Periodontal Review Q&ASecond 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 | Periodontium | 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/2019055802LC ebook record available at https://lccn.loc.gov/2019055803

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5 4 3 2 1

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Editor: Zachary KocandaDesign: Sue ZubekProduction: Sarah Minor

Printed in the United States

Periodontal Review Q&A

Deborah A. Termeie, ddsClinical InstructorDepartment of PeriodonticsSchool of DentistryUniversity of California, Los AngelesLos Angeles, California

Second Edition

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 Periodontology (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.

v

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 408Index 417

Contents

vi

PrefaceThe first edition of Periodontal 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.

AcknowledgmentsI 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.

1

Background

1Evidence-Based Dentistry

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

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

Dentist’s expertise

Scientific evidence

Patient needs and

preferences

EBD

2

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.

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.

Formulate a PICO question

Research the PICO question and collect evidence

Analyze the data that has been collected

Apply the data to the dental practice

Evaluate the results

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

3

Studies

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.

Systematic reviews and meta-analyses

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

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

Case report studies

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

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

Controlled trials not randomized

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

4

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.

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.

Internal validity• Refers to the fundamental

soundness of the study• Looks at the study’s bias

and statistical approach• May determine if the study

should be included in a systematic review

External validity• Refers to the extent to

which the evidence is rele-vant and generalized to the population and the dental practice

Fig 1-4 Internal and external validity.

5

References

References1. 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.

417

Index

A

ABCDE staging of skin cancer, 331, 331f

Abfraction, 125–126, 126f, 131

Abrasion, 125–126, 126fAbscess

gingival, 100pericoronal, 100periodontal, 98–100,

99f–100f, 403pulpal, 99

Abutment teethAnte’s law, 8platform switching, 272for soft tissue recession, 268

Acellular cementum, 13Acellular dermal matrix, 204–

205, 205tAcetaminophen, 70–71Actinobacillus actinomycet-

emcomitans, 54Actinomyces naeslundii, 47Actinomyces viscosus, 47Actisite, 59tActive eruption, 213Acyclovir, 77, 328Adaptive immune response,

299fAdaptive remodeling, 135ADM. See Acellular dermal

matrix.Adrenal cortex, 319Adrenal gland, 319Adrenal insufficiency, 75, 356f

Adrenal medulla, 319Advanced glycation end

products, 306, 306fAdvanced periodontitis, 105AED. See Automated external

defibrillator.Age, periodontitis risks and, 32Aggregatibacter actinomycet-

emcomitans, 44t, 48Aggressive periodontitis

bacteria associated with, 47description of, 37–38generalized. See Generalized

aggressive periodontitis.localized. See Localized

aggressive periodontitis.systemic antibiotics for, 54

AIDS, 47, 47f, 344Airway obstruction, 357Alanine aminotransferase, 321Alcohol consumption, 33Alendronate sodium, 61tAlloDerm, 204–205, 207tAllogeneic block grafts, 225Allografts

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

description of, 224–225, 237

freeze-dried bone. See Freeze-dried bone allografts.

Alloplast, 224Alpha cells, 319

Alprazolam, 67tALT. See Alanine

aminotransferase.Altered active eruption, 213Alveolar bone

anatomy of, 12–13smoking effects on, 41

Alveolar bone proper, 13Alveolar crest, 109Alveolar mucosa, 7f, 8Alveolar process, 7fAlveolar ridge

defects of, 193deformities of, Siebert’s

classification of, 223splitting of, 237, 238f, 388

Alveolar ridge augmentationdescription of, 225horizontal, 237f, 237–238vertical, 238–239

Alveologingival fibers, 9Alzheimer disease, 307Ameloblastoma, 332American Academy of

Periodontology, 21, 21t, 105

American Association of Tissue Banks, 225

American Society of Anesthesiologists

blood pressure classification, 312

physical status classification, 54

Amorphous calcium phosphate, 228

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

418

Index

Amoxicillin, 55t, 56Amoxicillin and metronidazole,

55t, 56Amyloid beta, 307Analgesics, 322Anatomy

for mucogingival therapy, 203–204

of periodontium, 6, 7fAnesthetics, local, 65, 357–

358Angina, 359Angular defects, 167Ankylosis, 12Anterior guidance, 85Anterior implants, 266–268,

391Anterior pituitary gland, 320Anterior segment, pockets in,

169–170Anterior-posterior spread, 264Ante’s law, 8Antibiotics

commonly prescribed types of, 55t

dosage of, 56drug interactions with, 56tlocally delivered, 59, 59tin membrane placement,

232–233metabolism of, 322prophylaxis uses of, 57–58,

257selection of, 54systemic, 54–58

Anticoagulants, 73–74, 320Anti-convulsants, 74fAntifungals, 322Antigen-stimulated

lymphocytes, 301Antihistamines, 75Antimicrobial agents,

supragingival irrigation with, 156–157

Antiplatelet therapy, 72Anti-resorptive medications,

61t, 61–65Antiseptics, 143Antithrombin III, 320Aphthous ulcers, 327, 328tApically repositioned flap, 150,

168Apixaban, 74Apoptosis, 302Arestin, 59tArthritis, 307–308

Articaine, 66tASA. See American Society of

Anesthesiologists.Aspartate aminotransferase,

321Aspirin, 72AST. See Aspartate

aminotransferase.Atheroma, 315, 315fAtivan. See Lorazepam.Atridox (Atrix), 59tAtrophic candidiasis, 338,

403–404Attached gingiva

anatomy of, 7f, 8around restorations, 188,

194gingival recession and, 188widening of, 188

Attrition, 125–126, 126fAugmentin, 56Autogenous graft, 205, 224,

388Automated external defibrillator,

355Avitene, 180

BB cells, 301Bacteremia, 157Bacteria

in gingivitis, 47in periodontitis, 43–48,

44t–45tin refractory periodontal

disease, 47, 47fsensitivity testing of, 368,

369t, 381Bacterial complexes, 46Barrier, 374Bass technique, 144Benzocaine, 65Benzodiazepines, 69–70Beta cells, 319Bile, 319Biofilms, 43Bio-Gide membrane, 233,

233f, 390Biologic mediators, 23Biologic width, 15BioMend membrane, 233, 233fBiopsies, 108, 327Biotene gel, 75

Bisphosphonatesdefinition of, 62osteonecrosis caused by, 62periodontal surgery in

patients receiving, 62properties of, 60ttypes of, 61t

Bleeding on probing, 34–36, 87, 88t, 105–106, 153

Bleeding time, 311Block grafts, 225, 286Blood, 320–321Blood loss, during periodontal

surgery, 183–184Blood pressure, 312–313BMP. See Bone morphogenetic

proteins.Body mass index, 311Bone cells, 222Bone decortication, 229Bone grafts and grafting

allogeneic, 225block grafts, 225case study of, 373fguided tissue regeneration

with, for grade II furcation lesions, 19

horizontal, 388materials used in, 224onlay grafts, 225particle size, 228–229saddle grafts, 225studies of, 226–227tetracycline added to, 229

Bone induction, demineralized freeze-dried bone allografts for, 227

Bone lossafter implant placement, 253alveolar crest level, 109case study of, 387digital radiographs of, 109etiology of, 387marginal, 268in periodontal disease, 301progressive crestal, around

implants, 279retreatment for, 383

Bone morphogenetic proteins, 244–245

Bone regenerationamorphous calcium

phosphate for, 228anatomical considerations,

235guided. See Guided bone

regeneration.

