289 ridge aug-mentation surgeries. Various configurations of Gore-Tex membranes were used in addition to various nonautogenous particulate materials. Of the 289 augmented ridges, 279 had adequate regenerated hard tissues for im-plant placement in ideal prosthetic positions. The horizontally augmented ridges had a success rate of 97%.

Fig 12-10 (a) Allograft material placed for horizontal augmentation. (b) Membrane placed over the allograft for horizontal augmentation.

a b

161

Considerations for Regeneration

• Autogenous block graft (eg, tuberosity, chin, and lateral ramus). • Ridge splitting (Fig 12-11): When doing the procedure, it is important to

prevent fracture of the buccal plate. Sethi and Kaus43 performed a 5-year study evaluating 449 implants placed in maxillary ridges expanded by the ridge-split technique. The study revealed a survival rate of 97%. According to McAllister and Haghighat,7 the avoidance of a separate donor site with the ridge-split technique, whether it uses particulate, block graft, or GBR, and its associated reduced treatment time and morbidity represent its pri-mary advantage compared with other lateral augmentation techniques.

Fig 12-11 (a) Ridge split with direction indicators. (b) Ridge split with implants placed.

a b

• Distraction osteogenesis: Laster et al44 treated nine patients with distrac-tion osteogenesis, increasing the alveolar width from 4 to 6 mm. Of the 21 implants placed, 20 implants successfully osseointegrated. After 12 months’ follow-up, no marginal bone resorption was observed. They listed soft tissue expansion, high dimensional stability, reduced treatment time, and the avoidance of a graft as the advantages of horizontal distraction compared with block grafting.

• Block allograft: Because allograft is not living bone, it must be hydrated, and air bubbles must be removed. Nissan et al45 did a study on 40 patients (83 implants) with 60 cancellous freeze-dried bone block allografts. The study had an average percentage of newly formed bone of 33% and implant survival of 98.8%. In a two-stage implant placement procedure, cancellous bone block allograft is osteoconductive and biocompatible, allowing new bone formation following augmentation of extremely atrophic anterior maxillae.

Esposito et al46 conducted a systematic review and observed no statisti-cally significant differences when comparing various horizontal augmentation techniques.

Index

279

19

279

AABCDE staging of skin cancer, 223,

223fAbfraction, 83fAbrasion, 83fAbscess

pericoronal, 71periodontal, 64, 64f, 70, 70f, 275f,

275–276pulpal, 70

Abutment teethAnte’s law, 7platform switching, 184

Acellular cementum, 11Actinic cheilitis, 231tActinobacillus actinomycetemcomitans,

42Actinomyces naeslundii, 37Actinomyces viscosus, 37Actisite, 46tAcyclovir, 57, 221Adaptive immune response, 197fAdaptive remodeling, 89Adipokines, 204Adrenal cortex, 214Adrenal gland, 214Adrenal insufficiency, 55, 241fAdrenal medulla, 214Advanced glycation end products,

203f, 204Advanced periodontitis, 66Age, periodontitis risks and, 26Aggregatibacter actinomycetemcomitans,

34t, 38Aggressive periodontitis

bacteria associated with, 37characteristics of, 63t

description of, 29generalized. See Generalized aggres-

sive periodontitis.localized. See Localized aggressive

periodon-titis.systemic antibiotics for, 42treatment of, 63

AIDS, 37, 38f, 232Alcohol consumption, 26Alendronate, 48Alloderm, 137–138, 139tAllogenic block grafts, 150Allografts

demineralized freeze-dried bone. See Demineralized freeze-dried bone allografts.

description of, 149–150, 161freeze-dried bone. See Freeze-

dried bone allografts.Alloplast, 149Alpha cells, 214Alprazolam, 50tAlveolar bone

anatomy of, 11resorption of, 91smoking effects on, 31

Alveolar bone proper, 11Alveolar crest, 69Alveolar mucosa, 6f, 7Alveolar process, 6fAlveolar ridge

defects of, 133splitting of, 161, 161f, 271

Alveolar ridge augmentationdescription of, 150horizontal, 160f, 160–161lateral, 271vertical, 162

Alveologingival fibers, 8Alzheimer disease, 204Ameloblastoma, 224American Association of Tissue

Banks, 149American Society of Anesthesiolo-

gistsblood pressure classification, 208physical status classification, 42

Amorphous calcium phosphate, 153Amoxicillin, 43, 43tAmoxicillin and metronidazole, 43t,

43–44Anatomy

for mucogingival therapy, 135–136

of periodontium, 5, 6fAnesthetics, local, 49–50, 243Angina, 243–244Angular cheilitis, 231tAngular defects, 119Ankylosis, 11Anterior guidance, 85Anterior implants, 180–181, 274Anterior pituitary gland, 214–215Anterior-posterior spread, 178Ante’s law, 7Antibiotics

commonly prescribed types of, 43t

dosage of, 43locally delivered, 46, 46tin membrane placement, 157prophylaxis uses of, 44–45, 174selection of, 42–43systemic, 42–44

Anticoagulants, 215Anti-convulsants, 54f

280

IndexA

Antifungal therapy, 277Antigen-stimulated lymphocytes, 199Antihistamines, 54Antimicrobial agents, supragingival

irrigation with, 107Antiplatelet therapy, 54, 216Antiseptics, 96Aphthous ulcers, 220, 220tApically repositioned flap, 102, 116,

143Apoptosis, 200Arestin, 46tArthritis, 204Articaine, 49ASA. See American Society of

Anesthesiologists.Aspirin, 54Atheroma, 210, 211fAtivan. See Lorazepam.Atridox (Atrix), 46tAtrophic candidiasis, 227Attached gingiva

anatomy of, 6f, 7around restorations, 131–132gingival recession and, 131widening of, 132

