Lindhe's Clinical Periodontology and Implant Dentistry, 2 Volume Set

Discover the latest edition of the cornerstone reference on periodontology and implant dentistry that combines scholarship and science with practical clinical instruction

The Seventh Edition of Lindhe's Clinical Periodontology and Implant Dentistry brings together a distinguished team of periodontal specialists and academics who deliver another must-have resource for students, researchers, and practitioners specializing in periodontal care and implant dentistry.

Seamlessly integrating the foundational science behind periodontology with practical clinical protocols in two comprehensive volumes, the chapters cover anatomy, microbiology, occlusion trauma, pathology, tissue regeneration, treatment planning protocols, infection control, reconstructive therapy, occlusal and prosthetic therapy, and more.

The Seventh Edition of Lindhe's Clinical Periodontology and Implant Dentistry:

• Provides an introduction to anatomy, including periodontal tissues, the edentulous ridge, the mucosa at teeth and implants, and osseointegration
• Discusses the epidemiology of periodontal and peri-implant diseases
• Explores the microbiology, including dental biofilms and calculus, periodontal infections, peri-implant infections, the pathogenesis of gingivitis and periodontitis, and the genetic susceptibility to periodontal disease
• Includes the latest perio- and peri-implant disease classifications
• Contains updated evidence-based preventive and treatment modalities for the treatment of periodontal and peri-implant diseases
• Features the latest evidence-based therapeutic alternatives on the use of dental implants to rehabilitate the lost dentition

Perfect for postgraduate dental students, researchers, and practitioners specializing in periodontal care and implant dentistry, Lindhe's Clinical Periodontology and Implant Dentistry continues to be the cornerstone reference work on periodontology.

Tord Berglundh is Professor and Chair of Periodontology at the Institute of Odontology, University of Gothenburg, Sweden.

William V. Giannobile is Dean and Professor of Oral Medicine, Infection, and Immunity at the Harvard School of Dental Medicine, Boston, USA.

Niklaus P. Lang is Honorary Professor at the University of Hong Kong, the University College London, the University of Zurich, Switzerland, and Complutense University of Madrid, Spain, and Professor Emeritus at the University of Bern, Switzerland.

Mariano Sanz is Professor and Chair of Periodontology at the Faculty of Odontology, Complutense University of Madrid, Spain, and Professor Type II at the Institute of Odontology, University of Oslo, Norway.