419

Bovine-derived bone xenograft, 226

Bradycardia, 312Bradykinin, 302Brushing, 144Bruxism, 120, 129, 131–132Buccal wall thickness, in

esthetic area, 267–268Bump, 339–340Bupivacaine, 66t

CCAF. See Coronally advanced

flap.Calcitonin, 319Calcium channel blockers, 74fCalculus, 43Caloric restriction, 305Campylobacter rectus, 127Cancellous trabeculae, 13Candida, oral, 77Candidiasis, atrophic, 403–404Canine protection, 128Canine-guided occlusion, 128Canker sores, 327Carbon dioxide laser, 347f, 352Cardiopulmonary resuscitation,

354–355Cardiovascular disease,

314–316Caries

pulpal changes and, 122root coverage over, 215tunnel preparation in furcation

lesion area and, 23Case report studies, 3fCase studies, 3f, 362–404Case-control studies, 3fCathepsin C, 339CD4+ cells, 302, 303fCefazolin, 58CEJ. See Cementoenamel

junction.Cellular cementum, 13, 23Cemental tears, 104Cementicles, 28Cementoblasts, 13Cementoenamel junction

anatomy of, 7f, 8, 13greater palatine foramen to,

203, 203fCemento-osseous lesions, 345

Cementumdescription of, 13–14instrumentation used to

remove, 144removal of, 143–144

Cephalexin, 58Cephalosporins, 56tCephradine, 58Cervical enamel projections, 25Chest pain, 359, 359fChlorhexidine, 59t, 76, 156–

157, 281, 327, 336Chromic gut sutures, 181fChronic periodontitis

bacteria associated with, 47description of, 37implant placement in patients

with, 261laser therapy for, 349metronidazole plus amoxicillin

for, 57Cigar smoking, 42Cigarette smoking, 42Circular fibers, 9Circumferential occlusal access

procedure, 281Circumscribed elevated lesion,

340Circumscribed flat lesion, 340Citric acid, 158, 246Clarithromycin, 56tClass I MHC proteins, 308Class II MHC proteins, 308Class V resin, 195Clindamycin, 55t, 56, 58Clinical attachment level, 82,

107Clinical attachment loss

description of, 8uneven marginal ridges effect

on, 131Closed flap scaling and root

planing, 19, 141Clotting factors, 320COAP. See Circumferential

occlusal access procedure.

Codeine, 71tCo-destruction, 130Coe-Pak, 375Cohort studies, 3fCollagen, 14Complex odontoma, 332Compound odontoma, 332

Cone beam computed tomography, 110, 374

Confusion, 357Congenital heart defects,

57–58Congestive heart failure, 316,

359–360Conical roots, 16Connective tissue, 11Connective tissue attachment

anatomy of, 7fcervical enamel projections

effect on, 25enamel pearls effect on, 27

Connective tissue fibers, 7fConnective tissue graft

acellular dermal matrix versus, 205t

epithelium in, 197free gingival graft versus, 196guided tissue regeneration

versus, 206harvesting of, 203mean defect coverage using,

207tperiosteum in, 197placement of, 196fsubepithelial, 400

Connective tissue lesions, 331Conscious sedation, 68–69Contraceptives, 33Controlled clinical trials, 3fCoronally advanced flap, 400,

401fCoronally positioned flap, 200Cortical bone, 12Coumadin, 73, 320CPR. See Cardiopulmonary

resuscitation.C-reactive protein, 302Creeping attachment, 202Crestal bone loss, 279Crestal sinus elevation, 290fCritical probing depths,

142–143Cross-linked membranes, 233Cross-sectional study, 3Crown lengthening, 213f,

213–215, 340Crown restorations, furcation

lesions in, 28C-terminal telopeptide, 62Cuboidal cells, 10Curette, 144

420

Index

Cyanotic congenital heart defects, 57

Cyclosporine, 74fCysts, 327–328, 336, 337tCytokines, 40, 48Cytomegalovirus, 48

DDabigatran, 74Delta cells, 319Demerol. See Meperidine.Demineralized freeze-dried

bone allograftsbone formation induced by,

227–228description of, 224expanded

polytetrafluoroethylene membrane and, 22

freeze-dried bone allografts versus, 227

studies of, 226–227tetracycline and, 229

Denosumab, 61t, 64–65DenSonic sonic scaler, 282–

283Dentin hypersensitivity, 149Dentinogenesis imperfecta,

343tDentogingival fibers, 9Dentoperiosteal fibers, 9Depot medroxyprogesterone

acetate, 33Desmosomes, 10Desquamative gingivitis, 332Developmental deformities,

102–104DFDBA. See Demineralized

freeze-dried bone allografts.

Diabetes mellitusbacteria associated with, 48inflammation and, 306–307macrovascular complications

of, 318fmanagement of, 318microvascular complications

of, 318foral manifestations of, 317fperi-implant mucositis and,

279periodontitis and, 32, 117proinflammatory molecules

associated with, 303type 1, 317ttype 2, 317t

Diabetic coma, 318Diagnosis

background on, 81–83biopsies for, 108case study examples of, 367,

386medical history questionnaire

used in, 108predictors of, 105–107

Diazepam, 67t, 69Digastric muscle, 16Digital radiographs, 109Dilantin, 74fDirect-acting oral

anticoagulants, 73–74Distal wedge excision, 168Distraction osteogenesis

definition of, 236horizontal ridge augmentation

use of, 238indications for, 388phases of, 237fvertical ridge augmentation

use of, 239Divergent roots, 16DMPA. See Depot

medroxyprogesterone acetate.