Attrition, 83fAugmentin, 43Autogenous graft, 138, 149, 271Avitene, 124

BB cells, 199Bacteremia, 108Bacteria

in gingivitis, 37in natural teeth versus implants, 174in periodontitis, 33–38, 34t–35tin refractory periodontal disease,

37, 38fsensitivity testing of, 250, 251t

Bacterial complexes, 36Barrier, 257Bass technique, 97Benzocaine, 50Benzodiazepines, 52Beta cells, 214Biofilms, 33Bio-Gide membrane, 158, 158f, 272Biologic mediators, 19Biologic width, 13BioMend membrane, 158, 158fBiopsies, 68, 220Biotene gel, 54Bisphosphonates

definition of, 47osteonecrosis caused by, 47–49periodontal surgery in patients

receiving, 47–48properties of, 47t

Bleeding on probing, 28, 66–67, 105Bleeding time, 207Block allografts, 161Block grafts, 150, 189Blood, 215–216

Blood loss, during periodontal surgery, 127

Blood pressure, 208–209BMP. See Bone morphogenetic pro-

teins.Body mass index, 207Bone cells, 148Bone decortication, 154Bone grafts and grafting

allogenic, 150block grafts, 150case study of, 256fguided tissue regeneration with, for

grade II furcation lesions, 18horizontal, 271materials used in, 149onlay grafts, 150particle size, 153saddle grafts, 150studies of, 151–152tetracycline added to, 153–154

Bone induction, demineralized freeze-dried bone allografts for, 152

Bone lossalveolar crest level, 69case study of, 270digital radiographs of, 69etiology of, 270after implant placement, 172in periodontal disease, 199retreatment for, 266supporting, after osseous surgery,

118Bone morphogenetic proteins, 165Bone regeneration

amorphous calcium phosphate for, 153

anatomical considerations, 159guided. See Guided bone regen-

eration.Bovine-derived bone xenograft, 151Bradycardia, 208Bradykinin, 200Brushing, 97Bruxism, 78, 86, 87–88Buccal plate fracture, 161Bump, 228Bupivacaine, 49

CCalcium channel blockers, 54fCalculus

description of, 33removal of, in natural teeth versus

implants, 174Caloric restriction, 202Campylobacter rectus, 85Cancellous trabeculae, 11Candida, oral, 56Canine protection, 85Canine-guided occlusion, 85Canker sores, 220Carbon dioxide laser, 233f, 236Cardiopulmonary resuscitation, 239tCardiovascular disease, 210–211

Cariespulpal changes and, 79root coverage over, 143tunnel preparation in furcation

lesion area and, 18Case control study, 2Case report study, 2Case studies, 245–278Cathepsin C, 228CD4+ cells, 199–200Cefazolin, 45CEJ. See Cementoenamel junction.Cellular cementum, 11, 19Cementicles, 22Cementoblasts, 12Cementoenamel junction

anatomy of, 6f, 7, 11, 28, 95greater palatine foramen to, 136

Cemento-osseous lesions, 232Cementum

description of, 11–12instrumentation used to remove, 97removal of, 97

Cephalexin, 45Cephradine, 45Cervical enamel projections, 20Chest pain, 243, 243f, 276–277Chlorhexidine, 46t, 55–56, 107, 220,

226–227Chromic gut sutures, 125fChronic inflammation, 203–204Chronic periodontitis

bacteria associated with, 37description of, 29implant placement in patients with,

176laser therapy for, 234–235metronidazole plus amoxicillin for,

44types of, 62

Circular fibers, 8Circumscribed elevated lesion, 228–

229Circumscribed flat lesion, 228–229Citric acid, 109, 166–167Class I MHC proteins, 204Class II MHC proteins, 205Clindamycin, 43, 43t, 45Clinical attachment level

description of, 59, 67enamel matrix derivative effects on,

165Clinical attachment loss

description of, 7uneven marginal ridges effect on, 86

Clinical trials, 2Closed flap scaling and root planing,

17, 95Clotting factors, 215Codeine, 53Coe-Pak, 258Cohort study, 2Collagen, 13Complex odontoma, 224Compound odontoma, 223–224

281

FIndex

Cone beam computed tomography, 69, 257

Confusion, 243Congenital heart defects, 44Congestive heart failure, 211Connective tissue, 10Connective tissue attachment

anatomy of, 6fcervical enamel projections effect

on, 20enamel pearls effect on, 21

Connective tissue fibers, 6fConnective tissue graft

free gingival graft versus, 134guided tissue regeneration versus,

138harvesting of, 135–136mean defect coverage using, 139tplacement of, 133, 134f

Connective tissue lesions, 223Conscious sedation, 51Contraceptives, 27Controlled clinical trials, 2Coronally positioned flap, 136Coronary heart disease, 210Cortical bone, 11Coumadin, 215CPR. See Cardiopulmonary resusc-

itation.C-reactive protein, 200Creeping attachment, 135Critical probing depths, 96Cross-linked membranes, 158Cross-sectional study, 2–3Crown lengthening, 142f, 142–143,

235Crown restorations

furcation lesions in, 22implants with, 80

C-terminal telopeptide, 48Cuboidal cells, 9Curette, 99Cyanotic congenital heart defects, 44Cyclosporine, 54fCysts, 220–221Cytokines, 31, 39Cytomegalovirus, 38

DDelta cells, 214Demerol. See Meperidine.Demineralized freeze-dried bone

allograftsbone formation induced by, 152description of, 149freeze-dried bone allografts versus,

152studies of, 151tetracycline and, 154

Densonic sonic scaler, 186Dentin hypersensitivity, 101Dentinogenesis imperfecta, 231tDentogingival fibers, 8Dentoperiosteal fibers, 8Depot medroxyprogesterone acetate,

