Carranza's Clinical Periodontology

by Newman, Michael G.; Takei, Henry H.; Klokkevold, Perry R.

• ISBN13: 9781416024002
• ISBN10: 141602400X
• Edition: 10th
• Format: Hardcover
• Copyright: 2006-06-30
• Publisher: Elsevier Science Health Science

Summary

Unsurpassed in its authority and scope, the 10th edition of the most widely used periodontics text has been revised to include the most up-to-date information on new technology and emerging concepts. Published for the first time in full-color, and containing a new section on evidence-based decision-making, new chapters, scores of new illustrations, and exclusive special features like Science Transfer information boxes, this edition reinforces its reputation as the text with the best coverage of periodontology available. Comprehensive coverage provides readers with information on the entire spectrum of periodontics in a single volume Unique approach combining evidence-based decision-making, science transfer, and classification/nomenclature gives readers an efficient and decisive introduction to material Chapter outlines at the start of chapters highlight important topics at a glance Extensive references direct readers to the most current resources available for additional research 4 chapter covering Oral Malador, Host Modulation Agents, Recent Advances in Implant Surgical Technology, and Periodontal Treatment in Practice, Dental Insurance, Managed Care Over 16 completely revised/rewritten chapters bring forth the latest cutting-edge information on dozens of periodontal topics Section on Evidence-Based Decision-Making provides readers with an in-depth introduction to evidence-based decision-making, accessing evidence, and implementing evidence-based decisions in clinical practice Science Transfer boxes with commentary from leading periodontists appear in every chapter to provide scientific basis for clinical procedures Over 2,300 full-color illustrations and pictures provide readers with color accurate images for easier comprehension of specific conditions and treatments

Table of Contents

Introduction The Historical Background of Periodontology	1	(1)
Early Civilizations	1	(1)
The Classical World	2	(1)
The Middle Ages	2	(1)
The Renaissance	2	(1)
Eighteenth Century	3	(1)
Nineteenth Century	4	(2)
Necrotizing Ulcerative Gingivitis	5	(1)
Twentieth Century	6	(5)
Vienna	6	(1)
Berlin	6	(1)
United States and Other Countries	7	(1)
Focal Infection	7	(1)
Dental Implants	8	(1)
After World War II	8	(3)
PART 1 EVIDENCE-BASED DECISION MAKING	11	(34)
Introduction to Evidence-Based Decision Making	12	(10)
Background and Definition	12	(1)
Principles of Evidence-Based Decision Making	13	(1)
Evidence-Based versus Traditional Decision Making	13	(1)
Evidence-Based Dentistry	13	(1)
Need for Evidence-Based Decision Making	13	(1)
Variations in Practice Patterns	13	(1)
Assimilating Evidence into Practice	14	(1)
Evidence-Based Decision-Making Process and Skills	14	(6)
Asking Good Questions: the PICO Process	14	(1)
Searching for and Acquiring the Evidence	15	(3)
Appraising the Evidence	18	(1)
Evaluating the Outcomes	19	(1)
Conclusion	20	(2)
Assessing Evidence	22	(14)
Twelve Tools for Assessing Evidence	22	(10)
Be Skeptical	22	(1)
Don't Trust Biologic Plausibility	23	(1)
What Level of Controlled Evidence Is Available?	23	(1)
Did the Cause Precede the Effect?	24	(1)
No Betting on the Horse after the Race Is Over	25	(1)
What Is a Clinically Relevant Pretrial Hypothesis?	25	(1)
Size Does Matter	26	(3)
Is There ``Even One Different Explanation That Works as Well or Better''?	29	(1)
Was the Study Properly Randomized?	30	(1)
When to Rely on Nonrandomized Evidence?	30	(1)
Placebo Effects: Real or Sham?	31	(1)
Was There Protection against Conflict of Interest?	31	(1)
Conclusion	32	(4)
Implementing Evidence-Based Decisions in Clinical Practice	36	(9)
Variation in Clinical Decisions	36	(1)
Managing Uncertainty	36	(1)
Incorporating Evidence into Practice	37	(1)
Linking Outcomes with Diagnosis and Treatment	38	(2)
Outcomes	38	(1)
Diagnosis	39	(1)
Treatment	39	(1)
Implementing Evidence-Based Decisions	40	(2)
Change Management	42	(3)
PART 2 THE NORMAL PERIODONTIUM	45	(54)
The Gingiva	46	(22)
Clinical Features	46	(2)
Marginal Gingiva	46	(1)
Gingival Sulcus	46	(1)
Attached Gingiva	47	(1)
Interdental Gingiva	47	(1)
Microscopic Features	48	(13)
Gingival Epithelium	48	(9)
Gingival Connective Tissue	57	(4)
Correlation of Clinical and Microscopic Features	61	(7)
Color	61	(1)
Size	62	(1)
Contour	62	(1)
Shape	62	(1)
Consistency	62	(1)
Surface Texture	62	(1)
Position	63	(5)
The Tooth-Supporting Structures	68	(25)
Periodontal Ligament	68	(7)
Periodontal Fibers	68	(3)
Cellular Elements	71	(1)
Ground Substance	72	(1)
Functions of the Periodontal Ligament	72	(3)
Cementum	75	(4)
Permeability of Cementum	76	(1)
Cementoenamel Junction	76	(1)
Cementodentinal Junction	77	(1)
Thickness of Cementum	77	(1)
Cementum Resorption and Repair	77	(2)
Exposure of Cementum to Oral Environment	79	(1)
Alveolar Process	79	(6)
Cells and Intercellular Matrix	80	(2)
Socket Wall	82	(1)
Bone Marrow	82	(1)
Periosteum and Endosteum	82	(1)
Interdental Septum	82	(1)
Osseous Topography	83	(1)
Fenestration and Dehiscence	84	(1)
Remodeling of Alveolar Bone	85	(1)
Development of the Attachment Apparatus	85	(1)
Cementum	85	(1)
Periodontal Ligament	86	(1)
Alveolar Bone	86	(1)
Physiologic Migration of the Teeth	86	(1)
External Forces and the Periodontium	86	(2)
Vascularization of the Supporting Structures	88	(5)
Aging and the Periodontium	93	(6)
Effects of Aging on the Periodontium	93	(3)
Gingival Epithelium	93	(2)
Gingival Connective Tissue	95	(1)
Periodontal Ligament	95	(1)
Cementum	96	(1)
Alveolar Bone	96	(1)
Bacterial Plaque	96	(1)
Immune Responses	96	(1)
Effects of Aging on Progression of Periodontal Disease	96	(1)
Aging and Response to Treatment of the Periodontium	97	(2)
PART 3 CLASSIFICATION AND EPIDEMIOLOGY OF PERIODONTAL DISEASES	99	(34)
Classification of Diseases and Conditions Affecting the Periodontium	100	(10)
Gingival Diseases	100	(3)
Dental Plaque--Induced Gingival Diseases	100	(3)
Non--Plaque-Induced Gingival Lesions	103	(1)
Periodontitis	103	(3)
Chronic Periodontitis	105	(1)
Aggressive Periodontitis	105	(1)
Periodontitis as a Manifestation of Systemic Diseases	105	(1)
Necrotizing Periodontal Diseases	106	(1)
Necrotizing Ulcerative Gingivitis	107	(1)
Necrotizing Ulcerative Periodontitis	107	(1)
Abscesses of the Periodontium	107	(1)
Periodontitis Associated with Endodontic Lesions	107	(1)
Endodontic--Periodontal Lesions	107	(1)
Periodontal--Endodontic Lesions	107	(1)
Combined Lesions	107	(1)
Developmental or Acquired Deformities and Conditions	107	(3)
Localized Tooth-Related Factors That Modify or Predispose to Plaque-Induced Gingival Diseases or Periodontitis	107	(1)
Mucogingival Deformities and Conditions around Teeth	108	(1)
Mucogingival Deformities and Conditions on Edentulous Ridges	108	(1)
Occlusal Trauma	108	(2)
Epidemiology of Gingival and Periodontal Diseases	110	(23)
What Is Epidemiology?	111	(1)
Epidemiologic Measures of Disease	111	(1)
Epidemiologic Study Designs	112	(1)
Diagnosis	112	(2)