Contributors

Preface

Volume 1

Part 1 Anatomy

1 Anatomy and Histology of Periodontal Tissues
Dieter D. Bosshardt,Jan Lindhe, Niklaus P. Lang, and Maurício Araújo

Introduction

Gingiva

Anatomy

Histology

Periodontal ligament

Root cementum

Bone of the alveolar process

Macroscopic anatomy

Microscopic anatomy

Blood supply of the periodontium

Lymphatic system of the periodontium

Nerves of the periodontium

Acknowledgment

2 Bone as a Living Organ
Darnell Kaigler and William V. Gannobile

Introduction

Development

Endochondral bone formation

Intramembranous bone growth

Structure

Osseous tissue

Periosteal tissue

Bone marrow

Function

Mechanical properties

Metabolic properties

Skeletal homeostasis

Healing

Disorders

3 The Edentulous Ridge
Maurício Araújo and Jan Lindhe

Clinical considerations

Remaining bone in the edentulous ridge

Classification of remaining bone

Topography of the alveolar process

From an alveolar process to an edentulous ridge

Intra‐alveolar processes

Extra‐alveolar processes

Topography of the edentulous ridge: summary

4 The Mucosa at Teeth and Implants
Jan Lindhe, Tord Berglundh,Anton Sculean,and Niklaus P. Lang

Gingiva

Dimensions of the supracrestal attachment

Dimensions of the buccal tissue

Dimensions of the interdental papilla

Peri‐implant mucosa

Dimensions of the supracrestal attachment

Structure and composition

Vascular supply

Probing gingiva and peri‐implant mucosa

Dimensions of the buccal soft tissue at implants

Dimensions of the papilla between teeth and implants

Dimensions of the “papilla” between adjacent implants

5 Osseointegration
Niklaus P. Lang,Tord Berglundh, and Dieter D. Bosshardt

Introduction

Implant installation

Tissue injury

Wound healing

Cutting and non‐cutting implants

Process of osseointegration

Morphogenesis of osseointegration

Overall pattern of implant integration

Biopsy sample observations

Part 2 Epidemiology

6 Epidemiology of Periodontitis
Panos N. Papapanou and Ryan T. Demmer

Introduction

Methodological issues

Examination methods: index systems

Assessment of inflammation of the periodontal tissues

Assessment of loss of periodontal tissue support

Radiographic assessment of alveolar bone loss

Assessment of periodontal treatment needs

Periodontitis “case definition” in epidemiologic studies

Prevalence of periodontitis

Periodontitis in adults

Periodontitis in children and adolescents

Periodontitis and tooth loss

Risk factors for periodontitis

Introduction: definitions

Measures of disease occurrence

Measures of association

Causal inference and causal models

Non-modifiable background factors

Environmental, acquired, and behavioral factors

Conclusion

7 Epidemiology of Peri-Implant Diseases
Jan Derks, Cristiano Tomasi, and Tord Berglundh

Introduction

Disease definition

Case definition

Peri-implant health

Peri-implant mucositis

Peri-implantitis

Examination methods

Prevalence of peri-implant diseases

Extent and severity of peri-implantitis

Peri-implantitis and implant loss

Etiology of peri-implant diseases

Risk factors for peri-implant diseases

Peri-implant mucositis

Peri-implantitis: risk factors related to the patient

Peri-implantitis: risk factors related to the implant

Conclusion

Part 3 Microbiology

8 Dental Biofilms and Calculus
Philip D. Marsh,Mariano Sanz, Niklaus P. Lang, and Dieter D. Bosshardt

Introduction

The human microbiome

The oral microbiome

The mouth as a microbial habitat

Methods to determine the composition and function of the oral microbiome

The development and composition of the oral microbiome

Dental biofilm formation

Conditioning film formation

Reversible and more permanent attachment

Co-adhesion

Plaque maturation

Detachment

The significance of a biofilm and community lifestyle for microorganisms

Benefits to the host of a resident oral microbiota

Biofilms on implant surfaces

Dental calculus

Clinical appearance and distribution

Calculus formation and structure

Attachment to tooth surfaces and implants

Calculus composition

Clinical implications

Conclusion

9 Periodontal and Peri-Implant Infections
Mike Curtis, Lisa Heitz-Mayfield, and Mariano Sanz

Periodontal infections

Introduction

Microbiological techniques to study the periodontal microbiota

Periodontal bacteria and virulence

Microbial pathogenesis of periodontal disease

Peri-implant infections

Introduction

Peri‐implant biofilm formation

Surface characteristics of the implant/abutment

Local oral environment

Oral hygiene and accessibility

Microbiota associated with peri‐implant mucosal health

Microbiota associated with peri‐implant infections

Periodontal and peri-implant microbiomes in health and disease

Patients at risk for peri‐implant infections

Part 4 Host–Parasite Interactions

10 Pathogenesis of Gingivitis and Periodontitis
Gregory J. Seymour, Tord Berglundh, and Leonardo Trombelli

Introduction

Gingivitis

Development of the homeostatic lesion

The epithelial barrier

Factors influencing the pathogenesis of gingivitis

Vascular response

Cellular response

Repair potential

Periodontitis

Histopathology of periodontitis

B cells in periodontitis

Macrophages in periodontitis (M1 and M2)

Conversion of gingivitis to periodontitis

The Th1/Th2 paradigm

Suppression of cell‐mediated immunity

T cells and homeostasis

Cytokine profiles

CD8 T cells

Control of the Th1/Th2 balance

Genetics

Innate immune response

Nature of the antigen

Nature of the antigen‐presenting cell

Hypothalamic–pituitary–adrenal axis and the sympathetic nervous system

Treg/Th17 axis

Autoimmunity

NK T cells

B‐cell subsets

Connective tissue matrix destruction

Bone loss

Conclusion

11 Systemic and Environmental Modifying Factors
Evanthia Lalla and Panos N. Papapanou

Introduction

Diabetes mellitus

Mechanisms underlying the effect of diabetes on periodontitis

Clinical presentation of the periodontal patient with diabetes

Concepts related to patient management

Tobacco smoking

Mechanisms underlying the effect of smoking on periodontitis

Clinical presentation of the periodontal patient who smokes

Concepts related to patient management

Obesity and nutrition

Osteoporosis

Stress

12 Genetic Susceptibility to Periodontal Disease: New Insights and Challenges
Arne S. Schaefer, Ubele van der Velden, Marja L. Laine, and Bruno G. Loos

Introduction

Evidence for the role of genetics in periodontitis

Heritability

Heritability of periodontitis among young people

Heritability of periodontitis in adults

Gene mutation of major effect on human disease and its association with periodontitis