DNA methylation, 300Double papilla flap, 199Doxycycline, 55t, 56, 59tDressings, surgical, 179–180,

180f, 377fDrug-induced gingival

enlargement, 74, 85f, 90, 163f

EEarly periodontitis, 105e-cigarettes, 42Edoxaban, 74EDTA gel, 158Electric toothbrush, 145–146EMD. See Enamel matrix

derivative.Emdogain, 207Emergency kit drugs, 355Enamel

anatomy of, 7fcementum and, overlapping

of, 13Enamel matrix derivative

definition of, 244furcation lesions treated

with, 23

mucogingival therapy use of, 207

studies of, 244Enamel pearls, 16, 27ENAP. See Excisional new

attachment procedure.Endodontic lesions, 100–102Endodontic therapy, 20, 120Endo-periodontal lesions,

100–102Envelope flap, 168Envelope technique, 200Epidemiology

prevalence. See Prevalence.terminology associated with,

33–34Epigenetics, 300Epinephrine, 65Epithelial disorders, 329–331Epithelium attachment, 7fEPL. See Endo-periodontal

lesions.Epstein-Barr infection, 48Erosive lichen planus, 335t,

337tEr:YAG laser, 349Erythema multiforme, 333, 337tErythromycin, 56tErythroplakia, 330Esthetic zone

buccal wall thickness in, 267–268

deficiencies in, 234fEthylenediaminetetraacetic

acid, 246Evidence-based dentistry, 1, 4Excisional new attachment

procedure, 179, 351Excursive positions, occlusal

contacts in, 131–132Expanded

polytetrafluoroethylene membranes, 22, 227

External carotid artery, 7External validity, 4, 4fExtrinsic cementum, 13Extrusion, 136

FF.A.S.T., 360–361Fasting blood sugar, 311FDBA. See Freeze-dried bone

allografts.Fenestration, 186, 187tFentanyl, 69

421

Fibersalveologingival, 9circular, 9connective tissue, 7fdentogingival, 9dentoperiosteal, 9gingival, 9periodontal ligament, 12transseptal, 9

Figure 8 suture, 182First molars, root concavities

on, 26Fixed partial denture

description of, 123implant-supported single

implant versus, 290Flap(s)

apically repositioned, 168coronally advanced, 400,

401fcoronally positioned, 200double papilla, 199envelope, 168full-thickness, 167laterally positioned, 199modified Widman, 167–168papilla preservation, 169partial-thickness, 165, 167single-flap approach, 172thickness of, 206

Floss/flossing, 144–145Flumazenil, 69–70Follicle-stimulating hormone,

320Food and Drug Administration

pharmaceutical pregnancy categories, 53

Food impaction, 39Force, on implant, 262Free gingiva, 7fFree gingival graft

connective tissue graft versus, 196

keratinized gingiva from, 198–199

mean defect coverage using, 207t

placement of, 196fwound healing of, 201

Freeze-dried bone allograftsalveolar ridge augmentation

using, 389–390case study of, 373, 390f

demineralized freeze-dried bone allografts versus, 227

description of, 224, 226studies of, 226–227tetracycline and, 229

Fremitus, 128Frenectomy, 210Full-thickness flap, 167Fungal infections, gingival

diseases caused by, 85Furcation defects and lesions

anatomical factors associated with, 24f, 24–28

biologic mediators for, 23cervical enamel projections

and, 25classification of, 18–19closed flap root planing for,

19entrance width, 26–27Glickman classification of,

18, 18fgrade I, 18f, 21grade II, 18f, 21grade III, 18f, 21grade IV, 18f, 21Hamp classification of, 18,

21timmediate bifurcation ridge

effects on, 28in mandibular molars, 17, 26in maxillary molars, 17, 27molars with accessory

canals, 25Nabers probe for diagnosing

of, 17open flap root planing for, 19prevalence of, 17prognosis of teeth with, 119restorations, 28root planing for, 19scaling for, 19Tarnow classification of, 19tooth loss secondary to, 114treatment of, 19–24tunnel preparation, 23, 397

Furcation fornix, 17Fusobacterium nucleatum,

45t, 46

GGastric inhibitory peptide, 320Gastrin, 320

GBR. See Guided bone regeneration.

GCF. See Gingival crevicular fluid.

Gender, periodontitis risks and, 32

Generalized aggressive periodontitis

antibiotics for, 57description of, 37

Genetics, periodontitis and, 32Giant cell fibroma, 339Gingiva

anatomy of, 7fattached. See Attached

gingiva.excessive display of, 212healthy, 9keratinized attached, 8marginal, 8narrowest zone of, 11overgrowth of, 211phenotype of, 102f, 194thickness of, 11widest zone of, 11zones of, 11

Gingival abscess, 100Gingival connective tissue cells,

222Gingival crevicular fluid, 34Gingival diseases

of bacterial origin, 85of fungal origin, 85non–plaque-induced, 85–86plaque-induced, 81of viral origin, 85

Gingival enlargement, drug-induced, 74, 85f, 90, 163f

Gingival epithelium, 9–11Gingival fibers, 9Gingival fibroblasts, 40Gingival Index, 34–35

modified, 35Gingival recession

attached gingiva required to avoid, 188

case study of, 398–402causes of, 189classification of, 191, 191fconsequences of, 189, 189fdecision trees for treating

defects caused by, 207–208, 209f

definition of, 188

422

Index

illustration of, 103fintrasulcular restorative

margin effects on, 194occlusal discrepancies effect

on, 131–132pinhole surgical technique

for, 201prevalence of, 190tunnel technique for, 200,

200fvestibular incision

subperiosteal tunnel access technique for, 201

worsening of, 190fGingivectomy, 150, 163–164Gingivitis

bacteria associated with, 47bleeding on probing in, 88tclassification of, 84definition of, 81desquamative, 332mouth breathing as risk factor

for, 40necrotizing ulcerative, 119peri-implant mucositis versus,

257, 258tperiodontitis and, 82, 257in periodontium, 89tplaque-induced, 81time needed for development

of, 145Glickman classification, of

furcations, 18, 18fGlucagon, 355Glycosylated hemoglobin, 311,

317Gore-Tex membranes, 237Gore-Tex sutures, 181f, 390Gracey curette, 19, 149Graft(s)

autogenous, 205barrier versus, 374bone, 224–229. See also

Bone grafts and grafting.connective tissue. See

Connective tissue graft.free gingival, 195–196, 196fthick versus thin, 202

Graft placementon bone, 204microsurgery versus

macrosurgery technique for, 197

on periosteum, 204shrinkage after, 202

Graftingbone. See Bone grafts and

grafting.socket, 241–243

Gram-negative bacteria, 47Gram-positive bacteria, 47Grand mal seizure, 357Granular cell tumor, 340Granular cells, 10Greater palatine foramen, 203,

