BOOK
Clinical Problem Solving in Periodontology and Implantology - E-Book
Francis J. Hughes | Professor Kevin G. Seymour | Wendy Turner | Shakeel Shahdad | Francis Nohl
(2012)
Additional Information
Book Details
Abstract
Clinical Problem Solving in Periodontics and Implantology - a new title in the successful Churchill Livingstone’s Clinical Problem Solving in Dentistry series - provides a highly visual step-by-step guide to the practical management of a wide variety of clinical problems commonly seen in practice.
Containing over 400 high-quality photographs, many in full colour, the book is written in an easy-to read ‘how to’ style and contains a large number of real life clinical cases carefully presented to maximise learning outcomes for the reader.
Covering the core aspects of practice, Clinical Problem Solving in Periodontics and Implantology will be of value to all undergraduate dental students and those embarking on post-graduate training in periodontology and implantology.
- More than 400 colour illustrations present clinical, diagnostic and practical information in an easy-to-follow manner
- Contains ‘practical tips’, ‘how to’ boxes and other useful aide-mémoires
- Practical approach to the subject makes learning especially easy
- Designed to help the reader organise their knowledge into a clinically useful format
- Explores treatment alternatives and evaluates their advantages and disadvantages
- Practical approach to the subject makes learning especially easy
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Clinical Problem Solving in Periodontology and Implantology | i | ||
| Copyright page | iv | ||
| Table of Contents | v | ||
| Preface | vii | ||
| 1 Periodontal assessment and diagnosis | 1 | ||
| 1 Periodontal assessment | 3 | ||
| Introduction | 3 | ||
| What factors in the dental history might indicate periodontal disease is present? | 3 | ||
| What is the relevance of a patient’s medical history to his or her periodontal care? | 3 | ||
| Why is it necessary to take a social history? | 4 | ||
| Clinical periodontal examination | 4 | ||
| What are the methods for screening for periodontal disease? | 5 | ||
| What do I need to carry out a BPE and how often should it be recorded? | 5 | ||
| How do I record a BPE screening examination? | 5 | ||
| Is the BPE used for children and teenagers? | 5 | ||
| How would I score a sextant where there are no probing depths greater than 5 mm but the furcation is detected? | 6 | ||
| Can I probe around implants? | 6 | ||
| How do I interpret the BPE scores to reflect the treatment needs of an individual patient? | 6 | ||
| What are the limitations of the BPE? | 6 | ||
| Case 1 | 6 | ||
| Why are the BPE scores inconsistent with the minimal attachment loss experienced? | 6 | ||
| Case 2 | 6 | ||
| Why did the BPE scores at recall not show any improvement? | 7 | ||
| Comprehensive periodontal assessment | 7 | ||
| What are clinical attachment loss and clinical attachment level? | 9 | ||
| Width of attached gingiva: How much is needed? | 9 | ||
| When would I carry out a radiographic assessment? | 9 | ||
| What are the appropriate radiographs to take? | 10 | ||
| Is there a difference between horizontal and vertical bone loss? | 10 | ||
| Assessment of co-morbidities | 10 | ||
| Conclusions | 12 | ||
| 2 Classification of periodontal diseases | 13 | ||
| Introduction | 13 | ||
| What are the current possible periodontal diagnoses? | 13 | ||
| How do I reach a periodontal diagnosis? Basic checklist | 14 | ||
| Gingival diseases | 14 | ||
| Case 1 | 14 | ||
| Case 2 | 14 | ||
| Periodontal diseases | 15 | ||
| Chronic periodontitis | 15 | ||
| Aggressive periodontitis | 15 | ||
| Case 3 | 16 | ||
| Is this plaque-related periodontitis? | 16 | ||
| Case 4 | 16 | ||
| 2 Periodontal treatment | 43 | ||
| 6 Initial treatment planning | 45 | ||
| Introduction | 45 | ||
| The treatment planning process | 45 | ||
| Assessing prognosis | 45 | ||
| Case 1 | 46 | ||
| Planning extractions | 47 | ||
| Case 2 | 48 | ||
| Summary | 49 | ||
| 7 Behaviour change | 51 | ||
| Introduction | 51 | ||
| Plaque control | 51 | ||
| Oral hygiene methods to control plaque formation | 51 | ||
| Toothbrushing | 51 | ||
| Interdental cleaning | 53 | ||