Identification of genetic risk factors of periodontitis

Sialic acid binding IG like lectin 5 (SIGLEC5) and other potential variants

Defensin alpha 1 and -3 (DEFA1A3)

CDKN2B antisense RNA 1 (CDKN2B-AS1)

Miscellaneous genetic associations with periodontitis

Epigenetic signatures

From genetic disease susceptibility to improved oral care

Part 5 Trauma from Occlusion

13 Effect of Load on Periodontal and Peri-Implant Tissues
Jan Lindhe, Niklaus P. Lang,and Tord Berglundh

PART I: PERIODONTAL TISSUES

Definition and terminology

Occlusal trauma and plaque‐associated periodontal disease

Clinical trials

Preclinical trials

Plaque-associated periodontitis

Conclusion

PART II: PERI-IMPLANT TISSUES

Orthodontic loading and alveolar bone

Bone reactions to functional loading

Excessive occlusal load on implants

Static and cyclic loads on implants

Load and loss of osseointegration

Masticatory occlusal forces on implants

Tooth–implant supported reconstructions

Part 6 Periodontal Pathology

14 Non-Plaque-Induced Gingival Diseases
Palle Holmstrup and Mats Jontell

Introduction

Genetic/developmental disorders

Hereditary gingival fibromatosis

Specific infections

Bacterial origin

Viral origin

Fungal origin

Inflammatory and immune conditions

Hypersensitivity reactions

Autoimmune diseases of skin and mucous membranes

Granulomatous inflammatory conditions (orofacial granulomatosis)

Reactive processes

Epulides

Neoplasms

Premalignant (potentially malignant)Malignancy

Endocrine, nutritional, and metabolic diseases

Vitamin deficiencies

Traumatic lesions

Physical/mechanical trauma

Chemical (toxic) burn

Thermal insults

Gingival pigmentation

15 Plaque-Induced Gingivitis
Leonardo Trombelli,Roberto Farina, and Dimitris N. Tatakis

Clinical features of plaque-induced gingivitis

Diagnostic criteria to assess a gingivitis lesion

Diagnostic criteria to define and grade a gingivitis case

Epidemiology of gingivitis

Impact of gingivitis on patient-reported quality of life

Impact of gingivitis on systemic inflammation

Prognostic value of gingivitis

Potential modifying factors of plaque‐induced gingivitis

Smoking

Sex steroid hormones

Malnutrition

Specific systemic diseases and conditions

Systemic drugs

Local factors

Prevention and management of plaque-induced gingivitis

16 Current Classification of Periodontitis
Panos N. Papapanou, Mariano Sanz, and Kenneth Kornman

Introduction

A brief historical perspective: recently used periodontitis classification systems

Need for the new classification

Key concepts and ground rules of the new classification of periodontal diseases

Assessment of Stage

Assessment of Grade

Implementation of the current classification: clinical examples

Interpretational challenges and “gray zones”

The value of the 218 periodontitis classification

17 Effect of Periodontal Diseases on General Health: Periodontal Medicine
Francesco D’Aiuto, Filippo Graziani, Panos N. Papapanou, and James Beck

Introduction

Evidence of common biologic mechanisms

Oral microbiome

Systemic inflammation

Atherosclerotic vascular disease

Biologic mechanisms

Epidemiologic evidence

Diabetes mellitus

Biological mechanisms

Epidemiologic evidence

Adverse pregnancy outcomes

Biological mechanisms

Epidemiologic evidence

Chronic renal disease

Biological mechanisms

Epidemiologic evidence

Cognitive decline/dementia

Biological mechanisms

Epidemiologic evidence

Cancer

Biological mechanisms

Epidemiologic evidence

Conclusion

18 Periodontitis and Systemic Diseases (Cardiovascular Disease and Diabetes): Biological Perspectives for Oral/Periodontal Implications
Alpdogan Kantarci and Hatice Hasturk

Introduction

Plausibility of periodontal disease as a risk factor for diseases at distant tissues

Plausibility of systemic dissemination of oral bacteria

Inflammatory processes as a link between periodontal and systemic diseases

Biological plausibility of a link between periodontal diseases and cardiovascular diseases