27

Desmosomes, 9Desquamative gingivitis, 224Developmental deformities, 65Dextrose, 53DFDBA. See Demineralized freeze-

dried bone allografts.Diabetes mellitus

bacteria associated with, 38chronic inflammation and, 203gingivitis associated with, 275macrovascular complications of, 213fmanagement of, 213microvascular complications of, 213foral manifestations of, 212fperiodontitis and, 26, 76pro-inflammatory molecules assoc-

iated with, 200type 1, 212ttype 2, 212t

Diabetic coma, 213Diagnosis

background on, 59–60biopsies for, 68case study examples of, 250, 269,

275–277medical history questionnaire used

in, 68predictors of, 66–67

Diazepam, 50t, 52Digastric muscle, 14Digital radiographs, 69Dilantin, 54fDistal wedge excision, 116Distraction osteogenesis

definition of, 160horizontal ridge augmentation use

of, 161indications for, 271phases of, 160fvertical ridge augmentation use of,

162DMPA. See Depot medroxypro-

gesterone acetate.DNA methylation, 198Double papilla flap, 136Doxycycline, 43, 43t, 46tDressings, surgical, 123f, 123–124, 260fDrug-eluting stents, 216Drug-induced gingival enlargement, 54,

60f, 113f

EEarly periodontitis, 66EDTA gel, 109Electric toothbrush, 98EMD. See Enamel matrix derivative.Emdogain, 139Emergency kit drugs, 240Enamel

anatomy of, 6fcementum and, overlapping of, 12

Enamel matrix derivativedefinition of, 164furcation lesions treated with, 19mucogingival therapy use of, 139

periodontal regeneration use of, 166

studies of, 164–165Enamel pearls, 21ENAP. See Excisional new attachment

pro-cedure.Endodontic therapy, 78Envelope flap, 117Epidemiology

prevalence. See Prevalence.terminology associated with, 27

Epigenetics, 198Epinephrine, 50Epithelial disorders, 221–223Epithelium attachment, 6fEpstein-Barr infection, 38Erosive lichen planus, 225tEr:YAG laser, 233, 235–236Erythema multiforme, 225Erythroplakia, 222Ethylenediaminetetraacetic acid, 167Evidence-based dentistry, 1–2Excisional new attachment procedure,

122–123, 236Excursive positions, occlusal contacts

in, 87Expanded polytetrafluoroethylene

membranes, 151External carotid artery, 6External validity, 3, 3fExtrinsic cementum, 12Extrusion, 90

FFacial artery, 6Fasting blood sugar, 207FDBA. See Freeze-dried bone allo-

grafts.Fentanyl, 52Fibers

alveologingival, 8circular, 8connective tissue, 6fdentogingival, 8dentoperiosteal, 8gingival, 8periodontal ligament, 11transseptal, 8

Figure 8 suture, 126First molars, root concavities on, 20–21Fixed partial denture

description of, 80implant-supported single implant

versus, 191–192Flap(s)

apically repositioned, 116, 143coronally positioned, 136double papilla, 136envelope, 117full-thickness, 116laterally positioned, 136modified Widman, 116partial-thickness, 116, 118thickness of, 138

Floss/flossing, 97–98

282

IndexF

Fluconazole, 277Flumazenil, 52Follicle-stimulating hormone, 215Food and Drug Administration

pharmaceutical pregnancy cate-gories, 41

Food impaction, 30Force, on implant, 177Free gingiva, 6fFree gingival graft

connective tissue graft versus, 134mean defect coverage using, 139tplacement of, 133, 134fwound healing of, 135

Freeze-dried bone allograftsalveolar ridge augmentation using,

271case study of, 255, 273fdemineralized freeze-dried bone

allografts versus, 152description of, 149–150studies of, 151tetracycline and, 154

Fremitus, 85Frenectomy, 140Full-thickness flap, 116Fungal infections, gingival diseases

caused by, 61Furcation defects and lesions

anatomical factors associated with, 19f, 19–22

biologic mediators for, 19cervical enamel projections and, 20classification of, 16–17closed flap root planing for, 17entrance width, 21–22Glickman classification of, 16, 16fgrade I, 16fgrade II, 16f, 18grade III, 16fgrade IV, 16fHamp classification of, 16immediate bifurcation ridge effects

on, 22in mandibular molars, 15, 21in maxillary molars, 15, 21–22molars with accessory canals, 20Nabers probe for diagnosing of, 15open flap root planing for, 17prevalence of, 15prognosis of teeth with, 77restorations, 22root planing for, 17scaling for, 17smoking effects on treatment of, 18Tarnow classification of, 17tooth loss secondary to, 74treatment of, 17–19tunnel preparation, 18

Furcation fornix, 15Fusobacterium nucleatum, 34t, 36

GGastric inhibitory peptide, 214Gastrin, 214GBR. See Guided bone regeneration.

Gender, periodontitis risks and, 26Generalized aggressive periodontitis

antibiotics for, 44characteristics of, 63tdescription of, 29localized aggressive periodontitis

versus, 62, 63tmucositis and, 176

Genetics, periodontitis and, 26Giant cell fibroma, 223Gingiva

anatomy of, 6fattached. See Attached gingiva.excessive display of, 141healthy, 8keratinized attached, 7marginal, 7narrowest zone of, 10overgrowth of, 141thickness of, 10widest zone of, 10zones of, 10

Gingival connective tissue cells, 148Gingival diseases

of bacterial origin, 61dental plaque-induced, 60of fungal origin, 61non–plaque-induced, 61–62of viral origin, 61

Gingival enlargement, drug-induced, 54, 60f, 113f

Gingival epithelium, 8–10Gingival fibers, 8Gingival fibroblasts, 31Gingival Index, 27

modified, 28Gingival recession

attached gingiva required to avoid, 131

causes of, 130consequences of, 130, 131fgingival augmentation procedures

in, 139illustration of, 65focclusal discrepancies effect on, 87prevalence of, 131

Gingivectomy, 102, 113–114, 143Gingivitis

bacteria associated with, 37classification of, 60definition of, 59desquamative, 224diabetes mellitus-associated, 275mouth breathing as risk factor for,

