Info

Immune delects, aggressive periodontitis ass k iated with, 107 Immune response, I I. 65 age-related changes and, < > l U-cell. 128 129, 129t, I30f ellecls ol gingipaiiis on, I S9t lo initiation ol inllammation. I < 8 innate, I 13 iu I l> . 147 maternal, SI7- 518 neutrophils in. 139 periodontal disease and. 204 primary, 126 during reproductive years. 514 secondare, 126 smoking and. 247 248. 2471 SKIN and. 179 specific, I I 3. 125 126, 1261 I-cell, 126 128, I27f, 1281 Immune status,...

Systemic Administration Of Antibiotics

Hie treatment of periodontal diseases is based on the infectious nature of these diseases ( Table SO-1). Ideally, the causative microorganism(s) should be identified and the most effective agent selected using antibiotic sensitivity tests. Although this appears simple, the difficulty lies pri marily in identifying specific etiologic microorganism(s) rather than microorganisms simply associated with various periodontal disorders.11 I he possible c linical benefits of administering antibiotics to...

And Aesthetics

Curing Period Tibia Bone Fracture

I he patients who seem to benefit most from dental implants are those with fully edentulous arches. In these patients, removable and fixed implant prosthetic devices can restore almost normal stomatognathic function. I he original design of the edentulous arch was a fixed bone-anchored bridge that used five to six implants in the anterior area of flic mandible or the maxilla and a cantilever through the premolar area. Most implant bridges currently used are screwed into place and can easily be...

Pathogenesis

Gingival Exudate

The initial lesion in the development o periodontitis is the inflammation of the gingiva in response to a bacterial challenge. Changes involved iti the transition from the normal gingival sulcus to the pathologic periodontal pocket are associated with different proportions of bac terial cells in dental plaque. Healthy gingiva is associated with few microorganisms, mostly coccoid cells and straight roils. Diseased gingiva is associated with increased numbers ol spirochetes and motile rods.44 4...

Table 501

Antibiotics Used to Ireat Periodontal Diseases I heir Major Features and Indications Agent(s) Used to Treat Periodontal Diseases Ciprofloxacin Azithromycin Clindamycin Extended spectrum of antimicrobial activity, excellent oral adsorption used systemically. Effective against penicillinase producing microorganisms used systemically. Effective against broad spectrum of microorganisms used systemically and applied locally (subgingivally). Elective against broad spectrum of microorganisms used...

Rationale For Supportive Periodontal Treatment

Studies have shown that even with appropriate periodontal therapy, some progression of disease is possible. ,H-'1 ' r One likely explanation lor the recurrence of periodontal disease is incomplete subgingival plutptc removal. If subgingival plaque is left behind during scaling, it regrows within the pocket. The regrowth of Supportive t Til h Ioii hi I Treatment < 11 API IK 76 967

Biologic Considerations

Supragingival Margin

Restorative clinicians must understand the role of biologic width in preserving healthy gingival tissues and controlling the gingival form around restorations. I hey must also apply this information in the positioning oi restoration margins, especially in the esthetic one where a primary treatment goal is to mask the unction of the margin with the tooth. clinician is presented with three options for margin placement supragingival, equigingival (even with the tissue), and subgingival locations....

Mci

Distal Molar Gingiva

Fig. 61-12 A, The impaction of a third molar distal to a second molar with little or no interdental bone between the two teeth B, Removal ol the third molar creates a pocket with tittle or no bone distal to the second molar. This olten leads to a veitical osseous delect distal to the second molai (C). Fig. 61-13 A, Removal of a pocket distal to the maxillary second molar may be difficult if there is minimal attached gingiva. If the bone ascends acutely apically, the removal of this bone may...

Disclosing Agents

I )isi losing agents are solutions or wafers capable of staining bacterial deposits on the surfaces ol teeth, tongue, and gingiva. I hev are excellent oral hygiene aids because they can provide the patient with an educational and motivational tool to improve the efficiency of plaque control procedures10 (Fig. 49-25). Solutions and wafers are available commercially. Solutions are applied to the teeth as concentrates on cotton swabs or diluted as rinses. Fhey usually produce heavy staining of...

Mm S3 filicsa

2051 Surgery

The patient was advised to have localized areas of periodontal surgery and periodontal recall every 3 months. However, the patient did not comply and only had dental cleanings once or twice yearly. B, Radiographs 4 years later. Note the loss of teeth US and Pi5 and the increased bone loss of several premolars and molars. Fitj. 76-8 A, Initial radiographs. The patient was advised to have localized areas of periodontal surgery and periodontal recall every 3...

Recurrence Of Gingival Enlargement

Chronic Periodontal Disease Localized

Recurrence after treatment is the most common problem in the management of gingival enlargement. Residual local irritation and systemic or hereditary conditions causing noninflammatory gingival hyperplasia are the responsible factors. Recurrence of chronic inflammatory enlargement immediately after treatment indicates that all irritants have Fiq S9 7 Treatment of a case of a combined cyclosporin- and nifedipine-induced gingival enlargement with a periodontal flap on a 35-year-old female who had...

Occlusal Considerations

Ihe importance ol occlusion and its role in dentistry has been decreasing significantly over the past 20 years. Occlusal trauma as ,i lactor in periodontal disease and its role in orofacial pain has been dccmphasixed in numerous papers.,vU *' 1 ' However, the role occ lusion plays in restorative dentistry is becoming reemphasi ed. The increase in ihe utilization ol denial implants and nonmetallk cosmetic restorations has resulted n an increased concern with force management. These restorations...

Implant Biomechanics

Maxillary Bone Trabeculae

It is becoming clear that a knowledge of implant biomechanics is essential il implant-supported restorations are to be employed predictably. The load-bearing capacity of implants supporting the restoration must exceed the loads anticipated during function. If the loads applied exceed load-bearing capacity of the implants, implant overload may be the result, and a resorption remodeling response of the bone around the implants is provoked.18 Several factors affect the load-hearing capacity of...