Normal versus Abnormal; Health versus Disease	112	(1)
Principles of Diagnostic Testing	113	(1)
Risk versus Prognosis	114	(1)
Risk, Risk Factors, and Risk Assessment	114	(1)
Prognosis, Prognostic Factors, and Prognosis Assessment	114	(1)
Gingival Disease	115	(5)
How Is Gingivitis Measured?	115	(1)
How Much Gingivitis Is Present?	116	(1)
Is More or Less Gingivitis Present Now than Previously?	117	(1)
Does My Patient with Gingivitis Fit the Typical Profile?	117	(2)
Why Do Patients Have Gingivitis, and What Puts Them at Risk?	119	(1)
Chronic Periodontitis	120	(7)
How Is Periodontitis Measured?	120	(2)
How Much Chronic Periodontitis Is Present?	122	(1)
Is More or Less Chronic Periodontitis Present Now than Previously?	123	(1)
How Much New or Progressing Chronic Periodontitis Is Present?	124	(1)
Does My Patient with Chronic Periodontitis Fit the Typical Profile?	124	(1)
Why Do Patients Have Chronic Periodontitis, and What Puts Them at Risk?	125	(2)
Aggressive Periodontitis	127	(6)
How Much Aggressive Periodontitis Is Present?	128	(1)
How Much New Aggressive Periodontitis Is Present?	128	(1)
Does My Patient with Aggressive Periodontitis Fit the Typical Profile?	128	(1)
Why Do Patients Have Aggressive Periodontitis, and What Puts Them at Risk?	128	(5)
PART 4 ETIOLOGY OF PERIODONTAL DISEASES	133	(150)
Microbiology of Periodontal Diseases	134	(36)
Diversity of Intraoral Surfaces for Bacterial Adhesion	135	(2)
Structure and Composition of Dental Plaque	137	(1)
Plaque as a Biofilm	138	(2)
Plaque Formation at the Ultrastructural Level	140	(4)
Formation of the Pellicle	140	(1)
Initial Adhesion and Attachment of Bacteria	141	(1)
Colonization and Plaque Maturation	141	(3)
Growth Dynamics of Dental Plaque	144	(5)
Ultrastructural Aspects	144	(1)
De Novo Supragingival Plaque Formation: Clinical Aspects	145	(3)
De Novo Subgingival Plaque Formation	148	(1)
Physiologic Properties of Dental Plaque	149	(1)
Special Bacterial Behavior in Biofilms	150	(1)
Principle of Bacterial Transmission, Translocation, or Cross-Infection	151	(1)
Microbiology of Implants in Partially Edentulous Patients	151	(1)
Translocation and Guided Tissue Regeneration	151	(1)
Translocation and Mechanical Debridement	151	(1)
Intraoral Equilibrium between Cariogenic Species and Periopathogens	152	(1)
Association of Plaque Microorganisms with Periodontal Diseases	152	(1)
Microbial Specificity of Periodontal Diseases	153	(2)
Nonspecific Plaque Hypothesis	153	(1)
Specific Plaque Hypothesis	153	(1)
Complicating Factors	154	(1)
Criteria for Identification of Periodontal Pathogens	155	(1)
Microorganisms Associated with Specific Periodontal Diseases	155	(5)
Periodontal Health	156	(1)
Gingivitis	156	(1)
Chronic Periodontitis	156	(1)
Localized Aggressive Periodontitis	157	(1)
Necrotizing Periodontal Diseases	158	(1)
Abscesses of the Periodontium	158	(1)
Periodontitis as Manifestation of Systemic Disease	158	(1)
Microbial Specificity in Periodontitis	158	(1)
Periimplantitis	159	(1)
Key Characteristics of Specific Periopathogens	160	(3)
Actinobacillus actinomycetemcomitans	160	(1)
Tannerella forsythia	161	(1)
Porphyromonas gingivalis	161	(1)
Prevotella intermedia and Prevotella nigrescens	161	(1)
Campylobacter rectus	162	(1)
Fusobacterium nucleatum	162	(1)
Peptostreptococcus micros	162	(1)
Eubacterium species	162	(1)
Spirochetes	163	(1)
Future Advances in Periodontal Microbiology	163	(7)
The Role of Dental Calculus and Other Predisposing Factors	170	(23)
Calculus	170	(6)
Supragingival and Subgingival Calculus	170	(1)
Prevalence	171	(1)
Composition	172	(1)
Attachment to the Tooth Surface	173	(1)
Formation	174	(1)
Etiologic Significance	175	(1)
Materia Alba, Food Debris, and Dental Stains	176	(1)
Other Predisposing Factors	176	(17)
Iatrogenic Factors	176	(4)
Malocclusion	180	(1)
Periodontal Complications Associated with Orthodontic Therapy	181	(2)
Extraction of Impacted Third Molars	183	(1)
Habits and Self-Inflicted Injuries	183	(2)
Tobacco Use	185	(1)
Radiation Therapy	186	(7)
Genetic Factors Associated with Periodontal Disease	193	(16)
Genetic Study Designs	193	(3)
Segregation Analyses	195	(1)
Twin Studies	195	(1)
Linkage and Association Studies	195	(1)
Aggressive Periodontal Diseases	196	(7)
Associations with Genetic and Inherited Conditions	197	(1)
Segregation Analyses	198	(2)
Linkage Studies	200	(1)
Association Studies	200	(3)
Chronic Periodontitis	203	(2)
Twin Studies	203	(1)
Association Studies	204	(1)
Clinical Implications of Genetic Studies	205	(1)
Future of Genetic Studies in Periodontology	206	(3)
Immunity and Inflammation: Basic Concepts	209	(19)
Cells of Immunity and Inflammation	211	(3)
Mast Cells	212	(1)
Dermal Dendrocytes	213	(1)
Peripheral Dendritic Cells	213	(1)
Neutrophils and Monocytes/Macrophages	213	(1)
Lymphocytes	213	(1)
T Cells	213	(1)
B Cells	213	(1)
Natural Killer (NK) Cells	214	(1)
Complement	214	(2)
Transendothelial Migration	216	(2)
Leukocyte Functions	218	(3)
Chemotaxis	218	(1)
Phagocytosis	218	(2)
Antigen Processing and Presentation	220	(1)
Specific Immune Responses	221	(1)
T-Cell Responses	222	(2)
B-Cell Responses and Antibodies	224	(1)
Summary	225	(3)
Microbial Interactions with the Host in Periodontal Diseases	228	(23)
Microbiologic Aspects of the Microbial-Host Interaction	228	(5)
Bacterial Colonization and Survival in the Periodontal Region	229	(3)
Microbial Mechanisms of Host Tissue Damage	232	(1)
Immunologic Aspects of the Microbial-Host Interaction	233	(7)
Innate Factors and Initiation of Inflammation	234	(2)
Controlling Bacterial Challenge: Primary Role for Neutrophils	236	(2)
Connective Tissue Alterations: Tissue Destruction in Periodontitis	238	(2)
Connective Tissue Alterations: Healing Processes in Periodontitis	240	(1)
Microbiology and Immunology in Gingival Health	240	(1)
Microbiology and Immunology in Periodontal Diseases	241	(4)
Gingivitis	241	(1)
Chronic Periodontitis	241	(2)
Aggressive Periodontitis	243	(2)
Necrotizing Periodontal Diseases	245	(1)
Periodontal Abscesses	245	(1)
Summary	245	(6)
Smoking and Periodontal Disease	251	(8)
Effects of Smoking on Prevalence and Severity of Periodontal Disease	251	(2)
Gingivitis	251	(1)
Periodontitis	251	(2)
Effects of Smoking on Etiology and Pathogenesis of Periodontal Disease	253	(2)
Microbiology	253	(1)
Immunology	254	(1)
Physiology	254	(1)
Effects of Smoking on Response to Periodontal Therapy	255	(4)
Nonsurgical Therapy	255	(1)
Surgical Therapy and Implants	255	(1)
Maintenance Therapy	256	(1)
Recurrent (Refractory) Disease	256	(3)
Molecular Biology of the Host-Microbe Interaction in Periodontal Diseases: Selected Topics: Molecular Signaling Aspects of Pathogen-Mediated Bone Destruction in Periodontal Diseases	259	(16)
Innate-Immune Response and Toll-Like Receptors	259	(1)
Toll-Like Receptor Expression and Microbial Recognition in Periodontal Tissues	260	(2)
Role of Pathogen-Associated Molecular Patterns in Periodontal Disease	262	(3)
Effects on Resident Cells	262	(3)
Effects on Nonresident Cells	265	(1)
Pathobiology of Lipopolysaccharide-Mediated Bone Destruction	265	(1)
Similarities of Periodontal Diseases to Other Chronic Inflammatory Diseases: Rheumatoid Arthritis	265	(2)