31necrotizing ulcerative, 77peri-implant mucositis versus, 174periodontitis and, 59, 175, 201stages of, 201ftime needed for development of, 98

Glickman classification, of furcations, 16, 16f

Glucagon, 240Glycosylated hemoglobin, 207, 212Gore-Tex membranes, 160Gore-Tex sutures, 125f, 272

Gracey curette, 17, 99, 101Graft(s)

autogenous, 138barrier versus, 257bone, 149–154. See also Bone grafts

and grafting.connective tissue, 133–135, 134ffree gingival, 133–135, 134f

Graft placementon bone, 136microsurgery versus macrosurgery

technique for, 135on periosteum, 136shrinkage after, 135–136

Graftingbone. See Bone grafts and grafting.socket, 162–164

Gram-negative bacteria, 37Gram-positive bacteria, 37Grand-mal seizure, 242Granular cells, 9Greater palatine foramen, 136Group function, 85Growth factor-enhanced matrix, 165–

166Growth factors, 164–166GTR. See Guided tissue regeneration.Guided bone regeneration

antibiotics after, 157case study of, 271description of, 149membrane exposure effects on,

156vertical ridge augmentation with,

162Guided tissue regeneration

definition of, 148enamel matrix derivative versus, 164grade II furcation treated with, 18intrabony defects treated with, 159,

166mean defect coverage using, 139tmembrane exposure effects on, 156open-flap debridement and, comp-

arison between, 159fsmoking effects on healing response

after, 167soft tissue procedure versus, 138

HHalcion. See Triazolam.Hamp classification, of furcations, 16Hard tissue grafting, 144Healing, wound, 119–120, 120t, 135Heart attack, 211Heart rate, 208Helper T cells, 199–200, 205Hemidesmosomes, 12Hemoglobin, 208Hemoglobin A1c, 207, 212Heparin, 215Herpes zoster, 226Herpetic lesions, 220–221HIV

description of, 37, 38fperiodontitis associated with, 227

283

Index L

Horizontal bone grafts, 271Horizontal ridge augmentation

description of, 150options for, 160f, 160–161

Host modulation, 47Host response, 174, 201Hydrocodone, 53Hydrocortisone, 240Hyperglycemia, 213Hypermobility, 166Hypertension, 208–209, 209fHyperventilation, 243Hypoglycemia, 241

IIbuprofen, 53IgA, 198IgD, 198IgE, 198IgG, 198IgM, 199Immediate bifurcation ridge, 22Immediate implant

in esthetic zone, 180indications for, 183maxillary soft tissue grafting after

placement of, 181osseointegration using, 183success rate of, 183

Immune response, 197Immune system, 216–217Immune-mediated disorders, 224–226Immunoglobulins, 198–199Immunologic sounding, 210, 211fImmunosuppressants, 54fImplant(s)

alternatives to, 191–192anterior, 180–181, 274anterior-posterior spread for, 178apex of, 179contraindications, 173fcriteria for, 172epithelium and, interface between,

192esthetics of, 179–181evaluations of, at maintenance visits,

274force on, 177hygiene of, 186immediate. See Immediate implant.instruments used with, 186interproximal contact point, 179keratinized attached tissue around,

176lasers used near, 236natural teeth versus, 174–175occlusion for patients with, 85peri-implantitis, 175, 185–186in periodontal disease patients, 176platform switching, 184prognosis of, 78, 80rough surface modifications of, 175,

190screw-type, 190shapes of, 181–182, 181f–182fshort, 182

single, 80, 191–192sinus elevation, 186–190smoking effects on, 184smooth surface modifications of, 175surface modifications of, 175, 175ftitanium, 190wide-diameter, 182

Implant failureantibiotic prophylaxis to prevent, 174bacteria associated with, 38factors associated with, 172, 173fsmoking as cause of, 184

Implant placementantibiotic prophylaxis before, 174case study of, 257, 258fclassification to consider before,

171, 171fin clean conditions, 192distance considerations, 179in esthetic area, 274guidelines for, 180f, 180–181immediate, 180, 183improper, 173fin irradiated bone, 193in keratinized attached tissue, 178fin mandible, 173, 178in maxilla, 173, 178presurgical steps for, 177principles of, 178remodeling after, 172single-stage, 178sinus elevation and, 190after socket preservation, 163–164in sterile conditions, 192technique for, 177f, 177–178, 258ftwo-stage, 178–179

Implantable cardioverter-defibrillator, 101

Incidence, 27Indices, 27–29Infection

description of, 127oral, 226–227postoperative, 188, 189fafter sinus elevation, 188, 189f

Inferior alveolar artery, 10Inflammation

Alzheimer disease and, 204arthritis and, 204chronic, 203–204description of, 28, 148insulin resistance secondary to, 203fperiodontal disease and, 201–202,

202fpro-inflammatory molecules, 199–201signs of, 197

Inflammatory papillary hyperplasia, 223Infraorbital nerve, 187Inhalation steroids, 55Innate immune response, 197fInstrumentation

cementum removal using, 97ultrasonic, 99–100

Insulin resistance, 203, 203fInterdental brushes, 98Interdental cleaning, 97

Interdental papilla, 148Interferon-τ, 200Interleukin-1, 199, 201Interleukin-2, 199Interleukin-4, 199Interleukin-6, 199, 204Interleukin-8, 200, 202Interleukin-10, 200Internal validity, 3, 3fInternational normalized ratio, 207Interproximal contact point, 179Interrupted suture, 126Intrabony defects

guided tissue regeneration for, 159, 166–167

smoking effects on healing response in, 167

tooth movement for, 90tooth vitality effect on regenerative

outcomes in, 166Intrinsic cementum, 12Irradiated bone, implant placement in,

193Irrigation, 107–109IV sedation, 51–53, 53f

JJoint replacement, antibiotic prophy-

laxis indications for, 45Junctional epithelium, 6f, 9, 9f, 12–13,

148Juvenile rheumatoid arthritis, 204

KKeratinized attached gingiva

description of, 7around implant, 176, 178f

Keratinocytes, 9Keratohyalin granules, 9Kidneys, 214Kwok and Caton classification system,

