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Book Details
Abstract
Covering the essentials of periodontics in an accessible, easy-to-read manner, Practical Periodontics examines all aspects of the discipline ranging from aetiology through to diagnosis, treatment planning and clinical management. Richly illustrated and in full colour throughout, this brand new volume – which comes with an ASSOCIATED WEBSITE containing videos, self-assessment questions and case studies - will be ideal for all undergraduate students of dentistry, oral hygiene and therapy as well as practicing clinicians.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc_2 | ||
| Practical Periodontics | i | ||
| Copyright Page | iv | ||
| Table Of Contents | v | ||
| Contributors | vii | ||
| Foreword | ix | ||
| Preface | xi | ||
| 1 Aetiology of Periodontal Diseases | 1 | ||
| 1.1 The Macro- and Microanatomy of Periodontal Tissues | 3 | ||
| Overview of the Chapter | 3 | ||
| Introduction | 3 | ||
| Embryological Origins of the Periodontal Tissues | 4 | ||
| Microanatomy of the Gingival Tissues | 4 | ||
| Microanatomy of the Periodontal Ligament and Cementum | 9 | ||
| Periodontal ligament | 9 | ||
| Cementum | 11 | ||
| Microanatomy of the Alveolar Bone | 11 | ||
| Acknowledgement | 12 | ||
| 1.2 The Pathogenesis of Periodontal Diseases | 13 | ||
| Overview of the Chapter | 13 | ||
| Periodontal disease or diseases? | 13 | ||
| Introduction | 14 | ||
| Bacterial factors | 14 | ||
| Colonization | 14 | ||
| How do bacteria cause disease? | 15 | ||
| Host factors | 16 | ||
| Inflammatory response to the bacterial biofilm | 16 | ||
| The epithelial barrier | 16 | ||
| Complement | 16 | ||
| Cytokines | 17 | ||
| Neutrophils (polymorphonuclear leucocytes – PMNLs) | 17 | ||
| Mast cells | 19 | ||
| Immune responses to biofilm antigens | 19 | ||
| T lymphocytes (T cells) | 20 | ||
| B lymphocytes | 20 | ||
| Antibodies/immunoglobulins | 20 | ||
| Bacteria versus host | 21 | ||
| Does gingivitis inevitably lead to periodontitis? | 25 | ||
| Acknowledgement | 25 | ||
| Reference | 26 | ||
| 1.3 Epidemiology of Periodontal Diseases | 27 | ||
| Overview of the Chapter | 27 | ||
| Introduction | 27 | ||
| Principles of Descriptive Epidemiology | 28 | ||
| Why Is There a Need for Data on Periodontal Health/Disease? | 29 | ||
| Periodontal epidemiology | 29 | ||
| Indices Used in Epidemiological Surveys | 29 | ||
| Problems with Periodontal Epidemiology | 32 | ||
| What to measure | 32 | ||
| How to measure | 33 | ||
| Probes | 33 | ||
| Use of Radiographs in Epidemiological Surveys | 33 | ||
| What to measure – full vs part mouth assessment | 34 | ||
| Examiner consistency | 34 | ||
| Recent National Surveys | 34 | ||
| Positive Developments | 35 | ||
| References | 36 | ||
| 1.4 Host Response and Susceptibility | 37 | ||
| Overview of the Chapter | 37 | ||
| Introduction | 37 | ||
| Definitions | 39 | ||
| Host Susceptibility | 39 | ||
| Host Response to the Bacterial Biofilm | 41 | ||
| Normal Host Response | 41 | ||
| The Pathogenesis of Periodontal Lesions | 42 | ||
| Cell Signalling | 42 | ||
| Innate Immunity | 44 | ||
| Acquired Immunity | 47 | ||