Rug

Fixed Partial Denture Pontics

Color Fig. 74 1, cont'd I, Healing after 3 months. The crown is ready for restorations. J, The final restoration. Note the ideal symmetry Color Fig 75 1 Depth from the attachment to the level of the margin is greater than 3 mm. This patient had an altered eruption pattern and a sulcus of more than 3 mm at the time these restorations were placed. Color Fig. 75-2 Two options were available to appropriately manage treatment 1) place the original margins half the depth of the sulcus, in which case...

References

Alcoforado GA, Kristoffersen T, Johannessen V . et al The composition < > t gingival inflammatory cell infiltrates in chit* dren studied by enzyme histochemistry. J (tin Periodontal 1990 17 335. 2. Andlin-Sobocki A, Marcusson A. Persson M i-year observations on gingival recession in mandibular incisors in children. J Clin Periodontol 1991 18 155. i. Baer PN, Benjamin SD Periodontal Disease in Children and Adolescents. Philadelphia, IB Uppincott, 1974. 4. Bernick S, I recdman N Microscopic...

Periodontal Disease And Chronic Obstructive Pulmonary Disease

COPP is a disease state characterized by airflow obstruction due to chronic bronchitis or emphysema. Bronchial mucous glands enlarge, and an inflammatory process oc curs in which neutrophils and mononuclear inflammatory cells accumulate within the lung tissue.-'- * About 14 million Americans have COPD, and tobacco smoking is the primary risk factor. COPD shares similar pathogenic mechanisms with periodontal disease. In both diseases, a host inflammatory response is mounted in response to...

Future Of Genetic Studies In Periodontology

At present, the search lor risk alleles lor periodontitis must locus on candidate gene regions, (ienome-wide searches for risk alleles ire not feasible due to the limited number ol genetic markers currently available for typing. Single nucleotide polymorphisms (SNPs) .ire likely to be valuable tools in the search for disease alleles. SNPs are single base-pair substitutions that occur very Irequcntly (I.e., every 1000 or so base pairs) throughout the genome, lew SNPs alter the amino acid...

Differentiation Of Periodontal And Pulpal Lesions

The Signs and Symptoms of Periodontitis I he signs and symptoms of periodontitis ire described in ( hapters 26 to 28 ol this text. Periodontitis is a chronic inflammatory lesion, which begins in the marginal gingiva and extends apically causing attachment loss and periodontal pocket formation In general the progression rate of attachment loss is slow, unless an acute incident suc h is a periodontal abscess occurs. Feeth with c hronic periodontal lesions are commonly free ol acute symptoms. I he...

Chaptir outline

INFLAMMATORY ENLARGEMENT Chronic Inflammatory Enlargement Acute Inflammatory Enlargement DRUG-INDUCED GINGIVAL ENLARGEMENT General Information Anticonvulsants Immunosuppressants Calcium Channel Blockers Idiopathic Gingival Enlargement ENLARGEMENTS ASSOCIATED WITH SYSTEMIC DISEASES Conditioned Enlargement Systemic Diseases Causing Gingival Enlargement NEOPLASTIC ENLARGEMENT (GINGIVAL TUMORS) Benign Tumors of the Gingiva Malignant Tumors of the Gingiva FALSE ENLARGEMENT Underlying Osseous Lesions...

Simultaneous Implant Placement And Guided Bone Regeneration

Large alveolar bone defects need to be augmented prior to implant placement and require a healing period of f> months or longer. In selected cases, it is possible to perform a bone augmentation procedure simultaneously with the implant placement. It is essential to achieve good implant stability in the existing native bone so that endosseous integration can occur. A very predictable osseous defect to manage with simultaneous implant placement is the implant dehiscence or fenestration defect,...

Cardiovascular Diseases

Cardiovascular diseases are the most prevalent category of systemic disease in the I'.S. and many other countries, and they are more common with increasing age 1 Health histories should be closely scrutinized for cardiovascular problems. I hese conditions include hypertension, angina pectoris, myocardial infarction, previous cardiac bypass surgery, previous cerebrovascular accident, congestive heart failure, presence of cardiac pacemakers or automatic defibrillators, and infective endocarditis....

Box 371

Litiology of (Gingival Responses lo Elevated Estrogen and Progesterone during Pregnancy Anaerobic to aerobic ratio increases Higher concentrations of Prevotella intermedia (substitutes sex hormone for Vitamin K-growth factor) Higher concentrations of Bacteroides melaninogenicus Higher concentrations of Porphyromonous gmgivalis Depression of cell-mediated immunity Decreased neutrophil Chemotaxis Depression of antibody and T cell responses Decrease in the ratio of peripheral T helper cells to T...

Pulp Changes Associated With Periodontal Pockets

I he spread of inlcction from periodontal pockets may cause pathologic changes in the pulp. Such changes may give rise to painful symptoms or adversely affect the response ol the pulp to restorative procedures. Involvement of the pulp in periodontal disease occurs through either the apical foramen or the lateral canals in the root after infection spreads from the pocket through the periodontal ligament, trophic and inflammatory pulpal changes occ in m such cases (see also (Chapters < > 4...

Reevaluation Of Prognosis After Phase I Therapy

A frank reduction in pocket depth and inflammation after phase I therapy points to a favorable response to treatment and may suggest a better prognosis than previously assumed. It the inflammatory changes present cannot be controlled or reduced by phase I therapy, the overall prognosis may be unfavorable. In these cases, the prognosis can be directly related to the severity of inflammation. Given two patients with comparable bone destruction, the prognosis may be better for the patient with the...

Responses Against Extracellular Changes

Undisplaced Periodontal Flap

Pig. 7 10 Schematic illustration of T cell differentiation. Early inflammatory signals from macrophages and peripheral dendritic cells such as IL I activate the CD4 t 1-helper (Th) T-cell. The Th cell then produces many cytokines, including II - , INFy and IL-4, and is referred to as a fhO T-cell The ThO 1 cell further differentiates to form Th 1 or Th2 T-eelts, which regulate immune responses against intracellular and extracellular antigens, respectively. A key signal determining which pathway...