76, 76f

LLaboratory values, 207–208Lamina propria, 7LANAP. See Laser-assisted new attach-

ment procedure.Langerhans cells, 9Laser-assisted new attachment pro-

cedure, 234–236Lasers, 233–236Lateral pterygoid muscle, 14Laterally positioned flap, 136Lekholm and Zarb classification, 171fLeukoplakia, 221Leydig cells, 214Lichen planus, 225, 225tLidocaine, 49Lingual artery, 6Listerine, 56Liver disease, 217Local anesthetics

description of, 49–50reactions to, 243

284

IndexL

Localized aggressive periodontitisbacteria associated with, 37characteristics of, 63tdescription of, 29generalized aggressive periodontitis

versus, 62, 63tprognosis of, 77radiographic imaging of, 62f

Locally delivered antibiotics, 46, 46tLongitudinal study, 3Long-term prognosis, 75, 252Lorazepam, 50tLoss of consciousness, 241, 241fLow birth weight, periodontitis and, 30Low-density lipoprotein, 207Lupus erythematosus, 225Luteinizing hormone, 214

MMacrosurgery versus microsurgery,

for graft placement, 135Maintenance therapy

bleeding on probing affected by, 105case study of, 266compliance with, 104–105effectiveness of, 102elements of, 103fendpoints of, 103frequency of, 103schedule of, 104

Major histocompatibility complex pro- teins, 204–205

Malnutrition-related gingival diseases, 60

Mandibledehiscence of, 129implant placement in, 173, 178muscles of, 14

Mandibular molarsfurcations in, 15, 21second, cervical enamel projections

in, 20Mandibular occlusal view, 247fMarginal gingiva, 7Marginal ridges, uneven, 86Masseter muscle, 14Masticatory epithelium, 9, 9fMatrix metalloproteinases, 200Mattress suture, 126Maxilla

dehiscence of, 129grafting of, 272, 273fimplant placement in, 173, 178

Maxillary artery, 6Maxillary incisors, 270, 271f–272fMaxillary left quadrant, osseous sur-

gery on, 258, 259fMaxillary molars

furcations in, 15, 21–22root resection in, 122

Maxillary occlusal view, 247fMaxillary roots, 22Maxillary sinus, 187McGuire classification of prognosis,

74, 75f

Medial pterygoid muscle, 14Medical emergencies

cardiopulmonary resuscitation, 239tdiagnosis of, 241fdrugs used in, 240in office, 241–244

Medical history questionnaire, 68Medications

antibiotics. See Antibiotics.bisphosphonates, 47–49pain relievers, 53side effects of, 54–55

Melanocytes, 9Membranes

antibiotics given during placement of, 157

Bio-Gide, 158, 158fBioMend, 158, 158fcross-linked, 158expanded polytetrafluoroethylene,

151exposure of, 156–157, 157fnon–cross-linked, 158nonresorbable, 155f, 155–156placement of, 157–159properties of, 154, 155fresorbable, 155f, 155–156, 271tacks used to stabilize, 159titanium-reinforced, 155

Meniscal derangement, 13Mental nerve, 179Meperidine, 52Mepivacaine, 49Merkel cells, 9Meta-analyses, 2Metabolic disorders, 203Metastases, 222Metronidazole, 43t, 43–44, 107, 227Micro-macroporous biphasic calcium

phosphate, 153Microsurgery

advantages of, 118macrosurgery versus, for graft

placement, 135Midazolam, 51Miller classification

of mobility, 83of soft tissue resection, 132f

Minocycline, 43, 43t, 46tMisch bone density scale, 149Mobility, 83–84Moderate periodontitis, 66, 87Modified Gingival Index, 28Modified minimally invasive surgical

technique, 151–152Modified Widman flap, 116Moi-Stir moistening solution, 54Molars

with accessory canals, 20implant therapy versus root

resection in, 80restorations, furcation lesions in, 22root coverage of, 144root debridement in, 95uprighting of, using orthodontics, 91

Mouth breathing, 31Mouthrinses, 55–56Mucoepidermoid carcinoma, 232Mucogingival defects, Sullivan and

Atkins classification of, 133, 133fMucogingival deformities, 65Mucogingival junction, 6f, 137Mucogingival therapy

anatomy for, 135–136definition of, 129enamel matrix derivative for, 139endpoints of, 130side effects of, 130

Mucositis, peri-implant, 174–175, 185Mucous membrane pemphigoid, 224fMycelex troches, 56Mylohyoid muscle, 14Myocardial infarction, 211, 243–244,

277

NNabers probe, 15Naloxone, 52Nd:YAG laser, 233f, 236Neck lumps, 230Necrotizing periodontal diseases, 37,

38f, 64Necrotizing ulcerative gingivitis, 77Necrotizing ulcerative periodontitis

features of, 226, 227fprognosis of, 77treatment of, 227

Negative architecture, 118Neutropenia, 207New attachment, 147Nikolsky test, 224Nitrous oxide, 51, 240Non–cross-linked membranes, 158Nonfunctional contacts, 87Nonresorbable membranes, 155f,

155–156Nonspecific plaque hypothesis, 33Nonspecific ulcer, 229Nonsteroidal anti-inflammatory drugs,

47tNonsurgical therapy

irrigation, 107–109scaling and root planing. See Scaling

and root planing.surgical therapy versus, 106t, 121types of, 93

Nystatin, 56

OObesity

chronic inflammation and, 203osteoarthritis risks, 204periodontitis risks, 26

Occlusal adjustment, 88f, 88–89Occlusal contacts, 87Occlusal discrepancies, 86–87Occlusal forces, 89–90Occlusal trauma

alveolar bone resorption caused by, 91

285

Index P

definition of, 83description of, 65

Occlusioncanine-guided, 85endodontic therapy affected by, 78group function, 85for implant patients, 85implant therapy affected by, 78theories of, 86types of, 85