| The Contribution of Genes to Host Responses | 47 | ||
| Acknowledgement | 48 | ||
| References | 49 | ||
| Further reading | 49 | ||
| 1.5 The Role of Biofilms in Health and Disease | 51 | ||
| Overview of the Chapter | 51 | ||
| Introduction | 51 | ||
| What Are Biofilms? | 52 | ||
| Biofilms in the Mouth | 53 | ||
| Methods to Determine the Microbial Composition of Dental Biofilms | 53 | ||
| Microbial Composition of Dental Biofilms in Health | 55 | ||
| Fissures | 55 | ||
| Approximal surfaces | 55 | ||
| Gingival crevice | 55 | ||
| Stages in the Formation of Dental Biofilms | 56 | ||
| Stage 1. Conditioning film formation | 56 | ||
| Stage 2. Transport of microorganisms | 56 | ||
| Stage 3. Reversible attachment | 56 | ||
| Stage 4. Irreversible attachment | 56 | ||
| Stage 5. Secondary colonization | 56 | ||
| Stage 6. Biofilm maturation | 58 | ||
| Stage 7. Detachment from surfaces | 58 | ||
| Enhanced Tolerance to Antimicrobial Agents by Biofilms | 58 | ||
| Benefits of the Resident Oral Microbiota | 59 | ||
| Microbial Composition of Dental Biofilms in Periodontal Diseases | 60 | ||
| Gingivitis | 60 | ||
| Chronic periodontitis | 60 | ||
| Necrotizing periodontal diseases | 61 | ||
| Necrotizing Ulcerative Gingivitis (NUG) | 61 | ||
| Necrotizing Ulcerative Periodontitis | 62 | ||
| Aggressive periodontitis | 62 | ||
| Pathogenic Mechanisms in Periodontal Breakdown | 62 | ||
| Direct action | 62 | ||
| Indirect action | 62 | ||
| Pathogenic Synergism and Periodontal Diseases | 63 | ||
| Microbial Aetiology of Periodontal Breakdown – Contemporary Perspectives | 64 | ||
| Find Out More | 65 | ||
| References | 65 | ||
| 1.6 Periodontal Risk – Systemic and Local Risk Factors | 67 | ||
| Overview of the Chapter | 67 | ||
| Introduction | 67 | ||
| Risk Factors, Markers and Predictors | 68 | ||
| Risk Assessment and the “At Risk” Patient | 68 | ||
| Classification of Risk Factors | 69 | ||
| True or putative | 69 | ||
| Systemic or local | 69 | ||
| Modifiable or non-modifiable | 70 | ||
| Risk Factors in Periodontitis Progression | 70 | ||
| Systemic Risk Factors | 70 | ||
| Genetics | 70 | ||
| Age | 72 | ||
| Nutrition | 72 | ||
| Smoking | 72 | ||
| Diabetes and obesity | 73 | ||
| Stress | 73 | ||
| Poor oral hygiene (Figure 1.6.5) | 74 | ||
| Periodontal Risk Assessment | 74 | ||
| Risk assessment – The third dimension | 75 | ||
| Risk assessment technologies | 75 | ||
| Local Risk Factors | 76 | ||
| Iatrogenic | 76 | ||
| Anatomical | 77 | ||
| Root caries | 77 | ||
| Tooth position | 77 | ||
| False/true pockets | 77 | ||
| High frenal attachment | 78 | ||
| Mouth breathing | 78 | ||
| Calculus | 78 | ||
| Acknowledgement | 78 | ||
| References | 78 | ||
| 2 Periodontal Diagnosis and Prognosis | 81 | ||
| 2.1 Classification of Periodontal Diseases | 83 | ||
| Overview of the Chapter | 83 | ||
| Introduction | 83 | ||
| Clinical manifestation | 84 | ||
| Causative factors | 84 | ||
| History of Classification Systems | 84 | ||
| Early classification systems | 84 | ||
| Some 20th century classifications | 84 | ||
| Classifications prior to 1989 | 85 | ||
| 1989 World Workshop in Periodontics Classification | 85 | ||
| 1993 European Workshop on Periodontology Classification | 86 | ||