Targets for Inflammatory Periodontal Diseases	266	(1)
Cytokines and Inflammatory Diseases	267	(1)
Pathobiology of Periodontal Disease Progression	267	(2)
Therapeutic Strategies Disrupting Host-Cell Signaling for Treatment of Periodontal Diseases	269	(6)
Host Modulation	275	(8)
Historical Perspective	275	(1)
The Host Response and Potential Targets for Host Modulation	276	(2)
Host Modulatory Therapy	278	(2)
Host Modulation Factors	280	(1)
Periodontitis	280	(1)
Systemic Disorders	280	(1)
Summary	281	(2)
PART 5 RELATIONSHIP BETWEEN PERDIODONTAL DISEASE AND SYSTEMIC HEALTH	283	(60)
Influence of Systemic Disorders and Stress on the Periodontium	284	(28)
Endocrine Disorders and Hormonal Changes	285	(6)
Diabetes Mellitus	285	(3)
Female Sex Hormones	288	(2)
Corticosteroid Hormones	290	(1)
Hyperparathyroidism	290	(1)
Hematologic Disorders and Immune Deficiencies	291	(9)
Leukemia	292	(4)
Anemia	296	(1)
Thrombocytopenia	296	(1)
Leukocyte (Neutrophil) Disorders	297	(2)
Antibody Deficiency Disorders	299	(1)
Stress and Psychosomatic Disorders	300	(1)
Psychosocial Stress, Depression, and Coping	300	(1)
Stress-Induced Immunosuppression	301	(1)
Influence of Stress on Periodontal Therapy Outcomes	301	(1)
Psychiatric Influence of Self-Inflicted Injury	301	(1)
Nutritional Influences	301	(4)
Fat-Soluble Vitamin Deficiency	302	(1)
Water-Soluble Vitamin Deficiency	302	(2)
Protein Deficiency	304	(1)
Other Systemic Conditions	305	(7)
Hypophosphatasia	305	(1)
Congenital Heart Disease	305	(1)
Metal Intoxication	306	(6)
Periodontal Medicine: Impact of Periodontal Infection on Systemic Health	312	(18)
Pathobiology of Periodontitis	312	(1)
Focal Infection Theory Revisited	313	(1)
Evidence-Based Clinical Practice	313	(2)
Subgingival Environment as Reservoir of Bacteria	315	(1)
Periodontal Disease and Mortality	315	(1)
Periodontal Disease and Coronary Heart Disease/Atherosclerosis	315	(5)
Effect of Periodontal Infection	316	(2)
Role of Periodontal Disease in Myocardial or Cerebral Infarction	318	(2)
Periodontal Disease and Stroke	320	(2)
Periodontal Infection Associated with Stroke	320	(1)
Periodontal Disease and Diabetes Mellitus	320	(1)
Periodontal Infection Associated with Glycemic Control in Diabetes	321	(1)
Periodontal Disease and Pregnancy Outcome	322	(2)
Bacterial Vaginosis	322	(1)
Role of Periodontitis	323	(1)
Periodontal Disease and Chronic Obstructive Pulmonary Disease	324	(1)
Periodontal Disease and Acute Respiratory Infections	325	(1)
Periodontal Medicine in Clinical Practice	326	(1)
Periodontal Disease and Systemic Health	326	(1)
Patient Education	326	(1)
Summary	327	(3)
Oral Malodor	330	(13)
Epidemiology	330	(1)
Etiology	331	(2)
Intraoral Causes	331	(1)
Extraoral Causes	332	(1)
Physiology of Malodor Detection	333	(1)
Diagnosis of Malodor	333	(4)
Medical History	333	(1)
Clinical and Laboratory Examination	334	(3)
Treatment of Oral Malodor	337	(3)
Mechanical Reduction of Intraoral Nutrients and Microorganisms	337	(1)
Chemical Reduction of Oral Microbial Load	338	(1)
Conversion of Volatile Sulfide Compounds	339	(1)
Masking the Malodor	340	(1)
Summary	340	(3)
PART 6 PERIODONTAL PATHOLOGY	343	(1)
SECTION I GINGIVAL DISEASE	344	(90)
Defense Mechanisms of the Gingiva	344	(11)
Sulcular Fluid	344	(3)
Methods of Collection	345	(1)
Permeability of Junctional and Sulcular Epithelia	345	(1)
Amount	345	(1)
Composition	346	(1)
Cellular and Humoral Activity in Gingival Crevicular Fluid	347	(1)
Clinical Significance	347	(1)
Drugs in Gingival Crevicular Fluid	347	(1)
Leukocytes in the Dentogingival Area	347	(2)
Saliva	349	(6)
Antibacterial Factors	349	(1)
Salivary Antibodies	349	(1)
Salivary Buffers and Coagulation Factors	350	(1)
Leukocytes	350	(1)
Role in Periodontal Pathology	350	(5)
Gingival Inflammation	355	(7)
Stage I Gingivitis: The Initial Lesion	356	(2)
Stage II Gingivitis: The Early Lesion	358	(1)
Stage III Gingivitis: The Established Lesion	359	(1)
Stage IV Gingivitis: The Advanced Lesion	360	(2)
Clinical Features of Gingivitis	362	(11)
Course and Duration	362	(1)
Description	362	(2)
Clinical Findings	364	(9)
Gingival Bleeding on Probing	364	(1)
Gingival Bleeding Caused by Local Factors	364	(1)
Gingival Bleeding Associated with Systemic Changes	365	(1)
Color Changes in the Gingiva	366	(1)
Color Changes Associated with Systemic Factors	366	(1)
Changes in Consistency of the Gingiva	367	(1)
Changes in Surface Texture of the Gingiva	368	(1)
Changes in Position of the Gingiva	369	(1)
Changes in Gingival Contour	370	(3)
Gingival Enlargement	373	(18)
Inflammatory Enlargement	374	(1)
Chronic Inflammatory Enlargement	374	(1)
Acute Inflammatory Enlargement	375	(1)
Drug-Induced Gingival Enlargement	375	(4)
General Information	375	(2)
Anticonvulsants	377	(1)
Immunosuppressants	378	(1)
Calcium Channel Blockers	378	(1)
Idiopathic Gingival Enlargement	379	(1)
Enlargements Associated with Systemic Diseases	380	(4)
Conditioned Enlargement	380	(3)
Systemic Diseases That Cause Gingival Enlargement	383	(1)
Neoplastic Enlargement (Gingival Tumors)	384	(2)
Benign Tumors of the Gingiva	384	(2)
Malignant Tumors of the Gingiva	386	(1)
False Enlargement	386	(5)
Underlying Osseous Lesions	387	(1)
Underlying Dental Tissues	387	(4)
Acute Gingival Infections	391	(13)
Necrotizing Ulcerative Gingivitis	391	(7)
Clinical Features	391	(2)
Relation of Bacteria to Characteristic Lesion	393	(1)
Diagnosis	393	(3)
Etiology	396	(1)
Epidemiology and Prevalence	397	(1)
Communicability	397	(1)
Primary Herpetic Gingivostomatitis	398	(2)
Clinical Features	398	(1)
Diagnosis	399	(1)
Differential Diagnosis	399	(1)
Communicability	400	(1)
Pericoronitis	400	(4)
Clinical Features	400	(1)
Complications	401	(3)
Gingival Diseases in Childhood	404	(7)
Periodontium of the Deciduous Dentition	404	(1)
Physiologic Gingival Changes Associated with Tooth Eruption	405	(1)
Preeruption Bulge	405	(1)
Gingival Margin	405	(1)
Types of Gingival Disease	406	(3)
Chronic Marginal Gingivitis	406	(2)
Acute Gingival Infections	408	(1)
Traumatic Changes in the Periodontium	409	(1)
Oral Mucous Membrane in Childhood Diseases	409	(2)
Desquamative Gingivitis	411	(23)
Chronic Desquamative Gingivitis	411	(1)
Diagnosis of Desquamative Gingivitis: A Systematic Approach	412	(3)
Diseases Clinically Presenting as Desquamative Gingivitis	415	(13)
Lichen Planus	415	(4)
Pemphigoid	419	(2)
Pemphigus Vulgaris	421	(3)
Chronic Ulcerative Stomatitis	424	(1)
Linear IgA Disease (Linear IgA Dermatosis)	425	(1)
Dermatitis Herpetiformis	425	(1)
Lupus Erythematosus	426	(2)
Erythema Multiforme	428	(1)
Drug Eruptions	428	(1)
Miscellaneous Conditions Mimicking Desquamative Gingivitis	429	(5)
SECTION II PERIODONTAL DISEASE	434	(105)
The Periodontal Pocket	434	(18)
Classification	434	(1)
Clinical Features	435	(1)
Pathogenesis	436	(1)
Histopathology	437	(7)
Bacterial Invasion	439	(1)
Microtopography of Gingival Wall	439	(2)
Periodontal Pockets as Healing Lesions	441	(1)
Pocket Contents	442	(1)
Root Surface Wall	442	(2)
Periodontal Disease Activity	444	(1)
Site Specificity	445	(1)
Pulp Changes Associated with Periodontal Pockets	445	(1)
Relationship of Attachment Loss and Bone Loss to Pocket Depth	445	(1)
Area between Base of Pocket and Alveolar Bone	445	(1)