203fGroup function, 128Growth factor-enhanced matrix,

245Growth factors, 243–246GTR. See Guided tissue

regeneration.Guided bone regeneration

antibiotics after, 232description of, 223membrane exposure effects

on, 232technique for, 235vertical ridge augmentation

with, 238–239Guided tissue regeneration

definition of, 223enamel matrix derivative

versus, 244grade II furcation treated

with, 22intrabony defects treated

with, 235, 246mean defect coverage using,

207tmembrane exposure effects

on, 232open-flap debridement and,

comparison between, 235, 236f

smoking effects on healing response after, 247

soft tissue procedure versus, 206

HHalcion. See Triazolam.Hamp classification, of

furcations, 18, 21tHard tissue deficiencies, 254fHard tissue grafting, 216Healing, wound, 175, 176t,

201–202Heart attack, 316Heart rate, 312Helper T cells, 302, 309

Hemangioma, 340Hemidesmosomes, 14Hemoglobin, 311–312Hemoglobin A1C, 311, 317Hemorrhagic stroke, 314, 360Heparin, 320Herpes zoster, 336Herpetic lesions, 327–328,

328fHigh-density lipoprotein, 311HIV

description of, 47, 47fperiodontitis associated with,

338Horizontal ridge augmentation

description of, 225options for, 237f, 237–238

Host modulation, 60Host response, 257, 303Hydrocodone, 71tHydrocortisone, 355Hyperglycemia, 318Hypermobility, 246Hypertension, 312–313Hyperventilation, 358Hypoglycemia, 356f

IIbandronate sodium, 61tIbuprofen, 71tIgA, 300, 322IgD, 300IgE, 301, 322IgG, 301, 322IgM, 301, 322Immediate bifurcation ridge, 28Immediate implant

in esthetic zone, 267indications for, 270maxillary soft tissue grafting

after placement of, 268osseointegration using,

270–271success rate of, 271

Immune response, 299Immune system, 322–323Immune-mediated disorders,

332–336Immunoglobulins, 300–301Immunologic sounding, 315,

315fImmunosuppressants, 74f

423

Implant(s)alternatives to, 290–291anterior, 266–268, 391anterior-posterior spread for,

264apex of, 265contraindications, 256fcriteria for, 253epithelium and, interface

between, 291esthetics of, 265–268evaluations of, at

maintenance visits, 391force on, 262hygiene of, 282–283immediate. See Immediate

implant.instruments used with,

282–283interproximal contact point,

265keratinized attached tissue

around, 261lasers used near, 351mean success rate of, 253mean survival rate of, 253mobile, 279natural teeth versus, 257occlusion for patients with,

128–129peri-implantitis, 105, 257,

273, 274t–275t, 277–278, 280–282, 282f

in periodontal disease patients, 261–262

platform switching, 272prognosis of, 120, 122–123progressive crestal bone loss

around, 279rough surface modifications

of, 260, 287screw-type, 287shape of, 269, 269f–270fshort, 269single, 123sinus elevation, 283–287smoking effects on, 272–273smooth surface modifications

of, 260surface modifications of, 260,

260ftitanium, 287

Implant failure

antibiotic prophylaxis to prevent, 257

bacteria associated with, 48definition of, 278determination of, 278–279factors associated with,

254–255, 256fsmoking as cause of, 273

Implant placementafter socket preservation,

243antibiotic prophylaxis before,

257case study of, 374, 375fclassification to consider

before, 252, 252fin clean conditions, 291distance considerations, 265in esthetic area, 391guidelines for, 267, 267fimmediate, 267, 270–272improper, 255fin irradiated bone, 291–292in keratinized attached tissue,

264fin mandible, 256, 264, 292in maxilla, 256, 264, 292osteotome technique for, 289presurgical steps for,

262–263remodeling after, 253in sclerotic bone, 292single-stage, 264sinus elevation and, 287, 289in sterile conditions, 291technique for, 263, 263f,

375ftwo-stage, 264–265

Implant survivalmaintenance effects on, 283osteotome technique effects

on, 289Implantable cardioverter-

defibrillator, 148Implantitis. See Peri-implantitis.Incidence, 34Indices, 34–36Infection

after sinus elevation, 285, 286f

description of, 183oral, 336–338postoperative, 285, 286f

Inferior alveolar artery, 12

Inflammation, 306–307Alzheimer disease and, 307arthritis and, 307–308description of, 35, 222insulin resistance secondary

to, 306fperiodontal disease and,

304–305, 305fplaque-induced, 399proinflammatory molecules,

302–303signs of, 299

Inflammatory papillary hyperplasia, 331

Infraorbital nerve, 284Inhalation steroids, 75Innate immune response, 299fInstrumentation

cementum removal using, 144

ultrasonic, 146–148Insulin resistance, 305, 306fInterdental brushes, 145Interdental tissue maintenance,

171Interferon-τ, 302Interleukin-1, 301–303Interleukin-2, 302Interleukin-4, 302Interleukin-6, 302, 307Interleukin-8, 302, 305Interleukin-10, 302Internal validity, 4, 4fInternational normalized ratio,

73, 311Interproximal contact point, 265Interradicular distance, 121Interrupted suture, 182Intrabony defects

assessment of, 240fguided tissue regeneration

for, 235, 246smoking effects on healing

response in, 247tooth movement for, 136tooth vitality effect on

regenerative outcomes in, 246

Intrinsic cementum, 13Irradiated bone, implant

placement in, 291–292Irrigation, 156–158Ischemic stroke, 314

424

Index

ITM. See Interdental tissue maintenance.

IV sedation, 68–70, 70f

JJoint replacement, antibiotic

prophylaxis indications for, 58

Junctional epithelium, 7f, 10, 10f, 14, 222

Juvenile rheumatoid arthritis, 308

KKeratinized attached gingiva

around implant, 261, 264fdescription of, 8

Keratinized epithelium, 11Keratinized tissue, 187Keratinocytes, 10Keratohyalin granules, 10Kidneys, 319Kwok and Caton classification

system, 116–117, 117f

LLaboratory values, 311–312ß-Lactams, 56tLamina propria, 8LANAP. See Laser-assisted

new attachment procedure.