The Toothbrush Powered Toothbrushes Dentifrices

T00THBRUSHINC METHODS The Bass Method The Modified Stillman Method The Charters Method Methods of Cleaning with Powered Toothbrushes INTERDENTAL CLEANING AIDS Dental Floss Interdental Cleaning Devices GINGIVAL MASSAGE ORAL IRRIGATION DEVICES Supragingival Irrigation Subgingival Irrigation CARIES CONTROL FOR THE PERIODONTAL PATIENT CHEMICAL PLAQUE CONTROL Chlorhexidine Essential Oil Mouthrinse Other Products Recommendations DISCLOSING AGENTS FREQUENCY OF PLAQUE REMOVAL Recommendation PLAQUE...

Edentulous Mandible

Overlay Dentures

Implant-assisted overtax dentures are most commonly employed. An implant-assisted denture is designed so that most of the masticatory load is borne by the primary denture-support areas (retromolar pad, buccal shelf). A common practice is to place two implants in the anterior mandible with a connecting bar. I he den-lure is retained by two clips over the bar. When an occlusal force is applied posteriorly, the denture rotates around the bar, directing the force Into the primary denture support...

Periodontal Microsurgery

Periodontal Hand Instruments

In recent years periodontics has seen increasing employment of procedures requiring progressive ) more intricate surgical skills Regenerative and resective surgical procedures, periodontal plastic surgery, and dental implants all demand clinical performance levels that challenge the technical motor skills ol periodontal surgeons beyond a range possible with unassisted vision. Periodontal microsurgery introduces the potential lor a less invasive surgical approach in periodontics. I his is...

Periodontal Medicine In Clinical Practice

Ihe concept of periodontal diseases as localized entities affecting only the teeth and supporting apparatus is over simplified and in need of revision. Rather than being confined to the periodontium, periodontal diseases may have wide-ranging systemic effects. In most persons, these effects may be relatively inconsequential or at least not clinically evident. However, in susceptible individuals. periodontal infection may act as an independent risk factor tor systemic disease and may be involved...

Bqx 551

Instrru lions for _ _(Patient's Xante) The following information on your gum operation has been prepared to answer questions you may have about how to take care of your mouth. Please read the instructions carefully our patients have found them very helpful. Although there will be little or no discomfort when the anesthesia wears off, you should take two acetaminophen (Tylenol) tablets every 6 hours for the f rst 24 hours. After that, take the same medication it you have some discomfort. Do not...

The Periimplant Mucosa

Sulcular Epithelium

The mucosal tissues around intraosseous implants form a tightly adherent hand consisting of a dense collagenous lamina propria covered by stratified squamous keratinizing epithelium (Pigs. 68-1 and 68-2).In general, the term biologic width height is being used when describing the soft tissue dimensions around implants.1 I'be implant-epithelium junction is analogous to the junctional epithelium around natural teeth, in that the epithelial cells attach to the titanium implant by means of...

Conclusions

It is obvious that these scientific search sites offer everyone an enormous opportunity to retrieve the whole range ol information relevant In periodontics. The Internet and World Wide Web provide the means for a complete understanding of current knowledge in our field. In the immediate future, more nonspecialist dentists will become skilled in periodontal therapy, and these skills will he improved by continuing educational programs using the World Wide Web and national and international...

Limitations Of Conventional

PERIODONTAL DIAGNOSIS ADVANCES IN CLINICAL DIAGNOSIS Gingival Bleeding Gingival Temperature Periodontal Probing ADVANCES IN RADIOGRAPHIC ASSESSMENT Digital Radiography Subtraction Radiography Computer-Assisted Densitometrie Image Analysis System (CADIA) ADVANCES IN MICROBIOLOGIC ANALYSIS Bacterial Culturing Direct Microscopy Immunodiagnostic Methods Enzymatic Methods of Bacterial Identification Deoxyribonucleic Acid Probe Technology ADVANCES IN CHARACTERIZING THE HOST RESPONSE Source of Samples...

Rome

Long before 735 ist i. the I'.truscans were adept in the art ot constructing artificial dentures, but no evidence exists that they were aware of periodontal disease or its treatment. Among the Romans, Aulus Cornelius ( elsus (25 iw i .SO t i.) referred to diseases that affect the soft parts of the mouth and their treatment as follows If the gums separate from the teeth, it is beneficial to i. hew unripe pears and tipples and keep their juices in the mouth. He described looseness of the teeth...

Plaque Control Instruction

In periodontal therapy, plaque control has two important purposes to minimize gingival inflammation and to prevent the recurrence or progression of periodontal disease. Daily mechanical removal of plaque by the patient, including the use of appropriate antimicrobial agents, appears to be the only practical means lor improving oral hygiene on a long-term basis. I he process requires motivation on the part ol the patient, education, and 668 PARI S hvtilnnnt of I'ciioilontul Piwasi

Classification Of Posttreatment Patients Referral Of Patients To The Periodontist Tests For Disease Activity

Reservation of the periodontal health of the treated patient requires as positive a program as that required for the elimination of periodontal disease. After Phase I therapy is completed, patients are placed on a schedule ol periodic recall visits tor maintenance care to prevent recurrence of the disease tligs. 7< > -1 and 7r> -2). t ransfer of the patient from active treatment status to a maintenance program is a definitive step in total patient care tli.it requires time and effort on...

Periodontal Disease And Stroke

Ischemic cerebral infarction, or stroke, is often preceded by systemic bacterial or viral infection ' In one study, patients with cerebral ischemia were five times more likely to have had a systemic infection within I week before the ischemic event than were nonischemic control subjects. Recent infection was a significant risk factor tor cerebral ischemia and was independent ol other known risk factors such as hypertension, history of a previous stroke, diabetes, smoking and coronary heart...