Odds ratio, 27Odontogenic keratocyst, 221fOdontogenic tumors, 223–224Odontoma, 223Office emergencies, 241–244Onlay grafts, 150, 162Open flap curettage, 121Open flap scaling and root planing, 17,

95Open-flap debridement, 159fOpioid overdose, 52Oral cancers, 222Oral Candida, 56Oral epithelium, 9, 9fOral hygiene

after osseous surgery, 121brushing, 97–98flossing, 97–98overhanging dental margins effect

on, 30periodontitis and, 26supragingival irrigation as adjunct

in, 107Oral infections, 226–227Oral malodor, 217–218Oral medicine, 207–218Oral mucosa, 8, 8fOral mucous membrane, 6fOral sedation, 50Oral sulcular epithelium, 9, 9fOral viral infections, 57Organs, 214–215Orthodontics

prognosis affected by, 90–91recession and, relationship be-

tween, 140Orthokeratinization, 9Osseointegration, 174, 183Osseous recontouring, 121–122Osseous surgery. See also Periodontal

surgery; Surgical therapy.contraindications, 115definition of, 114failure of, 115indications for, 114lingual approach to, 117materials used in, 123f, 123–124on maxillary left quadrant, 258, 259foral hygiene after, 121palatal approach to, 117, 117tperiodontal flap surgery, 114positive architecture for, 118postoperative period, 126rationale for, 115supporting bone loss after, 118sutures, 124–126, 125f

techniques, 116–118wound healing after, 119–120, 120t

Ossix, 158Ostectomy, 115, 258Osteoarthritis, 204Osteoblasts, 175, 200Osteoclasts, 200Osteoconductive, 149Osteogenesis imperfecta, 231tOsteogenetic, 149Osteogenic protein-I, 19, 165Osteoinductive, 149Osteonecrosis, bisphosphonate-

associated, 47–48Osteoplasty, 115, 258Osteotome, 191Ovate pontic, 144Overhanging dental margins, 30–31Oxycodone, 53

PP value, 3Pacemakers, 100–101Pain relievers, 53Palatal approach to osseous surgery,

117, 117tPancreas, 214Papilla

height loss, 140loss of, 140–141reconstruction of, 141

Papillary lesion, 230Papillon-Lefèvre syndrome, 64, 228Parakeratinization, 9Partial prothrombin time, 215fPartial-thickness flap, 116, 118Passive eruption, altered, 142PDGF. See Platelet-derived growth

factor.Pedicle graft, for mean defect coverage,

139tPemphigus vulgaris, 224fPenciclovir, 221Penicillin, 45Pepsin, 214Pepsinogen, 214Peptostreptococcus micros, 85Percocet, 53Percodan, 53Pericoronal abscess, 71Pericoronal radiolucency, 229Peri-implant mucositis, 174–175, 185Peri-implantitis, 175, 185–186PerioChip, 46tPeriodic fever, aphthous pharyngitis

and cervical adenopathy. See PFAPA syndrome.

Periodic fever, aphthous stomatitis, pharyngitis, and adenitis, 232

Periodontal abscess, 64, 64f, 70, 70f, 275f, 275–276

Periodontal cyst, 221fPeriodontal disease

bacteria associated with, 36–38, 37fbleeding on probing as predictor of

progression of, 66–67

bone loss in, 199bruxism effects on, 87–88cardiovascular disease and, 210classification of, 60–66clinical attachment level as pre-

dictor of, 67gingivitis. See Gingivitis.host response inhibition effects on,

201host-based tests for susceptibility

to, 67implant placement in patients with,

176inflammation and, 201–202, 202fnecrotizing, 37, 38f, 64periodontitis. See Periodontitis.predictors of, 66–67probing depth as predictor of, 67progression of, 202pulpal changes and, 79radiographic evaluations, 68–69, 69frecurrent, 95, 105refractory, 37, 38f, 42rheumatoid arthritis as predictor

of, 71viruses in, 38–39

Periodontal Disease Index, 28Periodontal flap surgery, 114Periodontal Index, 28Periodontal ligament

anatomy of, 6f, 10–11description of, 86, 88in natural teeth versus implants,

174Periodontal ligament cells, 148Periodontal plastic surgery, 129Periodontal pocket. See Pocket.Periodontal regeneration

definition of, 147goals of, 147growth factors for, 166

Periodontal surgery. See also Osseous surgery; Surgical therapy.

blood loss during, 127cell types that repopulate the root

surface after, 148postinfection rate after, 127principles of, 118–119technique of, 119

Periodontal trauma, 84Periodontal treatment/therapy

lack of, 105mobile teeth effects on, 85results of, 264f–265f

Periodontitisadvanced, 66aggressive. See Aggressive peri-

odontitis.antibiotics for, 42atherosclerotic cardiovascular

disease risk factors, 211bacteria found in, 33–38, 34t–35tbiofilms, 33caloric restriction effects on, 202cardiovascular disease and, 210–211chronic. See Chronic periodontitis.