Langerhans cells, 10Laser-assisted new attachment

procedure, 348, 351Lasers, 347–352Lateral periodontal cyst, 328,

329fLateral pterygoid muscle, 16Lateral window sinus elevation,

284f, 290fLaterally positioned flap, 199LCC. See Living cellular

constructs.Leiomyoma, 340Lekholm and Zarb classification,

252fLeukoplakia, 329Leydig cells, 320Lichen planus, 334, 335tLidocaine, 66tLipoma, 339Listerine, 76Liver

disease of, 321–322

drug metabolism in, 322Living cellular constructs,

198–199Local anesthetics

description of, 65metabolism of, 322reactions to, 357–358

Localized aggressive periodontitis

bacteria associated with, 47description of, 37

Locally delivered antibiotics, 59, 59t

Longitudinal study, 3Long-term prognosis, 116, 368,

402Lorazepam, 67tLoss of consciousness, 356,

356fLow birth weight, periodontitis

and, 38Low-density lipoprotein, 311Lupus erythematosus, 334Luteinizing hormone, 320Lymphangioma, 339

MMacrosurgery versus

microsurgery, for graft placement, 197

Maintenance therapybleeding on probing affected

by, 153case study of, 383compliance with, 153effectiveness of, 150–151elements of, 151fendpoints of, 151frequency of, 152schedule of, 152

Major histocompatibility complex proteins, 308–309

Mandibledehiscence of, 186, 187tfenestration of, 186, 187timplant placement in, 256,

264, 292muscles of, 16

Mandibular molarsfurcations in, 17, 26second, cervical enamel

projections in, 25Mandibular occlusal view, 364fManual toothbrush, 145–146

Marginal bone loss, 268Marginal gingiva, 8Marginal ridges, uneven, 131Masseter muscle, 16Masticatory epithelium, 10, 10fMatrix metalloproteinases, 302Mattress suture, 182Maxilla

dehiscence of, 186, 187tfenestration of, 186, 187tgrafting of, 390, 390fimplant placement in, 256,

264, 292Maxillary incisors, 388, 389fMaxillary left quadrant, osseous

surgery on, 375, 376fMaxillary molars

furcations in, 17, 27root resection in, 178

Maxillary occlusal view, 364fMaxillary roots, 27Maxillary sinus, 283McGuire classification of

prognosis, 115, 116f, 368

Medial pterygoid muscle, 16Medical emergencies

cardiopulmonary resuscitation, 354–355

diagnosis of, 356fdrugs used in, 355in office, 356–361

Medical history questionnaire, 108

Medicationsantibiotics. See Antibiotics.bisphosphonates, 62–63pain relievers, 70–72side effects of, 74–75

Melanocytes, 10Membranes

antibiotics given during placement of, 232–233

Bio-Gide, 233, 233fBioMend, 233, 233fcross-linked, 233expanded polytetra-

fluoroethylene, 227exposure of, 231–232, 232fnon–cross-linked, 233nonresorbable, 230f,

230–231placement of, 232–233properties of, 230, 230f

425

resorbable, 230f, 230–231, 389

tacks used to stabilize, 234titanium-reinforced, 231

Meniscal derangement, 14Mental nerve, 265Meperidine, 69Mepivacaine, 66tMerkel cells, 10Meta-analyses, 3fMetabolic disorders, 305–306Metastases, 330Metronidazole, 55t–56t, 56,

157, 338Micro-macroporous biphasic

calcium phosphate, 228Microsurgery

advantages of, 175macrosurgery versus, for

graft placement, 197Midazolam, 68–69Miller classification

of gingival recession-type defects, 209f

of mobility, 126–127of soft tissue resection, 192f

Minimally invasive surgery, 170–173

Minimally invasive surgical technique, 171

Minocycline, 55t, 56, 59tMIS. See Minimally invasive

surgery.Misch bone density scale, 223MIST. See Minimally invasive

surgical technique.M-MIST. See Modified

minimally invasive surgical technique.

Mobile implant, 279Mobility, 126–128Moderate periodontitis, 105Modified Gingival Index, 35Modified minimally invasive

surgical technique, 172, 227

Modified Widman flap, 167–168

Moi-Stir moistening solution, 75Molars

with accessory canals, 25implant therapy versus root

resection in, 122–123

loss of, tooth-related factors for, 114–115

restorations, furcation lesions in, 28

root coverage of, 216root debridement in, 141uprighting of, using

orthodontics, 136Mouth breathing, 40Mouthrinses, 76MTA pulp capping, 121tMucocele, 336, 337tMucoepidermoid carcinoma,

345Mucogingival defects, Sullivan

and Atkins classification of, 192, 192f

Mucogingival deformities, 102–104

Mucogingival junction, 7fMucogingival surgery, smoking

effects on, 202Mucogingival therapy

anatomy for, 203–204definition of, 186enamel matrix derivative for,

207endpoints of, 187side effects of, 188

Mucositis, peri-implantadjunctive therapy for, 281causes of, 277–278chlorhexidine for, 281definition of, 273description of, 104–105diabetes and, 279gingivitis versus, 258tillustration of, 280fincidence of, 280laser treatment for, 350peri-implantitis and, 257,

274t–275t, 280prevalence of, 280

Mucous membrane pemphigoid, 333f, 337t

Mucus retention cyst, 336, 337tMycelex troches, 77Mylohyoid muscle, 16Myocardial infarction, 316, 359,

404

NNabers probe, 17Naloxone, 70

NCCLs. See Noncarious cervical lesions.

Nd:YAG laser, 347f, 351Neck lumps, 342Necrotizing gingivitis, 119Necrotizing periodontal

diseases, 47, 47f, 97–98Necrotizing ulcerative

periodontitisfeatures of, 338, 338fprognosis of, 119treatment of, 338

Neurofibroma, 339Neutropenia, 311New attachment, 221Nikolsky test, 333Nitrous oxide, 68, 355Noncarious cervical lesions,

125Non–cross-linked membranes,

233Nonfunctional contacts, 132Nonresorbable membranes,

230f, 230–231Nonspecific plaque hypothesis,

43Nonspecific ulcer, 340Nonsteroidal anti-inflammatory

drugs, 60tNonsurgical root canal therapy,

121tNonsurgical therapy

irrigation, 156–158scaling and root planing. See

Scaling and root planing.surgical therapy versus, 154t,

177types of, 139

Nystatin, 77

OObesity

inflammation and, 305–306osteoarthritis risks, 307periodontitis risks, 33

Occlusal adjustment, 133f, 133–134

Occlusal contacts, 131–132Occlusal discrepancies,

131–132Occlusal forces, 131, 134–135Occlusal overload, 129Occlusal trauma

definition of, 125

426

Index

description of, 104periodontal attachment loss

and, 131Occlusion

canine-guided, 128endodontic therapy affected

by, 120group function, 128for implant patients, 128–

129implant therapy affected by,

120theories of, 130–131types of, 128

Occlusive stroke, 360Odds ratio, 33Odontogenic keratocyst, 328,

329fOdontogenic tumors, 332Odontoma, 332OFD. See Open-flap

debridement.Office emergencies, 356–361Onlay grafts, 225, 239Open flap curettage, 177Open flap scaling and root

planing, 19, 141Open-flap debridement, 235,

236fOpioid overdose, 69–70Oral anticoagulants, 73–74Oral cancers, 330Oral candida, 77Oral epithelium, 10, 10fOral hygiene

after osseous surgery, 177–178

brushing, 144–145flossing, 144–145overhanging dental margins

effect on, 39periodontitis and, 31supragingival irrigation as

adjunct in, 156Oral infections, 336–338Oral malodor, 323–324,

402–403Oral medicine, 311–325Oral mucosa, 9, 9fOral mucous membrane, 7fOral sedation, 65Oral sulcular epithelium, 10, 10fOral viral infections, 77Organs, 319–320Orthodontics

prognosis affected by, 136–137

recession and, relationship between, 210

Orthokeratinization, 11Osseointegration, 256, 270–

271Osseous recontouring, 177Osseous surgery. See also

Periodontal surgery; Surgical therapy.