Techniques For Increasing Attached Gingiva

Undisplaced Periodontal Flap

Lb simplify and to better understand the techniques and the result of the surgery, the following classifications are presented Ungival augmentation apical to the area of recession. A graft, either pedicle or free, is placed on a recipient bed apical to the recessed gingival margin. No attempt is made to cover the denuded root surface where there is gingival tnd bone recession. Ungival augmentation coronal let the recession rttot coverage . A graft either pedicle or tree is placed covering the...

Epidemiology And Demographics Classification And Staging

CDC Surveillance Case Classification ORAL AND PERIODONTAL MANIFESTATIONS OF HIV INFECTION Oral Hairy Leukoplakia Oral Candidiasis Kaposi's Sarcoma Bacillary Epithelioid Angiomatosis Oral Hyperpigmentation Atypical Ulcers and Delayed Healing Adverse Drug Effects PERIODONTAL DISEASE Linear Gingival Erythema Necrotizing Ulcerative Gingivitis Necrotizing Ulcerative Stomatitis Necrotizing Ulcerative Periodontitis cquired immunodeficiency syndrome AIDS is I characterized by profound impairment of the...

Chapter outline

Probing Scaling And Root Planing

EVALUATION OF NEW ATTACHMENT AND BONE REGENERATION Clinical Methods Radiographic Methods Surgical Reentry Histologic Methods REGENERATIVE SURGICAL TECHNIQUES Non-Graft-Associated New Attachment Graft Materials and Procedures Combined Techniques FACTORS INFLUENCING A SUCCESSFUL OUTCOME SUMMARY 71 ew attachment with periodontal regeneration is V ideal outcome of therapy because it results in obliteration of the pocket and reconstruction of the marginal periodontium lt t olor Pig- 63-1 Pig. 63-1 ....

Transendothelial Migration

I he directed movement of leukocytes from the blood into the local tissues is central to inllanmiation. Irans-endotlielial migration is a selective interaction between leukocytes and endothelium that results in the leukocyte pushing its way between endothelial cells to exit the blood and enter the tissues. Defects in transendothelial migration are associated with aggressive periodontitis reflecting the importance of this process in periodontal diseases. Neutrophils and monocytes spend less than...

Normal Alveolar Bone Morphology

Knowledge of the morphology of the bony periodontium in 1 state ol health is required to correctl perform 788 I VMM S IhiitiMHt of Mihlontol IHwsc resective osseous surgery Fig. 62-2 . I he characteristics ol .1 normal bony form areas follows 1. flu interproximal bone is more coronal in position than the labial or lingual palatal bone and pyramidal in Ibrm. 2. The form o Ihe interdental bone is a function of the tooth torm and the embrasure width. Ihe more tapered the tooth, the more pyramidal...

Zipper Effect Cd31

B-cclls arul T-cells re-quirt1 the additional influence 0 lymphoid organs lymph nodes, spleen, tonsils, IVyer's patches, adenoids to function properly. I bus they constantly exit the blood, pass through lymphatics and secondary lymphoid organs, and re-enter the blood in a perpetual process known as lymphocyte recirculation. I he blood contains only 2 oi all lymphocytes at any given time, and lymphocytes .ire estimated to recirculate as much as 50 times a day....

Treatment Of Drugassociated Gingival Enlargement

Gingival enlargement has been associated with the administration ol three different types of drugs anticonvulsants, calcium channel blockers, and the immunosu-pressant cyclosporine. A comprehensive review of the clinical and microscopic features, and pathogenesis ol gingival enlargement induced by the above-mentioned drugs is provided in C.hapler IS. Inanimation of cases ol drug-induccd gingival enlargement reveals the overgrown tissues to have two components a fibroin one, which is caused by...

Limitations Of Conventional Periodontal Diagnosis

periodontal diseases are prevalent human diseases i defined by the signs and symptoms of gingival in-jL flamniation and or periodontal tissue destruction. These diseases are conventionally diagnosed by clinical evaluation of the signs of inflammation in the gingiva without periodontal tissue destruction gingivitis or by the presence of both inflammation and tissue destruction periodontitis . A clinical diagnosis of periodontitis is made by measuring the loss of connective tissue attachment to...

Diagnostic Decision Making

Lie masticatory system consists ot the temporomandibular joints iTMJs , masticatory muscles, teeth in occlusion, and neurologic and vascular supplies supporting all these structures. Research suggests that masticatory system disorders include many varied conditions with multiple possible contributing factors rather than different manifestations of a single disease or syndrome.' 1111 The ability to understand the anatomy and function of the masticatory system and correctly interpret relevant...

Cell Responses And Antibodies Summary

Fhe common periodontal diseases found in humans are gingivitis and periodontitis, t hese are inflammatory responses in the periodontal tissues induced hy microorganisms in dental plaque, which may lead to tissue destruction, this chapter focuses on the role of the immune system in inflammation. Ihe immune system is a network designed for the homeostasis of large molecules oligomers and cells hased on specific recognition processes. Recognition of the structural features of ,m oligomer hy...

Drug Eruptions

An increase in the incidence of skin and oral manifestations of hypersensitivity to drugs has been noted since the advent of the sulfonamides, barbiturates, and various antibiotics, t he eruptive skin and oral lesions are attributed to the fact that the drug acts as an allergen, either alone or in combination, sensitizing the tissues and then causing the allergic reaction. l.ruptions in the oral cavity resulting from sensitivity to drugs that have been taken by mouth or parenterals are termed...

Abc

Split Partial Thickness Graft

Fig. 66-1 i Semilunar coronally positioned flap. A, Slight recession in facial of the upper left canine B, After thorough scaling and root planing ol the area, a semilunar incision is made and the tissue separated from the underlying bone, fhe flap collapses, covcnng the recession C, Appearance alter 7 weeks Note coverage ot the previous root denudation. Courtesy Dr Steven Kwan, Los Angeles, Calif Ibis technique is very simple and predictably provides 2 to mm of root coverage. It can be...