Microbial factors

Host factors

Summary

Biological plausibility of a link between periodontal diseases and diabetes

Host factors

Microbial factors

Summary

Conclusion

19 Abscesses, Necrotizing Lesions of the Periodontium, and Endo-Periodontal Lesions
David Herrera and Magda Feres

Introduction

Abscesses in the periodontium

Periodontal abscess

Classification

Aetiology, pathogenesis, and histopathology

Microbiology

Diagnosis

Differential diagnosis

Why periodontal abscesses are relevant

Necrotizing periodontal diseases

What are necrotizing periodontal diseases

Classification

Aetiology, pathogenesis, and histopathology

Predisposing factors

Diagnosis

Why necrotizing periodontal diseases are relevant

Endo-periodontal lesions

Classification

Aetiology

Microbiology

Pathogenesis and histopathology

Risk factors

Clinical presentation and diagnosis

Conclusion

Part 7 Peri-implant Pathology

20 Peri-Implant Mucositis and Peri-Implantitis
Tord Berglundh, Jan Lindhe, and Niklaus P. Lang

Introduction

Healthy peri‐implant mucosa

Peri‐implant mucositis

Clinical features and diagnosis

Clinical models

Preclinical models

Peri‐implantitis

Clinical features and diagnosis

Human biopsy material

Preclinical models

Conclusion

Part 8 Tissue Regeneration

21 Periodontal Wound Healing and Regeneration
Darnell Kaigler, Giulio Rasperini, Saso Ivanovski, and William V. Giannobile

Introduction

Wound healing: outcomes and definitions

Wound healing biology

Phases of wound healing

Factors that affect healing

Periodontal wound healing

Healing after periodontal surgery

Advanced regenerative approaches to periodontal tissue reconstruction

Regenerative surgery

Guided tissue regeneration

Clinical applications of growth factors for use in periodontal regeneration

Cell therapy for periodontal regeneration

Gene therapeutics for periodontal tissue repair

Three-dimensional printed scaffolds for periodontal regeneration

Conclusion

Volume 2

Part 9 Examination Protocols

22 Examination of Patients
Giovanni E. Salvi, Tord Berglundh, and Niklaus P. Lang

Patient’s history

Chief complaint and expectations

Social and family history

Dental history

Oral hygiene habits

History of tobacco use

Medical history and medications

Genetic testing before periodontal and implant therapy

Signs and symptoms of periodontal diseases and their assessment

Gingiva

Keratinized mucosa at implant recipient sites

Periodontal ligament and the root cementum

Alveolar bone

Diagnosis and classification of periodontitis

Gingivitis

Periodontitis

Oral hygiene status

Additional dental examinations

Conclusion

23 Diagnostic Imaging of the Periodontal and Implant Patient
Michael M. Bornstein, Kuofeng Hung, and Dorothea Dagassan-Berndt

Introduction

Basic principles of diagnostic imaging in dental medicine

Modalities

Radiation hazards and radiation dose protection

Diagnostic imaging in periodontology

General recommendations

Future trends and developments

Diagnostic imaging in oral implantology

General recommendations for implant treatment planning purposes

Recommendations during and after implant placement (follow-up)

Recommendations for special indications and techniques

Future trends and developments

Conclusions and future outlook

24 Patient-Specific Risk Assessment for Implant Therapy
 Giovanni E. Salvi and Niklaus P. Lang

Introduction

Systemic factors

Medical conditions

Medications

Age

Growth considerations

Untreated periodontitis and oral hygiene habits

History of treated periodontitis

Compliance with supportive therapy

Tobacco use history

Genetic susceptibility traits

Conclusion

Part 1 Treatment Planning Protocols

25 Treatment Planning of Patients with Periodontal Diseases
Giovanni E. Salvi, Niklaus P. Lang,and Pierpaolo Cortellini

Introduction

Treatment goals

Systemic phase (including smoking counseling)

Initial phase (hygienic phase, infection control)

Corrective phase (additional therapeutic measures)

Maintenance phase (supportive periodontal and peri-implant therapy)

Screening for periodontal disease

Basic periodontal examination

Diagnosis

Treatment planning

Initial treatment plan

Pretherapeutic single tooth prognosis

Case presentations

Case presentation 1

Case presentation 2

Conclusion

26 Systemic Phase of Therapy
Niklaus P. Lang, Iain Chapple, Christoph A. Ramseier, and Hans-Rudolf Baur

Introduction

Protection of the dental team and other patients against infectious diseases

Protection of the patient’s health

Prevention of complications

Infective endocarditis and its prevention

Bleeding

Cardiovascular incidents

Allergic reactions and drug interactions

Systemic diseases, disorders, or conditions influencing pathogenesis and healing potential

