BOOK
Carranza's Clinical Periodontology - E-Book
Michael G. Newman | Henry Takei | Perry R. Klokkevold | Fermin A. Carranza
(2014)
Additional Information
Book Details
Abstract
The most widely used periodontics text, Carranza's Clinical Periodontology provides both print and online access to basic procedures as well as the latest in advanced procedures and techniques in reconstructive, esthetic, and implant therapy. Not only does this book show how to do periodontal procedures, it describes how to best manage the outcomes and explains the evidence supporting each treatment. Written by leading experts Michael Newman, Henry Takei, Perry Klokkevold, and Fermin Carranza, along with a pool of international contributors, this edition also discusses the close connection between oral health and systemic disease. A new Expert Consult website includes the entire, fully searchable contents of the book, and takes learning to a whole new level with content updates, videos, a drug database, and much more.
- Comprehensive coverage describes all aspects of periodontics in a single volume, including periodontal pathology, the etiology of periodontal diseases, the relationship between periodontal disease and systemic health, treatment of periodontal diseases, oral implantology, supportive treatment, and ethics, legal, and practical matters.
- Problem-solving, scenario-based learning opportunities use well-documented case reports to help you learn both basic and advanced procedures and techniques.
- 'Speed to competence' is enhanced with access to print, online, and mobile platforms.
- A unique approach combines evidence-based decision-making, science transfer, and classification/nomenclature throughout every chapter.
- A one-of-a-kind Genetic Factors and Periodontal Disease chapter examines the role of genetic factors in gum disease.
- In-depth information serves as an excellent foundation in preparing for the National Board Dental Exam.
- Coverage of the latest advances includes the emerging link between periodontal disease and systemic health.
- Full-color illustrations depict the newest developments in surgical technology.
- A new Multidisciplinary Approach to Dental and Periodontal Problems chapter discusses the importance of collaborative care in the practice of periodontics.
- Etiology of Periodontal Diseases (Part 4) provides a more comprehensive background in periodontal anatomy, physiology, and pathogenesis.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Inside front cover | ifc1 | ||
| Carranza's Clinical Periodontology, 12/e | i | ||
| Copyright page | iv | ||
| Editors | v | ||
| Contributors | vi | ||
| About the Book | xv | ||
| About The Authors | xvi | ||
| Preface | xviii | ||
| Acknowledgments | xix | ||
| Table of Contents | xx | ||
| Introduction: | 1 | ||
| Chapter Outline | 1 | ||
| Early Civilizations | 1 | ||
| The Classical World | 1 | ||
| The Middle Ages | 1 | ||
| The Renaissance | 1 | ||
| The Eighteenth Century | 3 | ||
| The Nineteenth Century | 3 | ||
| Necrotizing Ulcerative Gingivitis | 5 | ||
| The Twentieth Century | 5 | ||
| Vienna | 5 | ||
| Berlin | 5 | ||
| The United States and Other Countries | 6 | ||
| Focal Infection | 6 | ||
| Dental Implants | 6 | ||
| After World War II | 7 | ||
| The History of This Book | 8 | ||
| References | 8 | ||
| References | 8.e1 | ||
| 1 Biologic Basis of Periodontology | 9 | ||
| I Normal Periodontium | 9 | ||
| 1 Anatomy of the Periodontium | 9 | ||
| Chapter Outline | 9 | ||
| Oral Mucosa | 9 | ||
| Gingiva | 9 | ||
| Clinical Features | 9 | ||
| Marginal Gingiva. | 9 | ||
| Gingival Sulcus. | 9 | ||
| Attached Gingiva. | 10 | ||
| Interdental Gingiva. | 10 | ||
| Microscopic Features | 10 | ||
| Gingival Epithelium | 11 | ||
| General Aspects of Gingival Epithelium Biology. | 11 | ||
| Structural and Metabolic Characteristics of Different Areas of Gingival Epithelium. | 14 | ||
| Oral (Outer) Epithelium. | 14 | ||
| Sulcular Epithelium. | 14 | ||
| Junctional Epithelium. | 15 | ||
| Development of Gingival Sulcus. | 15 | ||
| Renewal of Gingival Epithelium. | 16 | ||
| Cuticular Structures on the Tooth. | 17 | ||
| Gingival Fluid (Sulcular Fluid). | 17 | ||
| Gingival Connective Tissue. | 17 | ||
| Gingival Fibers. | 17 | ||
| Cellular Elements. | 18 | ||
| Repair of Gingival Connective Tissue. | 18 | ||
| Blood Supply, Lymphatics, and Nerves. | 18 | ||
| Correlation of Clinical and Microscopic Features | 20 | ||
| Color. | 20 | ||
| Physiologic Pigmentation (Melanin). | 20 | ||
| Size. | 20 | ||
| Contour. | 20 | ||
| Shape. | 21 | ||
| Consistency. | 21 | ||
| Surface Texture. | 21 | ||
| Position. | 22 | ||
| Continuous Tooth Eruption. | 22 | ||
| Periodontal Ligament | 23 | ||
| Periodontal Fibers | 23 | ||
| Cellular Elements | 25 | ||
| Ground Substance | 25 | ||
| Functions of Periodontal Ligament | 26 | ||
| Physical Functions. | 26 | ||
| Resistance to Impact of Occlusal Forces (Shock Absorption). | 26 | ||
| Transmission of Occlusal Forces to Bone. | 26 | ||
| Formative and Remodeling Function. | 27 | ||
| Nutritional and Sensory Functions. | 27 | ||
| Regulation of Periodontal Ligament Width. | 28 | ||
| Cementum | 28 | ||
| Permeability of Cementum | 29 | ||
| Cementoenamel Junction | 29 | ||
| Cementodentinal Junction | 29 | ||
| Thickness of Cementum | 29 | ||
| Cementum Resorption and Repair | 30 | ||
| Ankylosis. | 31 | ||
| Exposure of Cementum to the Oral Environment | 31 | ||
| Alveolar Process | 31 | ||
| Cells and Intercellular Matrix | 33 | ||
| Socket Wall | 33 | ||
| Bone Marrow | 34 | ||
| Periosteum and Endosteum | 34 | ||
| Interdental Septum | 35 | ||
| Osseous Topography | 35 | ||
| Fenestration and Dehiscence | 36 | ||
| Remodeling of Alveolar Bone | 36 | ||
| Development of the Attachment Apparatus | 36 | ||
| Cementum | 37 | ||
| Periodontal Ligament | 37 | ||
| Alveolar Bone | 37 | ||
| Physiologic Migration of the Teeth | 37 | ||
| External Forces and the Periodontium | 37 | ||
| Vascularization of the Supporting Structures | 38 | ||
| References | 39 | ||
| Suggested Readings | 39 | ||
| References | 39.e1 | ||
| 2 Aging and the Periodontium | 40 | ||
| Chapter Outline | 40 | ||
| Effects of Aging on the Periodontium | 40 | ||
| Gingival Epithelium | 40 | ||
| Gingival Connective Tissue | 40 | ||
| Periodontal Ligament | 42 | ||
| Cementum | 42 | ||
| Alveolar Bone | 42 | ||
| Bacterial Plaque | 42 | ||
| Immune and Inflammatory Responses | 43 | ||
| Effects of Aging on the Progression of Periodontal Diseases | 43 | ||
| Aging and the Response to Treatment of the Periodontium | 43 | ||
| References | 44 | ||
| Suggested Readings | 44 | ||
| References | 44.e1 | ||
| II Classification and Epidemiology of Periodontal Diseases | 45 | ||
| 3 Classification of Diseases and Conditions Affecting the Periodontium | 45 | ||
| Chapter Outline | 45 | ||
| Gingival Diseases | 45 | ||
| Dental-Plaque–Induced Gingival Diseases | 45 | ||
| Gingivitis Associated with Dental Plaque Only. | 45 | ||
| Gingival Diseases Modified by Systemic Factors. | 45 | ||
| Gingival Diseases Modified by Medications. | 46 | ||
| Gingival Diseases Modified by Malnutrition. | 47 | ||
| Non–Plaque-Induced Gingival Lesions | 47 | ||
| Gingival Diseases of Specific Bacterial Origin. | 48 | ||
| Gingival Diseases of Viral Origin. | 48 | ||
| Gingival Diseases of Fungal Origin. | 48 | ||
| Gingival Diseases of Genetic Origin. | 49 | ||
| Gingival Manifestations of Systemic Conditions. | 49 | ||
| Traumatic Lesions. | 49 | ||
| Foreign-Body Reactions. | 50 | ||
| Periodontitis | 50 | ||
| Chronic Periodontitis | 52 | ||
| Aggressive Periodontitis | 54 | ||
| Periodontitis as a Manifestation of Systemic Disease | 55 | ||
| Bisphosphonate-Related Osteonecrosis of the Jaw | 59 | ||
| Necrotizing Periodontal Diseases | 60 | ||
| Necrotizing Ulcerative Gingivitis | 61 | ||
| Necrotizing Ulcerative Periodontitis | 61 | ||
| Abscesses of the Periodontium | 61 | ||
| Periodontitis Associated With Endodontic Lesions | 61 | ||
| Endodontic–Periodontal Lesions | 61 | ||
| Periodontal–Endodontic Lesions | 62 | ||
| Combined Lesions | 62 | ||
| Developmental or Acquired Deformities and Conditions | 63 | ||
| Localized Tooth-Related Factors That Modify or Predispose Individuals to Plaque-Induced Gingival Diseases or Periodontitis | 63 | ||