| The ability of the patient to perform these methods | 54 | ||
| The motivation of the patient | 55 | ||
| Summary | 55 | ||
| Smoking cessation | 55 | ||
| Behavioural and pharmacological support | 56 | ||
| 8 Nonsurgical treatment | 57 | ||
| Introduction | 57 | ||
| What is nonsurgical treatment? | 57 | ||
| Scaling technique | 57 | ||
| Particular difficulties of root surface debridement | 59 | ||
| Treatment outcomes | 60 | ||
| Summary | 60 | ||
| 9\r Reassessment | 63 | ||
| Assessing treatment outcomes | 63 | ||
| Reasons for poor responses to treatment | 63 | ||
| Remedies for inadequate treatment outcomes | 65 | ||
| Case 1 | 65 | ||
| Case 2 | 66 | ||
| Case 3 | 68 | ||
| Summary | 69 | ||
| 10 Surgical treatment of periodontal pocketing | 71 | ||
| Introduction | 71 | ||
| Indications for surgery | 71 | ||
| Contraindications for surgery | 71 | ||
| Surgical techniques | 72 | ||
| Case 1 | 73 | ||
| Case 2 | 75 | ||
| Postoperative management | 75 | ||
| Summary | 76 | ||
| 11 Other surgical procedures | 77 | ||
| Introduction | 77 | ||
| Gingival procedures to remove excess gingiva (gingivectomy) | 77 | ||
| Case 1: Drug-induced gingival enlargement | 77 | ||
| Could this have been carried out by alternative surgical methods? | 77 | ||
| Crown lengthening surgery | 77 | ||
| Main indications | 79 | ||
| What is the biologic width and why is it important? | 79 | ||
| Case 2: Biologic width invasion | 80 | ||
| Case 3: Fractured tooth with lack of crown height | 81 | ||
| What other treatment options would be possible? | 81 | ||
| Treatment timing | 81 | ||
| Root resection procedures | 81 | ||
| Case 4: Root resection | 82 | ||
| Summary | 83 | ||
| 12 Periodontal regeneration | 85 | ||
| Introduction | 85 | ||
| Overview of regenerative therapies | 85 | ||
| Guided tissue regeneration | 85 | ||
| Graft materials | 85 | ||
| Biologically active materials | 86 | ||
| Applications of regenerative therapies | 87 | ||
| Case 1 | 87 | ||
| Outcomes of periodontal regenerative treatments | 88 | ||
| Future developments | 89 | ||
| 13 Local and systemic antimicrobial agents | 91 | ||
| Introduction | 91 | ||
| Antiseptic agents and chemical plaque control | 91 | ||
| Chlorhexidine | 91 | ||
| Other antiseptic agents and plaque control | 91 | ||
| Other antiplaque agents | 92 | ||
| Systemic antimicrobial agents | 92 | ||
| Acute conditions | 92 | ||
| Treatment of periodontal pocketing | 92 | ||
| Case 1 | 93 | ||
| Case 2 | 94 | ||
| Locally delivered antimicrobial agents | 96 | ||
| 14 Gingival recession | 97 | ||
| Introduction | 97 | ||
| Assessment | 97 | ||
| Case 1 | 97 | ||
| Case 2 | 99 | ||
| Surgical procedures for treating recession defects | 100 | ||
| Recession following periodontal treatment | 101 | ||
| Case 3 | 101 | ||
| 15 Postoperative care and periodontal maintenance therapy | 105 | ||
| Introduction | 105 | ||
| Managing the consequences of periodontal disease | 105 | ||
| Case 1 | 105 | ||
| Case 2 | 106 | ||
| Case 3 | 108 | ||
| Periodontal maintenance therapy | 108 | ||
| Case 4 | 110 | ||
| Summary | 111 | ||
| 3 Introduction to dental implantology | 113 | ||
| 16 Indications for dental implant treatment | 115 | ||
| Why does the patient wish to replace missing teeth? | 115 | ||
| To improve aesthetics? | 115 | ||
| To improve masticatory function? | 115 | ||
| To improve speech function? | 115 | ||
| To enable wind instrument playing? | 115 | ||
| To regain what has been lost? | 115 | ||
| What are the prosthodontic advantages of implant treatment? | 115 | ||
| To avoid tooth preparation and possible sequelae | 115 | ||
| No need for connectors between pontic and abutment teeth | 116 | ||
| Avoids mechanical risks of conventional bridges | 116 | ||
| The deep complete overbite—No need to accommodate a denture connector | 116 | ||
| Concurrent use of an implant as an orthodontic anchor | 116 | ||
| Linking implant restorations together | 117 | ||
| Retrievability of the restoration | 117 | ||
| Denture retention and support | 117 | ||
| To take advantage of machined fitting parts | 117 | ||
| What is the problem with an existing fixed restoration or the natural teeth? | 117 | ||
| Problematic bridgework | 117 | ||
| Periodontal disease | 118 | ||