Lvu

Undisplaced Periodontal Flap

Fi gt i 60 4 Flap design for a sulcular incision flap. A, Design ol the incisions the sulcular incisions and the vertical incisions are depicted by interrupted lines B, The flap has been elevated, exposing the underlying bone see defect in one space C, Tissue returned to its original position covers the entire interdental the interdental papilla or its vicinity, thereby splitting the papilla into a facial halt and a lingual or palatal half d igs. 60-3 and 0-4 . I he entire surgical procedure...

Cells Of Immunity And Inflammation

Cardinal Signs Inflammation

Cells of the immune system that are important in inflammation and host defenses include in mast cells, dermal dendrocytes histiocytes , peripheral dendritic cells, neutrophils, monocytes macrophages, I'-cells, B-cells, and NK-cells see I able 7-1, I ig. 7-1 . Other hematopoietic leukocytes i.e., basophils, eosinophils, erythrocytes, and platelets also participate in certain forms of inflammation or immune function but will not be described here. Cells possess receptors, which ire molecules on...

Summary

Resective Periodontal Surgery

I hough osseous surgical techniques cannot be applied to every single bony abnormality or topographic modification, clearly it has been demonstrated that properly used osseous surgery can eliminate and modity detects, as well as gradualize excessive bony ledges, irregular alveolar bone, early furcation involvement, excessive bony exostosis, and circumferential defects. When properly performed, osseous resective surgery achieves a physiologic architecture of marginal alveolar bone conducive to...

Factors That Affect The Outcome Of Periodontal Plastic Surgery

Image Mesial Rotated Tooth

Abnormal tooth alignment is an important cause of gingival deformities that require corrective surgery and likewise, an important factor in determining the outcome of treatment. I'he location of the gingival margin, width of the attached gingiva, and alveolar bone height and thickness ire all allected b tooth alignment. On teeth that are tilted or rotated labiallv. the labial bony I 'riinhnittil l hislU tiinl F.stln'tU Surgery IIAIMI K 16 853 Fi lt j. 66-1 High frenum attachments. A, Frenum...

Occlusion Bone Destruction Caused By Systemic Disorders

FACTORS DETERMINING BONE MORPHOLOGY IN PERIODONTAL DISEASE Normal Variation in Alveolar Bone Trauma from Occlusion Buttressing Bone Formation Lipping Food Impaction Juvenile Periodontitis BONE DESTRUCTION PATTERNS IN PERIODONTAL DISEASE Horizontal Bone Loss Bone Deformities Osseous Defects Vertical or Angular Defects Osseous Craters Bulbous Bone Contours Reversed Architecture Ledges ithough periodontitis is an infectious disease of - f the gingival tissue, changes that occur in bone jL are...

Conclusion

Future oral health care trends will see inc reased numbers of older adults seeking periodontal therapy. Dental prac titioners of the 2YX century should be comfortable providing comprehensive periodontal care tor this segment of the population. Aging dental patients have particular oral and general health conditions that dentists should be familiar with detecting, consulting, and treating. Medical diseases and conditions that occur more often with age may require modification to periodontal...

Criteria For Selection Of Techniques

Different techniques have been presented for solving mucogingival problems outlined in this chapter. Ihe proper selection of the numerous techniques must be based on the predictability of success which, in turn, is based on the following criteria see also box 66-1 1. Surgical site free of plaque, calculus, and inflannnalion Periodontal plastic surgical procedures should be undertaken in a plaque- and inllammation-free environment to enable the clinician to manage gingival tissue that is firm....

The Periodontium Of The Deciduous Dentition

PHYSIOLOGIC GINGIVAL CHANGES ASSOCIATED WITH TOOTH ERUPTION Preeruption Bulge Formation of the Gingival Margin Normal Prominence of the Gingival Margin TYPES OF GINGIVAL DISEASE Chronic Marginal Gingivitis Localized Gingival Recession Acute Gingival Infections TRAUMATIC CHANGES IN THE PERIODONTIUM THE ORAL MUCOUS MEMBRANE IN CHILDHOOD DISEASES rhe elfects ol periodontal disease observed in adults have their inception earlier in lite, tiingival disease in the child may progress to jeopardize the...

Goals of Therapy

A thorough oral examination will determine the patient's dental treatment needs. I he primary goals of dental therapy should be the restoration and maintenance of oral health, comfort, and function. t Ihe vers least, periodontal treatment goals should he directed toward control of FfiV-associated mucosal diseases such as chronic candidiasis and recurrent oral ulcerations. Acute periodontal and dental infections should he managed, and the patient should receive detailed instruct ons in...

Furcation Involvement

Root Canal Root Amputation

Root resection max be indicated in multirooted teeth with grade II to l furcation involvements. Root resection may be performed on vital1 or endodonticallv treated teeth. It is preferable, however, to have endodontic therapy completed before resection of a root s .M It this is not possible, then the pulp should he removed, the patency ol the canals determined, and the pulp chamber medicated before resection. It is distressing to perform a vital root resection and to subsequently have an...

Laboratory Aids To Clinical Diagnosis

When unusual gingival or periodontal problems are present and cannot be explained by local causes, the possibility of contributing systemic factors must be explored. I'he dentist must understand the oral manifestations ol systemic disease so that he or she can question the patient's physician regarding the type ol systemic disturbance that may be involved in individual cases. Numerous laboratory tests aid in the diagnosis of systemic diseases. Descriptions of the manner in which they are...

Effects Of Pulpal Disease On The Periodontium

Root Sheath

Pulpal tissue may be significantly inflamed and yet exert little or no effect on the periodontium. As long as the pulp remains vital it is unlikely that significant changes will occur in the periodontium. Necrosis of the pulp, however, can result in bone resorption and the production ol racliolucency al the apex ol the tooth, in the furcation or at points along the root-v',MM lt Pig. 65-1 . Dental radiographs usually document the presence of apical or lateral lesions. The lesion that results...

Asj

Remedy Tooth Bone Loss

The patient was advised to have localized areas ot periodontal surgery and periodontal recall every 3 months However, the patient did not comply and had no treatment other than emergency care and occasional dental cleanings B, Radiographs 7 years later. Note the advanced bone loss and lt anes on many teeth. Ficj. 76-9 a, Initial radiographs. The patient was advised to have localized areas ot periodontal surgery and periodontal recall every 3 months However,...