| Tooth Anatomic Factors. | 63 | ||
| Dental Restorations and Appliances. | 63 | ||
| Root Fractures. | 63 | ||
| Cervical Root Resorption and Cemental Tears. | 63 | ||
| Mucogingival Deformities and Conditions Around the Teeth | 63 | ||
| Mucogingival Deformities and Conditions of the Edentulous Ridges | 63 | ||
| Occlusal Trauma | 66 | ||
| References | 67 | ||
| Suggested Readings | 66 | ||
| References | 67.e1 | ||
| 4 Fundamentals in the Methods of Periodontal Disease Epidemiology | 68 | ||
| Chapter Outline | 68 | ||
| The Need For Epidemiology | 68 | ||
| Measuring the Occurrence of Conditions or Diseases | 68 | ||
| Periodontal Conditions Typically Measured Clinically | 69 | ||
| Translating Periodontal Conditions into Traditional Epidemiologic Measures of Disease Occurrence | 70 | ||
| True and Surrogate Measures of the Periodontal Condition | 70 | ||
| Challenges of Obtaining Epidemiologic Measures of Periodontal Conditions and Diseases | 70 | ||
| Epidemiologic Study Designs | 71 | ||
| Randomized Controlled Trials | 71 | ||
| Cohort Studies | 72 | ||
| Case–Control Studies | 72 | ||
| Causes | 72 | ||
| Suspected Modifiable Causative Factors for Periodontal Disease | 73 | ||
| Tobacco Smoking. | 73 | ||
| Nutrition. | 73 | ||
| Dental Plaque. | 73 | ||
| The Cause of Periodontal Disease for the Patient Sitting in Your Chair | 74 | ||
| Diagnosis | 74 | ||
| Periodontal Conditions Versus Periodontal Diseases | 74 | ||
| Diagnostic Tests Available to Assess Periodontal Conditions | 74 | ||
| Translating Periodontal Diagnostic Test Results into Periodontal Disease Diagnosis | 74 | ||
| Normative or Arbitrary Values to Diagnose Periodontal Disease. | 74 | ||
| Risk-Based Reference Values to Diagnose Periodontal Disease. | 74 | ||
| Therapeutic Reference Values to Diagnose Periodontal Disease. | 75 | ||
| Periodontal Disease Diagnoses | 75 | ||
| References | 75 | ||
| Suggested Readings | 75 | ||
| References | 75.e1 | ||
| III Etiology of Periodontal Diseases | 76 | ||
| 5 Periodontal Pathogenesis | 76 | ||
| Chapter Outline | 76 | ||
| Histopathology of Periodontal Disease | 77 | ||
| Clinically Healthy Gingival Tissues | 77 | ||
| Histopathology of Gingivitis and Periodontitis | 78 | ||
| The Initial Lesion. | 79 | ||
| The Early Lesion. | 79 | ||
| The Established Lesion. | 80 | ||
| The Advanced Lesion. | 80 | ||
| Inflammatory Responses in the Periodontium | 81 | ||
| Microbial Virulence Factors | 81 | ||
| Lipopolysaccharide. | 81 | ||
| Bacterial Enzymes and Noxious Products. | 81 | ||
| Microbial Invasion. | 82 | ||
| Fimbriae. | 82 | ||
| Bacterial Deoxyribonucleic Acid and Extracellular Deoxyribonucleic Acid. | 82 | ||
| Host-Derived Inflammatory Mediators | 83 | ||
| Cytokines. | 83 | ||
| Prostaglandins. | 83 | ||
| Matrix Metalloproteinases. | 83 | ||
| Role of Specific Inflammatory Mediators in Periodontal Disease | 84 | ||
| Interleukin-1 Family Cytokines. | 84 | ||
| Other Interleukin-1 Family Cytokines. | 85 | ||
| Tumor Necrosis Factor-α. | 85 | ||
| Interleukin-6 and Related Cytokines. | 86 | ||
| Prostaglandin E2. | 86 | ||
| Matrix Metalloproteinases. | 86 | ||
| Chemokines. | 87 | ||
| Anti-inflammatory Cytokines. | 87 | ||
| Linking Pathogenesis to Clinical Signs of Disease | 88 | ||
| Alveolar Bone Resorption | 88 | ||
| Receptor Activator of Nuclear Factor-κβ Ligand and Osteoprotegerin | 89 | ||
| Resolution of Inflammation | 89 | ||
| Lipoxins | 89 | ||
| Resolvins and Protectins | 89 | ||
| Immune Responses in Periodontal Pathogenesis | 90 | ||
| Innate Immunity | 90 | ||
| Saliva. | 90 | ||
| Epithelial Tissues. | 91 | ||
| Gingival Crevicular Fluid. | 92 | ||
| Pathogen Recognition and Activation of Cellular Innate Responses. | 92 | ||
| Neutrophil Function. | 92 | ||
| Adaptive Immunity | 94 | ||
| Antigen-Presenting Cells. | 94 | ||
| T Cells. | 95 | ||
| Antibodies. | 97 | ||
| Concept of Host Susceptibility | 97 | ||
| References | 100 | ||
| Suggested Readings | 100 | ||
| References | 100.e1 | ||
| 6 Genetic Susceptibility to Periodontal Disease | 101 | ||
| Chapter Outline | 101 | ||
| Genetic and Genomic Methods of the 21st Century | 102 | ||
| Patterns in Populations and Pedigrees | 102 | ||
| Searching for Answers in the DNA | 105 | ||
| Inherited Variation and Risk of Periodontitis | 107 | ||
| Periodontitis in Genetic Syndromes and Other Diseases | 107 | ||
| Nonsyndromic Aggressive and Chronic Periodontitis | 109 | ||
| Challenges and Opportunities for the Future | 112 | ||
| Using Genetics for Personalized Treatment | 113 | ||
| Pharmacogenomics and Individualized Dentistry | 113 | ||
| Acknowledgments | 114 | ||
| References | 115 | ||
| Suggested Readings | 114 | ||
| References | 115.e1 | ||
| 7 The Role of Dental Calculus and Other Local Predisposing Factors | 116 | ||
| Chapter Outline | 116 | ||
| Calculus | 116 | ||
| Supragingival and Subgingival Calculus | 116 | ||
| Prevalence | 116 | ||
| Composition | 117 | ||
| Inorganic Content. | 117 | ||
| Organic Content. | 117 | ||
| Attachment to the Tooth Surface | 118 | ||
| Formation | 118 | ||
| Theories Regarding the Mineralization of Calculus. | 120 | ||
| Role of Microorganisms in the Mineralization of Calculus. | 120 | ||
| Etiologic Significance | 120 | ||
| Materia Alba, Food Debris, and Dental Stains | 121 | ||
| Other Predisposing Factors | 121 | ||
| Iatrogenic Factors | 121 | ||
| Margins of Restorations. | 121 | ||
| Retained Cement/Periimplantitis. | 122 | ||
| Contours/Open Contacts. | 123 | ||
| Materials. | 124 | ||
| Design of Removable Partial Dentures. | 124 | ||
| Restorative Dentistry Procedures. | 124 | ||
| Malocclusion | 124 | ||
| Periodontal Complications Associated with Orthodontic Therapy | 125 | ||
| Plaque Retention and Composition. | 126 | ||
| Gingival Trauma and Alveolar Bone Height. | 126 | ||
| Tissue Response to Orthodontic Forces. | 126 | ||
| Extraction of Impacted Third Molars | 127 | ||
| Habits and Self-Inflicted Injuries | 127 | ||
| Trauma Associated with Oral Jewelry. | 128 | ||
| Toothbrush Trauma. | 128 | ||
| Chemical Irritation. | 129 | ||
| Smokeless Tobacco | 129 | ||
| Radiation Therapy | 130 | ||
| References | 131 | ||
| Suggested Readings | 131 | ||
| References | 131.e1 | ||
| 8 Biofilm and Periodontal Microbiology | 132 | ||
| Chapter Outline | 132 | ||
| The Oral Cavity From a Microbe’s Perspective | 135 | ||
| Bacteria and Their Biofilm Mode of Living | 138 | ||
| Structure of a Mature Dental Plaque Biofilm | 141 | ||
| Accumulation of a Dental Plaque Biofilm | 144 | ||
| Formation of the Pellicle. | 144 | ||
| Initial Adhesion/Attachment of Bacteria. | 144 | ||
| Phase 1: Transport to the Surface. | 144.e1 | ||
| Phase 2: Initial Adhesion. | 144.e1 | ||
| Phase 3: Strong Attachment. | 144.e1 | ||
| Colonization and Plaque Maturation. | 144 | ||
| Factors That Affect Supragingival Dental Plaque Formation | 145 | ||
| Topography of Supragingival Plaque. | 145 | ||
| Surface Microroughness. | 147 | ||
| Individual Variables That Influence Plaque Formation. | 147 | ||
| Variation Within the Dentition. | 148 | ||
| Impact of Gingival Inflammation and Saliva. | 148 | ||
| Impact of Patient’s Age. | 148 | ||
| Spontaneous Tooth Cleaning. | 148 | ||
| De Novo Subgingival Plaque Formation | 149 | ||
| Characteristics of Biofilm Bacteria (Life in “Slime City”) | 149 | ||
| Metabolism of Dental Plaque Bacteria | 149 | ||
| Communication Between Biofilm Bacteria | 150 | ||
| Interactions Between Dental Plaque Bacteria | 150 | ||
| Biofilms and Antimicrobial Resistance | 151 | ||
| Bacterial Transmission and Translocation | 151 | ||
| Nonbacterial Inhabitants of the Oral Cavity | 152 | ||
| Viruses | 152 | ||
| Herpesviruses. | 152.e1 | ||
| Papillomaviruses. | 152.e1 | ||
| Picornaviruses/Enteroviruses. | 152.e1 | ||
| Retroviruses. | 152.e1 | ||
| Clinical Manifestations of Oral Viral Diseases | 153 | ||
| Oral Ulcers. | 153 | ||
| Oral Tumors. | 153 | ||
| Other Oral Pathologies. | 153 | ||
| Periodontitis. | 153 | ||
| Yeasts | 156 | ||
| Protozoa | 156 | ||
| Archaea | 157 | ||
| Microbiologic Specificity of Periodontal Diseases | 157 | ||
| Nonspecific Plaque Hypothesis | 157 | ||
| Specific Plaque Hypothesis | 157 | ||