| 1999 World Workshop in Periodontics Classification System | 86 | ||
| Characteristics of the major groups of conditions in the World Workshop Classification (1999) | 87 | ||
| I Gingival Diseases | 87 | ||
| II Chronic Periodontitis | 87 | ||
| III Aggressive Periodontitis | 89 | ||
| IV Periodontitis as a Manifestation of Systemic Diseases | 90 | ||
| V Necrotizing Periodontal Diseases | 90 | ||
| VI Abscesses of the Periodontium | 90 | ||
| VII Developmental or Acquired Deformities and Conditions | 90 | ||
| Key differences between the 1993 European Workshop and the 1999 World Workshop classifications | 90 | ||
| Practical Application of Classification of Periodontal Diseases | 91 | ||
| Possible Future Developments | 91 | ||
| References | 91 | ||
| 2.2 Assessment and Monitoring of a Periodontal Patient | 93 | ||
| Overview of the Chapter | 93 | ||
| Introduction | 93 | ||
| What Should be Assessed? | 94 | ||
| The Basic Periodontal Examination (BPE) | 94 | ||
| How to record the BPE | 95 | ||
| The BPE scores | 95 | ||
| Advantages of the BPE | 95 | ||
| Disadvantages of the BPE | 95 | ||
| When to record the BPE | 96 | ||
| Assessment of Disease Activity | 96 | ||
| Assessment of Plaque | 96 | ||
| The Plaque Index | 98 | ||
| Advantages and disadvantages of the plaque index (Silness and Löe, 1964) | 98 | ||
| The Simplified Plaque Index (Ainamo & Bay, 1975) | 98 | ||
| Advantages and disadvantages of the simplified plaque index (Ainamo & Bay, 1975) | 98 | ||
| The Quigley Hein Index (Modified by Turesky et al., 1970) | 98 | ||
| Advantages and disadvantages of the Quigley Hein index (modified by Turesky et al., 1970) | 98 | ||
| The Plaque Control Record (O’Leary et al., 1972) | 99 | ||
| Advantages and disadvantages of the plaque control record (O’Leary et al., 1972) | 99 | ||
| Assessment of the Gingivae | 100 | ||
| Appearance | 100 | ||
| Assessment of gingival inflammation | 100 | ||
| Gingival Indices | 100 | ||
| The gingival index (Löe & Silness, 1963) | 101 | ||
| Advantages and disadvantages of the gingival index (Löe & Silness, 1963) | 101 | ||
| The simplified gingival index (Ainamo & Bay, 1975) | 101 | ||
| Advantages and disadvantages of the simplified gingival index (Ainamo & Bay, 1975) | 102 | ||
| Assessment of calculus | 102 | ||
| Assessment of Periodontal Pockets | 102 | ||
| Probing pocket depths | 102 | ||
| Inter- and Intra-Operator Variability in Measurements | 102 | ||
| Other Probing Errors | 103 | ||
| Assessement of Loss of Attachment | 104 | ||
| The difference between probing pocket depth and loss of attachment | 104 | ||
| Assessment of Bleeding on Probing | 105 | ||
| Assessement of Tooth Mobility | 105 | ||
| Assessement of Furcation Involvements | 105 | ||
| Probing | 105 | ||
| Radiographic assessment | 105 | ||
| Clinical assessment | 105 | ||
| Assessment of Suppuration | 107 | ||
| Assessment of Bone Support | 107 | ||
| Radiographs in Periodontal Assessment | 108 | ||
| Interpretation of radiographs | 108 | ||
| Viewing and reporting on radiographs | 108 | ||
| New radiographic techniques | 109 | ||
| Monitoring a Periodontal Patient | 109 | ||
| References | 109 | ||