| Unrestorable teeth | 118 | ||
| Is there a denture-related problem the patient wishes to solve? | 119 | ||
| Improved removable denture | 119 | ||
| Fixed restoration instead of removable denture? | 119 | ||
| Does the cause of missing or failing teeth have any influence on the indication for implants? | 120 | ||
| Periodontal disease | 120 | ||
| Congenital/developmental absence | 120 | ||
| Caries | 120 | ||
| Related to treatment for head and neck cancer | 120 | ||
| Trauma | 120 | ||
| Root resorption | 120 | ||
| Periradicular infection | 120 | ||
| Does the timing of tooth loss have any influence on indication for implants? | 121 | ||
| What are the main drawbacks of implant treatment? | 122 | ||
| The need for surgery | 122 | ||
| Cost and duration of treatment | 122 | ||
| Lack of implant product standardization | 122 | ||
| Possible need for a tooth-free period | 123 | ||
| Difficulty achieving aesthetic perfection and easy access for oral hygiene | 123 | ||
| Are there contraindications to implant treatment? | 123 | ||
| 17 Assessing the patient for implant placement | 125 | ||
| What are the patient’s expectations and can they be safely met? | 125 | ||
| Does the treating team have the ability to meet the expectations of the patient? | 125 | ||
| What training has been undertaken? | 125 | ||
| Is the appropriate equipment available and are the practice premises suitable to carry out implant dentistry? | 125 | ||
| Is the patient able to give valid informed consent? | 125 | ||
| What are the time-scales for the completion of treatment? | 125 | ||
| Will the patient be able to attend for maintenance? | 125 | ||
| Can the patient afford the treatment and maintenance? | 125 | ||
| Might there be periods during treatment without tooth replacement and how might teeth be replaced temporarily? | 126 | ||
| What side effects from surgery are to be expected, and what are the more unusual but significant risks? | 126 | ||
| Will treatment involve the use of animal-derived products? | 126 | ||
| What is the likelihood of being able to satisfy the aesthetic desires of the patient? | 126 | ||
| Is it possible to communicate effectively to obtain a reliable history? | 127 | ||
| Does the patient have communication problems? | 127 | ||
| Are there any pre-existing general factors that might compromise the establishment of bone and soft tissue integration? | 127 | ||
| Does the patient smoke? | 127 | ||
| Has the patient had radiotherapy to the jaws? | 127 | ||
| Have bisphosphonates ever been prescribed? | 127 | ||
| Does the patient suffer from diabetes? | 127 | ||
| Will it be possible to access the oral cavity to perform the required diagnostic, surgical, and prosthodontic procedures with acceptable risk? | 128 | ||
| Does the patient have a reduced oral aperture or mandibular opening range? | 128 | ||
| Is the patient able to recline in the dental chair to allow the operator to work in a safe and acceptable position? | 128 | ||
| Does the patient have a compromised airway protective reflex? | 128 | ||
| Is the patient able to cooperate during assessment and treatment? | 128 | ||
| Is the patient likely to tolerate surgery, anaesthetic, and anxiety management techniques with acceptable risk? | 128 | ||
| How will the patient be anaesthetized? | 128 | ||
| Is there a risk from ionizing radiation in pregnancy? | 128 | ||
| Is there any risk of compromised wound healing due to underlying medical conditions or the effect of current or past therapies? | 129 | ||
| Is the oral environment stable and disease-free? | 129 | ||
| Is there any evidence of pulpal/periapical disease, active caries, heavily restored teeth at risk of mechanical failure, or tooth wear? | 129 | ||
| What is the risk of future peri-implantitis? | 129 | ||
| Does the patient have good oral hygiene? | 129 | ||
| Is there a history of previous periodontitis or peri-implantitis? | 129 | ||
| Does the patient have a dry mouth? | 129 | ||
| Has there been a course of orthodontic treatment? | 129 | ||
| Are tooth positions stable? | 129 | ||
| Is gingival architecture mature? | 129 | ||
| Is the patient’s age relevant? | 129 | ||
| Has craniofacial growth ceased? | 129 | ||
| Are there age-related co-morbidities? | 130 | ||