contraindications, 166definition of, 165failure of, 166indications for, 165lingual approach to, 169materials used in, 179–180,

180fon maxillary left quadrant,

375, 376foral hygiene after, 177–178palatal approach to, 168–

169, 169tperiodontal flap surgery, 165postoperative period,

182–183rationale for, 165–166sutures, 180–182, 181ftechniques, 168–169wound healing after, 175,

176tOssix, 233Ostectomy, 166, 375Osteoarthritis, 307–308Osteoblasts, 260, 302Osteoclasts, 302Osteoconductive, 224Osteogenesis imperfecta, 343tOsteogenic, 224Osteogenic protein-I, 24Osteoinductive, 224Osteonecrosis,

bisphosphonate-associated, 62, 64t

Osteoplasty, 166, 375Osteotome, 288–289Ovate pontic, 215Overhanging dental margins,

39Overload, occlusal, 129Oxycodone, 71t

PP value, 3Pacemakers, 148

Pain relievers, 70–72Palatal approach to osseous

surgery, 168–169, 169tPancreas, 319

PAOO. See Periodontally accelerated osteogenic orthodontics.

Papillaheight loss, 211loss of, 210–211reconstruction of, 211

Papilla preservation flap, 169Papilla preservation technique,

171Papillary lesion, 341Papillon-Lefèvre syndrome, 97,

339–343Parakeratinization, 11Partial prothrombin time, 321fPartial-thickness flap, 165, 167Passive eruption

active eruption versus, 213altered, 212

PDGF. See Platelet-derived growth factor.

Pedicle graft, for mean defect coverage, 207t

Pemphigus vulgaris, 333f, 337tPenciclovir, 328Penicillin, 58Pepsin, 320Pepsinogen, 320Peptostreptococcus micros,

127Percocet, 71tPercodan, 71tPericoronal abscess, 100Pericoronal radiolucency, 341Peri-implant health, 104Peri-implant mucosa

recession of, 255thickness of, 267–268

Peri-implant mucositisadjunctive therapy for, 281causes of, 277–278chlorhexidine for, 281definition of, 273description of, 104–105diabetes and, 279gingivitis versus, 258tillustration of, 280fincidence of, 280laser treatment for, 350peri-implantitis and, 257,

274t–275t, 280

427

prevalence of, 280Peri-implant tissue

periodontal tissue and, comparison between, 258t–259t

probing of, 255Peri-implantitis

causes of, 277–278circumferential occlusal

access procedure for, 281

definition of, 273description of, 105illustration of, 280fincidence of, 280laser treatment for, 350management of, 282fpattern of, 280–281peri-implant mucositis and,

257, 274t–275t, 280periodontitis and, comparison

between, 277tprevalence of, 280risk factors for, 278severity of, 280–281treatment of, 281–282, 282f

PerioChip, 59tPeriodic fever, aphthous

pharyngitis and cervical adenopathy. See PFAPA syndrome.

Periodic fever, aphthous stomatitis, pharyngitis, and adenitis, 344

Periodontal abscess, 98–100, 99f–100f, 403

Periodontal cyst, 329fPeriodontal disease

American Academy of Periodontology classification system for, 105

bacteria associated with, 46–48, 47f

bleeding on probing as predictor of progression of, 105–107

bone loss in, 301bruxism effects on, 132cardiovascular disease and,

315classification of, 83–87clinical attachment level as

predictor of, 107etiologic factors, 394–395

gingivitis. See Gingivitis.host response inhibition

effects on, 303host-based tests for

susceptibility to, 107implant placement in patients

with, 261–262inflammation and, 304–305,

305fnecrotizing, 47, 47f, 97–98periodontitis. See

Periodontitis.predictors of, 105–107probing depth as predictor

of, 107progression of, 304pulpal changes and, 122radiographic evaluations,

108–110, 109frecurrent, 154refractory, 47, 47f, 54rheumatoid arthritis as

predictor of, 110risk factors for, 394–395viruses in, 48

Periodontal Disease Index, 36Periodontal flap surgery, 165Periodontal health, 87, 87f, 88tPeriodontal Index, 36Periodontal ligament

anatomy of, 7f, 12description of, 131, 133widening of, tooth mobility

and, 107Periodontal ligament cells, 222Periodontal plastic surgery, 186Periodontal pocket. See Pocket.Periodontal regeneration

definition of, 221goals of, 221growth factors for, 246

Periodontal supporting tissues, 96–97

Periodontal surgery. See also Osseous surgery; Surgical therapy.

blood loss during, 183–184cell types that repopulate the

root surface after, 222postinfection rate after, 183technique of, 175

Periodontal tissue, peri-implant tissue and, 258t–259t

Periodontal trauma, 126Periodontal treatment/therapy

lack of, 153–154mobile teeth effects on, 127results of, 379t, 379–383

Periodontally accelerated osteogenic orthodontics, 210

Periodontitisadvanced, 105aggressive. See Aggressive

periodontitis.antibiotics for, 54atherosclerotic

cardiovascular disease risk factors, 316

bacteria found in, 43–48, 44t–45t

biofilms, 43bleeding on probing in, 88tcaloric restriction effects on,

305cardiovascular disease and,

315–316chronic. See Chronic

periodontitis.classification of, 90–91conditions associated with,

38–40definition of, 82diabetes mellitus and, 32,

117early, 105endodontic lesions

associated with, 100–102

epigenetic modifications in, 300

extraction of hopeless teeth in patients with, 118

generalized aggressive, 37genetic risks, 32gingivitis and, 81, 257grading of, 93–95, 94timplant placement in patients

with, 261–262localized aggressive, 37, 47low birth weight and, 38moderate, 105necrotizing ulcerative. See

Necrotizing ulcerative periodontitis.

nontreatment effects, 142oral hygiene and, 31overhanging dental margins

and, 39

428

Index

peri-implantitis and, comparison between, 277t

plaque and, 43in pregnancy, 38preterm birth and, 38, 39fprevalence of, 37prognosis of, orthodontics

effect on, 136–137pulpal changes and, 122refractory, 40risk factors for, 31–33risk indicators for, 32–33severe, 37smoking and, 32, 40–41,