| 2.3 Gingival Overgrowth | 111 | ||
| Overview of the Chapter | 111 | ||
| Introduction | 111 | ||
| The Aetiology of Gingival Overgrowth | 112 | ||
| The Mechanisms of Gingival Overgrowth | 113 | ||
| Common Causes of Gingival Overgrowth | 114 | ||
| Drug-induced gingival overgrowth | 114 | ||
| Distribution of Drug-Induced Gingival Overgrowth | 115 | ||
| Risk Factors for DIGO | 115 | ||
| Age | 115 | ||
| Gender | 116 | ||
| Drug variables | 116 | ||
| Periodontal status at onset of medication | 116 | ||
| Incidence of DIGO | 116 | ||
| Management of DIGO | 116 | ||
| Non-Surgical Care for DIGO | 117 | ||
| Surgical Management for DIGO (Which Also Applies to Other Causes of Gingival Overgrowth) | 118 | ||
| Changing Medication for DIGO | 120 | ||
| Hormonal overgrowth | 120 | ||
| Managing Hormonal Overgrowth | 121 | ||
| Diabetes | 121 | ||
| Other Causes of Gingival Overgrowth | 122 | ||
| Hereditary gingivo-fibromatosis | 122 | ||
| Individual fibromas | 122 | ||
| Mouth breathing | 123 | ||
| Down’s syndrome | 123 | ||
| Neoplasms | 123 | ||
| Conclusion – Reaching a Diagnosis | 124 | ||
| Determining the cause of gingival overgrowth | 124 | ||
| References | 124 | ||
| 2.4 Periodontitis and Systemic Diseases | 127 | ||
| Overview of the Chapter | 127 | ||
| Introduction | 127 | ||
| Periodontitis and Systemic Disease | 128 | ||
| Potential mechanisms linking oral disease to secondary non-oral disease | 128 | ||
| Metastatic Infection (Due to Transient Bacteraemia) | 128 | ||
| Inflammation and Inflammatory Injury (Due to Innate Immunity) | 129 | ||
| Adaptive Immunity | 129 | ||
| Periodontal diseases contributing to systemic disease susceptibility | 129 | ||
| Periodontitis and diabetes mellitus | 130 | ||
| Diabetes Mellitus | 130 | ||
| Diagnosis | 131 | ||
| Pathobiology of diabetes mellitus | 131 | ||
| Periodontitis and diabetes mellitus | 132 | ||
| Periodontal Treatment in Diabetes Patients | 132 | ||
| Periodontitis and cardiovascular diseases | 133 | ||
| Periodontal Treatment and Cardiovascular Diseases | 134 | ||
| Periodontal Disease and Adverse Pregnancy Outcomes | 135 | ||
| Periodontal Treatment and Adverse Pregnancy Outcomes | 135 | ||
| Periodontitis and respiratory diseases | 136 | ||
| Periodontal Treatment and Respiratory Diseases | 138 | ||
| Periodontitis and other systemic diseases | 138 | ||
| Systemic conditions affecting the periodontium | 138 | ||
| Systemic medication affecting the periodontium | 140 | ||
| Conclusion | 140 | ||
| References | 140 | ||
| 2.5 Determining Periodontal Prognosis | 145 | ||
| Overview of the Chapter | 145 | ||
| Introduction | 145 | ||
| What is a Prognosis? | 146 | ||
| Factors Affecting Prognosis | 146 | ||
| General factors | 146 | ||
| 1. Patient Compliance (with Oral Hygiene and Supportive Periodontal Treatment) | 146 | ||
| 2. Smoking | 147 | ||
| 3. Diabetes | 147 | ||
| 4. Other Systemic Conditions Influencing Prognosis | 147 | ||
| 5. Interleukin 1 (IL-1) Genotype | 147 | ||
| 6. Age | 147 | ||
| 7. Gender | 147 | ||
| Local factors | 147 | ||
| 1. Bacterial Plaque | 147 | ||
| 2. Bone Loss | 148 | ||
| 3. Furcation Involvement | 148 | ||
| 4. Pocket Probing Depth (PPD) | 148 | ||