Relationship of Pocket to Bone	446	(1)
Differences between Infrabony and Suprabony Pockets	446	(1)
Periodontal Abscess	446	(3)
Periodontal Cyst	449	(3)
Bone Loss and Patterns of Bone Destruction	452	(15)
Bone Destruction Caused by Extension of Gingival Inflammation	452	(5)
Radius of Action	456	(1)
Rate of Bone Loss	456	(1)
Periods of Destruction	456	(1)
Mechanisms of Bone Destruction	456	(1)
Bone Formation in Periodontal Disease	457	(1)
Bone Destruction Caused by Trauma from Occlusion	457	(1)
Bone Destruction Caused by Systemic Disorders	458	(1)
Factors Determining Bone Morphology in Periodontal Disease	458	(1)
Normal Variation in Alveolar Bone	458	(1)
Exostoses	458	(1)
Trauma from Occlusion	458	(1)
Buttressing Bone Formation (Lipping)	459	(1)
Food Impaction	459	(1)
Aggressive Periodontitis	459	(1)
Bone Destruction Patterns in Periodontal Disease	459	(8)
Horizontal Bone Loss	459	(1)
Bone Deformities (Osseous Defects)	459	(1)
Vertical or Angular Defects	459	(3)
Osseous Craters	462	(1)
Bulbous Bone Contours	462	(1)
Reversed Architecture	462	(1)
Ledges	462	(1)
Furcation Involvement	462	(5)
Periodontal Response to External Forces	467	(13)
Adaptive Capacity of the Periodontium to Occlusal Forces	467	(1)
Trauma from Occlusion	467	(2)
Acute and Chronic Trauma	468	(1)
Primary and Secondary Trauma from Occlusion	468	(1)
Stages of Tissue Response to Increased Occlusal Forces	469	(2)
Stage I: Injury	469	(1)
Stage II: Repair	470	(1)
Stage III: Adaptive Remodeling of the Periodontium	471	(1)
Effects of Insufficient Occlusal Force	471	(1)
Reversibility of Traumatic Lesions	471	(1)
Effects of Excessive Occlusal Forces on Dental Pulp	472	(1)
Influence of Trauma from Occlusion on Progression of Marginal Periodontitis	472	(2)
Clinical and Radiographic Signs of Trauma from Occlusion Alone	474	(1)
Pathologic Tooth Migration	474	(6)
Pathogenesis	474	(6)
Masticatory System Disorders	480	(14)
Temporomandibular Joint	480	(1)
Muscles and Nerves of the Masticatory System	481	(1)
Centric Relation	482	(1)
Biomechanics of the Masticatory System	482	(1)
Dysfunction and Deterioration	483	(2)
Orofacial Pain	485	(1)
Comprehensive Evaluation	486	(3)
Patient History and Interview	486	(1)
Clinical Examination	486	(3)
Imaging	489	(1)
Diagnostic Decision Making	489	(5)
Chronic Periodontitis	494	(6)
Clinical Features	494	(3)
General Characteristics	494	(2)
Disease Distribution	496	(1)
Disease Severity	496	(1)
Symptoms	497	(1)
Disease Progression	497	(1)
Prevalence	497	(1)
Risk Factors for Disease	497	(3)
Prior History of Periodontitis	497	(1)
Local Factors	497	(1)
Systemic Factors	498	(1)
Environmental and Behavioral Factors	498	(1)
Genetic Factors	499	(1)
Necrotizing Ulcerative Periodontitis	500	(6)
Clinical and Microscopic Description of Necrotizing Ulcerative Gingivitis	500	(1)
Characteristic Features of Necrotizing Ulcerative Periodontitis	501	(1)
Clinical Presentation	501	(1)
Microscopic Findings	501	(1)
HIV/AIDS Patient	502	(1)
Etiology of Necrotizing Ulcerative Periodontitis	502	(2)
Microbial Flora	503	(1)
Immunocompromised Status	503	(1)
Psychologic Stress	503	(1)
Malnutrition	504	(1)
Summary	504	(2)
Aggressive Periodontitis	506	(7)
Localized Aggressive Periodontitis	506	(2)
Historical Background	506	(1)
Clinical Characteristics	507	(1)
Radiographic Findings	508	(1)
Prevalence and Distribution by Age and Gender	508	(1)
Generalized Aggressive Periodontitis	508	(1)
Clinical Characteristics	508	(1)
Radiographic Findings	509	(1)
Prevalence and Distribution by Age and Gender	509	(1)
Risk Factors for Aggressive Periodontitis	509	(4)
Microbiologic Factors	509	(1)
Immunologic Factors	510	(1)
Genetic Factors	510	(1)
Environmental Factors	510	(3)
Pathology and Management of Periodontal Problems in Patients with HIV Infection	513	(26)
Pathogenesis	513	(1)
Epidemiology and Demographics	514	(1)
Classification and Staging	514	(2)
CDC Surveillance Case Classification	515	(1)
Oral and Periodontal Manifestations of HIV Infection	516	(11)
Oral Candidiasis	516	(4)
Oral Hairy Leukoplakia	520	(1)
Kaposi's Sarcoma and Other Malignancies	521	(3)
Bacillary (Epithelioid) Angiomatosis	524	(1)
Oral Hyperpigmentation	524	(1)
Atypical Ulcers	525	(2)
Dental Treatment Complications	527	(1)
Adverse Drug Effects	527	(1)
Gingival and Periodontal Diseases	527	(4)
Linear Gingival Erythema	527	(1)
Necrotizing Ulcerative Gingivitis	528	(1)
Necrotizing Ulcerative Periodontitis	528	(1)
Necrotizing Ulcerative Stomatitis	529	(1)
Chronic Periodontitis	530	(1)
Periodontal Treatment Protocol	531	(8)
Health Status	531	(1)
Infection Control Measures	532	(1)
Goals of Therapy	532	(1)
Maintenance Therapy	532	(1)
Psychologic Factors	532	(7)
PART 7 TREATMENT OF PERIODONTAL DISEASE	539	(1)
SECTION I DIAGNOSIS, PROGNOSIS, AND TREATMENT PLAN	540	(166)
Clinical Diagnosis	540	(21)
First Visit	541	(2)
Overall Appraisal of the Patient	541	(1)
Medical History	541	(1)
Dental History	542	(1)
Intraoral Radiographic Survey	542	(1)
Casts	542	(1)
Clinical Photographs	542	(1)
Review of Initial Examination	543	(1)
Second Visit	543	(15)
Oral Examination	543	(1)
Examination of the Teeth	544	(4)
Examination of the Periodontium	548	(10)
Laboratory Aids to Clinical Diagnosis	558	(1)
Nutritional Status	558	(1)
Patients with Special Diets for Medical Reasons	558	(1)
Blood Tests	558	(1)
Periodontal Screening and Recording System	558	(3)
Radiographic Aids in the Diagnosis of Periodontal Disease	561	(18)
Normal Interdental Septa	561	(1)
Distortions Produced by Variations in Radiographic Technique	562	(1)
Bone Destruction in Periodontal Disease	562	(3)
Bone Loss	562	(2)
Pattern of Bone Destruction	564	(1)
Radiographic Appearance of Periodontal Disease	565	(9)
Periodontitis	565	(3)
Interdental Craters	568	(1)
Furcation Involvement	568	(1)
Periodontal Abscess	568	(1)
Clinical Probing	569	(2)
Localized Aggressive Periodontitis	571	(1)
Trauma from Occlusion	571	(3)
Additional Radiographic Criteria	574	(1)
Skeletal Disturbances Manifested in the Jaws	574	(1)
Digital Intraoral Radiography	575	(4)
Advanced Diagnostic Techniques	579	(23)
Limitations of Conventional Periodontal Diagnosis	579	(2)
Advances in Clinical Diagnosis	581	(4)
Gingival Bleeding	581	(1)
Gingival Temperature	581	(1)
Periodontal Probing	582	(3)
Advances in Radiographic Assessment	585	(2)
Digital Radiography	585	(1)
Subtraction Radiography	585	(2)
Computer-Assisted Densitometric Image Analysis System	587	(1)
Advances in Microbiologic Analysis	587	(8)
Bacterial Culturing	589	(1)
Direct Microscopy	590	(1)
Immunodiagnostic Methods	591	(1)
Enzymatic Methods	591	(1)
Diagnostic Assays Based on Molecular Biology Techniques	592	(3)
Advances in Characterizing the Host Response	595	(3)
Source of Samples	595	(1)
Inflammatory Mediators and Products	596	(1)
Host-Derived Enzymes	597	(1)
Tissue Breakdown Products	598	(1)
Conclusion	598	(4)
Risk Assessment	602	(7)
Definitions	602	(1)
Risk Factors for Periodontal Disease	602	(1)
Tobacco Smoking	602	(1)
Diabetes	603	(1)
Pathogenic Bacteria and Microbial Tooth Deposits	603	(1)
Risk Determinants/Background Characteristics for Periodontal Disease	603	(2)
Genetic Factors	603	(1)
Age	604	(1)