41f, 117staging of, 90–93, 92tsystemic antibiotics for, 54systemic diseases associated

with, 96–97tobacco use and, 32, 40–41tooth extractions caused

by, 37types of, 90

Periodontiumalveolar bone, 12–13anatomy of, 6, 7fcementum, 13–14connective tissue, 11gingival epithelium, 9–11innervation of, 7phenotype of, 102f, 194removable partial denture

effects on health of, 123vascular supply of, 7

Perioscopy, 170Periosteal suture, 182Periosteum

description of, 11graft placement on, 204

Peripheral blood neutrophils, 302

Peripheral ossifying fibroma, 339

PFAPA syndrome, 344Pharmacology

antibiotics. See Antibiotics.bisphosphonates, 62–63Food and Drug

Administration pregnancy categories, 53

host modulation, 60IV sedation, 68–70, 70fmedication side effects,

74–75

nitrous oxide, 68oral sedation, 65pain relievers, 70–72

Phenytoin, 74fPhotodynamic therapy, 348,

350–351PICO question, 1–2Piezoelectric instrument, 285Pigmented lesions, 341fPinhole surgical technique, 201Pipe smoking, 42Pituitary gland, 320Plaque

definition of, 43flossing to remove, 144gingival diseases caused

by, 81gingivitis onset after

incomplete removal of, 145

host defense against, 323ftriclosan effects on, 75

Plaque Index, 36, 153Plaque lichen planus, 335tPlaque-induced gingivitis, 81Plaque-induced inflammation,

399Platelet count, 311Platelet-derived growth factor,

245Platelet-rich plasma

furcation lesions treated with, 24

sinus elevation use of, 286–287

Platform switching, 272Pocket

food impaction and, 39occlusal adjustment effects

on depth of, 134recurrent, 15supragingival and subgingival

irrigation projection into, 158

surgical reduction of, 372Pocket depths

enamel matrix derivative effects on, 244

occlusal adjustment effects on, 134

scaling and root planing effects on, 140

unresolved, 176–177Pontic, 215

Porphyromonas gingivalis, 44t, 127, 307

Postoperative chart, 397f–398fPostoperative infection, 285,

286fPostoperative instructions, 378Postoperative period, 182–183Postoperative photographs,

397fPosttreatment report record,

380fPostural hypotension, 356fPregnancy

Food and Drug Administration pharmaceutical categories, 53

periodontitis treatment during, 38

precautions during, 324pyogenic granulomas in, 331

Prehypertension, 312Preoperative chart, 393fPreoperative radiographs, 393fPreterm birth

bacteria associated with, 48periodontitis and, 38, 39f

Pretreatment report record, 365f

Prevalenceof furcation defects and

lesions, 17of gingival recession, 190incidence versus, 34of periodontitis, 37

Prevident, 76Prevotella intermedia, 44t, 46Prevotella nigrescens, 47Primary hypertension, 312Primary occlusal trauma, 125Primary wound healing, 175Probing

bleeding on, 34–36, 105–107, 153

of peri-implant tissue, 255Probing depths

critical, 142–143definition of, 83periodontal disease and, 107

Procaine, 65Prognosis

case study of, 388definition of, 113of endodontic therapy, 120of implants, 120, 122–123

429

long-term, 116, 368, 402McGuire classification of,

115, 116f, 368of necrotizing ulcerative

gingivitis, 118orthodontics effect on,

136–137short-term, 116, 368, 402of teeth with furcation

lesions, 118Progressive crestal bone loss,

around implants, 279Proinflammatory molecules,

302–303Proliferative verrous leukoplakia,

329Prophylaxis, antibiotic, 57–58,

257Prostaglandin E2, 302Protectins, 300Prothrombin time, 321fPRP. See Platelet-rich plasma.Pseudoepitheliomatous

hyperplasia, 329PST. See Pinhole surgical

technique.Pulp

caries and, 122periodontal disease and, 122periodontitis and, 122scaling effects on, 149

Pulpal abscess, 99Pyogenic granuloma, 331, 339

RRace, periodontitis risks and,

33Radiographs

case study uses of, 367fperiodontal disease

evaluations, 108–110, 109f

Randomized clinical trials, 3fRANKL inhibitors, 64–65Reattachment, 221Receptor activator of nuclear

factor kappa-B ligand inhibitors. See RANKL inhibitors.

Recessiongingival. See Gingival

recession.orthodontics and, 210peri-implant mucosa, 255soft tissue, 191–192, 268

Recombinant human osteogenic protein-I, 24

Recombinant human platelet-derived growth factor, 245

Recontouring, osseous, 177Recurrent periodontal disease,

154Red blood cell count, 311Red lesions, 341fReevaluation report record,

371f, 372Refractory periodontal disease,

47, 47fRefractory periodontitis, 40, 54Regeneration

bone. See Bone regeneration; Guided bone regeneration.

distraction osteogenesis for, 237f, 237–238

factors that affect, 222f, 222–223

goals of, 221growth factors for, 246guided bone, 223hypermobility effects on, 246measurement of, 247root surface demineralization

effects on, 246smoking effects on, 247tooth vitality effects on, 246

Remodeling, after implant placement, 253

Removable partial dentures, 123

Repair, 221Resolvins, 300Resorbable membranes, 230f,

230–231, 389Respiratory distress, 357, 358fRestorations

attached gingiva around, 188, 194

furcation lesions and, 28pulpal changes and, 123

Reticular lichen planus, 335tRhabdomyosarcoma, 340Rheumatoid arthritis, 110rhPDGF. See Recombinant

human platelet-derived growth factor.

Risedronate sodium, 61tRisk factors

definition of, 31

periodontitis, 31–33risk indicator versus, 31

Risk indicatorsdefinition of, 31periodontitis, 32–33risk factor versus, 31

Rivaroxaban, 74Root(s)

concavities of, 16, 26conical, 16curvatures of, 16divergent, 16maxillary, 27morphology of, tooth support

and, 16surface area of, 28

Root canal therapynonsurgical, 121tsuccess rates for, 290

Root conditioning, 158Root coverage

attachment apparatus for, 201

connective tissue graft effects on, 197

flap thickness and, 206molars, 216over caries lesions, 215soft tissue resection treated

with, 192fsuccess of, 201technical factors that

enhance, 207Root fracture, 16, 117f, 178Root planing. See also Scaling

and root planing.definition of, 139endpoints of, 139–140factors that affect, 140furcation defects and lesions

treated with, 19modified Widman flap,

167–168Root resection

contraindications for, 178endodontic therapy before,

20guidelines for, 20indications for, 178in molars, 122success rate of, 178–179technique for, 20–21