286

IndexP

conditions associated with, 30–31definition of, 59diabetes mellitus and, 26, 76early, 66extraction of hopeless teeth in

patients with, 77generalized aggressive, 29genetic risks, 26gingivitis and, 59, 175, 201implant placement in patients with,

176localized aggressive, 29, 37low birth weight and, 30moderate, 66, 87necrotizing ulcerative. See Necro-

tizing ulcerative periodontitis.nontreatment effects, 96oral hygiene and, 26overhanging dental margins and,

30–31plaque and, 33in pregnancy, 30preterm birth and, 30, 30fprevalence of, 29prognosis of, orthodontics effect

on, 91pulpal changes and, 79refractory, 31risk factors for, 25–26risk indicators for, 26–27severe, 29, 87smoking and, 25, 31–32, 32f, 76systemic antibiotics for, 42systemic diseases associated with,

63–64tobacco use and, 25, 31–32tooth extractions caused by, 29

Periodontiumalveolar bone, 11anatomy of, 5, 6fcementum, 11–12connective tissue, 10definitions, 7gingival epithelium, 8–10innervation of, 6regions of, 86removable partial denture effects

on health of, 80vascular supply of, 6

Periosteal suture, 126Periosteum, graft placement on, 136Peripheral blood neutrophils, 200PFAPA syndrome, 232Pharmacology

antibiotics. See Antibiotics.bisphosphonates, 47–49Food and Drug Administration

pregnancy categories, 41host modulation, 47IV sedation, 51–53, 53fmedication side effects, 54–55nitrous oxide, 51oral sedation, 50pain relievers, 53

Phenytoin, 54fPhotodynamic therapy, 234–235

PICO question, 1Piezoelectric instrument, 188Pigmented lesions, 229fPituitary gland, 214–215Plaque

definition of, 33flossing to remove, 97in generalized aggressive peri-

odontitis, 63tgingival diseases caused by, 60gingivitis onset after incomplete

removal of, 98host defense against, 217fin localized aggressive periodontitis,

63tremoval of, in natural teeth versus

implants, 174triclosan effects on, 55

Plaque Index, 29, 105Plaque lichen planus, 225tPlatelet count, 207Platelet-derived growth factor, 165–

166Platelet-rich plasma

furcation lesions treated with, 19sinus elevation use of, 189

Platform switching, 184Plavix, 54, 216Pocket

food impaction and, 30occlusal adjustment effects on depth

of, 89recurrent, 14supragingival and subgingival irrig-

ation projection into, 108surgical reduction of, 255

Pocket depthsenamel matrix derivative effects on,

164occlusal adjustment effects on, 89scaling and root planing effects on,

94unresolved, 120

Pontic, 144Porphyromonas gingivalis, 34t, 85Positive architecture, 118–119Postoperative infection, 188, 189fPostoperative instructions, 262Postoperative period, 126Postural hypotension, 241fPregnancy

Food and Drug Administration pharmaceutical categories, 41

periodontitis treatment during, 30precautions during, 218pyogenic granulomas in, 223

Prehypertension, 208Preterm birth

bacteria associated with, 38periodontitis and, 30, 30f

Prevalenceof furcation defects and lesions, 15of gingival recession, 131incidence versus, 27of periodontitis, 29

Prevident, 56

Prevotella intermedia, 34t, 36Prevotella nigrescens, 37Prilocaine, 50Primary hypertension, 208Primary occlusal trauma, 83Primary wound healing, 119Probing, bleeding on, 28, 66–67, 105Probing depths

critical, 96definition of, 59–60periodontal disease and, 67

Procaine, 50Prognosis

case study of, 270definition of, 73of endodontic therapy, 78of implants, 78, 80long-term, 75, 252McGuire classification of, 74, 75fof necrotizing ulcerative gingivitis,

77orthodontics effect on, 91short-term, 75, 252of teeth with furcation lesions, 77

Pro-inflammatory molecules, 199–201Proliferative verrous leukoplakia, 221Prophylaxis, antibiotic, 44–45, 174Prostaglandin E2, 200Protectins, 198Prothrombin time, 215fPRP. See Platelet-rich plasma.Pseudoepitheliomatous hyperplasia,

221Pulp

caries and, 79periodontal disease and, 79periodontitis and, 79scaling effects on, 101

Pulpal abscess, 70Pyogenic granuloma, 223

RRace, periodontitis risks and, 26Radiographs

case study uses of, 249flocalized aggressive periodontitis,

62fperiodontal disease evaluations,

68–69, 69fRandomized clinical trials, 2Reattachment, 147Recession

gingival. See Gingival recession.orthodontics and, 140soft tissue, 132–133

Recombinant human osteogenic protein-I, 19

Recombinant human platelet-derived growth factor, 165–166

Recontouring, osseous, 121–122Recurrent periodontal disease, 95, 105Red blood cell count, 207Red lesions, 229fReevaluation report record, 253, 254fRefractory periodontal disease, 37, 38fRefractory periodontitis, 31, 42

287

Index S

Regenerationbone. See Bone regeneration; Guid-

ed bone regeneration.distraction osteogenesis for, 160f,

160–161factors that affect, 148, 148fgoals of, 147growth factors for, 166guided bone, 149hypermobility effects on, 166measurement of, 167root surface demineralization

effects on, 166–167smoking effects on, 167tooth vitality effects on, 166

Remodeling, after implant placement, 172

Removable partial dentures, 80Repair, 147Resolvins, 198Resorbable membranes, 155f, 155–

156, 271Respiratory distress, 242fRestorations

attached gingiva around, 131furcation lesions and, 22pulpal changes and, 79tissue healing needed before initi-

ation of, 144Reticular lichen planus, 225tRheumatoid arthritis, 71rhPDGF. See Recombinant human

platelet-derived growth factor.Risk factors

definition of, 25periodontitis, 25–26risk indicator versus, 25

Risk indicatorsdefinition of, 25periodontitis, 26–27risk factor versus, 25

Root(s)concavities of, 20–21maxillary, 22surface area of, 22

Root conditioning, 109Root coverage

connective tissue graft effects on, 134

flap thickness and, 138molars, 144over caries lesions, 143soft tissue resection treated with,

132fRoot debridement

in molars versus nonmolars, 95periodontitis treated with, 63

Root fracture, 76f, 122Root planing. See also Scaling and root

planing.definition of, 93endpoints of, 94factors that affect, 94furcation defects and lesions

treated with, 17modified Widman flap, 116

Root resectioncontraindications for, 122indications for, 122in molars, 80success rate of, 122