| Ecological Plaque Hypothesis | 158 | ||
| Complicating Factors | 158 | ||
| Criteria for the Identification of Periodontopathogens | 157.e1 | ||
| The Transition From Health to Disease | 160 | ||
| Host Susceptibility | 161 | ||
| Pathogenic Bacteria | 161 | ||
| Beneficial Species | 162 | ||
| Periodontal Health | 162 | ||
| Gingivitis | 162 | ||
| Chronic Periodontitis | 163 | ||
| Localized Aggressive Periodontitis | 165 | ||
| Aggressive Periodontitis | 165 | ||
| Necrotizing Periodontal Diseases | 166 | ||
| Abscesses of the Periodontium | 166 | ||
| Periimplantitis | 167 | ||
| Virulence Factors of Periodontopathogens | 167 | ||
| Adhesive Surface Proteins and Fibrils | 167 | ||
| Tissue-Destruction–Promoting Factors | 167 | ||
| Strategies for Evading Host Immunity | 168 | ||
| Future Advances in Periodontal Microbiology | 168 | ||
| References | 169 | ||
| Suggested Readings | 169 | ||
| References | 169.e1 | ||
| 9 Molecular Biology of Host-Microbe Interactions | 170 | ||
| Chapter Outline | 170 | ||
| Innate Immunity in Periodontal Diseases | 171 | ||
| Vigilance and Tolerance | 171 | ||
| Defensins. | 174.e1 | ||
| Cell Signaling Pathways and the Expression of Biologically Active Mediators in the Innate Immune Response | 174 | ||
| Inflammasomes. | 174.e3 | ||
| Complement Systems. | 174.e4 | ||
| Adaptive Immunity in Periodontal Diseases | 174 | ||
| Activation of Adaptive Immunity in Periodontal Diseases | 174 | ||
| Host–Microbe Interactions in Adaptive Immunity | 174.e6 | ||
| Pathobiology of Periodontal Disease Progression | 174 | ||
| Cytokines and Mediators of Inflammation | 174 | ||
| Cell Signaling Events That Modulate Inflammatory Mediator Expression | 176 | ||
| Therapeutic Strategies for Disrupting Host-Cell Signaling in the Treatment of Periodontal Diseases | 177 | ||
| References | 177 | ||
| Suggested Readings | 177 | ||
| References | 177.e1 | ||
| 10 Smoking and Periodontal Disease | 178 | ||
| Chapter Outline | 178 | ||
| The Smoking Epidemic | 178 | ||
| Effects of Smoking on the Prevalence and Severity of Periodontal Diseases | 179 | ||
| Gingivitis | 179 | ||
| Periodontitis | 179 | ||
| Effects of Smoking on the Etiology and Pathogenesis of Periodontal Disease | 180 | ||
| Microbiology | 180 | ||
| Immune–Inflammatory Responses | 182 | ||
| Physiology | 183 | ||
| Effects of Smoking on Response to Periodontal Therapy | 183 | ||
| Nonsurgical Therapy | 183 | ||
| Surgical Therapy and Implants | 184 | ||
| Maintenance Therapy | 184 | ||
| Effects of Smoking Cessation on Periodontal Treatment Outcomes | 184 | ||
| References | 185 | ||
| Suggested Readings | 185 | ||
| References | 185.e1 | ||
| IV Relationship Between Periodontal Disease and Systemic Health | 186 | ||
| 11 Influence of Systemic Conditions | 186 | ||
| Chapter Outline | 186 | ||
| Endocrine Disorders and Hormonal Changes | 186 | ||
| Diabetes Mellitus | 186 | ||
| Oral Manifestations. | 187 | ||
| Bacterial Pathogens. | 188 | ||
| Polymorphonuclear Leukocyte Function. | 188 | ||
| Altered Collagen Metabolism. | 189 | ||
| Female Sex Hormones | 189 | ||
| Puberty. | 189.e1 | ||
| Menstruation. | 189.e1 | ||
| Pregnancy. | 189.e1 | ||
| Hormonal Contraceptives. | 189.e2 | ||
| Menopause. | 189.e2 | ||
| Hyperparathyroidism | 189.e2 | ||
| Hematologic Disorders and Immune Deficiencies | 190 | ||
| Leukocyte (Neutrophil) Disorders | 191 | ||
| Neutropenia. | 191 | ||
| Agranulocytosis. | 191 | ||
| Leukemia | 191 | ||
| The Periodontium in Leukemic Patients. | 192 | ||
| Leukemic Infiltration. | 192 | ||
| Bleeding. | 192 | ||
| Oral Ulceration and Infection. | 194 | ||
| Anemia | 189.e3 | ||
| Thrombocytopenia | 189.e4 | ||
| Antibody Deficiency Disorders | 189.e4 | ||
| Genetic Disorders | 195 | ||
| Chédiak–Higashi Syndrome | 195.e1 | ||
| Lazy Leukocyte Syndrome | 195.e1 | ||
| Leukocyte Adhesion Deficiency | 195.e1 | ||
| Papillon–Lefèvre Syndrome | 195.e1 | ||
| Down Syndrome | 195.e2 | ||
| Stress and Psychosomatic Disorders | 195 | ||
| Psychosocial Stress, Depression, and Coping | 195 | ||
| Stress-Induced Immunosuppression | 196 | ||
| Influence of Stress on Periodontal Therapy Outcomes | 196 | ||
| Psychiatric Influence of Self-Inflicted Injury | 197 | ||
| Nutritional Influences | 197 | ||
| Fat-Soluble Vitamin Deficiency | 197.e1 | ||
| Vitamin A Deficiency. | 197.e1 | ||
| Vitamin D Deficiency. | 197.e1 | ||
| Vitamin E Deficiency. | 197.e1 | ||
| Water-Soluble Vitamin Deficiency | 197.e1 | ||
| B-Complex Deficiency. | 197.e1 | ||
| Vitamin C (Ascorbic Acid) Deficiency. | 197.e2 | ||
| Possible Etiologic Factors. | 197.e2 | ||
| Epidemiologic Studies. | 197.e2 | ||
| Gingivitis. | 197.e2 | ||
| Periodontitis. | 197.e2 | ||
| Summary. | 197.e3 | ||
| Protein Deficiency | 197.e3 | ||
| Medications | 197 | ||
| Bisphosphonates | 197 | ||
| Bisphosphonates and Periodontal Bone Loss | 200 | ||
| Corticosteroids | 200 | ||
| Other Systemic Conditions | 197.e3 | ||
| Osteoporosis | 197.e3 | ||
| Congenital Heart Disease | 197.e4 | ||
| Tetralogy of Fallot. | 197.e5 | ||
| Eisenmenger’s Syndrome. | 197.e5 | ||
| Hypophosphatasia | 197.e5 | ||
| Metal Intoxication | 197.e5 | ||
| Bismuth Intoxication. | 197.e5 | ||
| Lead Intoxication. | 197.e5 | ||
| Mercury Intoxication. | 197.e5 | ||
| Other Chemicals. | 197.e6 | ||
| References | 201 | ||
| Suggested Reading | 201 | ||
| References | 201.e1 | ||
| 12 Impact of Periodontal Infection on Systemic Health | 202 | ||
| Chapter Outline | 202 | ||
| Pathobiology of Periodontitis | 202 | ||
| Focal Infection Theory Revisited | 203 | ||
| Evidence-Based Clinical Practice | 203 | ||
| Subgingival Environment as a Reservoir for Bacteria | 204 | ||
| Periodontal Disease and Mortality | 204 | ||
| Periodontal Disease and Coronary Heart Disease/Atherosclerosis | 205 | ||
| Effect of Periodontal Infection | 206 | ||
| Ischemic Heart Disease. | 206 | ||
| Systemic Infections. | 206 | ||
| Daily Activity. | 207 | ||
| Thrombogenesis. | 207 | ||
| Atherosclerosis. | 207 | ||
| Role of Periodontal Disease in Myocardial or Cerebral Infarction | 208 | ||
| Role of Periodontal Disease in Erectile Dysfunction | 209 | ||
| Periodontal Disease and Stroke | 209 | ||
| Periodontal Infection Associated with Stroke | 209 | ||
| Periodontal Disease and Diabetes Mellitus | 210 | ||
| Periodontal Infection Associated with Glycemic Control in Diabetes | 211 | ||
| Periodontal Disease and Pregnancy Outcome | 202.e1 | ||
| Bacterial Vaginosis | 202.e1 | ||
| Role of Periodontitis | 202.e2 | ||
| Periodontal Disease and Chronic Obstructive Pulmonary Disease | 202.e3 | ||
| Periodontal Disease and Acute Respiratory Infections | 202.e4 | ||
| Periodontal Medicine in Clinical Practice | 211 | ||
| Periodontal Disease and Systemic Health | 212 | ||
| Patient Education | 212 | ||
| Conclusions | 212 | ||
| References | 213 | ||
| Suggested Reading | 213 | ||
| References | 213.e1 | ||
| V Gingival Pathology | 214 | ||
| 13 Defense Mechanisms of the Gingiva | 214 | ||
| Chapter Outline | 214 | ||
| Sulcular Fluid | 214 | ||
| Methods of Collection | 214 | ||
| Permeability of Junctional and Sulcular Epithelia | 214 | ||
| Amount | 215 | ||
| Composition | 215 | ||
| Cellular Elements. | 215 | ||
| Electrolytes. | 215 | ||
| Organic Compounds. | 215 | ||
| Cellular and Humoral Activity in Gingival Crevicular Fluid | 216 | ||
| Clinical Significance | 216 | ||
| Circadian Periodicity. | 216 | ||
| Sex Hormones. | 216 | ||
| Mechanical Stimulation. | 216 | ||
| Smoking. | 216 | ||
| Periodontal Therapy. | 216 | ||
| Drugs in Gingival Crevicular Fluid | 216 | ||
| Leukocytes in the Dentogingival Area | 216 | ||
| Saliva | 217 | ||
| Antibacterial Factors | 217 | ||
| Salivary Antibodies | 217 | ||
| Enzymes | 217 | ||
| Salivary Buffers and Coagulation Factors | 218 | ||
| Leukocytes | 218 | ||
| Role in Periodontal Pathology | 218 | ||
| References | 218 | ||
| Suggested Readings | 218 | ||
| References | 218.e1 | ||
| 14 Gingival Inflammation | 219 | ||
| Chapter Outline | 219 | ||
| Stage I Gingival Inflammation: The Initial Lesion | 219 | ||
| Stage II Gingival Inflammation: The Early Lesion | 220 | ||
| Stage III Gingival Inflammation: The Established Lesion | 220 | ||
| Stage IV Gingival Inflammation: The Advanced Lesion | 223 | ||