Specific medications: bisphosphonates as a threat to implant therapy

Control of anxiety and pain

Tobacco use cessation counseling

 Tobacco use brief intervention

Conclusion

Part 11 Initial Periodontal Therapy (Infection Control)

27 Oral Hygiene Motivation
Jeanie E. Suvan and Christoph A. Ramseier

Health behavior change counseling in periodontal care

The challenge

Clinician–patient communication

Evidence for health behavior change counseling

Evidence in general health care

Evidence in periodontal care

Understanding health behavior change counseling

General principles

Giving advice

Agenda setting

Readiness ruler

Goal setting, planning, and self-monitoring

Technology to facilitate behavior change

The patient activation fabric

Band I: establish rapport

Band II: information exchange

Band III: closing

Ribbon A: communication style

Ribbon B: health behavior change tools

Case examples

Oral hygiene motivation I

Oral hygiene motivation II

Conclusion

28 Mechanical Supragingival Plaque Control
Fridus Van der Weijden and Dagmar Else Slot

Importance of supragingival plaque removal

Self‐performed plaque control

Brushing

Motivation

Oral hygiene instruction

Oral mHealth

Toothbrushing

Manual toothbrushes

Electric (power) toothbrushes

Electrically active (ionic) toothbrush

Interdental cleaning

Dental floss and tape

Woodsticks

Rubber/elastomeric interdental cleaning sticks

Interdental brushes

Single-tufted/end-tufted brushes

Dental water jets/oral irrigators

Tongue cleaners

Foam brushes, swabs, or tooth towelettes

Dentifrice

Side effects

Brushing force

Toothbrush abrasion

Toothbrush contamination

Importance of instruction and motivation in mechanical plaque control

First session

Second session

Third and subsequent sessions

Conclusion

29 Chemical Dental Biofilm Control
David Herrera and Jorge Serrano

Rationale for supragingival biofilm control

Oral hygiene products

Mechanical biofilm control

Limitations of mechanical biofilm control

Chemical biofilm control

Mechanisms of action

Categories of formulations

Ideal features

Evaluation of activity of agents for chemical biofilm control

In vitro studies

In vivo study models

Home-use clinical trials

Active agents

Antibiotics

Enzymes: disruption of the biofilm

Enzymes: enhancement of the host defences

Amine alcohols

Detergents

Oxygenating agents

Metal salts: zinc salts

Metal salts: stannous fluoride

Metal salts: stannous fluoride with amine fluoride

Other fluorides

Natural products

Essential oils

Triclosan

Bisbiguanides

Quaternary ammonium compounds

Hexetidine

Povidone iodine

Other evaluated products

Future approaches

Delivery formats

Mouth rinses

Dentifrices

Gels

Chewing gums

Varnishes

Lozenges

Irrigators

Sprays

Sustained release devices

Selection of delivery format

Clinical indications for chemical plaque control: selection of agents

Single use

Short-term use for the prevention of dental biofilm formation

Short-term use for therapy

Long-term use for the prevention of dental biofilm formation

Long-term use for the prevention of other oral conditions

Conclusion

30 Non-Surgical Therapy
Jan L. Wennström and Cristiano Tomasi

Introduction

Goal of non‐surgical pocket/root instrumentation

Debridement, scaling, and root planing

Instruments used for non‐surgical pocket/root debridement

Hand instruments

Sonic and ultrasonic instruments

Air-polishing devices

Ablative laser devices

Approaches to subgingival debridement

Full‐mouth instrumentation protocols

Full‐mouth disinfection protocols

Clinical outcomes following various approaches to pocket/root instrumentation

Microbiologic outcomes following various approaches to pocket/root instrumentation

Considerations in relation to selection of instruments and treatment approach

Selection of instruments

Selection of treatment approach

Re‐evaluation following initial non‐surgical periodontal treatment

Efficacy of repeated non‐surgical pocket/root instrumentation

31 Treatment of Acute Periodontal and Endo-Periodontal Lesions
David Herrera and Magda Feres

Introduction

Treatment of periodontal abscesses

Control of the acute condition

Re-evaluation of treatment outcomes

Management of the pre-existing and/or residual lesion

Treatment of necrotizing periodontal diseases

Treatment of necrotizing periodontal diseases in moderately and/or short-term immunocompromised patients

Treatment of necrotizing periodontal diseases in continuously and severely immunocompromised patients

Treatment of endo-periodontal lesions

Prognosis of teeth with endo-periodontal lesions

Should endo-periodontal lesions with hopeless or poor prognosis be treated?