Gender	604	(1)
Socioeconomic Status	604	(1)
Stress	604	(1)
Risk Indicators for Periodontal Disease	605	(1)
Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome	605	(1)
Osteoporosis	605	(1)
Infrequent Dental Visits	605	(1)
Risk Markers/Predictors for Periodontal Disease	605	(1)
Previous History of Periodontal Disease	605	(1)
Bleeding on Probing	605	(1)
Clinical Risk Assessment for Periodontal Disease	605	(1)
Conclusion	606	(3)
Levels of Clinical Significance	609	(5)
Tangible versus Intangible Benefits	609	(1)
Size of the Treatment Effect	610	(1)
Defining Four Levels of Clinical Significance	610	(2)
Clinical Significance Level 1	610	(1)
Clinical Significance Level 2	611	(1)
Clinical Significance Level 3	611	(1)
Clinical Significance Level 4	612	(1)
Summary	612	(2)
Determination of Prognosis	614	(12)
Definitions	614	(1)
Types of Prognosis	614	(1)
Overall versus Individual Tooth Prognosis	615	(1)
Factors in Determination of Prognosis	615	(7)
Overall Clinical Factors	615	(1)
Systemic and Environmental Factors	616	(3)
Local Factors	619	(3)
Prosthetic and Restorative Factors	622	(1)
Relationship between Diagnosis and Prognosis	622	(2)
Prognosis for Patients with Gingival Disease	622	(1)
Prognosis for Patients with Periodontitis	623	(1)
Reevaluation of Prognosis after Phase I Therapy	624	(2)
The Treatment Plan	626	(4)
Master Plan for Total Treatment	626	(1)
Extracting or Preserving a Tooth	626	(1)
Therapeutic Procedures	627	(1)
Explaining Treatment Plan to the Patient	627	(3)
Rationale for Periodontal Treatment	630	(6)
What Does Periodontal Therapy Accomplish?	630	(2)
Local Therapy	630	(1)
Systemic Therapy	630	(2)
Factors That Affect Healing	632	(1)
Local Factors	632	(1)
Systemic Factors	632	(1)
Healing after Periodontal Therapy	632	(2)
Regeneration	632	(1)
Repair	632	(1)
New Attachment	633	(1)
Periodontal Reconstruction	634	(2)
Periodontal Therapy in the Female Patient	636	(14)
Puberty	636	(1)
Management	637	(1)
Menses	637	(2)
Periodontal Manifestations	637	(1)
Management	638	(1)
Periodontal Manifestations of Pregnancy	639	(4)
Periodontal Diseases	639	(1)
Role of Pregnancy Hormones	639	(1)
Maternal Immunoresponse	640	(1)
Sex Hormone Levels	641	(1)
Other Oral Manifestations of Pregnancy	641	(1)
Clinical Management	642	(1)
Treatment	642	(1)
Oral Contraceptives	643	(2)
Management	644	(1)
Menopause	645	(2)
Oral Changes	646	(1)
Clinical Management	646	(1)
Conclusion	647	(3)
Periodontal Treatment of Medically Compromised Patients	650	(25)
Cardiovascular Diseases	650	(7)
Hypertension	651	(2)
Ischemic Heart Diseases	653	(1)
Congestive Heart Failure	654	(1)
Cardiac Pacemakers and Implantable Cardioverter-Defibrillators	654	(1)
Infective Endocarditis	654	(2)
Cerebrovascular Accident	656	(1)
Endocrine Disorders	657	(4)
Diabetes	657	(3)
Thyroid and Parathyroid Disorders	660	(1)
Adrenal Insufficiency	660	(1)
Renal Diseases	661	(1)
Liver Diseases	662	(1)
Pulmonary Diseases	662	(1)
Immunosuppression and Chemotherapy	663	(1)
Radiation Therapy	663	(1)
Prosthetic Joint Replacement	664	(1)
Pregnancy	664	(1)
Hemorrhagic Disorders	665	(3)
Coagulation Disorders	665	(3)
Thrombocytopenic Purpuras	668	(1)
Nonthrombocytopenic Purpuras	668	(1)
Blood Dyscrasias	668	(1)
Leukemia	668	(1)
Agranulocytosis	669	(1)
Infectious Diseases	669	(6)
Hepatitis	669	(2)
HIV and AIDS	671	(1)
Tuberculosis	671	(4)
Periodontal Treatment for Older Adults	675	(18)
The Aging Periodontium	675	(2)
Intrinsic Changes	676	(1)
Stochastic Changes	676	(1)
Physiologic Changes	676	(1)
Functional Changes	676	(1)
Clinical Changes	676	(1)
Demographics	677	(7)
Population Distribution	677	(1)
Health Status	677	(1)
Functional Status	678	(1)
Nutritional Status	679	(1)
Psychosocial Factors	679	(2)
Dentate Status	681	(1)
Periodontal Status	681	(1)
Caries Status	682	(1)
Dental Visits	683	(1)
Xerostomia	683	(1)
Candidiasis	684	(1)
Dental and Medical Assessments	684	(4)
Review of Dental History	684	(1)
Review of Medical History	684	(1)
Review of Medication Use	685	(1)
Extraoral and Intraoral Examinations	685	(2)
Assessment of Risk	687	(1)
Quality of Life	687	(1)
Periodontal Diseases in Older Adults	688	(1)
Etiology	688	(1)
Relationship to Systemic Disease	688	(1)
Periodontal Treatment Planning	688	(1)
Prevention of Periodontal Disease and Maintenance of Periodontal Health in Older Adults	689	(2)
Chemotherapeutic Agents	689	(1)
Risk Reduction	690	(1)
Conclusion	691	(2)
Treatment of Aggressive and Atypical Forms of Periodontitis	693	(13)
Aggressive Periodontitis	693	(8)
Therapeutic Modalities	694	(6)
Treatment Planning and Restorative Considerations	700	(1)
Periodontal Maintenance	700	(1)
Periodontitis Refractory to Treatment	701	(1)
Necrotizing Ulcerative Periodontitis	702	(1)
Conclusion	703	(3)
SECTION II TREATMENT OF PERIODONTAL EMERGENCIES	706	(16)
Treatment of Acute Gingival Disease	706	(8)
Acute Necrotizing Ulcerative Gingivitis	706	(4)
Sequence of Treatment	706	(2)
Gingival Changes with Healing	708	(1)
Additional Treatment Considerations	708	(2)
Persistent or Recurrent Cases	710	(1)
Acute Pericoronitis	710	(1)
Acute Herpetic Gingivostomatitis	711	(3)
Treatment of Periodontal Abscess	714	(8)
Classification of Abscesses	714	(2)
Periodontal Abscess	714	(1)
Gingival Abscess	714	(1)
Pericoronal Abscess	714	(1)
Acute versus Chronic Abscess	715	(1)
Periodontal versus Pulpal Abscess	716	(1)
Specific Treatment Approaches	716	(6)
Acute Abscess	718	(1)
Chronic Abscess	719	(1)
Gingival Abscess	719	(1)
Pericoronal Abscess	719	(3)
SECTION III NONSURGICAL THERAPY	722	(159)
Phase I Periodontal Therapy	722	(6)
Rationale	722	(1)
Treatment Sessions	723	(1)
Sequence of Procedures	724	(1)
Results	725	(1)
Healing	725	(1)
Decision to Refer for Specialist Treatment	725	(3)
Plaque Control for the Periodontal Patient	728	(21)
The Toothbrush	729	(2)
Toothbrush Design	731	(1)
Recommendations	731	(1)
Powered Toothbrushes	731	(1)
Recommendations	732	(1)
Dentifrices	732	(1)
Recommendations	733	(1)
Toothbrushing Methods	733	(2)
Bass Technique	733	(1)
Brushing with Powered Toothbrushes	734	(1)
Recommendations	734	(1)
Interdental Cleaning Aids	735	(3)
Dental Floss	735	(2)
Interdental Cleaning Devices	737	(1)
Recommendations	738	(1)
Gingival Massage	738	(1)
Oral Irrigation	739	(1)
Supragingival Irrigation	739	(1)
Subgingival Irrigation	740	(1)
Recommendations	740	(1)
Caries Control	740	(1)
Recommendations	740	(1)
Chemical Plaque Control with Oral Rinses	740	(1)
Prescription Chlorhexidine Rinse	741	(1)
Nonprescription Essential Oil Rinse	741	(1)
Other Products	741	(1)
Recommendations	741	(1)
Disclosing Agents	741	(1)
Frequency of Plaque Removal	742	(1)
Recommendations	742	(1)
Patient Motivation and Education	742	(2)
Motivation for Effective Plaque Control	742	(1)
Education and Scoring Systems	743	(1)
Instruction and Demonstration	744	(1)
Recommendations	744	(1)
Summary	744	(5)
Scaling and Root Planing	749	(49)
Classification of Periodontal Instruments	749	(15)
Periodontal Probes	750	(1)
Explorers	750	(1)
Scaling and Curettage Instruments	750	(13)
Cleansing and Polishing Instruments	763	(1)
General Principles of Instrumentation	764	(10)
Accessibility: Positioning of Patient and Operator	764	(1)