Root sensitivity, 109Root surface

demineralization of, effect on regeneration, 166–167

Er:YAG laser effects on, 236modification of, 109, 167

Rough surface modifications, of implants, 175, 190

Round bur, 188

SSaddle grafts, 150Salivary gland disorders, 226–227Scalers, 99–100, 100tScaling and root planing

attachment level benefits after, 44closed flap, 17, 95definition of, 93effectiveness of, 94–97factors that affect, 94furcation defects and lesions

treated with, 17lasers and, comparison between,

234–235open flap, 17, 95pulpal effects of, 101reevaluation after, 102single versus weekly appointments,

96Secondary hypertension, 208Secondary occlusal trauma, 83Secondary wound healing, 119Sedation

conscious, 51IV, 51–53, 53foral, 50

Seizures, grand-mal, 242Semilunar technique, 137Sensitivity, 27Sensitivity testing, 250, 251tSensodyne, 56Severe periodontitis, 29, 87Sex, periodontitis risks and, 26Sharpey fibers, 12Short-term prognosis, 75, 252Shrinkage, after graft placement, 135–

136Silk sutures, 125fSingle implants, 80Single-stage implant placement, 178Sinus

maxillary, 187septa with, 186

Sinus augmentation, 189, 190fSinus elevation

bone-added osteotome, 191implant placement and, 190infection after, 188, 189flateral window, 187, 187fsinus membrane perforation during,

188

Sinus membrane perforation, 188Sjögren syndrome, 225–226Skin cancer, 223, 223fSling suture, 126, 136Smear layer, 109Smoking

cessation of, 32furcation lesion treatment affected

by, 18implants affected by, 184periodontitis risks, 25, 31–32, 32f,

76regeneration affected by, 167wound healing affected by, 167

Snuff dipper’s pouch, 230fSocioeconomic status, periodontitis

risks and, 26Socket grafting, 162–164, 271Socket preservation, implant place-

ment after, 163–164Soft tissue grafting, 144Soft tissue recession, 132–133Sonic scalers, 99–100, 100tSpecific plaque hypothesis, 33Specificity, 27Spleen, 214Splinting, 89Squamous cell carcinoma, 222Staging

ABCDE, 223, 223fTNM, 219

Steroids, inhalation, 55Stomach, 214Stratum basale, 9Stratum corneum, 9Stratum granulosum, 9Stratum spinosum, 9Streptococcus mitis, 37Streptococcus sanguis, 37Stress, periodontitis risks and, 26Studies

case, 245–278types of, 2f, 2–3

Subantimicrobial dose doxycycline, 47t

Subgingival irrigation, 107–109Sulcus, 6fSuperior alveolar artery, 10Superior alveolar nerve, 187Suppuration, 67Supragingival irrigation, 107–108Surface modifications

of implants, 175, 175f, 190of root, 109, 167

Surgical dressings, 123f, 123–124Surgical pocket reduction therapy, 255Surgical therapy. See also Osseous

surgery; Periodontal surgery.envelope flap, 117full-thickness flap, 116gingivectomy, 102, 113–114, 143modified Widman flap, 116nonsurgical therapy versus, 106t, 121osseous surgery, 114–116partial-thickness flap, 116postoperative instructions, 262

288

IndexS

Surgicel, 124Sutures, 124–126, 125fSuturing, 125–126Systematic reviews, 2Systemic antibiotics, 42–44Systemic conditions, gingival mani-

festations of, 61–62

TT cells, 199Tachycardia, 208Tannerella forsythia, 35tTarnow classification, of furcations, 17Temporalis muscle, 14Temporomandibular joint, 12–13Tertiary wound healing, 119Testosterone, 214Tetracycline

bone graft and, 153–154description of, 43, 43troot surface modification using, 167

T-helper cells, 199–200, 205Thrombosis, 209fThyroid gland, 214Tissue responses, to occlusal forces, 89TNM staging system, 219Tobacco use, periodontitis risks and,

25, 31–32Tonofilaments, 9Tooth extractions

case study of, 255, 256fdecision-making considerations in,

78–79of hopeless teeth, 76f, 77periodontitis as cause of, 29saving the tooth versus, 78–79single anterior implant placement

after, 181socket grafting after, 162wound healing after, 163

Tooth lossHirschfeld and Wasserman studies

on, 73–74, 74tMcFall study on, 73–74, 74t

Toothbrusheschanging of, 99electric, 98manual, 98sonic, 101ultrasonic, 101

Toothpastes, 55–56Transforming growth factor β, 200Transseptal fibers, 8Trauma

occlusal. See Occlusal trauma.periodontal, 84

Treatment planning, 245–278Treponema denticola, 35tTriazolam, 50tß-Tricalcium phosphate, 165–166Triclosan, 55Trigeminal nerve, 6Tumor(s)

biopsy of, 220odontogenic, 223–224TNM staging system of, 219

Tumor necrosis factor α, 199, 201Tunnel preparations, in furcation

lesion area, 18Two-stage implant placement, 178–179Tylenol #3, 53Type 1 diabetes mellitus, 212tType 2 diabetes mellitus, 212t

UUlcers, 220–221, 229Ultrasonic scalers, 99–100, 100tUnconsciousness, 240–241Uprighting of molars, using ortho-

dontics, 91

VValidity, 3, 3fValium, 240. See also Diazepam.Vasodepressor syncope, 241fVersed. See Midazolam.Vertical ridge augmentation, 150, 162Vestibule, 144Vicodin, 53Vicoprofen, 53Vicryl sutures, 125fViral infections, oral, 57Viruses

gingival diseases caused by, 61periodontal disease and, 38–39

WWarfarin, 215White blood cell count, 207White lesions, 229fWidman flap, 102

modified, 116Wound healing

after osseous surgery, 119–120, 120t, 135

smoking effects on, 167after tooth extraction, 163

XXanax. See Alprazolam.Xenografts, 149, 151–152Xerostomia, 54