Root sensitivity, 159Root surface

biomodification of, 198

430

Index

demineralization of, effect on regeneration, 246

Er:YAG laser effects on, 352modification of, 158, 246

Rough surface modifications, of implants, 260, 287

Round bur, 285

SSaddle grafts, 225Salivary gland disorders, 336Scalers, 146–148, 147tScaling and root planing

attachment level benefits after, 57

closed flap, 19, 141definition of, 139effectiveness of, 140–144factors that affect, 140furcation defects and lesions

treated with, 19lasers and, comparison

between, 349–350open flap, 19, 141photodynamic therapy and,

350pulpal effects of, 149reevaluation after, 150single versus weekly

appointments, 143Sclerotic bone, implant

placement in, 292SCTG. See Subepithelial

connective tissue graft.Secondary hypertension, 312Secondary occlusal trauma,

125Secondary wound healing, 175Sedation

conscious, 68–69IV, 68–70, 70foral, 65

Sedatives, 322Seizures, grand mal, 357Semilunar technique, 199Sensitivity, 4, 34Sensitivity testing, 368, 369t,

381Sensodyne, 76Severe periodontitis, 37Sex, periodontitis risks and, 32Sharpey fibers, 13Short-term prognosis, 116,

368, 402

Shrinkage, after graft placement, 202

Siebert’s classification, of alveolar ridge deformities, 223

Silk sutures, 181fSimplified papilla preservation

flap, 171Single implants, 123Single-flap approach, 172Single-stage implant

placement, 264Sinus

maxillary, 283septa with, 283

Sinus augmentation, 286, 288fSinus elevation

bone-added osteotome, 288implant placement and, 287,

289infection after, 285, 286flateral window, 284, 284f,

290fsinus membrane perforation

during, 285Sinus membrane perforation,

285Sjögren syndrome, 336Skin cancer, 331, 331fSling suture, 182Smear layer, 158Smoking

cessation of, 42cigarettes versus pipe or

cigars, 42implants affected by, 272–

273mucogingival surgery

affected by, 202periodontitis risks, 32, 40–

41, 41f, 117regeneration affected by, 247wound healing affected by,

247Socioeconomic status,

periodontitis risks and, 32

Socket grafting, 241–243Socket preservation, implant

placement after, 243Soft tissue deficiencies, 254fSoft tissue grafting, 215Soft tissue recession, 191–

192, 268Sonic scalers, 146–148, 147t

Sonic toothbrush, 148Specific plaque hypothesis, 43Specificity, 4, 34Spleen, 319Splinting, 134SPPF. See Simplified papilla

preservation flap.Squamous cell carcinoma, 330Staging

ABCDE, 331, 331fTNM, 326

Steroids, inhalation, 75Stomach, 320Stratum basale, 10Stratum corneum, 11Stratum granulosum, 10Stratum spinosum, 10Streptococcus mitis, 47Streptococcus sanguis, 47Stress, periodontitis risks and,

33Stroke, 314, 360–361Studies

case, 362–404types of, 2–3, 3f

Subantimicrobial dose doxycycline, 60t

Subepithelial connective tissue graft, 400

Subgingival irrigation, 156–158Sulcus, 7fSuperior alveolar artery, 12Superior alveolar nerve, 284Suppuration, 107Supracrestal tissue attachment,

15Supragingival irrigation, 156Surface modifications

of implants, 260, 260f, 287of root, 158, 246

Surgical dressings, 179–180, 180f

Surgical pocket reduction therapy, 372

Surgical root canal therapy, 121t

Surgical therapy. See also Osseous surgery; Periodontal surgery.

envelope flap, 168full-thickness flap, 167gingivectomy, 150, 163–164modified Widman flap,

167–168

431

nonsurgical therapy versus, 154t, 177

osseous surgery, 164–167partial-thickness flap, 167postoperative instructions,

378Surgicel, 180Sutures, 180–182, 181fSuturing, 182Systematic reviews, 3fSystemic antibiotics, 54–58Systemic conditions, gingival

manifestations of, 85–86

TT cells, 301Tachycardia, 312Tannerella forsythia, 45tTarnow classification, of

furcations, 19Temporalis muscle, 16Temporomandibular joint, 14Teriparatide, 63Tertiary wound healing, 175Testosterone, 320Tetracycline

bone graft and, 229description of, 55tdrug interactions with, 56troot surface modification

using, 246T-helper cells, 302, 309Thrombosis, 313fThyroid gland, 319Tissue responses, to occlusal

forces, 134–135TNM staging system, 326Tobacco use, periodontitis risks

and, 32, 40–41Tonofilaments, 11Tooth extractions

case study of, 372–374, 373f

decision-making considerations in, 121

of hopeless teeth, 117f, 118periodontitis as cause of, 37saving the tooth versus, 121single anterior implant

placement after, 268

socket grafting after, 241wound healing after, 241–

242Tooth loss

amount of, 115Hirschfeld and Wasserman

studies on, 113t, 113–114

McFall study on, 113–114, 114t

Tooth mobility, 107Toothbrushes

changing of, 146electric, 145–146manual, 145–146sonic, 148ultrasonic, 148

Toothpastes, 76Transforming growth factor ß,

302Transseptal fibers, 9Trauma

occlusal. See Occlusal trauma.

periodontal, 126Treatment planning, 362–404Treponema denticola, 45tTriazolam, 67tß-Tricalcium phosphate, 245Triclosan, 75–76Trigeminal nerve, 7Tumor(s)

biopsy of, 327odontogenic, 332TNM staging system of, 326

Tumor necrosis factor α, 301, 303

Tunnel preparations, in furcation lesion area, 23

Tunnel technique, 200, 200fTwo-stage implant placement,

264–265Tylenol #3, 71tType 1 diabetes mellitus, 317tType 2 diabetes mellitus, 317t

UUlcers, 327–328, 340Ultrasonic scalers, 146–148,

147tUltrasonic toothbrush, 148

Unconsciousness, 356Uneven marginal ridges, 131Uprighting of molars, using

orthodontics, 136

VValidity, 4, 4fValium, 355. See also

Diazepam.Vaping, 42–43Vasodepressor syncope, 356fVersed. See Midazolam.Vertical ridge augmentation,

225, 239Vertical root fracture, 117fVestibular incision subperiosteal

tunnel access technique, 201

Vestibule, 216Vicodin, 71tVicryl sutures, 181fViral infections, oral, 77Viruses

gingival diseases caused by, 85

periodontal disease and, 48VISTA technique. See Vestibular

incision subperiosteal tunnel access technique.

WWarfarin, 73, 320White blood cell count, 311White lesions, 341fWidman flap, 150

modified, 167–168Wound healing

after osseous surgery, 175, 176t, 201–202

after tooth extraction, 241–242

smoking effects on, 247

XXanax. See Alprazolam.Xenografts, 224, 227Xerostomia, 75

ZZoledronic acid, 61t