Visibility, Illumination, and Retraction	764	(1)
Condition and Sharpness of Instruments	765	(1)
Maintaining a Clean Field	765	(1)
Instrument Stabilization	766	(2)
Instrument Activation	768	(3)
Instruments for Scaling and Root Planing	771	(3)
Principles of Scaling and Root Planing	774	(12)
Definitions and Rationale	774	(2)
Detection Skills	776	(1)
Supragingival Scaling Technique	777	(1)
Subgingival Scaling and Root-Planing Technique	777	(7)
Ultrasonic Scaling	784	(2)
Evaluation	786	(1)
Instrument Sharpening	786	(12)
Evaluation of Sharpness	787	(1)
Objective of Sharpening	787	(1)
Sharpening Stones	787	(1)
Principles of Sharpening	788	(1)
Sharpening Individual Instruments	788	(10)
Chemotherapeutic Agents	798	(15)
Definitions	799	(1)
Systemic Administration of Antibiotics	799	(6)
Background and Rationale	799	(1)
Biologic Implications	800	(2)
Tetracyclines	802	(1)
Metronidazole	803	(1)
Penicillins	804	(1)
Cephalosporins	804	(1)
Clindamycin	804	(1)
Ciprofloxacin	805	(1)
Macrolides	805	(1)
Serial and Combination Antibiotic Therapy	805	(1)
Rationale	805	(1)
Clinical Use	805	(1)
Host Modulation	806	(1)
Doxycycline Hyclate	806	(1)
Nonsteroidal Antiinflammatory Drugs	806	(1)
Local Delivery of Antibiotics	807	(2)
Tetracycline-Containing Fibers	808	(1)
Subgingival Doxycycline	808	(1)
Subgingival Minocycline	808	(1)
Subgingival Metronidazole	809	(1)
Local Delivery of Antiseptic Agent	809	(1)
Conclusion	810	(3)
Host Modulation Agents	813	(15)
Host Response	813	(1)
Host Modulatory Therapy	814	(1)
Definition and Rationale	814	(1)
Systemically Administered Agents	814	(1)
Locally Administered Agents	815	(1)
Host Modulation and Comprehensive Periodontal Management	815	(1)
Subantimicrobial-Dose Doxycycline	816	(9)
Mechanisms of Action	817	(1)
Clinical Research Data and Patient Populations	817	(4)
Suggested Uses and Other Considerations	821	(3)
Emerging Host Modulatory Therapies	824	(1)
Summary	825	(3)
Sonic and Ultrasonic Instrumentation	828	(8)
Mechanism of Action	828	(1)
Frequency	828	(1)
Stroke	829	(1)
Water Flow	829	(1)
Types of Power Instruments	829	(1)
Sonic Scalers	829	(1)
Ultrasonic Scalers	830	(1)
Efficacy and Clinical Outcomes	830	(1)
Plaque and Calculus	830	(1)
Bacterial Reduction and Endotoxin/Cementum Removal	830	(1)
Bleeding on Probing, Probing Depth, and Clinical Attachment	831	(1)
Furcation Access	831	(1)
Efficiency	831	(2)
Tip Designs	831	(1)
Time	832	(1)
Special Considerations	833	(1)
Aerosol Production	833	(1)
Cardiac Pacemakers	833	(1)
Principles of Instrumentation	833	(1)
Summary	833	(3)
Supragingival and Subgingival Irrigation	836	(9)
Professionally Delivered Irrigation	836	(1)
Efficacy	836	(1)
Clinical Outcomes	837	(1)
Home (Self-Applied) Irrigation	837	(3)
Mechanism of Action	837	(2)
Safety	839	(1)
Clinical Outcomes	840	(2)
Plaque Removal and Calculus Reduction	840	(1)
Gingivitis, Bleeding on Probing, and Probing Depth Reductions	840	(1)
Periodontal Pathogens and Inflammatory Mediators	841	(1)
Patients with Special Considerations	841	(1)
Summary	842	(3)
Occlusal Evaluation and Therapy	845	(11)
Terminology	845	(1)
Functional Anatomy of Masticatory System	846	(1)
Biologic Basis of Occlusal Function	846	(1)
Clinical Evaluation Procedures	847	(2)
Temporomandibular Disorder Screening Examination	847	(1)
Intraoral Evaluation of Occlusion	848	(1)
Role of Articulated Casts	848	(1)
Interpretation and Treatment Planning	849	(1)
Temporomandibular Disorder Screening	849	(1)
Occlusal Evaluation	849	(1)
Diagnostic Interocclusal Appliance	849	(1)
Occlusal Therapy	850	(4)
Interocclusal Appliance Therapy	851	(2)
Occlusal Adjustment	853	(1)
Summary	854	(2)
Adjunctive Role of Orthodontic Therapy	856	(15)
Benefits of Orthodontic Therapy	856	(1)
Preorthodontic Osseous Surgery	857	(1)
Osseous Craters	857	(1)
Three-Wall Intrabony Defects	858	(1)
Orthodontic Treatment of Osseous Defects	858	(8)
Hemiseptal Defects	858	(1)
Advanced Horizontal Bone Loss	859	(1)
Furcation Defects	860	(2)
Root Proximity	862	(2)
Fractured Teeth and Forced Eruption	864	(1)
Hopeless Teeth Maintained for Orthodontic Anchorage	865	(1)
Orthodontic Treatment of Gingival Discrepancies	866	(4)
Uneven Gingival Margins	866	(1)
Significant Abrasion and Overeruption	867	(1)
Open Gingival Embrasures	868	(2)
Summary	870	(1)
The Periodontic-Endodontic Continuum	871	(10)
Pulpal Disease	871	(2)
Etiologic Factors	871	(1)
Classification	871	(1)
Effects on the Periodontium	872	(1)
Effect of Periodontitis on the Dental Pulp	873	(1)
Differentiation between Periodontal and Pulpal Lesions	873	(1)
Signs and Symptoms of Periodontitis	873	(1)
Signs and Symptoms of Pulpal Disease	873	(1)
Differentiation between Pulpal and Periodontal Abscesses	874	(1)
Therapeutic Management of Pulpal and Periodontal Disease	874	(3)
Primary Endodontic Lesion	874	(1)
Independent Periodontal and Endodontic Lesions	875	(1)
Combined Periodontal and Endodontic Lesions	875	(2)
Special Issues in Endodontic Therapy	877	(4)
Potential Complications	877	(1)
Restorative Implications	878	(3)
SECTION IV SURGICAL THERAPY	881	(158)
Phase II Periodontal Therapy	881	(6)
Objectives of the Surgical Phase	881	(2)
Surgical Pocket Therapy	882	(1)
Results of Pocket Therapy	882	(1)
Pocket Elimination versus Pocket Maintenance	883	(1)
Reevaluation after Phase I Therapy	884	(1)
Critical Zones in Pocket Surgery	884	(1)
Zone 1: Soft Tissue Pocket Wall	884	(1)
Zone 2: Tooth Surface	884	(1)
Zone 3: Underlying Bone	884	(1)
Zone 4: Attached Gingiva	884	(1)
Indications for Periodontal Surgery	884	(1)
Methods of Pocket Therapy	885	(2)
Criteria for Method Selection	885	(1)
Approaches to Specific Pocket Problems	885	(2)
General Principles of Periodontal Surgery	887	(15)
Outpatient Surgery	887	(10)
Patient Preparation	887	(1)
Emergency Equipment	888	(1)
Measures to Prevent Transmission of Infection	888	(1)
Sedation and Anesthesia	888	(1)
Tissue Management	889	(1)
Scaling and Root Planing	889	(1)
Hemostasis	889	(2)
Periodontal Dressings (Periodontal Packs)	891	(2)
Postoperative Instructions	893	(1)
First Postoperative Week	893	(1)
Removal of Pack and Return Visit	894	(1)
Mouth Care between Procedures	894	(1)
Management of Postoperative Pain	895	(2)
Hospital Periodontal Surgery	897	(1)
Indications	897	(1)
Patient Preparation	897	(1)
Postoperative Instructions	897	(1)
Surgical Instruments	898	(4)
Excisional and Incisional Instruments	898	(1)
Surgical Curettes and Sickles	899	(1)
Periosteal Elevators	899	(1)
Surgical Chisels	899	(1)
Tissue Forceps	900	(1)
Scissors and Nippers	900	(1)
Needleholders	900	(2)
Surgical Anatomy of the Periodontium and Related Structures	902	(7)
Mandible	902	(2)
Maxilla	904	(2)
Muscles	906	(1)
Anatomic Spaces	906	(3)
Gingival Surgical Techniques	909	(9)
Gingival Curettage	909	(3)
Rationale	909	(1)
Indications	910	(1)
Procedure	911	(1)
Healing after Scaling and Curettage	912	(1)
Clinical Appearance after Scaling and Curettage	912	(1)
Gingivectomy	912	(3)
Indications and Contraindications	912	(1)
Surgical Gingivectomy	913	(1)
Gingivoplasty	914	(1)
Healing after Surgical Gingivectomy	914	(1)
Gingivectomy by Electrosurgery	915	(1)
Laser Gingivectomy	915	(1)
Gingivectomy by Chemosurgery	915	(1)
Summary	915	(3)