Clinical Implications Of Genetic Studies

The role of host genes in the etiology and pathogenesis ot the periodontal diseases is just beginning to be understood. ienetic tests may prove useful lor identifying patients who are most likely to develop disease, suffer from recurrent disease, or suffer tooth loss as a result of disease. I he utility of any screening tool, however, must be evaluated in diverse populations, tiiven the complex etiology of the periodontal diseases, it is likely that any genetic test will be useful in only a...

Menopause

Female life expectancy is S0 years, therefore many women will live 40 of their lives in menopause. I bis cohort represents a large number of the patients that present in clinical practices. Therefore we must be aware of the implications that reduced hormones have on the periodontal tissues is well as the systemic changes that may manifest. Throughout a woman's lifetime, the number of oocytes steadily diminishes. Menopause is associated with symptoms of estrogen deficiency. Estradiol levels fall...

Posterior Teeth Flaps

Periodontal Wall Defect Types

Color Fig. 60-2 The papilla preservation flap. A, Facial view alter sulcular incisions have been made. B, Straight line incision in the palatal area about 3 mm from gingival margins. This incision is then connected to the margins with vertical incisions in the mid-part ol each tooth. C, The papillae are reflected with the facial llap. D, Ungual view alter reflection ol the llap. E, Lingual view after the flap is brought back to its original position. It is then sutured with independent sutures...

Suturing Techniques

After all the necessary procedures ire completed, the area is reexamined and cleansed, and the llap is placed in the desired position, where it should remain without tension. It is convenient to keep it in place with light pressure with a piece ol gauze so that a blood clot can form. The purpose of suturing is to maintain the llap in the desired position until healing has progressed to the point where sutures are no longer needed. There are many types ol sutures, suture needles, and...

Procedure

Rhe word curettage is used in periodontics to mean the scraping of the gingival wall of a periodontal pocket to separate diseased soft tissue. Scaling refers to the removal of deposits from the root surface, whereas planing means smoothing the root to remove infected and necrotii tooth substance. Scaling and root planing may inadvertently include various degrees of curettage. However, they are different procedures, with different rationales and indications, and should he considered separate...

Prognosis Of Combined Lesions

With proper treatment the healing of an endodontic lesion is highly predictable. However, the prognosis for teeth with combined lesions varies with the extent that each lesion contributes to the loss of attachment, lesions resulting from pulpal disease tend to resolve with endodontic therapy, whereas the repair regeneration of attachment loss from periodontitis is less predictable. The long-term prognosis lor a tooth with a combined lesion is therefore closely related to the extent and...

Prevention And Treatment Of Loss Of Attachment

Levels Periodontal Disease

Although periodontal therapy has been used for more than 100 years, it is only since the mid-1970s that a number of studies have been conducted to determine the effect ol treatment on reducing the progressive loss of periodontal support for the natural dentition. longitudinal investigation to study the natural development and progression ol periodontal disease was ion-ducted by loe and co-workers.K,,k 1 he first group, established in Oslo, Norway in 1969, consisted of 565 healthy male nondental...

Magnification Systems

Prism Telescopic Dental Loupes

A variety ol simple and complex magnification systems are available to dentists, ranging from simple loupes to prism telescopic loupes and surgical microscopes, liach magnification system has its sped lit advantages and limitations. Although magnification improves the accuracy ol clinical and diagnostic skills, it requires an understanding of optical principles that govern all magnification systems lhe assumption that more magnification is better must always be weighed against a decrease in...

Indications And Contraindications

The gingivectomy tec hnique may be performed lor 1. Elimination of suprahony pockets, regardless ol their depth, it the pocket wall is fibrous and Firm 2. Elimination of gingival enlargements 3. Elimination of suprahony periodontal abscesses8 Contraindications include the following 1. The need for bone surgery or examination of the bone shape and morphology 2. Situations in whit h the bottom of the poi ket is apical to the mucogingival unction A. Esthetic considerations, particularly in the...

Techniques To Deepen The Vestibule

I he presence of adequate vestibular depth is important tor both oral hygiene and retention of prosthetic appliances. Numerous surgical techniques have been pro posed to accomplish this objective. Ihe classic clinical studies in the early 1960s by Bohannan indicated that deepening of the vestibule by n on free graft procedures were not successful when evaluated years later. Predictable deepening of the vestibule can only be accomplished by the use of free autogenous grafts anil its variants....

Table 222

Distinguishing Features of the Suprabony and Intrabony Pockets 1. The base of the pockel is coronal lo the level of the alveolar bone. 2. The pattern of destruction of I he underlying bone is horizontal. 3. Inlerproximally, the transseptal fibers that are restored during progressive periodontal disease are arranged horizontally in the space between the base of the pocket and the alveolar bone see Fig. 22-22 . 4. On the facial and lingual surfaces, the periodontal ligament fibers beneath the...

Etiologic Factors Of Pulpal Disease

Lhe major causes of pulpal inflammation are 1 instrumentation during periodontal, restorative or prosthetic dentistry 2 the progression of denial caries and 3 direct. local trauma such as tooth fracture, lhe extent of inflammation of the pulp and the signs and symptoms that result vary with the severity of the insult and the ability of the host to ameliorate- the inflammation that results. Of these, dental caries is lhe most common cause of pulpal disease. Bacteria are present in carious enamel...

Inirodk I

Severe periodontal disease with loose teeth and purulent discharge from the gingiva. ' In a later treatise, the lt Iiiihikii Samhita, toothbrushing ami oral hygiene are stressed I'he stick for brushing the teeth should he either astringent or pungent or hitter. One of its ends should he chewed in the form of a brush. It should be used twice a day. taking cure that the gums not be injured,ls Ancient lt hinese medical works also discussed periodontal disease. In the oldest hook, written by...