| References | 223 | ||
| Suggested Readings | 223 | ||
| References | 223.e1 | ||
| 15 Clinical Features of Gingivitis | 224 | ||
| Chapter Outline | 224 | ||
| Course and Duration | 224 | ||
| Description | 224 | ||
| Clinical Findings | 224 | ||
| Gingival Bleeding on Probing | 225 | ||
| Gingival Bleeding Caused by Local Factors | 226 | ||
| Chronic and Recurrent Bleeding. | 226 | ||
| Gingival Bleeding Associated with Systemic Changes | 227 | ||
| Color Changes in the Gingiva | 227 | ||
| Color Changes with Gingivitis. | 227 | ||
| Metallic Pigmentation. | 227 | ||
| Color Changes Associated with Systemic Factors | 228 | ||
| Changes in the Consistency of the Gingiva | 228 | ||
| Calcified Masses in the Gingiva. | 228 | ||
| Toothbrushing. | 229 | ||
| Changes in the Surface Texture of the Gingiva | 229 | ||
| Changes in the Position of the Gingiva | 229 | ||
| Traumatic Lesions. | 229 | ||
| Gingival Recession. | 229 | ||
| Positions of the Gingiva. | 229 | ||
| Clinical Significance. | 230 | ||
| Changes in Gingival Contour | 230 | ||
| References | 231 | ||
| Suggested Readings | 230 | ||
| References | 231.e1 | ||
| 16 Gingival Enlargement | 232 | ||
| Chapter Outline | 232 | ||
| Inflammatory Enlargement | 232 | ||
| Chronic Inflammatory Enlargement | 232 | ||
| Clinical Features. | 232 | ||
| 2 Clinical Periodontics | 357 | ||
| I Diagnosis, Prognosis, and Treatment Plan | 357 | ||
| 29 Clinical Diagnosis | 357 | ||
| Chapter Outline | 357 | ||
| First Visit | 357 | ||
| Overall Appraisal of the Patient | 357 | ||
| Medical History | 357 | ||
| Dental History | 358 | ||
| Current Illness. | 358 | ||
| Intraoral Radiographic Survey | 361 | ||
| Casts | 361 | ||
| Clinical Photographs | 362 | ||
| Review of the Initial Examination | 362 | ||
| Second Visit | 362 | ||
| Oral Examination | 362 | ||
| Oral Hygiene. | 362 | ||
| Oral Malodor. | 362 | ||
| Examination of the Oral Cavity. | 362 | ||
| Examination of the Lymph Nodes. | 362 | ||
| Examination of the Teeth and Implants | 362 | ||
| Wasting Disease of the Teeth. | 362 | ||
| Dental Stains. | 363 | ||
| Hypersensitivity. | 363 | ||
| Proximal Contact Relations. | 363 | ||
| Tooth Mobility. | 364 | ||
| Trauma from Occlusion. | 365 | ||
| Pathologic Migration of the Teeth. | 365 | ||
| Sensitivity to Percussion. | 365 | ||
| Dentition With the Jaws Closed. | 365 | ||
| Functional Occlusal Relationships. | 366 | ||
| Examination of the Periodontium | 366 | ||
| Plaque and Calculus. | 366 | ||
| Gingiva. | 366 | ||
| Use of Clinical Indices in Dental Practice. | 366 | ||
| Periodontal Pockets. | 366 | ||
| Signs and Symptoms. | 366 | ||
| Detection of Pockets. | 366 | ||
| Pocket Probing. | 366 | ||
| Probing Technique. | 369 | ||
| Level of Attachment Versus Pocket Depth. | 370 | ||
| Determining the Level of Attachment. | 370 | ||
| Bleeding on Probing. | 370 | ||
| When to Probe. | 370 | ||
| Probing Around Implants. | 370 | ||
| Automatic and Electronic Periodontal Probing. | 370 | ||
| Probing Force. | 370 | ||
| Probe Angulation. | 370 | ||
| Determination of Disease Activity. | 371 | ||
| Amount of Attached Gingiva. | 371 | ||
| Degree of Gingival Recession. | 372 | ||
| Alveolar Bone Loss. | 372 | ||
| Palpation. | 373 | ||
| Suppuration. | 373 | ||
| Periodontal Abscess. | 373 | ||
| Periodontal Abscess and Gingival Abscess. | 374 | ||
| Periodontal Abscess and Periapical Abscess. | 374 | ||
| Laboratory Aids to Clinical Diagnosis | 374 | ||
| References | 374 | ||
| Suggested Readings | 374 | ||
| References | 374.e1 | ||
| 30 Significance of Clinical and Biologic Information | 375 | ||
| Chapter Outline | 375 | ||
| Tangible versus Intangible Benefits | 375 | ||
| Size of the Treatment Effect | 375 | ||
| Defining Four Levels of Clinical Significance | 376 | ||
| Clinical Significance Level 1 | 376 | ||
| Clinical Significance Level 2 | 376 | ||
| Clinical Significance Level 3 | 377 | ||
| Clinical Significance Level 4 | 377 | ||
| Conclusion | 377 | ||
| References | 377 | ||
| Suggested Readings | 377 | ||
| References | 377.e1 | ||
| 31 Radiographic Aids in the Diagnosis of Periodontal Disease | 378 | ||
| Chapter Outline | 378 | ||
| Normal Interdental Bone | 378 | ||
| Radiographic Techniques | 378 | ||
| Bone Destruction in Periodontal Disease | 378 | ||
| Bone Loss | 379 | ||
| Amount. | 379 | ||
| Distribution. | 379 | ||
| Pattern of Bone Destruction | 379 | ||
| Radiographic Appearance of Periodontal Disease | 380 | ||
| Periodontitis | 380 | ||
| Interdental Craters | 382 | ||
| Furcation Involvement | 383 | ||
| Periodontal Abscess | 383 | ||
| Clinical Probing | 383 | ||
| Localized Aggressive Periodontitis | 385 | ||
| Trauma from Occlusion | 385 | ||
| Digital Intraoral Radiography | 386 | ||
| Advanced Imaging Modalities | 387 | ||
| Conclusion | 387 | ||
| References | 390 | ||
| Suggested Readings | 390 | ||
| References | 390.e1 | ||
| 32 Clinical Risk Assessment | 391 | ||
| Chapter Outline | 391 | ||
| Definitions | 391 | ||
| Risk Factors for Periodontal Disease | 391 | ||
| Tobacco Smoking | 391 | ||
| Diabetes | 391 | ||
| Pathogenic Bacteria and Microbial Tooth Deposits | 391 | ||
| Risk Determinants/Background Characteristics for Periodontal Disease | 392 | ||
| Genetic Factors | 392 | ||
| Age | 392 | ||
| Gender | 392 | ||
| Socioeconomic Status | 393 | ||
| Stress | 393 | ||
| Risk Indicators for Periodontal Disease | 393.e1 | ||
| Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome | 393.e1 | ||
| Osteoporosis | 393.e1 | ||
| Infrequent Dental Visits | 393.e1 | ||
| Risk Markers/Predictors for Periodontal Disease | 393.e1 | ||
| Previous History of Periodontal Disease | 393.e1 | ||
| Bleeding on Probing | 393.e1 | ||
| Clinical Risk Assessment for Periodontal Disease | 393.e1 | ||
| Conclusion | 393 | ||
| References | 393 | ||
| Suggested Readings | 393 | ||
| References | 393.e4 | ||
| 33 Determination of Prognosis | 394 | ||
| Chapter Outline | 394 | ||
| Definitions | 394 | ||
| Types of Prognosis | 394 | ||
| Overall Versus Individual Tooth Prognosis | 395 | ||
| Factors in Determination of Prognosis | 395 | ||
| Overall Clinical Factors | 395 | ||
| Patient Age. | 395 | ||
| Disease Severity. | 395 | ||
| Plaque Control. | 396 | ||
| Patient Compliance and Cooperation. | 396 | ||
| Systemic and Environmental Factors | 396 | ||
| Smoking. | 396 | ||
| Systemic Disease or Condition. | 396 | ||
| Genetic Factors. | 397 | ||
| Stress. | 398 | ||
| Local Factors | 398 | ||
| Plaque and Calculus. | 398 | ||
| Subgingival Restorations. | 398 | ||
| Anatomic Factors. | 398 | ||
| Tooth Mobility. | 400 | ||
| Prosthetic and Restorative Factors | 400 | ||
| Caries, Nonvital Teeth, and Root Resorption. | 401 | ||
| Relationship Between Diagnosis and Prognosis | 401 | ||
| Prognosis for Patients with Gingival Disease | 401 | ||
| Dental Plaque–Induced Gingival Diseases | 401 | ||
| Gingivitis Associated with Dental Plaque Only. | 401 | ||
| Plaque-Induced Gingival Diseases Modified by Systemic Factors. | 401 | ||
| Plaque-Induced Gingival Diseases Modified by Medications. | 401 | ||
| Gingival Diseases Modified by Malnutrition. | 401 | ||
| Non–Plaque-Induced Gingival Lesions. | 401 | ||
| Prognosis for Patients with Periodontitis | 401 | ||
| Chronic Periodontitis. | 401 | ||
| Aggressive Periodontitis. | 402 | ||
| Periodontitis as Manifestation of Systemic Diseases. | 402 | ||
| Necrotizing Periodontal Diseases. | 402 | ||
| Reevaluation of Prognosis After Phase I Therapy | 403 | ||
| References | 403 | ||
| Suggested Readings | 403 | ||
| References | 403.e1 | ||
| 34 Rationale for Periodontal Treatment | 404 | ||
| Chapter Outline | 404 | ||
| What Does Periodontal Therapy Accomplish? | 404 | ||
| Local Therapy | 404 | ||
| Systemic Therapy | 404 | ||
| Factors That Affect Healing | 404 | ||
| Local Factors | 404 | ||
| Systemic Factors | 405 | ||
| Healing After Periodontal Therapy | 405 | ||
| Regeneration | 406 | ||
| Repair | 406 | ||
| New Attachment | 406 | ||
| Periodontal Reconstruction | 407 | ||
| References | 407 | ||
| Suggested Readings | 407 | ||
| References | 407.e1 | ||
| 35 The Treatment Plan | 408 | ||
| Chapter Outline | 408 | ||
| Master Plan for Total Treatment | 408 | ||