Steps in the management of an endo-periodontal lesion

Part 12 Additional Therapy

32 Periodontal Surgery
Mariano Sanz, Jan L. Wennström, and Filippo Graziani

Introduction

Techniques in periodontal surgery (historical perspective)

Gingivectomy procedures

Flap procedures

Modified Widman flap

Apically repositioned flap

Distal wedge procedures

Osseous surgery

Techniques in periodontal surgery (current perspective)

Objectives of surgical treatment

Indications for surgical treatment

Contraindications for periodontal surgery

Selection of the surgical technique

Instruments used in periodontal surgery

Step by step surgical flap procedure

Specific surgical interventions for papilla management

Papilla preservation flap

Modified papilla preservation technique

Simplified papilla preservation flap

Minimally invasive surgical techniques

Outcomes of surgical periodontal therapy

Histological healing

Clinical outcomes of surgical periodontal therapy

Factors affecting clinical healing

Conclusion

33 Treatment of Furcation-Involved Teeth
Søren Jepsen, Peter Eickholz, and Luigi Nibali

Anatomy

Diagnosis of furcation involvement

Clinical diagnosis of furcation involvement

Classification of furcation involvement

Distinction between class II and class III furcation involvement

The vertical dimension of furcation involvement

Radiographic diagnosis of furcation involvement

Furcations and risk of tooth loss

Treatment options

Non-surgical treatment

Corrective surgery in furcation defects

Decision making (clinical recommendations) in the surgical treatment of class II and III furcation defects

Long-term maintenance of teeth with furcation involvement

Tooth loss by vertical furcation component

34 Non-Surgical Therapy of Peri-Implant Mucositis and Peri-Implantitis
Lisa Heitz-Mayfield, Giovanni E. Salvi, and Frank Schwarz

Introduction

Non-surgical therapy of peri-implant mucositis

Assessment of the implant-supported prosthesis

Oral hygiene measures for self-performed biofilm removal

Professional mechanical debridement (supra-and submucosal calculus and biofilm removal

Adjunctive measures for peri-implant mucositis treatment

Non-surgical therapy of peri-implantitis

Professional mechanical debridement

35 Surgical Treatment of Peri-Implantitis
Tord Berglundh, Jan Derks, Niklaus P. Lang, and Jan Lindhe

Introduction and goals of surgical therapy

Implant surface decontamination

Pocket elimination/reduction procedures

Preclinical data

Clinical data

Reconstructive procedures

Preclinical data

Clinical data

Conclusion

36 Systemic Antibiotics in Periodontal Therapy
Magda Feres and David Herrera

Introduction

Microbiological basis for periodontal treatment

The long search for periodontal pathogens and the concept of beneficial species

Understanding the target: bacterial biofilms

Rationale for the use of adjunctive systemic antibiotics in periodontal treatment

Mechanical periodontal therapy and its limitations

Local versus systemic antimicrobials

Systemic antibiotics in periodontal therapy

Should systemic antimicrobial therapy be aimed at specific pathogens?

Which antimicrobial(s) would provide the most predictable results? A historical perspective

Which antimicrobial(s) would provide the most predictable results? Weighting the evidence: clinical outcomes in randomized clinical trials and systematic reviews

Which antimicrobial(s) would provide the most predictable results? Microbiological impact

Which subjects would benefit most from systemic antimicrobial therapy?

Protocols of use of systemic antimicrobials in periodontics

Use of systemic antibiotics: associated risks

Adverse events/reactions

Emergence of resistant strains/global increase in antibiotic resistance

Concluding remarks and recommendations for clinical practice

37 Local Antimicrobial Delivery for the Treatment of Periodontitis and Peri-Implant Diseases
Maurizio S. Tonettiand David Herrera