| 5. Tooth Type | 148 | ||
| 6. Anatomical Defects | 148 | ||
| 7. Mobility | 148 | ||
| 8. Crown Root Ratio | 148 | ||
| 9. Tooth Position | 148 | ||
| 10. Occlusal Trauma | 149 | ||
| 11. Other Pathology | 149 | ||
| Assigning a Prognosis | 149 | ||
| Good prognosis | 149 | ||
| Questionable prognosis | 150 | ||
| Hopeless prognosis | 150 | ||
| When to Determine Prognosis | 150 | ||
| 1. Initial prognosis (baseline) | 150 | ||
| 2. Revising prognosis | 151 | ||
| Weighting Prognostic Factors | 151 | ||
| Improving the determination of prognosis | 151 | ||
| References | 152 | ||
| 3 Periodontal Treatment Planning | 155 | ||
| 3.1 Treatment Planning – Gingivitis and Periodontitis | 157 | ||
| Overview of the Chapter | 157 | ||
| Introduction | 157 | ||
| Outcomes of Periodontal Treatment | 158 | ||
| The Place of Periodontal Treatment in Overall Treatment Planning | 159 | ||
| Acute Gingival Conditions and Their Management | 159 | ||
| Periodontal abscess | 159 | ||
| Acute necrotizing ulcerative gingivitis (ANUG) | 161 | ||
| Acute herpetic gingivostomatitis | 162 | ||
| Management of Simple Plaque-Induced Chronic Gingivitis | 163 | ||
| Phased Treatment Planning for Chronic Periodontitis | 164 | ||
| Achieving the Ideal End Points of Treatment | 165 | ||
| Root-surface instrumentation | 165 | ||
| Reassessment | 166 | ||
| Management of Furcations | 166 | ||
| Scaling and root-surface instrumentation (non-surgical treatment) | 167 | ||
| Furcation surgery | 167 | ||
| Tunnel preparation | 167 | ||
| Root resection | 168 | ||
| References | 169 | ||
| 3.2 The Management of Gingival Recession | 171 | ||
| Overview of the Chapter | 171 | ||
| Introduction | 171 | ||
| Definitions | 172 | ||
| Gingival recession | 172 | ||
| Dentine hypersensitivity | 172 | ||
| Prevalence of Gingival Recession and Dentine Hypersensitivity | 173 | ||
| Mechanisms for Gingival Recession | 173 | ||
| Mechanisms for Sensory Transmission of Dentine Hypersensitivity Sensitivity | 173 | ||
| Aetiology of Gingival Recession and Dentine Hypersensitivity | 174 | ||
| Classification of Gingival Recession | 175 | ||
| Predisposing Factors for Gingival Recession | 175 | ||
| Anatomical recession (tooth position) | 175 | ||
| Quantity of attached gingiva | 175 | ||
| Gingival biotype | 176 | ||
| Bone morphology | 177 | ||
| Malocclusion | 178 | ||
| High attachment of fraenum | 178 | ||
| Precipitating Factors for Gingival Recession | 178 | ||
| Plaque, calculus and periodontal diseases | 178 | ||
| Toothbrush trauma | 178 | ||
| Tooth movement | 178 | ||
| Smoking | 179 | ||
| Healing after periodontal treatment | 179 | ||
| Restorative dentistry | 179 | ||
| Removable partial dentures | 179 | ||
| Self-inflicted trauma/chemical trauma | 180 | ||
| Clinical outcomes of gingival recession | 180 | ||
| Dentine hypersensitivity | 180 | ||
| Aesthetics | 181 | ||
| Plaque retention and gingival inflammation | 181 | ||
| Tooth abrasion | 182 | ||
| Root caries | 182 | ||
| Management and Treatment of Gingival Recession Defects and Dentine Hypersensitivity | 182 | ||
| Non-surgical management of gingival recession and dentine hypersensitivity | 182 | ||