| Extracting or Preserving a Tooth | 408 | ||
| Sequence of Therapeutic Procedures | 409 | ||
| Explaining Treatment Plan to the Patient | 410 | ||
| II Management of Patients with Special Needs | 411 | ||
| 36 Conscious Sedation | 411 | ||
| Chapter Outline | 411 | ||
| Rationale for Sedation During Periodontal and Implant Surgical Procedures | 411 | ||
| ADA Policy Statement and Guidelines for Conscious Sedation | 411 | ||
| ADA Policy Statement: The Use of Sedation and General Anesthesia by Dentists | 411 | ||
| ADA Guidelines for the Use of Sedation and General Anesthesia by Dentists | 412 | ||
| Definitions and Levels of Sedation | 412 | ||
| Pediatric Sedation | 412 | ||
| Adult Sedation | 412 | ||
| Minimal Sedation. | 412 | ||
| Maximum Recommended Dose. | 413 | ||
| Incremental Dosing. | 413 | ||
| Supplemental Dosing. | 413 | ||
| Moderate Sedation. | 413 | ||
| Titration. | 414 | ||
| Deep Sedation. | 414 | ||
| General Anesthesia. | 414 | ||
| Clinical Guidelines for Minimal and Moderate Sedation | 414 | ||
| Patient Evaluation. | 414 | ||
| Preoperative Preparation. | 414 | ||
| Personnel and Equipment. | 415 | ||
| Monitoring. | 415 | ||
| Documentation. | 418 | ||
| Recovery and Discharge. | 418 | ||
| Mild Sedation/Anxiolysis | 411.e1 | ||
| Oral Sedation | 411.e1 | ||
| Guidelines for Mild Sedation with Oral Medications. | 411.e1 | ||
| Inhalation Sedation | 411.e4 | ||
| Induction Phase. | 411.e4 | ||
| Treatment Phase. | 411.e4 | ||
| Recovery Phase. | 411.e4 | ||
| Moderate (Conscious) Sedation | 411.e5 | ||
| Oral Sedation | 411.e5 | ||
| Combined Oral and Inhalation Sedation | 411.e5 | ||
| Intravenous Sedation | 411.e5 | ||
| Single Benzodiazepine Intravenous Sedation Techniques | 411.e5 | ||
| Midazolam Technique. | 411.e5 | ||
| Diazepam Technique. | 411.e5 | ||
| Combination Intravenous Sedation. | 411.e6 | ||
| Meperidine Combined with Diazepam or Midazolam. | 411.e6 | ||
| Fentanyl Combined with Midazolam. | 411.e6 | ||
| Combined Oral and Intravenous Sedation | 411.e6 | ||
| Rationale for Technique. | 411.e6 | ||
| Sedation Failures | 418 | ||
| Emergency Preparedness | 419 | ||
| Conclusion | 419 | ||
| References | 419 | ||
| Suggested Readings | 419 | ||
| References | 419.e1 | ||
| 37 Periodontal Treatment of Medically Compromised Patients | 420 | ||
| Chapter Outline | 420 | ||
| Cardiovascular Diseases | 420 | ||
| Hypertension | 420 | ||
| Ischemic Heart Diseases | 422 | ||
| Congestive Heart Failure | 423 | ||
| Cardiac Pacemakers and Implantable Cardioverter-Defibrillators | 423 | ||
| Infective Endocarditis | 423 | ||
| Cerebrovascular Accident | 425 | ||
| Endocrine Disorders | 425 | ||
| Diabetes | 425 | ||
| Thyroid and Parathyroid Disorders | 420.e1 | ||
| Adrenal Insufficiency | 420.e1 | ||
| Hemorrhagic Disorders | 428 | ||
| Coagulation Disorders | 428 | ||
| Anticoagulant Medications. | 430 | ||
| Antiplatelet Medications. | 430 | ||
| Thrombocytopenic Purpuras | 420.e2 | ||
| Nonthrombocytopenic Purpuras | 420.e2 | ||
| Blood Dyscrasias | 420.e2 | ||
| Leukemia | 431 | ||
| Agranulocytosis | 431 | ||
| Renal Diseases | 420.e2 | ||
| Liver Diseases | 420.e3 | ||
| Pulmonary Diseases | 420.e3 | ||
| Medications and Cancer Therapies | 431 | ||
| Bisphosphonates | 431 | ||
| Anticoagulant/Antiplatelet Therapy | 432 | ||
| Corticosteroids | 432 | ||
| Immunosuppression and Chemotherapy | 433 | ||
| Radiation Therapy | 433 | ||
| Prosthetic Joint Replacement | 435 | ||
| Recommendation 1. | 435 | ||
| Recommendation 2. | 435 | ||
| Recommendation 3. | 435 | ||
| Pregnancy | 420.e3 | ||
| Infectious Diseases | 420.e4 | ||
| Hepatitis | 420.e4 | ||
| HIV and AIDS | 420.e5 | ||
| Tuberculosis | 420.e6 | ||
| References | 436 | ||
| Suggested Readings | 436 | ||
| References | 436.e1 | ||
| 38 Periodontal Therapy in the Female Patient | 437 | ||
| Chapter Outline | 437 | ||
| Puberty | 437 | ||
| Management | 437 | ||
| Menses | 438 | ||
| Periodontal Manifestations | 438 | ||
| Management | 439 | ||
| Pregnancy | 439 | ||
| Periodontal Manifestations | 439 | ||
| Role of Pregnancy Hormones | 440 | ||
| Subgingival Plaque Composition. | 440 | ||
| Periodontal Disease and Preterm, Low-Birth-Weight Infant. | 440 | ||
| Preeclampsia. | 441 | ||
| Maternal Immunoresponse | 441 | ||
| Other Oral Manifestations of Pregnancy | 442 | ||
| Clinical Management | 442 | ||
| Plaque Control. | 442 | ||
| Prenatal Fluoride. | 442 | ||
| Treatment | 442 | ||
| Elective Dental Treatment. | 442 | ||
| Dental Radiographs. | 442 | ||
| Medications. | 443 | ||
| Breastfeeding. | 443 | ||
| Oral Contraceptives | 445 | ||
| Management | 445 | ||
| Menopause | 437.e1 | ||
| Oral Changes | 437.e1 | ||
| Clinical Management | 437.e1 | ||
| Conclusion | 445 | ||
| References | 446 | ||
| Suggested Readings | 446 | ||
| References | 446.e1 | ||
| 39 Periodontal Treatment for Older Adults | 447 | ||
| Chapter Outline | 447 | ||
| The Aging Periodontium | 447 | ||
| Intrinsic Changes | 447 | ||
| Stochastic Changes | 447 | ||
| Physiologic Changes | 447 | ||
| Functional Changes | 448 | ||
| Clinical Changes | 448 | ||
| Demographics | 447.e1 | ||
| Population Distribution | 447.e1 | ||
| Health Status | 447.e1 | ||
| Functional Status | 447.e2 | ||
| Nutritional Status | 447.e2 | ||
| Psychosocial Factors | 447.e3 | ||
| Dentate Status | 447.e4 | ||
| Periodontal Status | 447.e5 | ||
| Caries Status | 447.e5 | ||
| Dental Visits | 447.e6 | ||
| Xerostomia | 447.e7 | ||
| Candidiasis | 447.e7 | ||
| Dental and Medical Assessments | 447.e7 | ||
| Review of Dental History | 447.e7 | ||
| Review of Medical History | 447.e7 | ||
| Review of Medication Use | 447.e8 | ||
| Extraoral and Intraoral Examinations | 447.e8 | ||
| Assessment of Risk | 447.e9 | ||
| Quality of Life | 447.e9 | ||
| Periodontal Diseases in Older Adults | 448 | ||
| Etiology | 448 | ||
| Relationship to Systemic Disease | 448 | ||
| Periodontal Treatment Planning | 449 | ||
| Prevention of Periodontal Disease and Maintenance of Periodontal Health in Older Adults | 449 | ||
| Chemotherapeutic Agents | 449 | ||
| Antiplaque Agents. | 449 | ||
| Fluoride. | 450 | ||
| Saliva Substitutes. | 450 | ||
| Risk Reduction | 450.e1 | ||
| Conclusion | 450 | ||
| References | 450 | ||
| Suggested Readings | 450 | ||
| References | 450.e2 | ||
| 40 Treatment of Aggressive and Atypical Forms of Periodontitis | 451 | ||
| Chapter Outline | 451 | ||
| Aggressive Periodontitis | 451 | ||
| Therapeutic Modalities | 451 | ||
| Conventional Periodontal Therapy. | 452 | ||
| Surgical Resective Therapy. | 452 | ||
| Regenerative Therapy. | 452 | ||
| Antimicrobial Therapy. | 452 | ||
| Microbial Testing. | 456 | ||
| Local Delivery. | 457 | ||
| Full-Mouth Disinfection. | 457 | ||
| Host Modulation. | 458 | ||
| Treatment Planning and Restorative Considerations | 458 | ||
| Use of Dental Implants. | 458 | ||
| Clinical Consideration. | 458 | ||
| Periodontal Maintenance | 458 | ||
| Periodontitis Refractory to Treatment | 459.e1 | ||
| Necrotizing Ulcerative Periodontitis | 459 | ||
| References | 459 | ||
| Suggested Readings | 459 | ||
| References | 459.e3 | ||
| III Diagnosis and Treatment of Periodontal Emergencies | 460 | ||
| 41 Treatment of Acute Gingival Disease | 460 | ||
| Chapter Outline | 460 | ||
| Acute Necrotizing Ulcerative Gingivitis | 460 | ||
| First Visit | 460 | ||
| Instructions to the Patient. | 461 | ||
| Second Visit | 461 | ||
| Third Visit | 461 | ||
| Gingival Changes with Healing | 462 | ||
| Additional Treatment Considerations | 462 | ||
| Contouring of Gingiva as Adjunctive Procedure. | 462 | ||
| Role of Drugs. | 462 | ||
| Persistent or Recurrent Cases | 462 | ||
| Acute Pericoronitis | 463 | ||
| Acute Herpetic Gingivostomatitis | 463 | ||
| References | 464 | ||
| Suggested Readings | 464 | ||
| References | 464.e1 | ||
| 42 Treatment of Periodontal Abscess | 465 | ||
| Chapter Outline | 465 | ||
| Classification of Abscesses | 465 | ||
| Periodontal Abscess | 465 | ||
| Gingival Abscess | 465 | ||
| Pericoronal Abscess | 465 | ||
| Acute Versus Chronic Abscess | 465 | ||
| Periodontal Versus Pulpal Abscess | 465 | ||
| Specific Treatment Approaches | 465 | ||
| Acute Abscess | 465 | ||
| Drainage through Periodontal Pocket. | 465 | ||
| Drainage through External Incision. | 467 | ||