| Are there any lifestyles or habits that might influence treatment options or that might pose a risk to implant restoration longevity? | 130 | ||
| 18 Treatment planning | 131 | ||
| What is the overall treatment objective? | 131 | ||
| Is the final restoration to be fixed or removable by the patient? | 131 | ||
| What are the diagnoses and constraints for treatment and maintenance? | 131 | ||
| What are the aesthetic goals? | 131 | ||
| Which teeth are to be replaced in part-dentate patients? | 131 | ||
| What is the ideal soft tissue frame of the teeth to be replaced? | 131 | ||
| Does acceptable lip and facial support rely largely on the presence of a removable prosthesis? | 132 | ||
| What are the occlusal objectives? | 134 | ||
| Is there space within an existing tooth-borne occlusal scheme to accommodate the proposed arrangement of teeth to be replaced? | 134 | ||
| Is the proposed restoration protected in excursions? | 134 | ||
| Is there space within the prosthetic envelope of a denture to accommodate overdenture attachments? | 135 | ||
| What are the requirements to facilitate access for oral hygiene? | 135 | ||
| What are the ideal implant positions to satisfy the aesthetic, occlusal, and hygiene goals? | 135 | ||
| How deeply placed should implants be? | 135 | ||
| What should the mesiodistal position of implants be? | 135 | ||
| What should the buccolingual position of implants be? | 136 | ||
| What should the trajectory of the implants be? | 136 | ||
| What moderating factors indicate a departure from “one implant per missing tooth” for fixed restorations? | 136 | ||
| Narrow teeth | 136 | ||
| Edentate fixed restoration | 136 | ||
| How many implants for overdentures? | 136 | ||
| What support is intended for the overdenture? | 136 | ||
| What are the ideal implant product features to satisfy the aesthetic, occlusal, and hygiene goals? | 138 | ||
| How wide should implants be? | 138 | ||
| How long should the implants be? | 138 | ||
| What about other implant product features? | 138 | ||
| Is satisfactory volume and quality of bone available to house the chosen implant products in the selected positions? | 138 | ||
| How much bone will remain after a tooth is extracted? | 138 | ||
| What can radiography show? | 138 | ||
| Will the peri-implant soft tissue be appropriate? | 139 | ||
| Is the peri-implant tissue attached mucosa or mobile alveolar mucosa? | 139 | ||
| If bone and/or soft tissue is lacking, can it be created? | 139 | ||
| It is anticipated that the implant will gain adequate primary stability from existing bone | 139 | ||
| It is anticipated that initial implant stability in existing bone cannot be achieved | 139 | ||
| It is anticipated that peri-implant soft tissue will be lacking | 140 | ||
| If bone or soft tissue is lacking, is it possible to proceed, accepting the risk of compromise? | 140 | ||
| What are the aesthetic risks? | 140 | ||
| What are other possible compromise outcomes? | 140 | ||
| How will the patient make the transition to implant restoration? | 140 | ||
| Provisional fixed restoration borne by teeth | 140 | ||
| Provisional removable restoration | 140 | ||
| Provisional fixed restoration borne by implants | 140 | ||
| Immediate final restoration using implants | 140 | ||
| No provisional restoration | 141 | ||
| What is the stage-by-stage plan of treatment? | 141 | ||
| 19 Basic surgery for implant placement | 143 | ||
| Surgical placement of an implant to replace an upper first molar | 143 | ||
| Summary | 143 | ||
| History | 143 | ||
| Complaint | 143 | ||
| History of complaint | 143 | ||
| Dental history | 143 | ||
| Examination | 143 | ||
| Intraoral examination | 143 | ||
| Radiographic examination | 143 | ||
| What is the diagnosis and what factors will determine the prognosis of this tooth? | 143 | ||
| What replacement restorations would you consider and why? | 143 | ||
| Preimplant assessment | 144 | ||
| What factors would you consider when planning an implant to replace a maxillary and a mandibular molar? | 144 | ||
| Describe the surgical technique pertinent to molar region | 144 | ||
| Immediate implant placement to replace two upper premolars | 145 | ||
| Summary | 145 | ||
| History | 146 | ||