General principles of local drug delivery

Rationale of local drug delivery

Subgingival pharmacokinetics

Development of subgingival delivery devices

Antimicrobial effects of subgingival delivery devices

Local antimicrobial delivery for the treatment of periodontitis

Efficacy of subgingival delivery devices

Indications for locally delivered, sustained-released antimicrobials

Summary

Local antimicrobial delivery for the treatment of peri-implant diseases

Clinical rationale

Efficacy of subgingival delivery devices

Indications for locally delivered, sustained-release antimicrobials

Summary

Part 13 Reconstructive Therapy

38 Regenerative Periodontal Therapy
Pierpaolo Cortellini and Maurizio S. Tonetti

Introduction

Classification and diagnosis of periodontal osseous defects

Clinical indications

Long‐term effects and benefits of regeneration

Evidence for clinical efficacy and effectiveness

Patient, defect, and tooth prognostic factors

Patient factors

Defect factors

Tooth factors

Factors affecting the clinical outcomes in furcations

Relevance of the surgical approach

Surgical approach to intrabony defects

Papilla preservation flaps

Postoperative regimen

Postoperative period and local side effects

Surgical and postsurgical morbidity

Barrier materials for regenerative surgery

Non‐bioresorbable materials

Bioresorbable materials

Membranes for intrabony defects

Membranes for furcation involvement

Bone replacement grafts

Grafts for intrabony defects

Grafts for furcation involvement

Biologically active regenerative materials

Growth factors for intrabony defects

Growth factors for furcation involvement

Enamel matrix derivatives for intrabony defects

Enamel matrix derivatives for furcation involvement

Combination therapy

Combination therapy for intrabony defects

Combination therapy for furcation involvement

Root surface biomodification

Clinical potential and limits for regeneration

Clinical strategies

Clinical flowcharts

Conclusion

39 Mucogingival Therapy: Periodontal Plastic Surgery
Mariano Sanz, Jan L. Wennström, Massimo de Sanctis, and Anton Sculean

Introduction

Mucogingival conditions

Mucogingival conditions without gingival recession

Gingival dimensions and periodontal health

Gingival augmentation

Mucogingival condition with gingival recessions

Diagnosis of gingival recessions

Treatment of gingival recessions

Root coverage procedures

Pedicle grafts

Pedicle soft tissue graft procedures combined with a barrier membrane

Healing of pedicle soft tissue grafts over denuded root surfaces

Use of free soft tissue graft procedures

Tunnel approaches for the treatment of gingival recessions

The use of soft tissue substitutes for the treatment of gingival recessions

Healing of free soft tissue grafts

Selection of surgical procedure for root coverage

Clinical outcomes of root coverage procedures

Factors influencing the degree of root coverage

Interdental papilla reconstruction

Surgical techniques

Crown‐lengthening procedures

Excessive gingival display

Exposure of sound tooth structure

Selection of the crown lengthening procedure

Gingivectomy

Apically positioned flaps

Forced tooth eruption

Ectopic tooth eruption

Part 14 Surgery for Implant Installation

40 Timing of Implant Placement
Christoph H.F. Hämmerle, Maurício Araújo, and Jan Lindhe

Introduction

Type 1 placement as part of the same surgical procedure as and immediately following tooth extraction

Ridge alterations in conjunction with implant placement

Stability of implant

Type 2 placement: completed soft tissue coverage of the tooth socket

Type 3 placement: substantial bone fill has occurred in the extraction socket

Type 4 placement: alveolar process is healed following tooth loss

Clinical concepts

Aim of therapy

Success of treatment and long‐term outcomes

Conclusion

Part 15 Reconstructive Ridge Therapy

41 Ridge Augmentation Procedures
Fabio Vignoletti, Darnell Kaigler, William V. Giannobile, and Mariano Sanz

Introduction: principles of bone regeneration

Promoting primary wound closure

Enhancing cell proliferation and differentiation

Protecting initial wound stability and integrity

Treatment objectives

Diagnosis and treatment planning

Patient

Defect classification

Bone augmentation therapies

Biologic principles of guided bone regeneratioRegenerative materials

Barrier membranes

Bone grafts and soft tissue substitutes

Evidence-based results for ridge augmentation procedures

Alveolar ridge preservation

Bone regeneration at implants into fresh extraction sockets

Horizontal ridge augmentation

Ridge splitting/expansion

Vertical ridge augmentation

Emerging technologies

Growth factors

Cell therapy

Scaffolding matrices to deliver genes, proteins, and cells

Future perspectives

Conclusion

42 Maxillary Sinus Floor Augmentation
Gustavo Avila-Ortiz, Bjarni E. Pjetursson, and Niklaus P. Lang

The maxillary sinus

Options for the rehabilitation of the posterior edentulous maxilla

Maxillary sinus floor augmentation techniques

Surgical modalities

Presurgical examination and care

Healing dynamics

Maxillary sinus floor augmentation: lateral window approach

Maxillary sinus floor augmentation: transalveolar approach

Conclusion

Part 16 Occlusal and Prosthetic Therapy

43 Tooth-Supported Fixed Dental Prostheses
Jan Lindhe, Niklaus P. Lang, and Sture Nyman

Clinical symptoms of trauma from occlusion

Angular bony defects

Increased tooth mobility

Progressive (increasing) tooth mobility

Clinical assessment of tooth mobility (physiologic and pathologic tooth mobility)