| Chronic Abscess | 468 | ||
| Gingival Abscess | 468 | ||
| Pericoronal Abscess | 468 | ||
| References | 469 | ||
| Suggested Readings | 469 | ||
| References | 469.e1 | ||
| 43 Diagnosis and Management of Endodontic-Periodontic Lesions | 470 | ||
| Chapter Outline | 470 | ||
| Anatomic Considerations of the Pulpal and Periodontal Continuum | 470 | ||
| Factors Initiating Pulpal and Apical Diseases | 472 | ||
| Classification of Pulpal and Apical Diseases | 472 | ||
| Biologic Effects of Pulpal Infection on Periodontal Tissues | 472 | ||
| Biologic Effects of Periodontal Infection on the Dental Pulp | 475 | ||
| Differential Diagnosis of Pulpal and Periodontal Infection | 475 | ||
| Patients’ Subjective Symptoms | 476 | ||
| Coronal Integrity | 476 | ||
| Radiographic Appearance | 477 | ||
| Vitality | 477 | ||
| Treatment Considerations of Endodontic-Periodontic Lesions | 477 | ||
| Effect on the Periodontium of Endodontic Procedural Complications and Dental Anomalies | 478 | ||
| Perforations | 478.e1 | ||
| Tooth Fractures | 478.e1 | ||
| Crown-Root Fractures. | 478.e1 | ||
| Horizontal Root Fractures. | 478.e2 | ||
| Horizontal Fractures in the Coronal Area. | 478.e2 | ||
| Horizontal Fractures in the Midroot Area. | 478.e2 | ||
| Horizontal Fractures in the Apical Area. | 478.e3 | ||
| Vertical Root Fractures. | 478.e3 | ||
| Definition. | 478.e3 | ||
| Incidence. | 478.e3 | ||
| Clinical Findings. | 478.e4 | ||
| Sodium Hypochlorite Accident | 478.e5 | ||
| Resorptive Defects | 478.e5 | ||
| Dental Anomalies | 478.e6 | ||
| Dens Invaginatus. | 478.e6 | ||
| Dens Evaginatus. | 478.e7 | ||
| Lingual Groove. | 478.e7 | ||
| Ultrasonic Devices | 478.e7 | ||
| Conclusion | 479 | ||
| References | 479 | ||
| Suggested Readings | 479 | ||
| References | 479.e1 | ||
| IV Non-Surgical Treatment | 480 | ||
| 44 Phase I Periodontal Therapy | 480 | ||
| Chapter Outline | 480 | ||
| Rationale | 480 | ||
| Treatment Sessions | 480 | ||
| Sequence of Procedures | 481 | ||
| Step 1: Plaque Biofilm Control Instruction. | 481 | ||
| Step 2. Removal of Supragingival and Subgingival Plaque Biofilm and Calculus. | 481 | ||
| Step 3. Recontouring Defective Restorations and Crowns. | 482 | ||
| Step 4. Management of Carious Lesions. | 482 | ||
| Step 5. Tissue Reevaluation. | 482 | ||
| Results | 482 | ||
| Healing | 482 | ||
| Decision to Refer for Specialist Treatment | 482 | ||
| Conclusion | 483 | ||
| References | 484 | ||
| Suggested Readings | 484 | ||
| References | 484.e1 | ||
| 45 Plaque Biofilm Control for the Periodontal Patient | 485 | ||
| Chapter Outline | 485 | ||
| The Toothbrush | 485 | ||
| Toothbrush Design | 486 | ||
| 3 Oral Implantology | 684 | ||
| I Biology, Diagnosis, Biomechanics and Treatment Plan | 684 | ||
| 71 Periimplant Anatomy, Biology, and Function | 684 | ||
| Chapter Outline | 684 | ||
| Implant Geometry (Macrodesign) | 684 | ||
| Endosseous Implants | 684.e1 | ||
| Blade Implants. | 684.e1 | ||
| Pins. | 684.e1 | ||
| Disk Implants. | 684.e1 | ||
| Root Form (Cylindrical) Implants | 684.e1 | ||
| Transmandibular Implants | 684.e2 | ||
| Subperiosteal Implants | 684.e2 | ||
| Implant Surface Characteristics (Microdesign) | 684.e2 | ||
| Additive Processes | 684.e3 | ||
| Subtractive Processes | 684.e4 | ||
| Implant Surface Chemical Composition | 684.e4 | ||
| Implant Surface Free Energy and Micro-Roughness | 684.e5 | ||
| Hard Tissue Interface | 685 | ||
| Initial Bone Healing | 685 | ||
| Bone Remodeling and Function | 686 | ||
| Soft Tissue Interface | 686 | ||
| Epithelium | 687 | ||
| Connective Tissue | 689 | ||
| Keratinized Tissue | 689 | ||
| Vascular Supply and Inflammation | 690 | ||
| Clinical Comparison of Teeth and Implants | 691 | ||
| Conclusion | 692 | ||
| References | 692 | ||
| Suggested Readings | 692 | ||
| References | 692.e1 | ||
| 72 Clinical Evaluation of the Implant Patient | 693 | ||
| Chapter Outline | 693 | ||
| Case Types and Indications | 693 | ||
| Edentulous Patients | 693 | ||
| Partially Edentulous Patients | 694 | ||
| Multiple Teeth. | 694 | ||
| Single Tooth. | 696 | ||
| Esthetic Considerations. | 696 | ||
| Pretreatment Evaluation | 696 | ||
| Chief Complaint | 697 | ||
| Medical History | 697 | ||
| Dental History | 697 | ||
| Intraoral Examination | 698 | ||
| Diagnostic Study Models. | 698 | ||
| Hard Tissue Evaluation. | 698 | ||
| Radiographic Examination. | 699 | ||
| Soft Tissue Evaluation. | 699 | ||
| Risk Factors and Contraindications | 699 | ||
| Medical and Systemic Health–Related Issues | 699 | ||
| Diabetes Mellitus. | 699 | ||
| Bone Metabolic Disease. | 699 | ||
| Medications. | 701 | ||
| Immune Compromise and Immune Suppression. | 703 | ||
| Radiation Therapy. | 703 | ||
| Psychologic and Mental Conditions | 704 | ||
| Habits and Behavioral Considerations | 704 | ||
| Smoking and Tobacco Use. | 704 | ||
| Parafunctional Habits. | 704 | ||
| Substance Abuse. | 704 | ||
| Posttreatment Evaluation | 704 | ||
| Conclusion | 704 | ||
| References | 705 | ||
| Suggested Readings | 704 | ||
| References | 705.e1 | ||
| 73 Diagnostic Imaging for the Implant Patient | 706 | ||
| Chapter Outline | 706 | ||
| Standard Projections | 706 | ||
| Periapical Radiographs | 706 | ||
| Occlusal Radiographs | 706 | ||
| Panoramic Radiographs | 707 | ||
| Lateral Cephalometric Radiographs | 708 | ||
| Cross-Sectional Imaging | 708 | ||
| Multislice Computed Tomography | 708 | ||
| Cone-Beam Computed Tomography | 709 | ||
| Interactive “Simulation” Software Programs | 710 | ||
| Patient Evaluation | 710 | ||
| Exclude Pathology | 710 | ||
| Identify Anatomic Structures | 710 | ||
| Assess Bone Quantity, Quality, and Volume | 710 | ||
| Evaluate Relation of Alveolar Ridge with Existing Teeth and Desired Implant Position | 717 | ||
| Clinical Selection of Diagnostic Imaging | 719 | ||
| Clinical Examination | 719 | ||
| Screening Radiographs | 719 | ||
| Fabrication of Radiographic and Surgical Guides | 719 | ||
| Cross-Sectional Tomography | 719 | ||
| Intraoperative and Postoperative Radiographic Assessment | 719 | ||
| Conclusion | 720 | ||
| References | 722 | ||
| Suggested Reading | 722 | ||
| References | 722.e1 | ||
| 74 Biomechanics, Prosthetic Considerations, and Treatment Planning | 723 | ||
| Chapter Outline | 723 | ||
| Biomechanical Considerations | 723 | ||
| Load-Bearing Capacity | 723 | ||
| Angulation and Arrangement | 724 | ||
| Treatment Planning With Dental Implants | 726 | ||
| Edentulous Maxilla | 726.e1 | ||
| Edentulous Mandible | 726.e2 | ||
| Partially Edentulous Patients | 726 | ||
| Multiple-Tooth Sites. | 726 | ||
| Single-Tooth Sites. | 726 | ||
| Strategies to Avoid Implant Overload | 728 | ||
| Occlusal Design | 728 | ||
| Cantilevers | 728 | ||
| Connecting Implants to Teeth | 728 | ||
| Conclusion | 728 | ||
| References | 729 | ||
| Suggested Readings | 728 | ||
| References | 729.e1 | ||
| II Surgical Procedures | 730 | ||
| 75 Basic Implant Surgical Procedures | 730 | ||
| Chapter Outline | 730 | ||
| General Principles of Implant Surgery | 730 | ||
| Patient Preparation | 730 | ||
| Implant Site Preparation | 730 | ||
| One-Stage Versus Two-Stage Implant Placement Surgery | 731 | ||
| Two-Stage “Submerged” Implant Placement | 731 | ||
| Flap Design, Incisions, and Elevation | 731 | ||
| Implant Site Preparation | 732 | ||
| Round Bur. | 732 | ||
| The 2-mm Twist Drill. | 732 | ||
| Pilot Drill. | 732 | ||
| The 3-mm Twist Drill. | 732 | ||
| Countersink Drill (Optional). | 732 | ||
| Bone Tap (Optional). | 733 | ||
| Implant Placement. | 735 | ||
| Flap Closure and Suturing | 735 | ||
| Postoperative Care | 735 | ||
| Second-Stage Exposure Surgery | 736 | ||
| Simple Circular “Punch” or Crestal Incision. | 736 | ||
| Partial-Thickness Repositioned Flap. | 736 | ||
| Postoperative Care. | 737 | ||
| One-Stage “Nonsubmerged” Implant Placement | 737 | ||
| Flap Design, Incisions, and Elevation | 737 | ||
| Implant Site Preparation | 738 | ||
| Flap Closure and Suturing | 738 | ||
| Postoperative Care | 738 | ||
| Conclusion | 738 | ||
| References | 738 | ||
| Suggested Readings | 738 | ||
| References | 738.e1 | ||
| 76 Localized Bone Augmentation and Implant Site Development | 739 | ||
| Chapter Outline | 739 | ||