| 1. Preventive Care | 182 | ||
| 2. Non-Surgical Correction of Recession Defects | 183 | ||
| Surgical treatment of gingival recession defects | 183 | ||
| 1. Pedicle Soft Tissue Grafts | 184 | ||
| 2. Free Soft Tissue Grafts | 184 | ||
| 3. Guided Tissue Regeneration | 184 | ||
| Summary | 184 | ||
| References | 184 | ||
| 3.3 Treatment Planning: | 187 | ||
| Overview of the Chapter | 187 | ||
| Introduction | 187 | ||
| Periodontal Diseases that Can Affect Children and Adolescents | 188 | ||
| Periodontal health | 188 | ||
| Gingivitis | 188 | ||
| Plaque-induced Gingivitis | 188 | ||
| Necrotizing Ulcerative Gingivitis | 188 | ||
| Non-plaque-induced Gingival Lesions | 189 | ||
| Periodontitis | 189 | ||
| Chronic Periodontitis | 190 | ||
| Aggressive Periodontitis | 190 | ||
| Necrotizing Ulcerative Periodontitis | 192 | ||
| Recession | 192 | ||
| Gingival overgrowth | 193 | ||
| Periodontal History, Examination and Simplified Basic Periodontal Examination | 193 | ||
| Periodontal history and examination | 193 | ||
| Simplified basic periodontal examination | 193 | ||
| BPE Codes | 193 | ||
| Use of radiographs | 196 | ||
| Periodontal diagnosis | 197 | ||
| Treatment Planning and Periodontal Therapy | 197 | ||
| Initial, corrective and supportive periodontal therapy | 197 | ||
| Initial Therapy | 197 | ||
| Corrective Therapy | 198 | ||
| Supportive Therapy | 198 | ||
| Plaque control | 198 | ||
| Toothbrushing and Motivation | 198 | ||
| Flossing | 198 | ||
| Non-surgical periodontal therapy | 199 | ||
| Management of Gingivitis and Periodontitis | 199 | ||
| Role of Antibiotics | 199 | ||
| Management of Recession | 199 | ||
| Management of Gingival Overgrowth | 200 | ||
| Treat or Refer | 200 | ||
| References | 201 | ||
| 3.4 Referral to a Periodontal Specialist | 203 | ||
| Overview of the Chapter | 203 | ||
| Introduction | 203 | ||
| Why Refer? | 204 | ||
| Who to Refer | 205 | ||
| What to Refer | 206 | ||
| Clinical criteria | 206 | ||
| Radiographic criteria | 207 | ||
| Restorative criteria | 207 | ||
| Implants | 208 | ||
| When to Refer | 208 | ||
| Where to Refer | 209 | ||
| How to Refer | 210 | ||
| What to Expect from a Referral | 210 | ||
| What to expect as a referring clinician | 210 | ||
| How to prepare your patient | 210 | ||
| After Referral | 212 | ||
| The specialist’s report | 212 | ||
| Legal and Ethical Issues | 213 | ||
| On Conclusion of Specialist Care | 213 | ||
| Managing the Patient Who Declines Referral | 214 | ||
| References and further reading | 214 | ||
| Links | 214 | ||
| Online | 214 | ||
| 4 The Role of Self-Care and Oral Hygiene Methods | 215 | ||
| 4.1 Patient Education and Self-Performed Biofilm Control | 217 | ||
| Overview of the Chapter | 217 | ||
| Introduction | 218 | ||
| Patients’ Health Beliefs | 218 | ||
| Motivating Patients to Clean Optimally | 219 | ||
| Tailoring Oral Health Advice | 219 | ||
| Techniques for Oral Hygiene | 220 | ||
| Self-assessment of home plaque control | 220 | ||
| Delivery of Oral Hygiene Advice | 220 | ||
| ToothBrushing | 221 | ||
| Manual | 221 | ||
| Brushing Technique | 222 | ||
| Powered brushes | 222 | ||
| Interdental cleaning | 224 | ||
| Floss | 224 | ||