Treatment of Gingival Enlargement	918	(8)
Chronic Inflammatory Enlargement	918	(1)
Periodontal and Gingival Abscesses	918	(1)
Drug-Associated Gingival Enlargement	919	(4)
Treatment Options	919	(4)
Leukemic Gingival Enlargement	923	(1)
Gingival Enlargement in Pregnancy	924	(1)
Timing of Treatment and Indications	924	(1)
Gingival Enlargement in Puberty	924	(1)
Recurrence of Gingival Enlargement	924	(2)
The Periodontal Flap	926	(11)
Classification of Flaps	926	(1)
Flap Design	927	(1)
Incisions	928	(2)
Horizontal Incisions	928	(2)
Vertical Incisions	930	(1)
Elevation of the Flap	930	(1)
Suturing Techniques	931	(3)
Technique	931	(1)
Ligation	931	(2)
Types of Sutures	933	(1)
Healing after Flap Surgery	934	(3)
The Flap Technique for Pocket Therapy	937	(13)
Overview	937	(1)
Techniques for Access and Pocket Depth Reduction/Elimination	937	(1)
Incisions	938	(1)
Reconstructive Techniques	938	(1)
Modified Widman Flap	938	(2)
Undisplaced Flap	940	(3)
Palatal Flap	942	(1)
Apically Displaced Flap	943	(2)
Flaps for Reconstructive Surgery	945	(1)
Papilla Preservation Flap	945	(1)
Conventional Flap	945	(1)
Distal Molar Surgery	945	(5)
Maxillary Molars	945	(3)
Mandibular Molars	948	(2)
Resective Osseous Surgery	950	(18)
Selection of Treatment Technique	950	(1)
Rationale	951	(1)
Normal Alveolar Bone Morphology	951	(1)
Terminology	952	(1)
Factors in Selection of Resective Osseous Surgery	953	(1)
Examination and Treatment Planning	954	(1)
Methods of Resective Osseous Surgery	954	(2)
Osseous Resection Technique	956	(4)
Instrumentation	956	(1)
Vertical Grooving	957	(1)
Radicular Blending	957	(1)
Flattening Interproximal Bone	957	(3)
Gradualizing Marginal Bone	960	(1)
Flap Placement and Closure	960	(1)
Postoperative Maintenance	960	(1)
Specific Osseous Reshaping Situations	960	(3)
Summary	963	(5)
Reconstructive Periodontal Surgery	968	(23)
Evaluation of New Attachment and Periodontal Reconstruction	968	(3)
Clinical Methods	968	(1)
Radiographic Methods	969	(1)
Surgical Reentry	970	(1)
Histologic Methods	970	(1)
Reconstructive Surgical Techniques	971	(12)
Non--Bone Graft--Associated Procedures	971	(5)
Graft Materials and Procedures	976	(6)
Combined Techniques	982	(1)
Summary	983	(8)
Furcation: Involvement and Treatment	991	(14)
Etiologic Factors	991	(1)
Diagnosis and Classification of Furcation Defects	991	(2)
Indices of Furcation Involvement	992	(1)
Local Anatomic Factors	993	(1)
Root Trunk Length	993	(1)
Root Length	994	(1)
Root Form	994	(1)
Interradicular Dimension	994	(1)
Anatomy of Furcation	994	(1)
Cervical Enamel Projections	994	(1)
Anatomy of the Bony Lesions	994	(1)
Pattern of Attachment Loss	994	(1)
Other Dental Findings	995	(1)
Treatment	995	(1)
Therapeutic Classes of Furcation Defects	995	(1)
Surgical Therapy	995	(8)
Root Resection	995	(1)
Hemisection	996	(1)
Root Resection/Hemisection Procedure	997	(2)
Reconstruction	999	(1)
Extraction	999	(4)
Prognosis	1003	(2)
Periodontal Plastic and Esthetic Surgery	1005	(25)
Terminology	1005	(1)
Objectives	1006	(1)
Problems Associated with Attached Gingiva	1006	(1)
Problems Associated with Shallow Vestibule	1006	(1)
Problems Associated with Aberrant Frenum	1006	(1)
Etiology of Marginal Tissue Recession	1006	(1)
Factors That Affect Surgical Outcome	1006	(2)
Irregularity of Teeth	1006	(2)
Mucogingival Line (Junction)	1008	(1)
Techniques to Increase Attached Gingiva	1008	(15)
Gingival Augmentation Apical to Recession	1008	(6)
Gingival Augmentation Coronal to Recession (Root Coverage)	1014	(9)
Techniques to Deepen the Vestibule	1023	(1)
Techniques to Remove Frenum	1023	(1)
Frenectomy or Frenotomy	1023	(1)
Procedure	1024	(1)
Criteria for Selection of Techniques	1025	(1)
Conclusion	1026	(4)
Recent Advances in Surgical Technology	1030	(9)
Microsurgery	1030	(1)
Magnification Systems	1030	(3)
Magnifying Loupes	1030	(2)
Surgical Microscope	1032	(1)
Periodontal Microsurgery	1033	(1)
Root Preparation	1033	(1)
Surgery under Magnification	1033	(1)
Microsurgical Instruments	1033	(1)
Ergonomics	1033	(1)
Conclusion	1034	(1)
Lasers in Periodontics	1035	(1)
Application for Periodontal Therapy	1035	(1)
Advantages and Disadvantages	1036	(3)
SECTION V PERIODONTAL-RESTORATIVE INTERRELATIONSHIPS	1039	(32)
Preparation of the Periodontium for Restorative Dentistry	1039	(11)
Rationale for Therapy	1039	(1)
Sequence of Treatment	1040	(1)
Control of Active Disease	1040	(2)
Emergency Treatment	1041	(1)
Extraction of Hopeless Teeth	1041	(1)
Oral Hygiene Measures	1041	(1)
Scaling and Root Planing	1041	(1)
Reevaluation	1041	(1)
Periodontal Surgery	1041	(1)
Adjunctive Orthodontic Therapy	1042	(1)
Preprosthetic Surgery	1042	(5)
Management of Mucogingival Problems	1042	(1)
Preservation of Ridge Morphology after Tooth Extraction	1043	(1)
Crown-Lengthening Procedures	1044	(3)
Alveolar Ridge Reconstruction	1047	(1)
Conclusion	1047	(3)
Restorative Interrelationships	1050	(21)
Biologic Considerations	1050	(9)
Margin Placement and Biologic Width	1050	(2)
Biologic Width Evaluation	1052	(1)
Correcting Biologic Width Violations	1052	(1)
Margin Placement Guidelines	1053	(2)
Clinical Procedures in Margin Placement	1055	(1)
Tissue Retraction	1055	(2)
Provisional Restorations	1057	(1)
Marginal Fit	1058	(1)
Crown Contour	1058	(1)
Subgingival Debris	1058	(1)
Hypersensitivity to Dental Materials	1058	(1)
Esthetic Tissue Management	1059	(5)
Managing Interproximal Embrasures	1059	(1)
Correcting Open Gingival Embrasures Restoratively	1060	(1)
Managing Gingival Embrasure Form for Patients with Gingival Recession	1060	(1)
Pontic Design	1061	(3)
Occlusal Considerations in Restorative Therapy	1064	(1)
Special Restorative Considerations	1064	(7)
Root-Resected Teeth	1064	(1)
Splinting	1065	(1)
Anterior Esthetic Surgery	1066	(5)
PART 8 ORAL IMPLANTOLOGY	1071	(122)
Biological Aspects of Oral Implants	1072	(15)
Implant Geometry (Macrodesign)	1073	(2)
Endosseous Implants	1073	(1)
Subperiosteal Implants	1074	(1)
Transmandibular Implants	1075	(1)
Implant Surface Characteristics (Microdesign)	1075	(1)
Additive Processes	1075	(1)
Subtractive Processes	1075	(1)
Hard Tissue Interface	1075	(6)
Stages of Bone Healing and Osseointegration: Cell Kinetics and Tissue Remodeling	1075	(3)
Implant Surface Free Energy and Micro-Roughness	1078	(1)
Implant Surface Chemical Composition	1079	(1)
Rigidity and Strength of Established Bone-to-Implant Interface	1079	(2)
Soft Tissue Interfaces	1081	(3)
Comparison of Tissues Surrounding Natural Dentition and Osseointegrated Oral Implants	1084	(1)
Conclusion	1084	(3)
Clinical Aspects and Evaluation of the Implant Patient	1087	(18)
Case Types and Indications	1088	(4)
Edentulous Patients	1088	(1)
Partially Edentulous Patients	1089	(3)
Pretreatment Evaluation	1092	(4)
Chief Complaint	1093	(1)
Medical History	1093	(1)
Dental History	1093	(1)
Intraoral Examination	1093	(3)
Risk Factors and Contraindications	1096	(4)
Medical and Systemic Health--Related Issues	1097	(2)
Psychologic and Mental Conditions	1099	(1)
Habits and Behavioral Considerations	1099	(1)
Posttreatment Evaluation	1100	(2)
Clinical Examination	1100	(1)
Radiographic Examination	1101	(1)
Oral Hygiene and Implant Maintenance	1101	(1)
Conclusion	1102	(3)