Considerations Of Fixture Design And Surface Characteristics For Implant Surgery

Exposed Rough Surface Implant

The root form implant surgical techniques are mostly based on the researches performed on the biologic, physiologic. and mechanical aspects of the Nobelpharma implant system developed by IVr-lngvar Braneinark and colleagues in Sweden approximately three decades ago. Since then, many diflerent designs of root form implants have been studied, and presently more than 50 implant manufacturers exist worldwide. The root form implants can be divided according to their body shapes macrodesign and...

Residual Soft Tissue Interdental Crater

Crest Periodontal Disease Pamphlet

L lt t gt 2 I I Compromise osseous surgery. A and B, Preoperative views ot the buccal and lingual surfaces C and D, Pre- and postoperative view ol the buccal osseous recontouring class I buccal furcation defects, a moderate crater between the two molars, and a deep 1-2-3 walled defect al the mesial of the first involvements D, The buccal aspects ol these lesions were corrected with osteoplasty and a small amount of os-tectomy. E and F, Pre and postoperative views of the lingual osseous...

Papila Interdentaria Cancer

Diabetes And Periodontal Disease

Color Fig. 11 2 cont'd I, Heavy calculus deposit on the facial surface of the lower cuspid with associated gingival recession. J, Palatal view of upper anterior teeth with heavy calculus deposits, particularly in interdental spaces. K, Different shapes of calculus on extracted teeth L, Overhanging margin of restoration and atrophied and inflamed gingival papilla. Color Fig. 12-1 Diabetes and periodontal disease. A, An adult patient with diabetes blood glucose level of 400 mg 100 ml . Note the...

Classification And Staging

In 1982 the Centers for Disease Control CDC developed a surveillance case definition tor AIDS based on the presence of opportunistic illnesses or malignancies secondary to defective cell-mediated immunity in HIV-positive individuals. This definition was further expanded in 1985, 1987, and 1993.' Ihe 1993 revision added invasive cervical cancer in women, bacillary tuberculosis, and recurrent pneumonia into the AIDS designation. Currently, any of 25 specific clinical conditions found in...

Connective Tissue Technique

How Cure Periodontal Disease

Step One Divergent Vertical Incisions. Divergent vertical incisions are made it the line angles of the looth to be covered, creating a partial-thickness Map to at least 5 mm apical to the receded area. Step Two Suturing. Suture the apical mucosal border to the periosteum using gut suture. Step Three Scaling and Planing. Thoroughly scale and plane the root surface, reducing any prominence of the root surface. Fig. 66-10 Laterally positioned Map for coverage of denuded root. lop, Incisions...

Techniques For The Removal Of The Frenum

Attached Frenum

A Irenum is a fold of mucous membrane, usually with enclosed muscle fibers, thai attaches the lips and cheeks to the alveolar mucosa and or gingiva and underlying periosteum. Irenum becomes a problem it the attachment is too close to the marginal gingiva. Pension on the frenum may pull the gingival margin away from the tooth. Ibis condition may he conducive to plaque accumulation and inhibit proper brushing of the teeth. I he terms frenectomy and frenotomy signily operations that differ in...

Diagnosis Of Periimplant Tissue Breakdown

Periimplant Soft Tissue Attachment

A number of clinical parameters used to evaluate periodontal conditions have also been used to assess pcriim-plant conditions. I hese parameters include the evaluation of oral hygiene, pcriimplant marginal tissues, and hone-implant interface. Successful implants generally allow probe penetration ot approximately 4 to 4 mm, and the location ol the periimplant bone level can be expected to be about I mm apical to the position of the probe tip. The long-term success of dental implants depends on...

Kie Bock Pilote Rally

Implant Cover Screw

Ficj 70-5 A, Crestal incision made along the crest of the ridge, bisecting the existing one of keratinized mucosa B, A lull thickness flap is raised huccally and lingually to the level ol the mucogingival junction. A sharp ridge can be surgically contoured to provide a reasonably Hat bed lor the implant. C, A partial-thickness llap is raised apically from the mucogingival junction to provide extension of the llap. D, Crestal llap closure without tension. IMPLANT PLACEMENT. Once the implant site...

Clinical Management Of Dental Implants

Lateral Mandible Implants

Lb achieve an osseoin legra ted dental implant with a high degree of predictability,10 L gt the implant must be I sterile, 2 made of a highly biocompatible material such lis titanium, inserted with an atraumatic surgical tec hnique that avoids overheating of the bone during prepara I ion of the recipient site, 4 gt placed with initial stability, and S not functionally loaded during the healing period of 4 to 6 months. When these clinical guidelines arc followed, successful osscointegration...

Phase I Therapy

Ihe specific goal of Phase I therapy is the control of active dental disease see Chapters 47 and 4tt . Therefore when this phase ol therapy is completed, patients should be in a stale ol dental health with active caries no longer present and active destruction ol Ihe periodontium under control. This results in elimination ol the acute inflammatory response associated with periodontal destruction. I litis the status ol the gingival tissues should be such that lurlhcr restorative procedures of a...

Online Dental Education

Dental education has used the Internet tor continuing education courses originating in universities, professional organizations, and private companies. Periodontics has always been prominent in these endeavors, and in 1999 periodontal online courses were the largest subject group in dentistry. Some ol the earliest educational sites in periodontics were the site established at the University ol l.und by Dr. Roll Attstrom anil associates this site is now called Peruulontulogy rum Sweden iiiul...

Esthetic Considerations In Gingival Tissue Management

Cancer Disease Images

Ihe interproximal embrasure created In restorations and the form ol the interdental papilla have a unique and intimate relationship.The ideal interproximal embrasure should house the gingival papilla without impinging on it and also extend the interproximal tooth contact to the top ol the papilla so that no excess space exists to trap food or be esthetically displeasing. Papillary height is established by the level ol tile bone, Ihe biologic width, and the form ol the gingival embrasure. hanges...