| Flossing Techniques | 225 | ||
| Interdental brushes | 226 | ||
| Subgingival cleaning | 227 | ||
| Dentifrices (Toothpastes) | 227 | ||
| Mouthwashes | 227 | ||
| Chlorhexidine | 228 | ||
| Conclusions | 230 | ||
| References | 230 | ||
| 4.2 Clinical Imaging in Patient Assessment and Motivation | 233 | ||
| Overview of the Chapter | 233 | ||
| Introduction | 233 | ||
| Types of Imaging Systems | 236 | ||
| Factors to Consider | 237 | ||
| 1. Radiography | 237 | ||
| Conventional Radiography | 237 | ||
| A. Analogue radiographs | 237 | ||
| B. Digital radiographs | 238 | ||
| Computerized Tomography | 239 | ||
| 2. Clinical photography | 239 | ||
| 3. Videos | 245 | ||
| Clinical Imaging to Enhance Adherence | 245 | ||
| References | 246 | ||
| 4.3 Patient Adherence | 247 | ||
| Overview of the Chapter | 247 | ||
| Importance of Adherence in Periodontal Care | 247 | ||
| Improving Adherence and Affecting Behaviour Change | 249 | ||
| Motivational interviewing (MI) | 249 | ||
| MI Step 1: Develop a “Guiding”Style | 249 | ||
| MI Step 2: Elicit Motivation to Change | 250 | ||
| MI Step 3: Respond to the Patient | 252 | ||
| Adherence to Oral Hygiene and Other Advice | 252 | ||
| Oral hygiene advice | 252 | ||
| Other advice | 254 | ||
| Smoking Cessation Advice | 255 | ||
| Diet Advice | 255 | ||
| Assessing Adherence in Practice | 255 | ||
| Conclusion | 255 | ||
| References | 255 | ||
| 5 Non–surgical Periodontal Management | 257 | ||
| 5.1 The Diseased Root Surface in Periodontitis | 259 | ||
| Overview of the Chapter | 259 | ||
| The Clinical Presentation of Periodontitis | 259 | ||
| Features of periodontitis | 259 | ||
| The role of bacteria | 260 | ||
| Current concepts of aetiology | 260 | ||
| Treating the Diseased Root Surface | 262 | ||
| Non-surgical vs surgical treatment | 262 | ||
| The role of the biofilm | 263 | ||
| Calculus in disease | 264 | ||
| Contaminated cementum | 265 | ||
| References | 266 | ||
| 5.2 Periodontal Instrumentation | 269 | ||
| Overview of the Chapter | 269 | ||
| Treatment objectives | 269 | ||
| Terminology and definitions | 270 | ||
| Scaling | 271 | ||
| Root planing (RP) | 271 | ||
| Root surface debridement (RSD) | 271 | ||
| Root surface instrumentation (RSI) | 271 | ||
| Full mouth disinfection (FMD) | 271 | ||
| Full mouth ultrasonic debridement (FMUD) | 271 | ||
| Types of instruments | 271 | ||
| Hand instruments | 271 | ||
| Types | 272 | ||
| Scalers | 272 | ||
| Curettes | 272 | ||
| Hoes | 272 | ||
| Methods | 273 | ||
| Machine-driven instruments | 273 | ||
| Types | 273 | ||
| Sonic scalers | 273 | ||
| Ultrasonic scalers | 273 | ||
| Magnetostrictive | 274 | ||
| Piezo-electric | 274 | ||
| Methods | 274 | ||
| Other types | 275 | ||
| Vector | 275 | ||
| Lasers | 275 | ||
| Photodynamic disinfection | 276 | ||
| Subgingival air polishing | 276 | ||
| Instrumentation strategies | 276 | ||
| RP or RSD – Choice of instruments | 277 | ||
| Hand vs ultrasonic instrumentation | 277 | ||
| Use of anaesthesia | 278 | ||
| Full mouth or quadrant approaches? | 278 | ||
| Conclusion | 279 | ||
| References | 279 | ||
| 5.3 Antibiotics in the Management of Periodontal Diseases | 283 | ||