| Guided Bone Regeneration | 739.e1 | ||
| Barrier Membranes | 739.e1 | ||
| Nonresorbable Barrier Membranes. | 739.e1 | ||
| Resorbable Barrier Membranes. | 739.e2 | ||
| Bone Graft Materials | 739.e2 | ||
| Autogenous Bone | 739.e2 | ||
| Localized Ridge Augmentation | 739 | ||
| Flap Management | 739 | ||
| Horizontal Bone Augmentation | 740 | ||
| Particulate Bone Graft. | 740 | ||
| Monocortical Block Graft. | 740 | ||
| Procedure. | 740 | ||
| Simultaneous Implant Placement | 743 | ||
| Complications | 746 | ||
| Alveolar Ridge Preservation/Management of Extractions | 746 | ||
| Delayed Implant Placement | 746 | ||
| Staged Implant Placement | 747 | ||
| Delayed Versus Staged Technique | 747 | ||
| Immediate Implant Placement | 747 | ||
| Conclusion | 749 | ||
| References | 749 | ||
| Suggested Readings | 749 | ||
| References | 749.e1 | ||
| 77 Advanced Implant Surgical Procedures | 750 | ||
| Chapter Outline | 750 | ||
| Maxillary Sinus Elevation and Bone Augmentation | 750 | ||
| Indications and Contraindications | 750 | ||
| Surgical Procedures for Sinus Elevation | 751 | ||
| Presurgical Evaluation of Maxillary Sinus. | 751 | ||
| Simultaneous Implant Placement. | 751 | ||
| Bone Graft Materials. | 751 | ||
| Crestal Osteotomy Technique. | 754 | ||
| Procedure. | 754 | ||
| Lateral Window Technique. | 755 | ||
| Risks and Complications | 756 | ||
| Supracrestal/Vertical Bone Augmentation | 756 | ||
| Guided Bone Regeneration and Augmentation | 756 | ||
| Distraction Osteogenesis | 758 | ||
| Growth Factors in Bone Augmentation | 758 | ||
| Bone Morphogenetic Proteins | 758 | ||
| Autologous Platelet Concentration | 762 | ||
| Conclusion | 762 | ||
| References | 763 | ||
| Suggested Readings | 763 | ||
| References | 763.e1 | ||
| 78 Esthetic Management of Difficult Cases (Minimally Invasive Approach) | 764 | ||
| Chapter Outline | 764 | ||
| Surgical Strategy for Predictable Esthetics | 765 | ||
| Determine the Level of Surgical Esthetic Goal | 765.e1 | ||
| Visualize the Final Outcome | 765.e1 | ||
| Preserve Existing Tissues Important for Esthetics | 765.e1 | ||
| Always Overbuild Bone and Soft Tissue in Augmentation Surgeries | 765.e1 | ||
| Immediate Implant Placement for Predictability and Esthetics | 765 | ||
| Surgical Management of Difficult Cases (Minimally Invasive Approach) | 766 | ||
| Components of Esthetic Examination | 766 | ||
| Case Presentation 1 | 766 | ||
| Patient Dental History and Chief Complaint. | 766 | ||
| Examination and Diagnosis. | 767 | ||
| Treatment Objectives. | 767 | ||
| Treatment Options. | 767 | ||
| Surgical Strategy for Predictable Esthetics. | 767 | ||
| Treatment Plan and Rationale. | 769 | ||
| Treatment Sequence. | 769 | ||
| Surgical Procedure. | 769 | ||
| Results. | 769 | ||
| Case Presentation | 769.e1 | ||
| Dental History and Chief Complaint. | 769.e1 | ||
| Examination and Diagnosis. | 769.e1 | ||
| Treatment Objectives. | 769.e2 | ||
| Treatment Options | 769.e2 | ||
| Surgical Strategy for Predictable Esthetics. | 769.e3 | ||
| Treatment Plan and Rationale. | 769.e3 | ||
| Treatment Sequence. | 769.e3 | ||
| Surgical Procedure. | 769.e3 | ||
| Results. | 769.e4 | ||
| Case Presentation 3 | 769.e4 | ||
| Dental History and Chief Complaint. | 769.e4 | ||
| Examination and Diagnosis. | 769.e4 | ||
| Treatment Objectives. | 769.e6 | ||
| Treatment Options | 769.e6 | ||
| Treatment Plan and Rationale. | 769.e6 | ||
| Treatment Sequence. | 769.e6 | ||
| Surgical Procedure. | 769.e6 | ||
| Results. | 769.e6 | ||
| Conclusion | 769 | ||
| References | 769 | ||
| Suggested Readings | 769 | ||
| References | 769.e8 | ||
| 79 Technologic Advances in Implant Surgery: | 770 | ||
| Chapter Outline | 770 | ||
| Implant Microsurgery | 770 | ||
| Microsurgical Tooth Extraction | 770 | ||
| Implant Drilling in the Extraction Site | 770 | ||
| Bone Grafting | 771 | ||
| Buccal Gingival Grafting | 772 | ||
| Immediate Provisional Fabrication | 772 | ||
| Immediate Implant Occlusion | 773 | ||
| Custom Impression Transfer Coping | 773 | ||
| Final Implant Restoration | 773 | ||
| Conclusion | 774 | ||
| References | 775 | ||
| Suggested Readings | 775 | ||
| References | 775.e1 | ||
| 80 Technologic Advances in Implant Surgery: | 776 | ||
| Chapter Outline | 776 | ||
| Clinical Characteristics of Ultrasonic Cutting | 776 | ||
| Microprecision | 776 | ||
| Selective Cutting | 777 | ||
| Maximum Visibility | 777 | ||
| Excellent Healing | 777 | ||
| Clinical Applications | 777 | ||
| Periodontal Surgery | 777 | ||
| Crown Lengthening | 777 | ||
| Tooth Extraction Techniques | 779 | ||
| Simplified Tooth Extraction. | 781 | ||
| Implant Site Preparation | 781 | ||
| Advanced Clinical Applications | 776.e1 | ||
| Sinus Lift | 776.e1 | ||
| Ridge Expansion | 776.e1 | ||
| Bone Harvesting | 776.e1 | ||
| Particulate Bone Chip Harvesting Technique. | 776.e1 | ||
| Clinical Note. | 776.e3 | ||
| Block Harvesting Technique. | 776.e3 | ||
| Conclusion | 784 | ||
| References | 785 | ||
| Suggested Readings | 785 | ||
| References | 785.e1 | ||
| 81 Technologic Advances in Implant Surgery: | 786 | ||
| Chapter Outline | 786 | ||
| Computer-Assisted Implant Surgery | 786 | ||
| Uses and Requirements | 786 | ||
| Sequence of Steps | 787 | ||
| Data Acquisition | 787 | ||
| CAIS CT-Based Technology. | 787 | ||
| CAIS Immediate Mapping. | 787 | ||
| Identification and Registration | 787 | ||
| Navigation and Positional Tracking | 788 | ||
| External Viewer, Augmented Reality, and 3D Projection Screens | 788 | ||
| Advantages and Disadvantages | 790 | ||
| Conclusion | 790 | ||
| References | 791 | ||
| Suggested Readings | 791 | ||
| References | 791.e1 | ||
| III Complications | 792 | ||
| 82 Implant-Related Complications and Failures | 792 | ||
| Chapter Outline | 792 | ||
| Definition of Implant Survival and Implant Success | 792 | ||
| Types and Prevalence of Implant Complications | 793 | ||
| Different Types of Dental Implants | 794 | ||
| Surgical Complications | 794 | ||
| Hemorrhage and Hematoma | 795 | ||
| Neurosensory Disturbances | 795 | ||
| Implant Malposition | 796 | ||
| Biologic Complications | 798 | ||
| Inflammation and Proliferation | 798 | ||
| Dehiscence and Recession | 798 | ||
| Periimplantitis and Bone Loss | 799 | ||
| Implant Loss or Failure | 800 | ||
| Complications Related to Augmentation Procedures | 792.e1 | ||
| Autogenous Bone Harvesting and Grafting | 792.e1 | ||
| Guided Bone Regeneration | 792.e1 | ||
| Sinus Bone Augmentation | 792.e2 | ||
| Lateral Window Sinus Lift. | 792.e2 | ||
| Crestal (Osteotome) Sinus Lift. | 792.e2 | ||
| Complications Related to Placement and Loading Protocols | 792.e3 | ||
| Immediate Implant Placement | 792.e3 | ||
| Immediate Loading after Implant Placement | 792.e3 | ||
| Implant Placement Using a Flapless Approach | 792.e4 | ||
| Prosthetic or Mechanical Complications | 801 | ||
| Screw Loosening and Fracture | 801 | ||
| Implant Fracture | 801 | ||
| Fracture of Restorative Materials | 802 | ||
| Esthetic and Phonetic Complications | 802 | ||
| Esthetic Complications | 802 | ||
| Phonetic Problems | 803 | ||
| Conclusion | 803 | ||
| References | 804 | ||
| Suggested Readings | 804 | ||
| References | 804.e1 | ||
| IV Supportive Care and Results of Implant Treatment | 805 | ||
| 83 Supportive Implant Treatment | 805 | ||
| Chapter Outline | 805 | ||
| Rationale for Supportive Implant Treatment | 805 | ||
| Examination of Implant(s) | 805 | ||
| Periimplant Probing | 806 | ||
| Microbial Testing | 807 | ||
| Stability Measures | 807 | ||
| Implant Percussion | 807 | ||
| Radiographic Examination | 807 | ||
| Assessment of Periimplant Health | 808 | ||
| Evaluation of Plaque (Biofilm) Control | 808 | ||
| Evaluation of Periimplant Health and Disease | 808 | ||
| Evaluation of Implant Osseointegration | 809 | ||
| Evaluation of Implant Restorations | 809 | ||
| Implant Maintenance | 809 | ||
| Methods for Patient Oral Hygiene | 809 | ||
| Methods for Professional Recall Maintenance | 810 | ||
| Treatment of Periimplant Diseases | 810 | ||
| Periimplant Mucositis | 811 | ||
| Periimplantitis | 811 | ||
| Referral of Patients to the Periodontist | 811 | ||
| References | 812 | ||
| Suggested Readings | 811 | ||
| References | 812.e1 | ||