Olf

Carpal Tunnel Radiograph

Fig. 65-9 Radiographs of vertical root fracture. A, Radiograph ol the mandibular right second molar in the same patient as Fig. 65-8. I he bicuspid, supporting a cantilevered pontic, has an endodontic post in the root. It also has radiographic evidence of loss of periodontal attachment and widening of the periodontal ligament space. Note the apical halolike radiolucency. B, Radiograph of no. 29 taken 10 months later showing advanced attachment loss around the apical area of the root and...

Phase I Therapy Periodontal Surgery

Restorative Considerations in Periodontal Surgery Preprosthetic Periodontal Surgery dive periodontal disease must he treated and controlled prior to any restorative dentistry. II restorative dentistry is performed on teeth where the periodontal prognosis is not determined and disease not treated, the loss of the restored tooth can occur. Restorative dentistry must he performed on a periodontium free of inflammation and pockets, without any mucogingival involvement, and with the contour and...

Potential Complications To Endodontic Therapy

Potential Complications Fractures

As with any therapeutic modality, complications may arise during endodontic treatment. Some are of an iatrogenic nature such as perforations of the floor of the pulp chamber or lhe root during access, canal instrumentation or preparation lor a post Pig. gt 5-7 . These accidents may result in periodontal defects, and treatment should be instituted as soon as the perforation occurs, l he healing of the lesion that occurs in the periodontium depends on whether bacterial infection can be excluded...

Aggressive Periodontitis

How Much Aggressive Periodontitis Is Present How Much New Aggressive Periodontitis Is Present Does My Patient with Aggressive Periodontitis Fit the Typical Profile Why Do Patients Have Aggressive Periodontitis, and What Puts Them at Risk Ithough information about the epidemiology of a disease is based on groups of people, whereas clinicians are primarily interested in the individual patient being treated, thoughtful clinicians understand the value of epidemiologic information for the decisions...

Differentiation Between Pulpal And Periodontal Abscesses

Endodontic Periodontal Lesion

Periodontal abscesses see hapter 22 are not usually severely painful lesions. They occur in the pocket or sulcus at the level of the connective tissue attachment, so there is little or no elevation of the periosteum to cause significant pain. The patient becomes aware of a sore or tender area in the gingiva and may notice swelling of the tissues to form a lump. Ibis area may be sensitive to touch, mastication, or toofhhnishing and or tlossing. Any stimulus to the site can indeed be painful. The...

Eqm

Disclosing Agents Dentistry

I iij. 49-25 Effect ol a disclosing agent A, Unstained. B, Plaque shows as dark-red particulate matter when stained with a disclosing dye C, The absence ol plaque is dramatically demonstrated by restaining the teeth alter met hanical plaque control procedures. I iij. 49-25 Effect ol a disclosing agent A, Unstained. B, Plaque shows as dark-red particulate matter when stained with a disclosing dye C, The absence ol plaque is dramatically demonstrated by restaining the teeth alter met hanical...

Management Of Extractions

Undisplaced Periodontal Flap

Because tooth extraction or tooth loss often results in alveolar ridge resorption or collapse, preservation of bone volume at the time of extraction is a desirable goal. A majority ol the bone loss after extraction occurs within the first o to 24 months. Therefore when clinicians are afforded the opportunity to intervene at the time ol extraction, the preservation of alveolar bone should be initiated. A conservative approach to the management ol extrac tion sites can eliminate or significantly...

S

Treatment of'Refractory Periodontitis, Aggressive Periodontitis Necrotizing Ulcerative lt 'II l'l I K 40 559 Per'uhlontitis, and t'ei odontitis ssociatcil with Svstemn Diseases After treatment, the differential diagnosis ol refractory periodontitis should exclude the following 1. Improperly treated periodontitis. Most forms ol periodontitis can he treated effectively with currently available modalities il such modalities arc performed properly. If, during a posttreatment examination, it is...

Eca Site Cancer

548 PA R I 5 treatment o PeritntonUil Diseuse Disease onlrol a ml Prevention CDCP guidelines ree-ommeiul idministration of hepatitis B immune globulin IIBK .' I he I IBV vaccine should also he administered il the injured individual has not previously received it. Untortunately, poste osure prophylaxis with immune globulin or antiviral agents is generally ineffective it a percutaneous injury occurs during treatment ot a hepatitis carrier.1' Since the beginning ot the AIDS epidemic, a wide range...

Periodontal Treatment After Radiotherapy

Sextants Dentitions

I'AIt I 5 I'reatnient of I'critnlanUil I disease to dental health personnel.''4' 4 The extent and severity ol mucositis, dermatitis, xerostomia, dysphagia, gustatory alteration, radiation caries, vascular changes, trismus, temporomandibular joint degeneration, and periodontal change depend on a myriad of radiation factors the type of radiation used, fields ol irradiation, number of ports, types ot tissues in the fields, and dosage. Patients scheduled to receive head and neck radiation therapy...

Liver Diseases

Liver diseases may range Irom mild to complete failure. Major causes of liver disease include drug toxicity, cirrhosis, viral infections e.g., hepatitis B and lt , neoplasms, and biliary tract disorders. ' Because the liver is the site ol production for most of the clotting factors, excessive bleeding during or after periodontal treatment may occur in patients with severe liver disease. Many drugs are metabolized in the liver thus liver disease alters normal dmg metabolism. Treatment...

Localized Ridge Augmentation

Labial Bone Augmentation

Patients often present lor implant planning after tooth loss and alveolar ridge resorption. In these cases, the clinician is obligated to perlorm advanced augmentation procedures to reconstruct lost bone and place implants in a proslhelically driven position. Surgical reconstructive procedures tor the preparation and placement ol dental implants have become more numerous and complex. Depending on the size arid morphology of the delect, various augmentation procedures can be used. Fliese...

Definition Of Prognosis

T ie prognosis is a prediction of the probable I course, duration, and outcome of a disease based J_ on a general knowledge of the pathogenesis of the disease and the presence of risk factors for the disease. It is established after the diagnosis is made and before the treatment plan is established. I he prognosis is based on specific information about the disease and the manner in which it can be treated, but it also can be influenced by the clinician's previous experience with treatment...