| Overview of the Chapter | 283 | ||
| The rationale for antibiotic use | 283 | ||
| Which periodontal conditions can be treated with antibiotics? | 284 | ||
| Reasons for the failure of root surface debridement | 285 | ||
| Antibiotics as an alternative monotherapy to RSD | 286 | ||
| Comparison of local or systemic delivery of antibiotics | 286 | ||
| Evaluating studies which use antibiotics as adjuncts to RSD | 287 | ||
| The evidence for antibiotic use in periodontal therapy | 289 | ||
| Local delivery antibiotics | 289 | ||
| Systemic delivery antibiotics | 290 | ||
| Recommendations on the use of systemic antibiotics in periodontal therapy | 291 | ||
| References | 292 | ||
| 5.4 Assessment of Treatment Outcomes and Supportive Periodontal Therapy | 295 | ||
| Overview of the Chapter | 295 | ||
| Introduction | 296 | ||
| What is Supportive Periodontal Therapy? | 297 | ||
| Gingival Inflammation | 298 | ||
| Value of SPT | 299 | ||
| Assessment of Treatment Outcomes | 300 | ||
| When and How to Provide SPT | 300 | ||
| SPT plan | 300 | ||
| SPT frequency | 300 | ||
| SPT appointment | 301 | ||
| Examination, Re-evaluation, Re-diagnosis | 301 | ||
| Oral Hygiene Motivation and Re-instruction | 302 | ||
| Risk Assessment | 302 | ||
| Assessing risk during SPT | 302 | ||
| References | 306 | ||
| 6 Surgical Periodontal Therapy | 309 | ||
| 6.1 Rationale for Periodontal Surgery | 311 | ||
| Overview of the Chapter | 311 | ||
| Introduction | 311 | ||
| When is Periodontal Surgery Appropriate? | 312 | ||
| 1. Control of disease | 312 | ||
| General Objectives | 312 | ||
| 2. Periodontal plastic surgery | 313 | ||
| Case Selection | 313 | ||
| Medical Contraindications | 315 | ||
| Surgical Approaches | 315 | ||
| Pocket Reduction Procedures | 315 | ||
| Pocket Elimination Procedures | 316 | ||
| Regenerative Procedures | 316 | ||
| Open flap debridement (OFD) | 316 | ||
| Objectives | 316 | ||
| Technique | 316 | ||
| Outcomes | 316 | ||
| Modified Widman Flap (MWF) | 316 | ||
| Objective | 316 | ||
| 7 Interaction with Other Dental Disciplines | 327 | ||
| 7.1 The Periodontal–Restorative Interface | 329 | ||
| Overview of the Chapter | 329 | ||
| General Restorative Considerations | 329 | ||
| Crown and Bridge Construction | 330 | ||
| Biological Width | 332 | ||
| Partial Dentures | 333 | ||
| Occlusion | 334 | ||
| Mobility | 335 | ||
| Periodontitis and Implant Dentistry | 336 | ||
| Endodontic/Periodontal Relationships | 337 | ||
| Summary and Conclusions | 338 | ||
| References | 339 | ||
| 7.2 The Periodontal–Orthodontic Interface | 341 | ||
| Overview of the Chapter | 341 | ||
| Introduction | 341 | ||
| The Role of Orthodontics in Periodontal Therapy | 341 | ||
| 1. Crowded teeth, anterior splaying or over eruption | 342 | ||
| Orthodontic Treatment | 342 | ||
| 2. Infra-bony defects | 343 | ||
| Index | 349 | ||
| A | 349 | ||
| B | 349 | ||
| C | 350 | ||
| D | 350 | ||
| E | 351 | ||
| F | 351 | ||
| G | 351 | ||
| H | 352 | ||
| I | 352 | ||
| J | 352 | ||
| K | 353 | ||
| L | 353 | ||
| M | 353 | ||
| N | 353 | ||
| O | 353 | ||
| P | 354 | ||
| Q | 356 | ||
| R | 356 | ||
| S | 356 | ||
| T | 357 | ||
| U | 357 | ||
| V | 357 | ||
| W | 357 |