Diagnostic Imaging for the Implant Patient	1105	(15)
Standard Projections	1105	(3)
Periapical Radiographs	1106	(1)
Occlusal Radiographs	1107	(1)
Panoramic Radiographs	1107	(1)
Lateral Cephalometric Radiographs	1108	(1)
Cross-Sectional Imaging	1108	(3)
Conventional X--Ray Tomography	1108	(2)
Computed Tomography	1110	(1)
Cone-Beam Computed Tomography	1111	(1)
Interactive ``Simulation'' Software Programs	1111	(3)
Patient Evaluation	1114	(3)
Exclude Pathology	1114	(1)
Identify Anatomic Structures	1114	(1)
Assess Bone Quantity, Quality, and Volume	1114	(2)
Evaluate Relation of Alveolar Ridge with Existing Teeth and Desired Implant Position	1116	(1)
Clinical Selection of Diagnostic Imaging	1117	(1)
Clinical Examination	1117	(1)
Screening Films	1117	(1)
Fabrication of Radiographic and Surgical Guides	1117	(1)
Cross-Sectional Tomography	1118	(1)
Conclusion	1118	(2)
Standard Implant Surgical Procedures	1120	(13)
Implant Selection and Design Considerations	1120	(1)
Implant Geometry (Macrodesign)	1120	(1)
Implant Surface Topography (Microdesign)	1121	(1)
General Principles of Implant Surgery	1121	(3)
Patient Preparation	1121	(1)
Implant Site Preparation	1121	(2)
One-Stage versus Two-Stage Implant Surgeries	1123	(1)
Two-Stage ``Submerged'' Implant Placement	1124	(7)
Flap Design, Incisions, and Elevation	1124	(1)
Implant Site Preparation	1124	(4)
Flap Closure and Suturing	1128	(1)
Postoperative Care	1128	(1)
Second-Stage Exposure Surgery	1128	(3)
One-Stage ``Non-Submerged'' Implant Placement	1131	(1)
Flap Design, Incisions, and Elevation	1131	(1)
Implant Site Preparation	1131	(1)
Flap Closure and Suturing	1132	(1)
Postoperative Care	1132	(1)
Conclusion	1132	(1)
Localized Bone Augmentation and Implant Site Development	1133	(15)
Guided Bone Regeneration	1133	(3)
Barrier Membranes	1134	(1)
Bone Graft Materials	1135	(1)
Harvesting Autogenous Bone	1136	(1)
Localized Ridge Augmentation	1136	(5)
Flap Management for Ridge Augmentation	1137	(1)
Horizontal Bone Augmentation	1137	(3)
Simultaneous Implant Placement and Guided Bone Regeneration	1140	(1)
Complications of Localized Ridge Augmentation	1140	(1)
Long-Term Results of Implants in Localized Bone-Augmented Sites	1141	(1)
Management of Extractions	1141	(5)
Immediate Implant Placement	1144	(1)
Delayed Implant Placement	1145	(1)
Staged Implant Placement	1145	(1)
Delayed versus Staged Technique	1145	(1)
Conclusion	1146	(2)
Advanced Implant Surgical Procedures	1148	(13)
Maxillary Sinus Elevation and Bone Augmentation	1148	(9)
Indications and Contraindications	1149	(1)
Anatomy and Physiology	1149	(1)
Surgical Procedures for Sinus Elevation	1150	(6)
Risks and Complications	1156	(1)
Supracrestal/Vertical Bone Augmentation	1157	(2)
Guided Bone Regeneration and Augmentation	1157	(1)
Distraction Osteogenesis	1157	(2)
Growth Factors in Bone Augmentation	1159	(1)
Bone Morphogenic Proteins	1159	(1)
Autologous Platelet Concentration	1159	(1)
Conclusion	1159	(2)
Recent Advances in Implant Surgical Technology	1161	(6)
Computer-Assisted Implant Surgery	1162	(3)
Uses and Requirements	1162	(1)
Sequence of Steps	1162	(1)
Preoperative Data Acquisition	1162	(1)
Identification and Registration	1162	(1)
Navigation and Positional Tracking	1163	(1)
External Viewer and Augmented Reality	1164	(1)
Advantages and Disadvantages	1165	(1)
Conclusion	1165	(2)
Biomechanics, Treatment Planning, and Prosthetic Considerations	1167	(15)
Biomechanical Considerations	1168	(3)
Load-Bearing Capacity	1168	(1)
Linear Configurations and Implant Overload	1169	(2)
Treatment Planning with Dental Implants	1171	(7)
Edentulous Maxilla	1171	(1)
Edentulous Mandible	1172	(4)
Partially Edentulous Patients	1176	(2)
Clinical Strategies to Avoid Implant Overload and Other Prosthetic Considerations	1178	(1)
Connecting Implants to Natural Dentition	1179	(1)
Immediate or Early Loading in Posterior Quadrants	1179	(1)
Conclusion	1179	(3)
Implant-Related Complications and Failures	1182	(11)
Definition of Implant Success	1182	(1)
Types and Prevalence of Implant Complications	1183	(1)
Surgical Complications	1184	(2)
Hemorrhage and Hematoma	1184	(1)
Neurosensory Disturbances	1185	(1)
Damage to Adjacent Teeth	1185	(1)
Biologic Complications	1186	(2)
Inflammation and Proliferation	1186	(1)
Dehiscence and Recession	1187	(1)
Periimplantitis and Bone Loss	1187	(1)
Implant Loss or Failure	1188	(1)
Technical or Mechanical Complications	1188	(1)
Screw Loosening and Fracture	1188	(1)
Implant Fracture	1189	(1)
Fracture of Restorative Materials	1189	(1)
Esthetic and Phonetic Complications	1189	(1)
Esthetic Complications	1189	(1)
Phonetic Problems	1189	(1)
Conclusion	1190	(3)
PART 9 PERIODONTAL MAINTENANCE	1193	(22)
Supportive Periodontal Treatment	1194	(12)
Rationale for Supportive Periodontal Treatment	1194	(2)
Maintenance Program	1196	(5)
Examination and Evaluation	1196	(1)
Checking of Plaque Control	1196	(4)
Treatment	1200	(1)
Recurrence of Periodontal Disease	1200	(1)
Classification of Posttreatment Patients	1201	(1)
Referral of Patients to the Periodontist	1201	(1)
Tests for Disease Activity	1202	(1)
Maintenance for Dental Implant Patients	1202	(4)
Results of Periodontal Treatment	1206	(9)
Prevention and Treatment of Gingivitis	1206	(1)
Prevention and Treatment of Loss of Attachment	1207	(1)
Prevention of Loss of Attachment	1207	(1)
Treatment of Loss of Attachment	1208	(1)
Tooth Mortality	1208	(4)
Summary	1212	(3)
PART 10 ETHICAL, LEGAL, AND PRACTICAL ISSUES IN THE MANAGEMENT OF PERIODONTAL PATIENTS	1215	(19)
Dental Ethics	1216	(5)
Professional Organizations	1216	(1)
Dental Organizations and Dental Boards	1216	(1)
Periodontal Specialty Organizations	1217	(1)
Licensing	1217	(1)
Practical Considerations in Ethical Practice of Dentistry	1218	(1)
Referral	1218	(1)
Evidence-Based Dentistry	1218	(1)
Dental Board Discipline	1218	(1)
Negligence	1218	(1)
Insurance Fraud	1218	(1)
Other Legal Issues	1218	(1)
Continuing Education	1219	(1)
Scope of Periodontal Specialty Practice	1219	(1)
Ethical Responsibilities of General Practitioners in Treatment of Periodontal Disease	1219	(2)
Summary	1220	(1)
Legal Principles: Jurisprudence	1221	(6)
Definitions	1221	(1)
Common Periodontal Malpractice Issues	1222	(1)
Legal Elements of Malpractice	1223	(1)
Standard of Care	1223	(1)
Informed Consent	1223	(1)
Beneficence	1223	(1)
Abandonment	1224	(1)
Record Keeping	1224	(1)
Practical Components in Litigation	1224	(1)
Legal Process	1224	(1)
Malpractice Insurance	1225	(1)
Avoidance of Lawsuits	1225	(1)
Peer Review	1226	(1)
Federal Legislation	1226	(1)
Occupational Safety and Health Administration	1226	(1)
Health Insurance Portability and Accountability Act	1226	(1)
Summary	1226	(1)
Dental Insurance and Managed Care in Periodontal Practice	1227	(7)
History	1227	(2)
Health Insurance	1227	(1)
Dental Insurance	1227	(2)
Principles	1229	(1)
Classification of Programs	1230	(1)
Benefits Design	1231	(3)
Time Limits	1231	(1)
Balance Billing	1231	(1)
Coordination of Benefits	1232	(1)
Alternate Benefits	1232	(1)
Exclusions	1233	(1)
Adjudication	1233	(1)
Attachments	1233	(1)
Health Insurance Portability and Accountability Act	1234	(1)
Most Common Errors	1234	(1)
Conclusion	1234