| 84 Results of Implant Treatment | 813 | ||
| Chapter Outline | 813 | ||
| Defining Implant Outcomes | 813 | ||
| Factors That Influence Implant Outcomes | 815 | ||
| Anatomic Location | 815 | ||
| Implant Design | 815 | ||
| Placement and Loading Protocols | 816 | ||
| Immediate Implant Placement. | 816 | ||
| Immediate Occlusal Loading. | 816 | ||
| Bone Augmentation | 816 | ||
| Risk Factors | 816 | ||
| Smoking. | 817 | ||
| Diabetes. | 817 | ||
| Periodontitis. | 817 | ||
| Esthetic Results and Patient Satisfaction | 817 | ||
| Conclusion | 818 | ||
| References | 818 | ||
| Suggested Readings | 818 | ||
| References | 818.e1 | ||
| 4 Supplementary Topics (Online-Only) | e9 | ||
| 85 Atlas of Periodontal Diseases | e9 | ||
| Suggested Readings | e71 | ||
| Plaque-Induced Gingival Diseases | e10 | ||
| Clinical Features of Gingivitis | e10 | ||
| Melanin Pigmentation | e12 | ||
| Etiology of Periodontal Diseases | e13 | ||
| Gingival Diseases Modified by Systemic Factors | e20 | ||
| Gingival Diseases Associated with Blood Dyscrasias | e23 | ||
| Leukemia | e23 | ||
| Anemia | e23 | ||
| Drug-Induced Gingival Diseases | e25 | ||
| Non–Plaque-Induced Gingival Lesions | e26 | ||
| Streptococcus Species | e26 | ||
| Herpes Virus Infections | e27 | ||
| Gingival Diseases of Fungal Origin | e28 | ||
| Gingival Lesions of Genetic Origin | e30 | ||
| Hereditary Gingival Fibromatosis | e30 | ||
| Gingival Manifestations of Systemic Conditions | e32 | ||
| Mucocutaneous Lesions | e32 | ||
| Other Systemic Diseases | e35 | ||
| Allergies | e39 | ||
| Traumatic Lesions (Factitious, Iatrogenic, and Accidental) | e40 | ||
| Cysts and Tumors | e44 | ||
| Chronic Periodontitis | e46 | ||
| Chronic Periodontitis Modified by Systemic Factors | e49 | ||
| Diabetes Mellitus | e49 | ||
| Aggressive Periodontitis | e53 | ||
| Periodontitis as a Manifestation of Systemic Diseases | e58 | ||
| Leukemias | e58 | ||
| Genetic Disorders | e60 | ||
| Necrotizing Periodontal Diseases | e65 | ||
| Bisphosphonates | e67 | ||
| Abscesses of Periodontium | e69 | ||
| Endodontic-Periodontal Lesions | e71 | ||
| 86 Introduction to Evidence-Based Decision Making | e72 | ||
| Chapter Outline | e72 | ||
| Background and Definition | e72 | ||
| Principles of Evidence-Based Decision Making | e72 | ||
| Evidence-Based Dentistry | e72 | ||
| Evidence-Based Decision-Making Process and Skills | e73 | ||
| Asking Good Questions: The PICO Process | e73 | ||
| Becoming a Competent Consumer of the Evidence | e73 | ||
| Sources of Evidence. | e75 | ||
| Levels of Evidence. | e76 | ||
| Searching for and Acquiring the Evidence | e77 | ||
| Appraising the Evidence | e78 | ||
| Common Ways Used to Report Results. | e78 | ||
| Applying the Evidence: Evidence-Based Dentistry in Action | e79 | ||
| Evaluating the Outcomes | e79 | ||
| Conclusion | e80 | ||
| Suggested Readings | e80 | ||
| References | e80 | ||
| 87 Assessing Evidence | e82 | ||
| Chapter Outline | e82 | ||
| Twelve Tools for Assessing Evidence | e82 | ||
| Be Skeptical | e82 | ||
| Don’t Trust Biologic Plausibility | e83 | ||
| What Level of Controlled Evidence Is Available? | e83 | ||
| Did the Cause Precede the Effect? | e83 | ||
| No Betting on the Horse After the Race Is Over | e84 | ||
| What Is a Clinically Relevant Pretrial Hypothesis? | e84 | ||
| Clinically Relevant Endpoint. | e85 | ||
| Common and Relevant Comparisons. | e85 | ||
| Representative Study Sample. | e85 | ||
| Small Type I and Type II Error Rates. | e86 | ||
| Size Does Matter | e86 | ||
| Is There a Better Alternative Explanation | e87 | ||
| Was the Study Properly Randomized? | e88 | ||
| When to Rely on Nonrandomized Evidence? | e88 | ||
| Did the Investigators Take into Account the Placebo/Nocebo Effects? | e89 | ||
| Was There Protection Against Conflict of Interest? | e89 | ||
| Conclusion | e90 | ||
| References | e90 | ||
| 88 Electronic Dental Records and Decision Support Systems | e92 | ||
| Chapter Outline | e92 | ||
| Functionalities and Components Available in Electronic Dental Records | e92 | ||
| Patient Registration | e92 | ||
| Periodontal Chart | e92 | ||
| Electronic Dental Record Use in Dental Practices | e92 | ||
| Commonly Used Electronic Dental Records | e94 | ||
| Barriers to Using Electronic Dental Records | e94 | ||
| Limited Functionality for Communication and Collaboration. | e94 | ||
| Suboptimal Usability and Steep Learning Curve. | e95 | ||
| Insufficient Reliability of Electronic Dental Records and Infection Control Issues. | e95 | ||
| Challenges to Realizing the Full Potential of Electronic Dental Records | e95 | ||
| Standards for Information Content of Electronic Dental Records. | e95 | ||
| Data Representation and Interoperability. | e95 | ||
| Benefits of Using Electronic Dental Records | e95 | ||
| Reusing Electronic Dental Records Data for Research Purposes. | e95 | ||
| Clinical Decision Support Systems | e95 | ||
| Decision Support System Types. | e95 | ||
| Risk-Based Decision Support Systems for Periodontal Disease. | e96 | ||
| Barriers to the Adoption of Clinical Decision Support Systems. | e96 | ||
| Factors That Improve the Adoption of Clinical Decision Support Systems. | e96 | ||
| Future of Electronic Dental Records and Decision Support Systems in Dentistry | e96 | ||
| Suggested Readings | e96 | ||
| References | e96 | ||
| 89 Locally Delivered, Controlled-Release Antimicrobials | e98 | ||
| Chapter Outline | e98 | ||
| Background and Objectives | e98 | ||
| Currently Available Agents (U.S.) | e98 | ||
| Chlorhexidine Chip. | e98 | ||
| Doxycycline Gel. | e99 | ||
| Minocycline Microspheres. | e99 | ||
| Rationale for Local Delivery and Controlled-Release | e101 | ||
| Pharmacokinetics | e102 | ||
| Chlorhexidine Chip. | e102 | ||
| Doxycycline Gel. | e102 | ||
| Minocycline Microspheres. | e103 | ||
| Drug Development and Registration | e103 | ||
| Locally Delivered, Controlled-Release Antimicrobials: Magnitude of the Effect | e103 | ||
| Statistical Versus Clinical Significance | e115 | ||
| Clinical Use | e116 | ||
| Costs and Outcomes | e116 | ||
| Tobacco Smoking | e118 | ||
| Potential New Indications | e118 | ||
| Currently Available Agents (Non-U.S.) | e118 | ||
| Conclusion | e118 | ||
| Key Points | e119 | ||
| Suggested Readings | e120 | ||
| References | e120 | ||
| 90 Locally Delivered, Controlled-Release Antimicrobials: | e123 | ||
| Chapter Outline | e123 | ||
| Drug Development and Registration | e123 | ||
| Phases of Drug Development | e123 | ||
| Evaluating Safety and Efficacy | e123 | ||
| Informed Consent and Legal Considerations | e123 | ||
| Clinical Trial Evidence | e124 | ||
| Trial Design Considerations | e124 | ||
| Trial I Error Rate Control. | e124 | ||
| Clear Statement of the Objectives, Proposed and Actual. | e124 | ||
| Methods of Analysis in the Protocol, Statistical Plan, and Reports. | e124 | ||
| Methods of Adequate Assurance of Patient Selections. | e125 | ||
| Patient Assignments That Minimize Bias, Group Comparability. | e125 | ||
| Methods to Minimize Bias for All Parties: Patients, Investigators, and Data Analysts. | e125 | ||
| Endpoints Well Defined and Addressing the Primary Hypothesis. | e125 | ||
| Analysis of Results Allows for the Interpretability of the Effects of the Study Drug. | e125 | ||
| Clinical Use | e126 | ||
| Combination Adjunctive Therapy | e126 | ||
| Surgical Therapy | e126 | ||
| Periimplantitis | e126 | ||
| Adverse Effects and Cautions for Use | e127 | ||
| Currently Available Agents (Non-U.S.) | e127 | ||
| Chlorhexidine-Based Products | e127 | ||
| PerioCol-CG. | e127 | ||
| Chlo-Site. | e127 | ||
| Tetracycline-Based Products | e128 | ||
| PerioCol-TC. | e128 | ||
| Periodontal Plus AB. | e128 | ||
| Clinical Studies | e128 | ||
| Considerations for Future Research | e128 | ||
| Key Points | e134 | ||
| References | e134 | ||
| Index | 819 | ||
| A | 819 | ||
| B | 823 | ||
| C | 825 | ||
| D | 830 | ||
| E | 833 | ||
| F | 835 | ||
| G | 837 | ||
| H | 841 | ||
| I | 842 | ||
| J | 845 | ||
| K | 846 | ||
| L | 846 | ||
| M | 848 | ||
| N | 852 | ||
| O | 853 | ||
| P | 856 | ||
| Q | 866 | ||
| R | 866 | ||
| S | 867 | ||
| T | 871 | ||
| U | 874 | ||
| V | 875 | ||
| W | 875 | ||
| X | 875 | ||
| Y | 875 | ||
| Z | 875 |