| Complaint | 146 | ||
| History of complaint | 146 | ||
| Dental history | 146 | ||
| Examination | 146 | ||
| Intraoral examination | 146 | ||
| Radiographic examination | 147 | ||
| What is the prognosis for these teeth? | 147 | ||
| What replacement restorations would you consider and why? | 147 | ||
| What surgical protocols would you consider for implant placement? Discuss the risks and benefits | 147 | ||
| Preimplant assessment | 147 | ||
| Describe the surgical technique, with particular consideration for immediate implant placement | 147 | ||
| Replacement of an upper central incisor with a dental implant | 148 | ||
| Summary | 148 | ||
| History | 148 | ||
| Complaint | 148 | ||
| History of complaint | 148 | ||
| Dental history | 149 | ||
| Examination | 149 | ||
| Intraoral examination | 149 | ||
| Radiographic examination | 149 | ||
| What replacement restorations would you consider and why? | 149 | ||
| Preimplant assessment | 149 | ||
| What important factors would you assess when replacing implants in the aesthetic zone? | 149 | ||
| Describe the surgical technique most appropriate for the highly demanding aesthetic zone | 149 | ||
| Summary | 150 | ||
| 20 Managing bone deficiencies for implant surgery | 151 | ||
| Surgical placement of an implant with simultaneous guided bone regeneration | 151 | ||
| Summary | 151 | ||
| History | 151 | ||
| Complaint | 151 | ||
| History of complaint | 151 | ||
| Dental history | 151 | ||
| Examination | 151 | ||
| Intraoral examination | 151 | ||
| Radiographic examination | 151 | ||
| What important factors would you consider when placing implants with simultaneous GBR? | 151 | ||
| Describe the surgical technique of simultaneous GBR | 152 | ||
| Surgical placement of an implant after staged augmentation with block bone graft | 154 | ||
| Summary | 154 | ||
| History | 154 | ||
| Complaint | 154 | ||
| History of complaint | 154 | ||
| Dental history | 155 | ||
| Examination | 155 | ||
| Intraoral examination | 155 | ||
| Radiographic examination | 155 | ||
| Describe the surgical technique for block bone grafting | 156 | ||
| Conclusion | 157 | ||
| 21 Restorative options in implant dentistry | 159 | ||
| What are the techniques for transferring the implant position to a working cast? | 159 | ||
| What is an implant abutment and what are the various available types? | 159 | ||
| What are the methods of attaching a restoration to the dental implant? | 161 | ||
| Single-tooth posterior replacement | 161 | ||
| Posterior cement-retained crown | 161 | ||
| Posterior screw-retained crown | 162 | ||
| Anterior cement-retained crown | 163 | ||
| Anterior screw-retained crown | 165 | ||
| What restorative options can be considered for an edentulous patient? | 165 | ||
| Implant-retained removable overdenture options | 165 | ||
| Locator attachment | 165 | ||
| Ball attachment | 166 | ||
| Bar attachment | 166 | ||
| Milled bar | 166 | ||
| Implant-supported fixed prosthesis option | 167 | ||
| Summary | 167 | ||
| 22 Implant failures | 169 | ||
| What is peri-implant disease? Describe its aetiology and discuss the recommended treatment | 169 | ||
| Describe the various prosthetic complications and failures associated with implant restorations | 169 | ||
| What are the common aesthetic failures when replacing teeth with dental implants? | 170 | ||
| Clinical case examples of implant failures | 170 | ||
| Case 1 | 170 | ||
| Case 2 | 170 | ||
| Case 3 | 170 | ||
| Case 4 | 171 | ||
| Case 5 | 171 | ||
| Case 6 | 172 | ||
| Case 7 | 172 | ||
| Case 8 | 172 | ||
| Case 9 | 172 | ||
| Case 10 | 173 | ||
| Case 11 | 173 | ||
| Case 12 | 173 | ||
| Summary | 175 | ||
| Further reading | 177 | ||
| Additional textbooks | 177 | ||
| Section 1. Periodontal assessment and diagnosis | 177 | ||
| Section 2. Periodontal treatment | 177 | ||
| Section 3. Introduction to dental implantology | 177 | ||
| Index | 179 | ||
| A | 179 | ||
| B | 179 | ||
| C | 180 | ||
| D | 181 | ||
| E | 181 | ||
| F | 181 | ||
| G | 181 | ||
| H | 181 | ||
| I | 182 | ||
| J | 183 | ||
| L | 183 | ||
| M | 183 | ||
| N | 183 | ||
| O | 183 | ||
| P | 183 | ||
| R | 184 | ||
| S | 185 | ||
| T | 185 | ||
| U | 185 | ||
| V | 185 | ||
| W | 185 | ||
| X | 186 | ||
| Z | 186 |