Treatment of increased tooth mobility

Situation 1

Situation 2

Situation 3

Situation 4

Situation 5

44 Implant-Supported Fixed Dental Prostheses
Ronald. E. Jung, Franz J. Strauss, and Daniel S. Thoma

Introduction

Indications for implants in the posterior dentition

Therapeutic concepts at sites with sufficient bone quantity

Therapeutic concepts at sites with insufficient bone quantity

Diagnostics

Preoperative diagnostics in the posterior dentition

General considerations and decision-making for implants in the posterior dentition

Decision-making between implant-supported reconstruction and tooth-supported fixed dental prostheses

Provisional reconstructions

Loading concepts

Splinted versus single-unit restorations of multiple adjacent posterior implants

Type of reconstruction(s)

Applied clinical concepts

Therapeutic concepts at sites with sufficient bone quantity

Therapeutic concepts at sites with insufficient bone quantity

45 Implants in the Zone of Esthetic Priority
Rino Burkhardt, Franz J. Strauss, and Ronald. E. Jung

Introduction

Patient safety first: how to protect patients from avoidable harm?

Understanding benefits and harms of implant treatments

The gap between scientific evidence and what happens

Transparent risk communication and shared decision-making programs

Preoperative diagnostics

Clinical measurements

Image‐guided diagnostics

Visualization of prospective results for diagnostics and patient information

Preoperative risk assessment

Evaluation of alternative treatments and checklists

Surgeon-related risk factors

Provisional restorations and timing of the treatment sequences

From tooth extraction to implant placement

At implant placement with immediate provisionalization

From implant placement to abutment connection

From abutment connection to final crown/bridge placement

New manufacturing techniques (CAD CAM and 3D printing)

Surgical considerations when dealing with implants in the zone of esthetic priority

Surgical aspects for undisturbed wound healing

Incisions and flap design

Clinical concepts for replacement of a single missing tooth

Sites with no or minor tissue deficiencies

Sites with extended tissue deficiencies

Clinical concepts for replacement of multiple missing teeth

Sites with minor tissue deficiencies

Sites with severe tissue deficiencies

Prosthetic reconstruction in the zone of esthetic priority

Decision-making process: standardized versus customized abutments

Decision-making process: all-ceramic versus porcelain-fused-to-metal

Adverse esthetic outcomes

Origin, causes, and prevalence of esthetic adverse outcomes

Clinical findings and classification of esthetic adverse outcomes

Strategies for retreatment of esthetic adverse outcomes and clinical results

Concluding remarks and perspectives

46 Technical Complications in Implant Dentistry
Clark M. Stanford and Lyndon F. Cooper

Introduction

Implant fractures

Implant complications

Abutment and abutment screw complications

Residual cement as a technical problem

Prosthesis attrition and fracture

Prevention of technical complications

Conclusion

Part 17 Orthodontics and Periodontics

47 Tooth Movement in the Periodontally Compromised Patient
Mariano Sanz and Conchita Martin

Introduction: biologic principles of orthodontic tooth movement

Periodontal and orthodontic diagnosis

Treatment planning

Periodontal considerations

Orthodontic considerations

Orthodontic treatment

Specific orthodontic tooth movements

Extrusion movements

Molar uprighting

Orthodontic tooth movements through cortical bone

Intrusive tooth movements

Orthodontic tooth movements and periodontal regeneration

Pathologic tooth migration

Multidisciplinary treatment of esthetic problems

Part 18 Supportive Care

48 Supportive Periodontal Therapy
Christoph A. Ramseier, Niklaus P. Lang, Janet Kinney, Jeanie E. Suvan, Giedrė Matulienė, and Giovanni E. Salvi

Introduction

Definition

Basic paradigms for the prevention of periodontal disease

Patients at risk for periodontitis without regular supportive periodontal therapy

Supportive periodontal therapy for patients with gingivitis

Supportive periodontal therapy for patients with periodontitis

Continuous multilevel risk assessment

Subject periodontal risk assessment

Conducting the patient’s individual periodontal risk assessment

Tooth risk assessment

Site risk assessment

Objectives for supportive periodontal therapy

Determination of personalized supportive periodontal therapy intervals

Supportive periodontal therapy in daily practice

Examination, re‐evaluation, and diagnosis

Motivation, re‐instruction, and instrumentation

Treatment of re‐infected sites

Polishing, fluorides, and determination of supportive periodontal therapy interval

Index

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